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Thyroid Diseases

Pre-Endo Appointment

01/25/2010

Question:

I am in the process if getting tests, as ordered by my PCP, to prepare for an Endocrinologist appointment. I have experienced significant weight gain (10 lbs in one month, total 25 lbs in 12 months.) In researching hypothyroidism, I find many symptoms that I experience: Depression, sensitivity to cold, cold hands/feet, slow wound/bruise healing, joint stiffness in hips and shoulders, ringing in ears despite better than average hearing, muscle cramps while at rest (hips), need more than 8 hours sleep, not feeling rested upon waking, increased cramps during period, increased moodiness before period. So far, my Cortisol was 24.2 then 26 and my T3 was 193 with a normal range of 60-181. My t4 was "normal" (no ref range) and TSH seems normal at 2.59, though much research indicated that`s not viewed as reliable anymore. I am the type of patient who researches and goes in with questions, and frankly pessimistic because my PCP said the Endo was ""not impressed" with my test results. I`m not obese but I am overweight (165 at 5`5) and upset that I can`t lose this weight, despite working out 6 days a week burning 300-700 calories and eating no more than 1700 calories. (Nutritionist said eat between 1400 and 1800 calories.) My nutritionist was at a loss, and both she and my PCP agree something medical seems to be a problem, not lifestyle. Can you point me in another direction so I can go in as informed as possible, or do you have any leads?

Answer:

Unfortunately, I think your doctors are right. The symptoms of hypothyroidism are notoriously non-specific, and the fact that you have these symptoms doesn't really prove that you have a thyroid problem (especially in light of your normal TSH). I'm afraid the cause of each symptom will need to be addressed individually now that we know your thyroid is not the problem. The total T3 is a very poor test and I wouldn't ascribe any significance to the slight elevation that you have, in light of your normal TSH.

I'm afraid that the Internet is leading you astray. The TSH is an extremely reliable test, and it tells me that the thyroid is not the cause of your symptoms. I suspect that you could spend the next 10 years trying various doses of thyroid pills and none of them would make you feel any better, because I do not believe that the thyroid is the source of your symptoms.

I must confess that I am not very impressed with your test results either. The cortisol level is a bit high, and your endocrinologist might want to test you for cortisol excess if you have findings on history and physical examination that would point in that direction. As far as your weight loss is concerned, you appear, unfortunately, to be a person with a metabolism that is very efficient at turning calories into fat. 10,000 years ago that was probably a big advantage, but no longer. The one thing I can tell you for certain is that, no matter how little food you are eating, if you are gaining weight (or not losing) it is because you are eating more calories than your body absolutely needs to survive and it is storing the extra as fat. The only way you can lose weight is to eat fewer calories than your body needs to survive - then it uses your fat stores to make up the difference.

No matter how little you are eating, the only answer is to eat less. Try eating 1000 to 1400 calories rather than 1400 to 1800. Those number are for the average person, and you are not average. There are only a tiny handful of diseases, as such, that cause weight gain, and they are pretty rare. I suspect that you will not find a medical explanation for your weight problem, and will need to attack the problem from a lifestyle point of view.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University