Talking About Stuff, with Mike and Christiana

They were checking my TSH level. TSH is actually a pituitary hormone, but it's the one that regulates the thyroid. Think of it like your house's climate control system. Your thyroid, which controls metabolism, is the controller that tells the heater or the A/C when to turn on. The pituitary, by way of TSH, serves as the little lever that lets you set the temperature on the thermostat.

So if you're sitting around and you're cold, then you check the thermostat. If the lever is set at 90 degrees and you can still see your breath, then it's a pretty good indicator that your heater isn't working. In a similar way, they test for underactive thyroid by checking for a high TSH level. Normally, the pituitary increases production of TSH in order to stimulate the thyroid's production of T3 and T4 thyroid hormones, which regulate metabolism. If the body isn't getting enough T3 and T4, the pituitary steps up TSH production. T3 and T4 levels can vary a lot from day to day for a variety of reasons, but a high TSH level pretty much means that the body has a consistently low level of T3 and T4 over time.

A TSH level of ~0.5 - 5.5 is considered "normal" though it seems that the ideal is somewhere around 2 and many people will begin showing mild symptoms above 3 or so.

Mine was over 11. Not that I was terribly surprised, because as I have researched this condition, I recognized a number of symptoms including weight gain, fatigue, muscle aches, dry skin and hair, and depression. (Note: I'm not depressed, but I haven't been quite myself either.)(Note also: any of these symptoms in and of itself doesn't necessarily mean hypothyroidsm, but taken together, and that they have gotten notably worse over the last couple years is pretty strongly indicative of an underactive thyroid.)

So what does this mean? Well, my doctor phoned over a prescription for Synthroid, a synthetic hormone that supplements the body's own production of T4, some of which is then automatically metabolized into T3. I've got it now, and I'll take my first dose tomorrow morning. I probably won't see any results for three to six weeks, but then, *fingers crossed* I should start feeling a lot better.

I have another appointment on August 29th to evaluate the dosage, and there will be some trial and error until we find the right dosage for me. Then, once it's set, I'll have a follow-up once a year to see if it's still working. Changing dosages aside, I'll pretty much be taking a tablet every day from here on out.

That aspect is no fun, but the upside is that, with treatment, I should be feeling a whole lot better than I do now. That's something that I can't quite express my feelings about. As I noticed myself needing more and more sleep, gaining weight, feeling tired all the time, etc., it never occurred to me that there was any kind of illness involved. I had just assumed that, well, that's just the way it was going to be. That I just needed more sleep than other people, that I just had a naturally lower energy level or whatever. That something can actually be done about it is really...

I can't think of a word for it. But it's definitely in the "good" neighborhood.

Oddly enough though, it's a little scary too. It's just so strange to think that one little chemical inside my body could have such a dramatic impact on the way I feel and function. It's one thing when you read about someone with diabetes or MS or whatever, and thank God I've got something relatively non-serious, but it's strange to imagine that these tiny little pills I've got will make me feel so different.

How different will it be? What will it feel like? How much sleep will I need? Will I still feel tired when I get home from work? What other little differences will I see?

Maybe I'm being overdramatic, but it just has me thinking about how much of our personalities and the way we feel is chemically determined. We all, from time to time, have days where we just really don't want to get out of bed in the morning, and we just don't want to go to work. Still, we do get out of bed and we do go to work anyway.

When someone doesn't get out of bed, our first reaction is to just tell them to suck it up and do it anyway, because that's what we do. But for someone with clinical depression or some other kind of mental illness, or chronic fatigue syndrome or something, does that absolve them of responsibility? How much? Where do you draw the line between "they have a condition" and "they're just lazy"? Does someone have Social Anxiety Disorder and need treatment, or are they just shy and need self-confidence? (Note, this NYTimes article addresses some of these same questions from the psychiatric point of view.)

I have no answers, but just pondering the effects my own treatment may have makes me think about these things.

Anyway, the thought I'll leave this on is something my mom told me. "The best way to lead a long, healthy life is to have a treatable illness, because it makes you pay attention."