Wednesday, March 25, 2009

On reference ranges, baselines, and symptoms.

This is kind of a long, rambling post, but I'm hoping it might be useful for someone.
So, yeah. That thyroid thing. I see it everywhere - it's human nature that if you get some sort of condition, you see it everywhere.
I didn't even order this test. It was just part of a routine physical. On my way out the door the nurse said, "he needs to talk to you about this," and I glanced at the paper in her hand: Thyroid Stim Hormone 8.02 (H). What's that? I asked. What the hell is a thyroid? I mean, I know we have one. What does it do? Is it like an appendix? Oh, so many questions.

There are reference ranges for everything in medicine. They are a start, but they aren't the whole story. What is normal for me is probably not normal for you, and that is why annual physicals are so important, because they help establish a baseline for what is "normal" for you, and spot sudden changes.

I've had regular physicals all my life, but changed doctors when I moved and rarely had my medical records fowarded. Why should I--I had your average, run-of-the-mill stuff: Asthma, allergies...the usual. I figued annual physcials were cross-sectional research, and didn't think much about the whole, "baseline functioning" thing.

In my reading, I've found that there are some common symptoms of low thyroid function, regardless of cause...and I've been looking back to see if perhaps I should have been paying more attention. That isn't so much useful to me, but maybe it's useful for someone else out there.

Have you been feeling cold? Well, yes, but who thinks this is a symptom? You put on your robe and your slippers and crank up the thermostat. On the other hand, Baboo and my multisport friends can attest that I've ditched a lot of bike rides because it was too cold. How can you guys ride when it's so freakin' cold out there?

Have you had dry skin and/or hair? I live in the desert, where the average humidity index is about 15%. Everyone's skin is dry here. You buy moisturizer. You deal with it.

Are you having weight problems?
THAT is an interesting question. The answer is, yes and no. In fact my weight has stayed even for the past 9 years. It is documented at my doctor's office; on average, it's hovered between 160 and 170. I even blogged about it.

So let's lay this out: In nine years, my weight has stayed steady. I became a runner, and then a triathlete, then a marathoner, and then an Ironman, and my weight stayed steady. While my eating wasn't always what it should be, it didn't change until early 2005 when the weight had really started piling on. I starting tracking my calories and lowering them to an average of 1800-2000 a day. I lost the weight I'd gained the past year. Then, I took up running but never lost another ounce.
In 2008, I trained for my 2nd ironman: In a week, I biked 60-100 miles, ran 15-20 miles, and swam 2 or so miles, minimum. My weight dropped to about 158, a size 10, which puts me in the "normal" range for my height. In other words, for me to be "normal weight," I had to train for an ironman.
Last year, I ran 7 marathons and an Ironman and several other events, and basically, my weight stayed steady. When my activity level dropped a bit, for me, I gained weight, even though, while injured, I was still more active than the average American. Hmm. I was stunned and disappointed at how quickly I was aging, but worked on accepting it. There wasn't anyone to ask about it; all my female relatives is dead, save one older sister.

Have you felt tired or depressed? There is some debate about this particular symptom - that the tired feeling is really a form of depression. Depression is a sneaky little bastard. There have been times that I haven't written about when I felt like I was near tears even when, arguably, I have the best life a woman could have. I told Baboo, "I don't know what's wrong with me, but it has to be chemical. Everything in my life makes me happy."

As for energy, from my doctor's standpoint, I am an active woman, so my energy level must be okay, right? RIGHT?

But lets look at my baseline functioning. I have always been hyperactive. I was diagnosed with AD/HD, combined type. My mother reported that, as a child, I was up at sunrise and up until nearly midnight throughout most of my childhood. From my elementary teachers straight through to my old college boyfriend, they will all tell you that I am hyper as hell. Between 1990 and 2000, on 6 hours of sleep per night, I worked part-time (20-30 hours a week), raised three kids, and finished my education all the way through a master's degree. This past decade, I have worked full time as a high school teacher, raised two teenagers, finished another master's degree, and trained for an ironman. This is my normal baseline functioning. Normal for me.

But, in the last couple of years, though, I've started complaining to Baboo. I need more sleep. I can't face those teenagers without more sleep. Another part of growing old, I thought. You slow down, right? It's what you do. I figured it was just a woman thing.

My doctor said, You do a lot for a woman your age - I'm surprised you don't need more sleep. I accepted it, and set about trying to get more rest. My friends protested this form of thinking, You're too young to be going through menopause.

Even now, as tired as I "feel," I am working full time, beginning a new season of training, and working on another master's degree. I need 7 or 8 hours of sleep these days, which is NOT normal for me, and I don't feel like working out most of the time. Not normal for me.

Do you have low heartrate?
My resting heart rate is about 57, but I'm a marathoner. There's no way to know if I have a clinically low heart rate or not.

Have you had decreased libido?
I've complained to my doc about it every single year. First I thought it was some medication I used to take. Then I thought it was menopause. It's gotten low for me, but again, what's low for me is low for me, probably not low for most women.

Now, this isn't some dramatic, life threatening condition - it has serious consequences, if left untreated, but I'm curious, so curious about what medication means. It's a quick and easy fix: I take medication, once the proper medication is targeted, and I take it on time, as directed. Maybe levels have to be adjusted from time to time. Blood tests everyone once in a while, which I can do on my lunch hour at the hospital next to where I work.

So, what happens next?

Well, I have an appointment with an endocrinologist on the 31st. ANd I have so many questions. Did I do this to myself? If my current functioning is "normal" for most women my age, what will happen when I take meds? Will I go back to the way I used to be? I said to Baboo the other night, "I don't care about anything else except that maybe I'll have more energy and I can be faster. I can lose my own weight, I just need the energy to do it."

How sick is it that all I care about is getting faster? Oh, I'm a multisport addict. I am, I am, I am.

So, yeah. That thyroid thing. If you feel like you're having menopause symptoms, (other than just the usual hot flashes) and it's very different from what is "normal" for you, and it bothers you but your doctor insists that you're within "normal" reference range, push for the test anyway. It's a simple blood test. The worst that can happen is you wear a purple band-aid for 20 minutes. That's all I'm saying.



  1. Very good advice GG! My doctor runs the thyroid test as part of the at annuals, but not all do.

  2. A word of advice as well, once you begin taking thyroid medication (as I do, thyroidectomy due to primary papillary carcinoma) never, NEVER let anyone except an endocrinologist alter your dose. NEVER! Many health care professionals will look at your dose and change it if you go in for soemthing simple, assuming your thyroid meds are the culprit. If someone tries to change your dose, ask them to consult with your endo or you call the endo yourself to double check. I spent 8 months on a dose too low (by 25%) because a doctor reduced my dose when he assumed headaches I was having were due to my high dose (which I need desperately because I have no gland), when in reality I had a major sinus infection. 8 months of lethargy, hair falling our, exhaustion, bad skin, and aching joints.

    Thou shalt obey thine endocrinologist before any other.

  3. Thanks for the posts. I'm really starting to think I have an underactive thyroid. All the symptoms. Tests have always showed "borderline" function. But I read you can't always go by what the blood test shows. Also, I'm going through menopause big time. And with my RA, I assumed the symptoms to be attributed to both of those--plus being almost 54. I'm going to make an appt. to get this stuff checked out ASAP.
    Again, thanks for such an informative blog!

  4. Interesting. I found out about my thyroid the same way - by suggesting to my doc that she test me for menopause and she was smart enough to test my TSH instead. I seriously doubt that you will be told you're normal and to deal with it. You'll be put on some sort of meds, which will make you more normal - is there such a thing? Believe me, once you start to feel better, you'll wonder how you EVER functioned under the old normal.

  5. Hey GG check out references to Iodine. My X had Hashimoto's so we researched it quite a bit. I think one of the books we picked up was Iodine, why you need it and why you can't live without it. By Brownstein. There are a lot of studies and references in the book. The book isn't that technical but there are good references. It's worth looking into! It's worth the read and pretty eye opening.

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  7. Hey, Misty,
    I went through a bunch of this thyroid testing stuff last year and found out that I'm "subclinical" hypothyroid, whatever that means, so I've been working on nutrition to balance things out. I supplement with kelp (for iodine), zinc and selenium. The other thing that I'm pretty sure has made a big difference is drastically reducing the amount of soy in my diet. I know you've switched from a vegan to vegetarian diet, so I'm not sure how much you're still relying on the soy, but if you just google soy and hypothyroid, there's lots of information about out there.

  8. Wow! Thanks for the post - I'm going to have mine checked!

  9. I just wanted to let you know I enjoy your blog very much. thank you for taking the time to write it

  10. Wow ! Thanks for the informative post. Good luck and keep us posted.

  11. I went into menopause at 45. You're never too young...

  12. I really did think that's what it was. I had an ablation a couple years ago and have never had another period, so I had no way of knowing for sure, especially since I and my sister are the only living female relatives in our family. But yes, it can happen young.

  13. No, you didn't do this to yourself. I'm so glad you've been diagnosed. when you get on the appropriate meds you will start to remember what feeling 'well' means.

  14. Great post! I have no living female kin in a direct bloodline, with the exception of an aunt. I therefore have no clue what's going to be "normal" for me, although we're a pretty hardy lot on both sides. If I take after my grandmothers and meet with no unfortunate accidents I can expect to be pretty healthy until my 90s.

    I do need to get a thorough checkup, though. I'm overdue and need to quit putting it off now that I'm in sort of a clear space at the office and can take a day off. It's easy to get lazy when one has no symptoms, but that's really no excuse after 40.

  15. I really don't meant to gloss things over, but isn't it amazing how easy it is to fix all this?

    My wife has been on synthroid since her teenage years. It's funny that whenever she's "not in the mood" I joke to her to take an extra dose. And yes, I AM just joking.

    Many people do just fine with the generic med btw but some people do not. If your lab values keep fluctuating consider only the original brand and not generics.

    It will take a couple months but I hope you feel better soon!

  16. Thanks so much for this honest and insightful post.

    I had a similar outpouring late last year...(see towards the end)...may seem only tangentially related on the surface, but as far as I can tell from the rest of what's rattling around in my head right now, we're possibly on the same page.

    You're not alone in your ups and downs. Hang in there, and take care of yourself, glorious Athena! :o)

  17. Wow, that's a lot of good information.
    And thanks for the reminder. My last annual physical was 3 years ago. I guess that makes it a 'tri-annual'. I'm such a dork.

  18. I have thyroid issues that I first thought were menopause symptoms. It's interesting how they can be similar especially the sleep and night sweat problems. Now that I have my thyroid issues resolved, I am going through menopause.Anita


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