Disclaimer: I’m not a doctor/medical professional. Don’t take health advice from me, and do your own research.
I had a recognizable pattern of “bad summers.” It started when I was 16, or at least that’s the first time we noticed it. I was sleeping all the time, preferring it to being awake. The summer in between tenth and eleventh grade was hell. I had just spent the previous few months helping my best friend with her campaign to be elected on the student body council—we had tons of fun making posters and she ended up winning. Then through the natural rhythms of life, she had a super busy summer. A lot of it was outings with the rest of the student body council. The first sign that something was wrong (though I didn’t realize it at the time) came when I hadn’t heard from her in a while, but heard through a mutual friend that she had visited Stanford. It was a routine sort of field trip, nothing crazy. We were all thinking about colleges then, and she just happened to go with the student body council. I got so mad. Not really jealousy that she had gotten to go visit the campus, but anger that she hadn’t told me about it. Irrational anger, obviously. I justified it in my head by saying that Stanford was one of the most prestigious schools for writing, and she should have known I would care about it as a writer, and so she should have told me.
I gave her a hard time about it, left angry voicemails, and generally acted like a crazy person. She stopped talking to me entirely (can’t really blame her, when we were only sixteen and I was obviously off my rocker).
My mom was worried about me, thought that all the sleeping meant that I was depressed. She took me in for blood tests, and we got my thyroid levels checked. I don’t remember much about it—just the probing questions from the doctor about whether I felt sad all the time, and the rebellious sullen answers a typical teenager would give to those sorts of questions.
Fast forward to years later. I’m 24, and realizing the pattern of horrible, depressed, sometimes suicidal summers. I’m mystified—seasonal affective disorder is certainly a thing, but reverse seasonal affective disorder was still new enough to maybe not be real. So I start researching. And asking about family history. And finding obscure internet articles about how depression can be linked to thyroid issues. And even more obscure references to the seasonal fluctuations in thyroid levels. I think I was determined to find something that meant I could treat my depression with something other than antidepressants. I’d already been on the suicide crisis lines for a while, and I hated that so many of the callers were dealing with suicidality as a side effect of their mood stabilizers. And so many of them weren’t monitored as closely as they should have been, with follow-up psychiatrist appointments months in the future, when they were obviously having adverse side effects to the dosage NOW.
I dug through old paperwork and managed to find the results from that thyroid test when I was 16. My TSH was at 4.5. Most labs say the cutoff for a normal thyroid is 5.0, but some big group of certified Endocrinologists said those numbers should be revised, that anything above a 3.0 was worrisome… So I started the hunt. I saw a doctor who said that if I was depressed I should listen to happy music. She was also the one who asked about my religion and tried to imply that I was depressed because I wasn’t Christian. That was a fun visit. I saw an endocrinologist who said that she wouldn’t even think of treating me unless I had a TSH above 9.0 and an obviously enlarged thyroid (goiter).
Finally, the third doctor agreed to treat me based on my symptoms rather than the lab numbers. My TSH was coming back as 4.3, near the tail end of another difficult summer. What doctors now call “subclinical hypothyroidism” but what for me means a terrifying stretch of time when depression and suicidal thoughts rule my life.
Long story short? I got on thyroid meds and haven’t had a bad summer since.
Just to prove how delightfully tricky it is to recognize thyroid issues, though, here were my symptoms back when I was trying to get treatment:
-Hair loss (which, due to my genetics, meant that my very thick, vibrant, copious amounts of hair clogged my hairbrush more than it should. I wasn’t going bald, my hair was not noticeably thinning out, strands would just fall out more than what was “normal”)
-Temperature sensitivity (Cold was super cold, hot was unbearably awful. It’s most obvious when I go to work at our company’s beautiful warehouse-style location that takes a while to warm up in the mornings. The guys are down to shirt sleeves within an hour. I’m still in two sweaters after lunchtime.)
-Depression/Suicidality in the summertime (Confusing, because some people who are hypothyroid are hypothyroid enough for the depression to last all the time, whereas my numbers are low enough that seasonal fluctuations mean some of my symptoms go away during the colder months…)
-Fatigue (Difficult to distinguish from the depression, since they’re usually wrapped up in each other. Mine was most recognizable after spending time in hot environments—any time in the sun and I would have to nap for hours to get anywhere close to a normal energy level again.)
-Weight gain (This was very gradual. Just over ~5 pounds a year, over the course of several years. But that certainly adds up.)
Then, along came pregnancy and my lovely hyperemesis gravidarum. Sleepless nights spent scouring the internet for any little distraction that might help me put off the next vomit session by a half a minute uncovered the weird link between thyroid hormones and hCg. HCg is the growth hormone that is detected via pregnancy tests. Your numbers multiply for a while, peaking somewhere near the end of your first trimester, and then remain elevated somewhere into your second trimester, until the placenta can start taking over some of the hormone production. High levels of hCg are thought to be linked to hyperemesis, a nifty explanation for why women pregnant with twins often end up with HG or just higher levels of nausea and vomiting during pregnancy. Turns out the alpha subunit of thyroid stimulating hormones is nearly identical to hCg. What does that mean for me? It shouldn’t have meant anything. Unless my hypothyroidism is caused by Hashimoto’s autoimmune disorder, in which case it could mean very bad things.
I don’t really want to go into all the intricacies—everyone should do their own research on this stuff, and since I haven’t been formally trained in it there are probably bits that I’m getting wrong. But basically when you have Hashimoto’s your immune system is trained to attack your thyroid, slowly breaking it down until it loses more and more of its mass and ability to produce the T4 hormones that are converted to T3 and then used throughout your body to regulate everything from your metabolic system to your temperature. Homeostasis in the face of Hashimoto’s? Pretty tough on the body to maintain.
So, basically beyond a certain threshold of hCg, my immune system started going into overdrive. I’m guessing (though it isn’t proven) that this is why my body was rejecting everything useful during the worst times of my hyperemesis (ex: food, liquid, any nutrient whatsoever). The hyperemesis, again for unknown/unproven reasons, sometimes causes what they call “transient hyperthyroidism.” Which meant that for a while my TSH numbers went the opposite direction. I had to stop taking my Synthroid (synthetic T4 replacement hormone used to treat hypothyroidism), because I was getting all these symptoms of hyperthyroidism. I had heart palpitations, increased heart rate, I was losing weight at an alarming rate (also due to the hyperemesis though, of course).
So I’ve been off my thyroid meds for a few months, ever since the last hospital admission. Unfortunately, in most normal pregnant women, doctors don’t have a standard protocol of checking all areas of thyroid production/health throughout pregnancy. In one routine blood test (I think for the second trimester screening) they only tested my free T4 numbers, which came back normal. They advised me to not re-start my thyroid meds, because everything looked good.
Along comes a visit to my primary care physician, who is following up on my overall health now that my body has been going through so much (and to think, before the pregnancy all I was dealing with was a vitamin D deficiency!). He runs some tests, and low and behold, my TSH is all the way up to 7.0!
Have I been dealing with depression? Just the normal amounts for any woman with hyperemesis, which thankfully died back down after the steroids started allowing me to eat and drink again. Am I sensitive to cold? Hell no, I’m pregnant, I run way hotter than usual and end up soaking my sheets in sweat every night.
The depression is usually my big indicator that something isn’t right. If the depression isn’t present, I don’t really notice that anything’s wrong. So the recent levels of insane fatigue I’ve been feeling, I just attributed to third trimester symptoms, plus a possible correlation with my gestational diabetes diagnosis, because high blood sugar numbers can cause extreme fatigue.
It’s only after my doctor comes to me saying myTSH is at a record 7.0 that I realize I’ve been having to clean off the hair from my hairbrush about five times more often than I normally would have to.
Interestingly enough, women with hypothyroidism are something like 17% more likely to develop gestational diabetes. Probably something to do with how the thyroid hormones are hooked into your metabolism, and therefore the way and rate your body metabolizes glucose…
The lesson in all this is pretty simple, for me. Stay more on top of my thyroid condition. I’m a little hopeful now that with some thyroid meds we might see some improvement in my fatigue levels, which would mean I can go back to trying to work again. Who knows, maybe it will even make the gestational diabetes easier to keep in check. I’m a little miffed that my body is so complicated right now…my PCP says that it’s probably due to the lasting effects of the steroids on my system that things are so complex and confusing now. I thought that hyperemesis gravidarum was enough to have to deal with—I wouldn’t wish it on my worst enemy. Then add the gestational diabetes, and now thyroid issues…
The one definite good thing in all of this is that we’ve finally tested for, and confirmed, Hashimoto’s. Right now with my weird dietary restrictions/needs, I can’t do much about it. I’m still eating whole wheat carbs and just trying to manage my blood sugar numbers in any way I can. But after delivery, when I can get rid of this placenta and my body will return to functioning the way I’m used to it doing…I can go gluten-free to help limit the negative affect of the Hashimoto’s. It feels good, knowing that I will finally be able to manage a health problem myself, with just some lifestyle tweaks. I don’t have to feel like such a victim, buffeted by the endless storms of uncontrollable pregnancy complications. Just ten weeks to go. Longest ten weeks of my life…but the end is in sight.