Last week I had my first appointment with an endocrinologist. I was diagnosed with hypothyroidism about 10 years ago, but have always had my primary care physician manage my treatment and medication for it. However, since I am now thinking about getting pregnant, my PCP wanted me to see a specialist.
An endocrinologist is a doctor specializing in the glands that produce hormones released into the bloodstream, including the thyroid gland. The thyroid is a gland in the neck that produces the thyroid hormones triiodothyonine (T3) and tetraiodothyronine (T4), which are primarily responsible for regulation of metabolism and affect the growth and rate of function of many other systems in the body. Hormonal output from the thyroid is regulated by thyroid-stimulating hormone (TSH), which is produced by the anterior pituitary gland, which itself is regulated by thyrotropin-releasing hormone (TRH) produced by the hypothalamus. Regulation of T3 and T4 production is done through a negative feedback loop. When T4 levels are high, TSH production is suppressed. When T4 levels are low, TSH is stimulated.
Diseases of the thyroid include hyperthyroidism (an over active thyroid) and, what I have, hypothyroidism (under active thyroid). With hypothyroidism, the amounts of T3 and T4 remain low and often have symptoms of weight gain, fatigue, baldness, dry skin, depression, and cold intolerance. Does this sound familiar? These are also very common symptoms of lupus, and thus, it can be difficult to know which condition is causing which symptoms. Hypothyroidism is often treated with synthetic hormones. I take Synthroid (generic name: levothyroxine), which is a synthetic form of T4. My hormone levels are monitored quarterly so that the dosage can be adjusted as needed.
The thyroid is especially important during pregnancy because uncorrected thyroid dysfunction could have adverse effects on the development of the fetus. It can also lead to complications such as premature birth, low birth weight, and increases neonatal respiratory distress. Demand for thyroid hormones is increased during pregnancy, and thus may require additional treatment.
When I went to see the endocrinologist, she reviewed my blood work and found my thyroid levels to be in the normal range with my current medication. This post is getting long, so I'll do a separate post explaining how to interpret the blood test later. Although my results were right in the normal range, Endo said that because I am thinking about pregnancy, she would like to see my levels in the higher end of the range. She increased the dose of my medication from 50 mcg daily to 75 mcg on Monday, Wednesday, and Friday, and 50 mcg on the remaining 4 days. I'll check back with her in about 6 weeks.
I felt Endo was very thorough and professional. I sat down with her in her office to talk before she moved me to an exam room for a physical evaluation. She asked me questions about why I was there, my situation and history, and went over my blood work and what it all means. I thought it was kind of interesting that she asked if I was the type to go online and do a lot of research. I said yes, and she noted it down but didn't really have a reaction. I wonder if doctors like patients who do a lot of research online, or if they find it misleads them and make their jobs harder. I know I shouldn't always trust Dr. Google, but I like having my own information to get another perspective than just the doctor's. It also helps me prepare for my doctor visits so I have time to process the sometimes confusing information and formulate questions. Anyway, back from my tangent, Endo did a good job explaining things, but was a little "clinical" at times -- not cold or unfriendly, but not necessarily warm and comforting.
I did learn something new about my condition from this appointment. I tested positive for Hashimoto's disease, which is what is causing my hypothyroidism. Hashimoto's is an autoimmune disorder, like lupus, in which the immune system attacks the thyroid gland and affects hormone production. It is the most common cause of hypothyroidism in the US. I had heard the term before, but didn't know that it was an autoimmune disease. (Heck, before lupus, I had never heard the term autoimmune!). I found this very interesting because I've read that it is common to have multiple autoimmune diseases, and in my case, it turns out to be true.
