That was exactly how I was diagnosed. My doctor saw I had normal T4 levels and said I was fine (it was part of a routine blood panel). I went in for a UTI and saw another doctor in the practice. She was looking over my records and said the combination of normal T4 with very high TSH was indicative of being on the path to hypothyroidism (basically, the body was sending out an overabundance of signal to get the shutting down thyroid to make just a normal amount of T4).
She put me on TRH right away and it’s been almost 18 years. Mine occurred postpartum in which I had a number of allergic responses pop up as my immune system was returning to normal. Some stayed, some went away. Apparently becoming hypothyroid, even transiently, postpartum is not uncommon.
I have no idea what you’re supposed to do with any of that. I brought it up because people were equating Hashimitos with hypothyroidism and dismissing the OP’s concerns out of a belief that they are synonymous and that the doctors treatment strategy would have been no different had he known 6 years ago that the patient had Hashimitos. Would it definitely have changed things? Dunno, I’m not the doctor. Might it have changed things? Might.
The point is, Hashimitos is its own disease process, which can lead to hypothyroidism. They are not interchangeable terms.
I asked him why he felt vindicated given that a diagnosis of Hashimoto’s does not actually change the prognosis if she has a weight problem.
This is how the OP read to me:
“My wife was having trouble and every time she went to a doctor the doctors would say stop eating so much and people on this board said she had to stop eating so much and she was put on thyroid meds and they didn’t fix it. Now BOOYAAH! She has this diagnosis. In your FACE!”
Granting that this is just how I read it:
The diagnosis does not change anything about whether she has a weight problem or eats too much. It may explain partially why she’s gaining weight (if she is) or why it’s a little harder to lose (if it is) but it does not change whether she needs to eat less. It doesn’t change whether she will be on thyroid meds. It doesn’t change whether thyroid meds will help her lose weight.
It may give a reason for the hypothyroidism, but does nothing to change the things he seems to be pointing to as the reasons they sought help in the first place, which seem to be tied up in weight given his description of what treatments were being offered.
Hypothyroidism, whether primary or following from Hashimoto’s disease, can make it difficult or impossible to lose weight, even on a healthy, realistic diet. No amount of lecturing is going to help the OP’s wife lose weight if her endocrine system is working against it, and it really, really won’t do anything for her thyroid disease.
Yes, it can make it harder to lose weight. But again, since the OP’s wife was already on thyroid replacement medications, and the OP is triumphant about this diagnosis, what exactly is supposed to be different now with regards to her ability to lose weight?
Some people do better with Hashimoto’s taking both T4 (synthroid) and T3 (cytomel). A doctor I know that has Hashi’s feels better if he also takes T3. Selenium is supposed to help with reducing thyroid peroxidase antibodies Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations - PubMed (abstract). A lot of Hashi’s treatments seem to be hit and miss. I do fine on Synthroid only, but I started taking Selenium recently once I heard about this study. Some people with Hashi’s also have celiac disease, but the percentage is small. I had a celiac panel done just in case, which was negative. There’s a lot of woo on the internet about Hashimoto’s too that you should be careful of. Some people recommend dropping gluten entirely, even if there is no celiac or other type of gluten insensitivity but there’s no evidence that that’s helpful at all.
Now? Maybe nothing. 6 years ago probably about $7500 in medical costs. It’s also vindication in that she has a disease - not just a weak-ass thyroid and dieting is her only concern. You must have missed my post where one endocrinologist’s solution was pretty heavy appetite suppressants because she of course ate too much and was lying in her food diary. :rolleyes:
Also, my understanding is that HRT for a weak thyroid is a little different than Hashimoto’s mainly because the added thyroid is for the most part ineffective due to the immune response. We’re also having some success with bio-identical hormones which I know is woo medicine right now but some claim is more effective because of the slightly different way the body processes it.
And you are ignoring the psychological impact. Can you imagine for 6 years knowing there’s something wrong and no one believes you? If nothing else she has peace of mind knowing she does have an illness and she’s not going crazy “imagining” all of the other symptoms like touch sensitivity.
AND we are going to reduce gluten because that may help. The selenium looks interesting too. That’s more treatment than low levels of levothyroid.
Hashimoto’s disease complicates the situation. In primary hypothyroidism, the thyroid simply doesn’t produce enough hormone. Treatment is usually a matter of taking oral supplements, often in seemingly trivial doses, to make up for what the body isn’t producing.
Hashimoto’s disease is an autoimmune disorder that can cause hypothyroidism. Treatment often isn’t as simple as swallowing a tiny bit of synthetic hormone. Some people need much higher doses than the basic T4 screen would suggest. The OP’s wife is on thyroid replacement therapy, but because she had been misdiagnosed, it is very likely not the *appropriate *therapy.
As has been mentioned upthread, a diagnosis of Hashimoto’s disease should be a red flag for other autoimmune disorders. Hypothyroidism may not be the *only *thing wrong with the OP’s wife.
So yeah, I don’t blame the OP for feeling a sense or relief as well as some anger.
The A.M.A. has absolutely no say in actions by state licensing boards. They go by their own rules on a state-by-state basis. The A.M.A. has ethical guidelines, some of which may have influenced the setting up of state medical board regulations. But the A.M.A. has zero power to enforce any of its guidelines.*
The idea that the A.M.A. is an all-powerful lobbying group and has control over what physicians do is so…1960s.
In its heyday, the A.M.A. had about 75% of America’s physicians as members. These days, that number is down to 15%.
*in the interest of full disclosure, I’m still an A.M.A. member, mostly because I get discounted insurance (and also take advantage of their continuing medical education program). As far as day to day practice goes, they’re a nonentity as far as I’m concerned. Specialty societies are much more important.
Where the previous doctors went wrong was in not explaining to you adequately that Hashimoto’s is what she had. If she had a high TSH and a low T4, then the overwhelming majority of the time, it’s autoimmune. I consulted two of the main medical references we use, and both of them agree with me that someone with overt primary hypothyroidism (high TSH, low T4) should be treated rather than have further testing.
It would have been great if the doctors had recognized that you wanted that level of detail about her condition, which not everyone does.
Furthermore, the evidence-based treatment for Hashimoto’s is thyroid hormone replacement, namely levothyroxine. Everything else mentioned in this thread regarding treatment of HT is speculative at best and outright woo at worst. And unfortunately, the weight that people gain when they have untreated thyroid disease tends not to go away easily (at least not as easily as you might expect) once they are treated. Same goes for the symptoms–they should improve, but the list is so vague and universal that they’re not likely to go away completely. (I don’t know anyone who doesn’t feel tired a lot of the time.)
I’m glad you found a doctor who will explain things in a way that is helpful, and I’m sorry that your previous doctors made you feel like their finding was nothing but a “weak-ass thyroid”. But don’t let the doctor make this more complicated than it is just to satisfy the part of you that thinks it has to be more complicated.
Personally, I’m very critical and skeptical of the anti-gluten bandwagon everyone is jumping on these days (though I am all about keeping your starchy carb intake to a minimum or even cutting it out entirely if you want to).
However, Saint Cad, I tell you this because it may help your wife. My mom went through a very, very similar process of misdiagnoses and being ignored by doctors and told to just eat less etc. Eventually she was diagnosed with Hashimoto’s and got treated for it, and I will never forget that day I came to visit from college after she had been on treatment for a while. It was profound. She had lost a lot of weight, and looked happier and healthier than ever.
Then, over time, she gained weight back even though she kept taking the medicine. Recently she cut out all gluten from her diet, and has lost a bunch of weight again, and says she feels a lot healthier overall. Personally, I think it’s mostly confirmation-bias, combined with just less calories and healthier substitutes resulting in actual weight-loss. But whatever it is, cutting ALL gluten out of her diet has made her happier and healthier.
I sympathize, Saint Cad. For a few years I was bouncing between doctors. I had a couple tell me to stop worrying my pretty little head over nothing. I had another who said he didn’t know what was wrong, but I had sumpin’. And then I had another doctor tell me to just pack it all in because I was going to die soon and in the most miserable way. I didn’t really believe any of them. I even thought the one who claimed ignorance was just pretending. But I just kept pressing on until I found the right doctor who asked the right questions and made the right connections. And in hindsight, the diagnosis was so simple that any medical student should have been able to make it. I was both relieved and angry when it finally came because I felt like I had been needlessly jerked around.
There’s something satisfying about having a name for something. People just look at you funny when you start listing symptoms because you just sound like a hypochondriac. Especially when you let them know the doctors haven’t been helpful. But if you say “My doctor says I have X Disease”, it’s like the sympathy switch immediately turns on. People stop blaming you . A name is definitely a good thing.
I get the sense the MDs treated the OPs spouse like just another self indulgent fatty, and considered said fatty not to be deserving of their time, attention, and skill.
Can imagine where they would develop such an attitude, of course.
I’m honestly baffled by the entire story. It’s confusing that she apparently had a diagnosis of low thyroid levels but not Hashimoto’s, which, from my understanding so I may be wrong, is by far the most common cause of hypothyroidism. I mean, I think the prevalence of hypothyroidism is about 10% of adult women in the US. If Hashimoto’s Disease is the most common cause of this very common problem, then it’s pretty darned common.
Then when you say that no one believed there was something wrong, I’m again confused. Because she was being treated for low thyroid levels. And low thyroid levels causes all sorts of terrible stuff. Again, every time I go to the doctor, I get quizzed on basically all of the symptoms of low thyroid and every time they do blood tests, they test for it. Maybe my experiences are really unusual, but given those prevalence numbers, they don’t seem that out of line.
It could be as simple as bias against the obese. Seriously, doctors are human beings and a certain percentage are prejudiced. They see fat and think “lazy slob” and don’t exert the effort for they would for someone thinner. It’s no different than doctors who dismiss the complaints of the elderly or some other group.
Thanks for the info, I REALLY need to get more updated econ textbooks. I think the idea in the examples I was originally referring to are about accreditation and the ability to limit the supply of doctors(the only thing I remember for certain is the worker supply limitation) in the same way some craft unions can limit the supply of workers and thus professional standards and pay are influenced by the reduced supply. I do not really know the specifics, but it is used as an example of union- like influence in a couple text books I have read, other than that I really know next to nothing about the AMA, so it is good to get a fuller picture.
My suspicion is that we got a series of doctors that felt she was overweight due to over eating, lying about her food intake and exercise, and when pushed only ordered the most rudimentary test to shut us up because we all know that every overweight person claims it’s glandular.
Let me answer it this way to make you more confused. When pregnant with our daughter, she weighed 50 lbs lighter (including the baby) at 9 mos than when she got pregnant. With our son it was about 35 lbs. All that weight came back withing 6 months despite healthy eating and 30-45 min of moderate aerobic exercise 5 days a week.
But of course the doctors ignored those data points. And based on her new HRT that she got pending her lab results including the followup labs when her doc noticed the T levels were screwy (by the way, it includes progesterone and who else has progesterone? Pregnant women) and the diet that she got from the new doctor which is no carbs except certain fruits, she has lost 35 lbs in about 4 months. Maybe it is less calories and maybe it is no gluten re: Hashimoto’s. She’s not exercising more than she used to. I know some will look at the no carbs and say “There ya go. It was calories in vs calories out.” but after all of the diets, weight watchers, exercise programs she’s been on and THIS plan works? I’m not convinced it was all about eat less and burn more calories.
