BoomerGirl Diary

Dear Crabby:

I am dieting and exercising my tail off and I still can’t lose weight! I am convinced I have a thyroid problem that’s affecting my metabolism. I just know if my health care provider gives me some thyroid medicine, I’ll lose weight. What should I do? PS: Just where is your thyroid, anyway?

Still Weighting

Dear Stilly,

Oh, if I had a dollar for every time some poor woman has looked at me with shining eyes, and asked eagerly, “Do you think it’s my thyroid?” I’d be a wealthy woman, or at least drive a fancier car. In all of medicine, thyroid disease is the one that women are secretly pulling for. They wouldn’t want eczema, endometriosis, or irritable bowel, but secretly, they long for hypothyroidism. It’s the answer to all their problems, all their symptoms. Check out this list of hypothyroidism symptoms from an endocrine Web site (the thyroid is part of the endocrine system):

• Fatigue

• Weakness

• Weight gain or increased difficulty losing weight

• Coarse, dry hair

• Dry, rough pale skin

• Hair loss

• Cold intolerance (can't tolerate the cold like those around you)

• Muscle cramps and frequent muscle aches

• Constipation

• Depression

• Irritability

• Memory loss

• Abnormal menstrual cycles (if you still have them)

• Decreased libido

Hmmm. Yup. Yup. Yup … OH MY GOD, I’VE GOT IT TOO! (Hysterical jubilation as Crabby realizes she won’t actually have to give up her nightly dish of Breyer’s ice cream) Oh, damn. I forgot. They checked it last year. Normal. Sigh.

OK, so first: the thyroid is a bow-tie shaped gland at the base of your throat on the outside of your neck — under the skin, though, of course, so you can’t mistake it for formalwear. Unless it’s enlarged, as with a goiter (remember Aunt Tilly’s goiter? Eeek! That’s a whole other column. And what a word: goiter. Urk. But I digress.) you usually can’t see it. The thyroid is kind of like the body’s engine idle; if it is running too fast (hyperthyroidism) you ramp up a lot of the body’s processes and usually lose a bunch of weight unintentionally. Yeah. I don’t know what that’s like either. Before you get all, “Oh, gosh that sounds great, Crabby,” consider this. Just one of the problematic symptoms of hyperthyroidism is that your eyes start to bug out, and it’s NOT REVERSIBLE if it’s left too long. No one aspires to be Barney Fife, girls.

It can also progress to a dangerous and sometimes life-threatening condition called “thyroid storm” when it really goes into overdrive. (Sounds like a Celtic heavy metal band: “And now, taking the stage, are the explosive guitars and bagpipes of … Thyroid Storm!”)

Anyway, if you get hyperthyroidism, sometimes the thyroid turns around on its own with a little medicine and some stern talk, but often, like some kind of glandular zombie, they have to actually destroy the hyperactive little thing with radiation and then give you a normal dose of thyroid hormone to replace it. For the rest of your life. So it’s not all it’s cracked up to be.

OK, so let’s look at the flip-side, and your question, Stilly. What if your thyroid is lazy, like Crabby on the Stairmaster? What if it’s lying around your neck like a string of cheap pearls, not lifting a finger to help you in your valiant weight-loss efforts? You get fat, tired, and all of those other things on the list. It’s a real drag. And a dose of synthetic thyroid can correct a lot of the symptoms. But I have to tell you, dear readers, in the 8 years I’ve been practicing, there have only been a few occasions when I’ve tested someone at her request because of weight gain and found a problem. It’s usually just something that turns up as an incidental finding. Most of the women I have tested are normal. They’re just tired, stressed, and living la vida loca. Or la vida Americana, which is about the same thing. And we also know that people tend to OVER estimate their exercise and UNDER estimate their eating. Not that you would do that, of course.

(A side note: Many alternative practitioners diagnose something called “sub-acute hypothyroidism.” This means your labs are normal but you have the symptoms. Some patients claim to feel much better on a low dose of a natural thyroid—who wouldn’t feel better with a little extra kick in the engine, right? Even if you don’t really need it —but it still has to be gotten with a prescription. The science is not good on this, and Crabby herself has mixed feelings. So your regular health care practitioner may not be willing to give you the prescription. Some — not me! — may be downright hostile about it. Just an FYI.)

I’m not saying you shouldn’t be tested. You should, if you have those symptoms. Maybe you do have a thyroid problem. It’s fairly common, after all. But I wouldn’t put all my donuts in one basket on it, if you take my meaning.