When Hypothyroidism Symptoms Persist

antonio-biancoBy Antonio C. Bianco, MD, PhD

Within two weeks of each other, two patients arrived in my office with almost identical stories. Both were middle-aged teachers who had lost their jobs months after being diagnosed with hypothyroidism, or an underactive thyroid. They had gained weight, lost energy and had trouble focusing.

Yet their hypothyroidism was under control, as judged by medical standards. They were taking the go-to medication that has been prescribed for hypothyroidism for 40 years, a synthetic thyroid hormone called levothyroxine. Blood tests revealed that the women had normal thyroid-stimulating hormone (TSH) levels, which is the lab value physicians look at to diagnose and manage hypothyroidism. Frustrated over their lingering symptoms, both women had sought second opinions from numerous endocrinologists. All of these specialists assured the women that their lab tests were normal and they should feel fine.

About 15 percent of people with hypothyroidism, including 2 million Americans, remain symptomatic despite following what we physicians call the standard of care, which has been recommended by the American Thyroid Association. Just like my two patients, these patients are fatigued, sluggish. Their cognition is compromised and they gain weight that they can’t lose. They are commonly depressed, and their lives are significantly impaired.

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Physicians often dismiss these complaints from hypothyroid patients as “all in their heads.” I should know. I used to be one of those physicians. Then eight years ago, because of these two patients and their strikingly similar stories, I started to listen more closely to what my patients were saying. As a result, I started to believe them.

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