This article is the second entry in A Dietitian’s Journey Part II, which began with my recent diagnosis of hypothyroidism. The first entry in Part II was written last Friday, and you can find it here. This article is about how the factors by which I measure health have changed due to my diagnosis.
NOTE: Articles posted under A Dietitian’s Journey are separate from referenced clinical articles (categorized as Science Made Simple articles) because these are about what happened to me (i.e., anecdotal) and based on my personal observation.
DISCLAIMER: The information in this post should not be taken as a recommendation to self-diagnose, self-interpret diagnostic tests, or self-treat any suspected disorder. It is essential that people who suspect they may have symptoms of any condition consult with their doctor, as only a medical doctor can diagnose and treat.
A Dietitian’s Journey – Part I
“A Dietitian’s Journey” was my personal weight-loss and health-recovery journey that began on March 5, 2017 when I decided to make dietary and lifestyle changes so that I could reclaim my health. At that time, I was obese, had type 2 diabetes for the previous 8 years, and extremely high blood pressure. I achieved my goal two years later, on March 5, 2019. In retrospect, I realize why it took a year longer than I anticipated. It is because I had high TSH levels, almost out of range. I had borderline subclinical hypothyroidism.
I believe that you can’t achieve a goal you don’t set“. In other words, I accomplished my health goals the last time, because I set them. As the popular expression goes, “A goal without a plan is a wish.”
I also believe that success needs to measurable — that is the “m” in SMART goals (specific, measurable, achievable, relevant /realistic and timely.) Before I began of Part I of A Dietitian’s Journey, I not only set my goals, I asked myself “what will success look like” which helped me define how I would measure success.
I wanted to achieve a normal body weight, be in remission of both type 2 diabetes and hypertension (high blood pressure).
Two years later, on March 5, 2019, I accomplished all but one of my goals, and the last one I achieve 3 months later. I lost:
- 55 pounds
- 12- 1/2 inches off my waist
- 3 -1/2 inches off my chest
- 6 -1/2 inches off my neck
- 4 inches off each arm
- 2- 1/2 inches off each thigh
- I met the criteria for partial remission of type 2 diabetes 3 months earlier
- my blood pressure still ranged between normal and pre-hypertension
If you want to get an idea of what I actually looked like at the beginning and at the end, there are two short videos on my Two Year Anniversary post that tell the story well. The first video was taken when I started my journey, and it is very apparent how obese I was, and how difficult it was for me to walk and talk at the same time. The second clip was taken when I completed my journey and the difference is unmistakable.
After recovering from Covid, I began hiking, and posted this encouraging “mountain top experience” post as my 5-year update. That was the pinnacle of recovering my heath.
Except for the 19 pounds (my “Covid-19”) that I gained over the past 2 years, my weight has been stable. I continued to remain in partial remission of type 2 diabetes, and my blood pressure was normal until this past December. In retrospect, that is when my health began to change.
A Dietitian’s Journey – Part II
As told in last week’s post which was the first entry in Part II of A Dietitian’s Journey), things didn’t go as planned. Here is an excerpt from that post;
“Despite having had both vaccines (April 2021, July 2021), in March of 2022, I came down with what my doctor assumed was Covid again. At first, the symptoms were pretty much the same as in August 2020, muscle aches and joint pain, being exhausted, feeling cold all the time and my lips were frequently blue, but I did not have a headache. I was loaned an oximeter by a family member who is a nurse and I found it quite strange that my body temperature was always two degrees below normal even though I had fever-like symptoms of being cold and shivering. The muscle aches were significant, as was the fatigue, but since these are also symptoms of Covid, I didn’t think much of it. It was only when I began to develop symptoms that were not associated with Covid that I began to become concerned.”
When I saw my doctor last Friday, he thought that it was very likely I had hypothyroidism, but wanted to run some lab tests to rule out any other possibilities. I went to the lab last Monday morning, and my results came back late in the day. The ones I was waiting for showed exactly what both my doctor and I expected they would based on the supplements I had been taking prior to seeing him. What I didn’t expect was that my blood sugar would indicate that I was no longer in partial remission of type 2 diabetes. My blood pressure was higher than it had been in many years in his office, so I began taking it several times a day to see if it was “white coat syndrome” or genuinely high. Unfortunately, it was the latter. I knew what I had to do. I sent him a fax, reported my blood pressure readings, and asked if he thought it was warranted, that he call in a prescription for the same medication I was on 4 years ago.
Last week I did quite a bit of research in the literature to better understand how low thyroid hormones could contribute to my high blood sugar and high blood pressure — despite me continuing to eat a low carb diet. I wrote this referenced article on the blog of my long standing clinical practice about the metabolic changes that occur due to hypothyroidism. It is about how thyroid hormones act on every organ system in the body, and as a result when someone has hypothyroidism, there is a slowing of metabolism, which results in weight gain, high cholesterol, high blood sugar and high blood pressure. Now it was making sense.
I now understood how over a period of three months (March 5, 2022 – June 3,2022) I went from looking as I have the last 5 years to looking as I did 55 pounds heavier.
I knew one of the symptoms of hypothyroidism was “weight gain,” but I had no idea that it could occur over such a short time frame!
Two months ago at my youngest son’s wedding, I looked like I did when I was 55 pounds heavier!
As described in last week’s post, I was very sick but it was devastating to look like I did!
Today my appearance is almost back to normal. [August 24, 2022: see updated picture below]
Sometimes we have to look beyond what something looks like to the timeframe over which it occurred.
Following Up With my Doctor
Today I had my follow-up appointment with my doctor where we reviewed my lab test results from last week, and discussed next steps. My doctor requisitioned a free T4 test to see how my body is responding to the thyroid hormone treatment that he is overseeing. He also gave me a requisition for a Thyroid Peroxidase antibody (TPO) test to find out if I have Hashimoto’s disease or if my hypothyroidism is due to my past thyroid surgery for a benign tumour. This article from my long-standing dietetic practice explains what these are.
Since Hashimoto’s is an autoimmune disease, how I would choose to approach my diet if the results of that test are positive would be different than if it comes back negative.
I should have the results back tomorrow or Monday, but in the meantime, I am thinking about what I will do to recover my health once again, and how I will measure my success.
Once again, I am asking myself “what does success look like,” but this time it is in the context of this new diagnosis.
From what I have read, it is possible for my blood sugar and blood pressure to return to normal once the doctor adjusts my thyroid hormone replacement to its optimal dose, however for this goal to be “measurable” I need to have a better idea of how long this could take.
A Dietitian’s Journey continues…
To your good health,
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UPDATE (August 19, 2022) – terrific news! I do not have TPO antibodies AND my fT4 is almost half way through the normal range. According to an April 25, 2021 webinar given by Endocrinologist Dr. Theodore Freidman, MD, PhD titled “Updates on Treating Hypothyroidism”, it is normal and expected for fT4 to be slightly lower given the type of thyroid hormone replacement that my doctor is overseeing.
[Put in plain English, this means I am the best kind of sick and the amount of medication I am currently taking is pretty close to optimal.]
I would have thought that not having antibodies meant that I didn’t have Hashimoto’s, but rather another type of primary hypothyroidism due to my past thyroid surgery (which is still a possibility). I was wrong. Not all people with Hashimoto’s have measurable TPO antibodies!
It was previously thought that 5% of people diagnosed with Hashimoto’s thyroiditis have serum-negative thyroiditis, which is where they do not have measurable TPO antibodies (TPO-ab) and ~50% don’t have positive thyroglobulin (Tg-ab) antibodies, either . People with serum-negative thyroiditis are diagnosed with Hashimoto’s based on clinical presentation, or by ultrasound appearance.
An updated study from 2020 indicates that the percentage of people Hashimoto’s with serum-negative thyroiditis is 20.8%, not 5% as previously thought. It is very encouraging that in subsequent follow-up only ~16% of those with SN-CAT eventually developed positive antibody tests for TPO-Ab and/or Tg-Ab .
In my opinion, in terms of a diagnosis of hypothyroidism, this is the best I could have hoped for. It is does not appear to be the autoimmune type (although Tg-ab antibodies weren’t tested, they are only positive in half of those with Hashimoto’s).
Based on this new study, there is a low likelihood of me going on to develop thyroid antibodies especially since I have no family history of autoimmune disorders!
I will take my time and read through the literature and then in light of these results determine what dietary changes I will make. Now that I know my fT4 is just about optimal, I will determine how I will measure success in terms of my restored health in the day’s ahead.
To your (and my!) good health!
- Rotondi M et al. Serum negative autoimmune thyroiditis displays a milder clinical picture compared with classic Hashimoto’s thyroiditis. Eur J Endocrinol 2014;171:31-6. Epub April 17 2014
- Croce, L., De Martinis, L., Pinto, S. et al. Compared with classic Hashimoto’s thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. J Endocrinol Invest 43, 1631–1636 (2020). https://doi.org/10.1007/s40618-020-01249-x
UPDATE (August 24, 2022) – It has been exactly 2 ½ months since my son’s wedding and 2 months since I began thyroid replacement medication and I am feeling quite a bit better about the image I see in the mirror. The change is more subtle this week, but I see less swelling in the cheeks. It will take a few more months for the less seen parts of my body to recover, but I am feeling hopeful.
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