"It's all in your head!"

Last night I was talking with friends about the controversial diagnosis of "mass hysteria" going on at a local high school. It's been all over the news, and even though I don't watch or read our local news, I've read strange reports online about the students who are exhibiting Tourette's-like symptoms.

Of course, one woman was quick to say she basically thought they were all making it up. I don't know where she got her information from, but she alluded that of the ones who stayed out of the spotlight and sought treatment, they recovered. The ones who were on the news and in the media, though, didn't. And apparently the alleged victims did not all receive Gardasil injections, and are not all girls (it includes one boy and an adult female, supposedly).

One article, though, contradicts what this woman is saying: officials do not believe the students involved are making up their symptoms. However, the neurologist this lady apparently spoke to does. What does that tell you?

Sometimes when it comes to finding
out what's wrong with you,
you have to think outside the box. 

If all those details are so skewed, it makes me continue to lose faith in the media. I mean, do they ever get the story right? And if the officials involved think the students are telling the truth, it also makes me lose more faith in the doctors. It seems like whenever they can't find the solution to something, they blame the patient: "It's all in your head."

The medical field's love of medicating doesn't help. As I've found in my research on thyroid diseases, and in my own personal experience, many people get a cocktail of drugs for each symptom - fatigue, depression, memory loss, etc. - and their real problem gets untreated and ignored. Could this be the case at this school? Who really knows.

I've been going through my own struggles lately that make me sympathize with these students. Long story short, since November I've been having weird feelings - vague at times, hard to describe but definitely there - in my head that I can't explain. Not quite a headache, but a pressure sensation that comes and goes. I know in the end probably the only thing to do is get an MRI, but I dread asking a neurologist about this: because he will likely tell me I'm nuts. I wonder, "Brain tumor? Middle ear? What the heck?" Considering I have Hashimoto's Disease, it could be linked to that: a "rare" neurological condition called Hashimoto's encephalopathy, which in some cases can actually mimic Alzheimer's and Parkinson's. In many people with it, they were all misdiagnosed with Alzheimer's, Parkinson's and even a variant of Mad Cow Disease (Crutzfeld-Jacob Disease), when really they all had Hashimoto's encephalopathy, which usually responds well to steroid treatment.

I think of people who are on tons of medications and yet still doing badly. One woman in particular comes to mind - a woman from my church who was morbidly obese and in very poor health. Looking back I bet a lot of her weight was contributed to fluid retention, and doctors eventually didn't know what was wrong with her - and she died.

The thing that further complicates a disease like this is that many of those symptoms - swelling, memory loss, tremors, weight gain, high cholesterol, and diabetes - can all be complications of long-term, untreated hypothyroidism. Not only that, but they strongly suspect that many people with suspected Hashimoto's encephalopathy are actually undiagnosed because doctors don't know how to treat it - and often ignore Hashimoto's Disease. Despite access to several blood tests, MRI technology and new research that suggests not only could Hashi's patients benefit from treatment, but that a simple TSH will not adequately diagnose them - doctors continue to ignore the evidence and wait for these people to slowly wither on the vine, which is disgusting. In the age of internet diagnostics (which many doctors heavily criticize and roll their eyes at), it's imperative for people to find answers and support from others, which is vital - while it's a double-edged sword of anxiety wondering whether you're actually right or not, it might be more information than your doctor is willing to give you.

It's easy to lose faith in a system that, at least in this case, often sticks to outdated, false logic in diagnosing, doesn't always listen to the patient, and treats the patient like they're working for you, instead of the other way around. The relationship between the pharmaceutical industry, your doctor and your insurance company is a complex hamster wheel that's often driven by one thing: money. "Big Pharma" airs their commercials on television and in magazines, convincing you that whatever you have is worthy of being treated. Maybe it is, maybe not. You visit your doctor to find out more. Or, you really do have something - but your doctor doesn't know how to treat it except to push more pills, which are conveniently provided by the drug manufacturer. Your insurance company might decide they want you to use something different, cheaper, perhaps - that might not have worked for you in the past, but because they're footing the bill they will insist you take it even though you and your doctor want to use something else. Or your doctor might suggest a new, better, faster (and more expensive) pill that does the same thing as the old, cheap one - simply because a drug rep told them it's the latest, greatest way to treat XYZ Disease.

They don't want you to know - or don't know themselves - that untreated conditions like thyroid diseases, for one, can cause the same symptoms they're treating ineffectively. Or that vitamin and mineral deficiencies can also mimic some of the symptoms you're having, for a fraction of the cost. If you knew all that, and approached it with the skepticism that you probably should, then your medicine cabinet wouldn't look like a mini pharmacy, and you wouldn't be filling their pockets nearly as full.

Food for thought:
Some of the most prescribed medications for 2011 include statins and cholesterol-lowering drugs. It's no secret that untreated (or under treated) hypothyroidism can cause high cholesterol, even among patients who follow a good diet and get reasonable exercise.

Other commonly prescribed drugs include antihypertensives, diabetic medications, antidepressants, migraine medications, and drugs to treat memory loss. Not coincidentally, hypothyroidism can lead to diabetes and high blood pressure, and among the symptoms are poor cognitive function ("brain fog"), migraines and headaches, and depression.

Low vitamin levels can also be a culprit. With vitamin and mineral enriched foods so readily available, you'd think that these deficiencies  wouldn't be as common as they are. However, a number of factors - heavy alcohol use, poor diet and digestive disorders can affect how you absorb nutrients. It's also been speculated that use of chemicals and preservatives in our food can block nutrient absorption (or cause a number of health problems, at the very least) despite all the "good stuff" they add to it to make us healthier. (Said tongue in cheek, of course)

While not absolute, I've listed symptoms in the table that tend to be commonly treated with prescription drugs (which can include anxiety meds, antidepressants, anticonvulsants, pain relievers and NSAIDs, birth control pills, and GI drugs). And while these are common deficiencies - especially among women - I've found in my experience that you can't always expect your doctor to automatically test you for it.

More reading:
How to eat right to overcome vitamin deficiencies 
Are vitamin D deficiency and hypothyroidism related?
Have you tested your B12? It's a deficiency thyroid patients need to catch. 

Testing your thyroid: why you can't always trust the TSH

For years, my wonderful gastroenterologist was testing my thyroid (or so I thought) and the results were always "normal!" I thought nothing of it until last winter, when I became concerned that I felt crummy more often than not. Things I used to love doing now seemed like a huge chore, and housework and laundry felt like the most unsurmountable tasks ever.

My mom kept asking me, "Have you had your thyroid checked?" I insisted that yes, it's been checked, and yes, it's normal. She told me how unreliable the TSH can often be for some people, and I dismissed it as more of her "woo" medicine. Until I started making a mental note of how I felt and decided to look into it. What a shocker I was in for.

Many of the symptoms I was experiencing showed up on lists all over the internet, including an explanation of why the often-hailed TSH can sometimes leave many people under treated or even undiagnosed. I learned to be wary of doctors who told me that the TSH was the 'best way' to determine if you had a thyroid problem.

The TSH is kind of like a complex math problem: it's one component of the equation, but without the other numbers, it might not make much sense. It could look okay on its own, but not really be complete. By only looking at the TSH, it is a very misleading piece of the puzzle, when in fact there's much more that needs to be considered before solving the problem.

Photo credit: thevreelandclinic.wordpress.com

Before the TSH blood test was invented in the 1970s, doctors often paid attention to the symptoms a patient was experiencing. While not always a perfect science, I think it also reflected how more patient-centered the medical profession used to be; now with the advent of more tests and drugs to treat everything, we've definitely gone in the opposite direction. The TSH test was developed with a pool of approximately 200 volunteers (that's it?!) to test for 'normal' ranges of thyroid function, and has been used as a guideline ever since. The problem is, not everyone is the same - some people can feel relatively great with a higher TSH than others, and some feel like crap when their TSH is in the normal range. To confuse you even further, even though there are clear guidelines established, different labs use different "normal ranges."

Some thyroid advocates argue that since hypothyroidism is so prevalent, the volunteers themselves were not really 'normal' and our guidelines are false. As our medical community moved away from a more individualized approach to medicine and pharmaceuticals became more widely available, doctors treated blood tests as all-encompassing methods to diagnose patients, which has backfired for many who fall within gray areas of the spectrum.

Just among the friends that I've talked to, I know that my neighbor is on medication (a higher dose than I am, even) and yet she said she had no symptoms. Without trying to pry, I concluded that her TSH must have been high and that her doctor was simply doing routine blood work (wow!). Someone else I know said that her TSH "was at the high end of normal" and her doctor didn't think she needed medication just yet, even though she is the most miserably tired-looking person I think I've ever met. I tried to explain it to her gently, but of course since I'm not a doctor my opinion is invalid. She is definitely someone I think who could benefit from treatment, but I guess she'll just have to wait until her TSH explodes off the charts before she gets it.

Normal reference ranges for TSH function have been changed within the last few years, and are from 0.3-3.0. Before that, 0.5-5.0 were considered "normal." And still, I read of physicians who refuse to treat someone with a TSH hovering at 5.0, acting as if everything is all in the patient's head. In comments read around the web, one patient said her doctor routinely doesn't treat you until your TSH is above 10. Time to find a new doctor!

One patient tells her story about having trouble reaching her normal weight (that she had maintained for years) and asked her doctor about the possibility of a thyroid problem.

I scheduled an appointment with my doctor. I explained why I thought I may be having thyroid problems. He just laughed at me, when I suggested I might be hypothyroid. I even took my documented temperature readings, plus hypothyroid symptoms with me, but he discounted them all. He said temperature readings to test for hypothyroidism dated back to the 1920's. He intimated that since at 130lbs I wasn't "fat" by medical standards, I therefore couldn't possibly have a problem with my thyroid. I still insisted on blood tests to check TSH (thyroid stimulating hormone) levels. This test came back showing a TSH level of 6.7, and in Canada, the reference range of 0.5 - 4.5 means, "No Problem", 4.5 - 10 means "Euthryoid - perhaps there may be a problem developing" and > 10 means "Possibly we had better treat the patient." Now this is where the issue starts getting murky. You see, the American Endocrinology Association and the British Medical Journal have all (for years) been saying that these reference ranges are incorrect, that since thyroid problems are actually extremely common (especially in women), that these numbers include large numbers of people with underlying thyroid problems - thus the numbers are skewed and actually anything > 2 (some say 2.5) should be treated as "suspect".

So, anyhow, despite my many symptoms such as dry skin, thinning hair, memory problems, low temperature, emotional spells, low energy at times, and now a TSH of 6.72 (obviously greater than the new TSH reference ranges) my doctor was unimpressed and wrote "Euthryoid" on my form and sent me packing.

This attitude prevails, even though TSH guidelines have been lowered in an attempt to diagnose more missed patients who fall through the cracks.

If your TSH is within normal limits, they will often ignore your symptoms. If it's high, it often means the majority of the damage to your thyroid has already been done. It doesn't mean it's too late to treat it, but it often signifies that thyroid damage has slowly been occurring for years before you finally pieced two and two together and sought treatment. This is why the most common cause of hypothyroidism is Hashimoto's Disease, which is an autoimmune precursor that begins to destroy the thyroid gland first (more on this later).

If your TSH is normal, it doesn't mean that damage isn't occurring. It just means that oftentimes it's not that bad yet that it's registering on a blood test. There are other tests that can be done, including ones that examine each level of thyroid hormone and how your body is converting that hormone into energy. Also, antibody tests can be ordered (peroxidase and thyroglobulin) to determine if you have Hashimoto's. However, beware: a certain percentage of the population do have Hashi's but do not have elevated antibodies; just because you don't doesn't mean you don't have a thyroid disorder. If your doctor is reluctant to order any thyroid tests, or wants to adhere strictly to the TSH, question his position or find a new doctor who will take you more seriously.

If left untreated (or under-treated), thyroid disease can cause major complications such as heart disease, diabetes, depression, infertility and other autoimmune diseases. Unfortunately, the modern medical approach is to treat symptoms instead of the root cause, which could explain why so many Americans are being treated with expensive drugs for diabetes, depression and high cholesterol. In fact, upwards of 20 percent of people treated for depression may really have underlying hypothyroidism that is undiagnosed. There's also evidence to suggest that hypothyroidism "brain fog" can mimic symptoms of fibromyalgia Alzheimer's, which means more expensive medications to treat the symptom rather than the root cause (and true Alzheimer's can only be diagnosed with autopsy).

The bottom line: when it comes to thyroid disease, there is no "normal," it seems. Healthcare professionals are too quick to put you in a neat, tidy little box that explains - or dismisses - your symptoms entirely. This could explain why so many people say "My doctor refuses to order more blood tests," or "My doctor refuses to put me on medication" - because they're either stuck to ridiculous, often flawed guidelines or are attempting to treat something that they don't fully understand.

More reading:
Rethinking the TSH Test - Mary Shomon interviews Dr. David Derry

January is Thyroid Awareness Month!

What a perfect time of year to have "Thyroid Awareness Month" - the weather is usually cold, dreary and generally yuk outside, and a time when most people are just ready for spring to hurry up and get here. Is it just the weather making you feel unmotivated and crappy, or could it be your thyroid?

Thyroid disorders affect millions of Americans. Are you
one of them? 

As a recent newcomer to the thyroid scene, I have talked to many, many people who have thryoid problems and are on medication. Some of those same people, I've noticed, are taking meds and yet have no idea what their thyroid does or how important it is to their overall health. Others are merely vaguely aware of basically feeling like shit more often than not, but aren't really sure why. There's no time like the present to evaluate your overall health, take stock in how you feel and discovering that perhaps there is a reason for  why you feel the way you do.

Hypothyroidism can affect both men and women, and can often be the root cause of many other underlying illnesses and problems in the body - from weight gain and general tiredness, to arthritis, high cholesterol, diabetes, depression, repeated miscarriages, infertility, low breast milk supply, among other things.

Some quick facts on thyroid diseases:

• Thyroid disease is the most common endocrine disorder.
• Eight out of ten (80 percent) diagnosed thyroid cases are hypothyroid; 20 percent are hyperthyroid.
• 27 million people in the US, and approximately 200 million worldwide, have a thyroid disorder.
• Of that 27 million, about half are considered undiagnosed.
• As of 2010, sales of Synthroid, the most popular drug used to treat hypothyroidism, went up 18.1% to $123 million.

Crash

That is, after about six weeks on Armour Thyroid, the best way to describe how I feel right now.

I have noticed a gradual resurgence of old symptoms - like shortness of breath, brain fog and now a wicked case of joint pain. I thought it was those new pillows I bought like two or three weeks ago, and now realize - it's probably because my meds started crapping out after not being increased properly and my symptoms were coming back worse than ever.

This is the point where patients often hear one of several things: "The meds aren't working, my doctor wants me to go back on Synthroid," or "See? It doesn't work - it can't be regulated so you need to stop using it." Sometimes the patient will exhibit hyperthyroid symptoms - I've heard people say, "My so-and-so was on that stuff and all her hair fell out and she almost had a heart attack and died. It's terrible." What that means is that the doctor put that person on too much Armour - because it's considered old-fashioned and bloodwork is king, many doctors - including mine, it looks like - don't often dose patients properly.

Do I blame the medication? No, not really. It's a combination of things - the dose, the amount of time spent on that dose without increasing, and other things. My vitamin D levels are low again, and my wonderful gastroenterologist has me on 2,000 units per day now (instead of the mega crazy 50 thousand a week like before). I started noticing symptoms before the Vitamin D was added, so I don't think it's a toxicity issue, since I'd probably have to take nearly the entire bottle in one sitting to achieve those levels.

As I thought about how my symptoms have manifested themselves - gradual tiredness at times that I usually had a lot of energy, brain fog, joint pain and decreasing motivation - I pictured myself digging a hole with the 1/2 grain (or 30 mg) dose I was on. That's quite low to start with, and it's customary to increase by 1/2 every two weeks or so, something my doctor didn't do. In fact, while he wanted blood levels taken again at the end of the month (which I just got done on Friday), he doesn't want to see me again until January. Sorry, but that isn't going to happen.

How I felt, I realized, was like treading water and then sinking into a hole. Once you increase your dose - I have actually been taking two pills a day now instead of one, just to see what happens - it's like trying to claw your way to the top of the hole to get out. When I read the Stop the Thyroid Madness! website, advocate and patient Janie Bowthorpe basically said the same thing:

The key to understanding this mistake is with the word “starting dose”. When first starting on any natural desiccated thyroid product, it can be wise to start on one grain or less, which is lower than you will ultimately need. Why? To help your body adjust to the direct T3. BUT, patients have found it UNWISE to stay on that low dose much longer than 2 weeks without raising. Why? Because hypothyroid symptoms can return with a VENGEANCE due to the feedback loop between the hypothalamus, pituitary and thyroid gland, i.e your hypothalamus gland senses the addition of desiccated thyroid (thinking the thyroid sent it), then sends a message to the pituitary gland, which in turn sends a message to the thyroid gland to stop producing, making you even more hypothyroid than you began.

Basically, I'm feeling exactly the way she described.

Interestingly enough, the hypothalamus regulates body temperature, and many people with hypothyroidism have consistently low body temperatures. I have had low body temps for years; in fact, last night I woke up with that stiff neck issue, took an Advil and suddenly felt ill - I took my temperature and it said 96. something or other. I took it this morning and it was 95.6, just a few minutes ago and it was 98.2. Holy crap.

Some doctors will scoff at the idea of considering low body temps as a marker for hypothyroidism, and then go back to the TSH values with religious fervency. I don't even know how I can adequately assess whether I'm ill half the time or not because my temps never reflect a typical 'fever' reading, so I generally just go by how I feel physically. Who knows.

In the meantime, I will ask for my blood test results after a month on the T3/T4 combination meds. I'm not sure if I should go back down to taking 1 1/2 pills, because splitting it myself doesn't sit well with me as it's not a surefire way to regulate the dose I'm getting. I definitely will call the doctor with my concerns and have him write a new prescription, this time only asking for a limited number of pills so that we can increase in increments of one-half every two weeks or so.

More reading:
Hypothalamus-pituitary-thyroid gland feedback loop - Wikipedia

Diary of a thyroid: Thunder Pig!

Oink.

It's been awhile since I've tabulated my latest thyroid exploits. I've been taking Synthroid since May, with an increase in dose in July. It was then that I accidentally discovered that my antibodies (peroxidase and thyroglobulin or whatever it's called) had gone up, which meant my dose was not strong enough. At that point we doubled the dose to 50 mcg and while I didn't really notice a butt-kicking boost of energy like before, at least now I had more stamina and energy to get things done. By the time I get to bed, I'm usually exhausted.

A thyroid ultrasound a few months ago yielded no nodules, which is good news. But it still feels like a rubber band snapping in my neck sometimes, like someone is very slightly starting to strangle me. Which is kind of ironic, I guess. The shortness of breath that troubled me while doing mundane things like having a conversation or reading my children a story (not anxiety, thank you very much) went away after I first started the meds, but slowly came back. Actually, I've noticed in the past few days that the need to just suck all the air out of a room has slowly subsided, but realized a few new symptoms have started up - difficulty swallowing and my hair began falling out. Not gobs and clumps, but kind of like many, many strands that come off into your hands while shampooing or brushing your hair - like they did in pregnancy. Thankfully my hair is pretty thick, but geez, are you kidding me? I still have the swollen neck that makes me look like I have jowls, despite weight loss, and one swollen ankle. Whatever. My antibodies are going down, which is good, but are still quite high compared to normal.

So I went to my doctor for a check up last week. As I waited, I thought, What the crap? I am actually nervous about this, like I had to "ask permission" about switching meds to Armour Thyroid (the natural desiccated pig stuff that my husband calls "Thunder Pig.") It has T3 and T4 in it, whereas the synthetic stuff only has T4 and is twice the price (which my insurance absolutely butt-headedly refuses to pay for, even though my doctor has written Dispense as Written on the script). Recent studies have shown that a combination of both T3 and T4 work well for some people and are more beneficial than T4 alone, something that I haven't heard reverberating through the medical community just yet. Which is sad - and annoying - because it means that if they do act on it, they're more likely to prescribe synthetic T3, which means two prescriptions and more $$$.

I spoke with the pharmacist about possible shortages of the medication and he confirmed my suspicion - that it's really hard to get. Apparently "world-wide shortages" make it hard to fill prescriptions, and I asked the pharmacist why (expecting to hear about mass outbreaks of hoof and mouth disease that claim the lives of pigs everywhere). He just simply said, "There's not as much demand for it," which means drug companies and physicians are trying to discredit the product (that is, unless you've already been on it and are doing okay and know it works) and are now funneling everyone down the T4 route. Fantastic!

My mom snagged some of my grandma's for a few days just to try it out and she said it was awful. It left her with a burning sensation in her throat, and I thought, Oh great, I can't wait to try this! My mom is pretty sensitive to things, though, and some people are apparently allergic to some of the new fillers in the reformulated product. We decided to start on the equivalent dose of Armour, and here is a handy conversion chart that makes no sense at all. Since I am completely mathematically-challenged, I'm hoping that I'll be able to figure out something that works for me, not makes all my hair fall out and gives me chest pains. Since T3 hormone is much stronger than T4, I'm waiting for all that energy to make me hike ski hills like never before...

More reading:
The FDA does away with Armour Thyroid (well, not quite, but close enough)
Stop the Thyroid Madness
Study Finds Patients Prefer combination T4/T3 treatment
New Study Shows that the Addition of T3 is Superior to Levothyroxine/T4 Only Treatment for Hypothyroidism

Diary of a thyroid: the misadventures continue!

It's been awhile since I've blogged/blabbed about this and wanted to update everyone on how things were progressing and what I've learned since. That, and perhaps while helping others it'll also serve as a journal of my symptoms, in a way.

May: I started on 25 mcg of Synthroid. Almost immediately I felt awesome, like I had a caffeine infusion all day long that everyone jokes about wishing they had. It was scary how awesome I felt. I noticed I had more energy all day long, even as I was getting ready for bed. My motivation to work on things increased, probably in combination with the good weather and having more time because husband and kids were not in school and we had fewer obligations to go places, etc. My overall mood seemed to improve, and aside from the usual PMS symptoms around my period, my irritation at things seemed to subside.

May 30: We traveled to visit family for a few days. I noticed how I was waking early in the mornings, not being able to fall back to sleep. I noticed overall how I needed less sleep and felt great in the morning, like I didn't even need coffee. Before Synthroid, I was sluggish in the morning, sometimes even after coffee, and felt like it was an impossible task just to wake up in the morning. Now it was like the crack high I'd never experienced.

June 20: Gradually I noticed being more tired in the evenings and definitely ready for bed, sleeping well and being near exhausted by the time bedtime rolled around. I figured I was so tired at night because I had done so much during the day, or felt like a ball of energy that finally gave way at the end of the day. We had gone to an area state park and hiked, and I felt like I could hike more easily without getting too tired or experiencing shortness of breath, something I'd felt (even while doing nothing) before the Synthroid was started.

Mid July: I am definitely noticing a tapering off of effectiveness with the medication. I won't say the meds have stopped working, but I definitely need to be re-evaluated. I still have energy, but am finding it harder to wake up in the mornings again. Earlier I had decreased my food intake and lost a few pounds, and while my diet isn't perfect, I've managed to gain some weight back as time has progressed, unfortunately, even while attempting to eat less. I'm wondering how much of that is fluid. One day I decided to take 1 1/2 pills instead and had enough energy to hike and do a more strenuous workout at the pool - it was like feeling like I could move a barge. However, I was exhausted that night but still had trouble 'coming down' from the medication to fall asleep.

July 18: I had bloodwork and visited the doctor. I explained my symptoms and how they were recurring; he thinks the shortness of breath is from 'anxiety.' I have no anxiety. All I know is that it disappeared after I started Synthroid in the beginning and is now returning. I am also extremely irritable about almost everything. He upped my dose - after telling me that my still-within-normal-range TSH levels are decreasing - and after four days on the meds, I feel no better. On Friday I requested that they order a Reverse T3 test - which determines if I have trouble converting the inactive hormone to the active, 'energy' hormone - and he said nothing about those results, so I'm going to have them faxed to me instead. I've still been exercising and eating less, but don't feel any different - although I know it's only been about 10 days I'm getting discouraged. It's miserably hot here and I wonder if the heat and humidity are making me feel so sluggish.

He also wrote a script for more bloodwork (to be done later) and an ultrasound of my neck, which should be interesting.

I'm not sure what my next course of action should be - if I need T3 in addition to T4, I do not want to be on two expensive meds; I'd rather take Armour, which is cheaper and has both in it. The next step would be finding someone willing to prescribe it, which will probably not be an easy task.

Your thyroid and infertility

If you're suffering from infertility, you have probably undergone many tests to find out why. But have you had your thyroid checked? (I mean, really checked?)

As a thyroid patient, I am amazed at how many underlying conditions improper thyroid hormone levels can cause, including infertility. And when I ask people "Have you had your thyroid checked?" they usually say "Yes." But then they aren't sure what tests they had, or what the results were, other than "normal."

I've also learned how under-educated many physicians are about properly recognizing and treating thyroid symptoms, and how many people differently interpret lab results. They use the word "normal" a lot, even though, really, everyone's definition of normal is different, and for many reasons. Many websites don't even mention thyroid problems as a cause for infertility, which concerns me: if they don't say anything about it, will your doctor?

Infertility problems are apparently very common among our population - and guess what? So are thyroid problems. I find it very hard to believe that so many women are infertile "just because." Many women don't even know they have it, and probably would never suspect it's a cause of why they can't get pregnant or can't carry a pregnancy to term.

When testing you for thyroid dysfunction, many doctors simply order one or two tests, usually a TSH (thyroid stimulating hormone). There is a wide range of normal, and it varies from lab to lab. If you fall somewhere in the "normal" range, that's usually as far as many physicians get. You might have other underlying symptoms that seem normal to you (or none at all, other than you can't get pregnant). It's really important, though, to have a complete panel with more extensive bloodwork done to look at individual hormone levels, rather than just the "big picture" (which sometimes gives a misleading result).

After Googling some fertility clinics and the blood workups they typically order, many will routinely order the TSH, free T3 and T4. That might be enough and it might not be. I have normal TSH and T3/T4 levels, but I still have hypo symptoms because my antibodies are high, which points to Hashimoto's, an autoimmune precursor that slowly destroys the thyroid gland. But your bloodwork (at least the few tests they did) comes back normal - could Hashi's be the cause? Yes!

Because of misleading TSH results, many patients go virtually untreated for hypothyroidism for years, which can result in an accumulation of symptoms and damage to the thyroid gland. Some people are hypo and don't even know it.

For some women, hypothyroidism can impair fertility because it interferes with ovulation. While it's recommended for women to get a complete bloodwork panel done, I wonder how many doctors turn to this first before recommending invasive procedures like IVF or a round of fertility drugs.

Hypothyroidism can also cause menstrual irregularities in some women, which can create whacked out fertility cycles when trying to get pregnant. Scant or very heavy periods are often clues that something is wrong with the thyroid. My grandmother has been on thyroid medication for years, and I only just realized that her extremely heavy periods - which resulted in a hysterectomy at age 40 - were probably from improperly treated hypothyroidism.

Hyperthyroidism - when the thyroid produces too much hormone - can also cause infertility by inhibiting ovulation. It can also produce light periods, which make it harder to track your cycles and conceive. In some women, thyroid problems can cause PCOS, which also inhibits conception. It can also cause repeated miscarriages in many women as well.

If you have had bloodwork done for thyroid and are still having problems getting pregnant, go over your results. Ask what specific tests were done and ask to see the results on paper so you have them for your records. Knowing what tests to ask for - and what they mean - can be the difference between struggling through invasive procedures for months, if not years, and having a baby.

More reading:
Hypothyroidism and Infertility: How thyroid problems can challenge your fertility
PCOS and Thyroid Disorders - What's the connection?