Then in 2003, after Dr. Phil, in an appearance on Oprah to discuss weight loss, rather cruelly laughed at a woman's claim that she had gained weight due to a thyroid condition, we again raised the issue. I wrote, Dear Oprah: Why Are You Ignoring Thyroid Disease?.
After watching Oprah gain back the weight she'd lost in recent years, she announced in the fall of 2007 that she had developed a thyroid condition. She reported that she had to go to four different doctors before one recognized that she had a thyroid condition. (Meanwhile, her viewers and my readers had been contacting her for years, suggesting she have her own thyroid checked.)
At the time she announced her diagnosis, she had as her guest Dr. Christiane Northup, and Dr. Northrup and Oprah discussed how thyroid conditions develop in women due to an inability to speak out, and that rest, stress-reduction, mind-body approaches, and nutrition -- including adding soy to the diet -- would resolve a thyroid condition like Oprah's.
In the year that followed, we watched as Oprah continued to gain weight, until more than a year later, she went public with the fact that she had reached 200 pounds. She claims that her thyroid condition caused her to give up, as she was told by a doctor that she must "embrace hunger" and that she would no longer have any metabolism. Surprisingly, she appears to have believed that doctor's dismal assessment wholeheartedly, and said that she then decided that if everything she ate would make her gain weight, she'd eat anything she wanted.
On her show this past Monday, January 5, 2009, Oprah Winfrey discussed her weight challenges, claiming that her weight gain is not about her thyroid, but is a symptom of a life out of balance. She says that in 2009, she plans to start losing some of the 40 pounds she has gained in the past two years by practicing self-love and following her trainer Bob Greene's diet and exercise plan.
It's interesting, however, that Oprah breezed past her thyroid discussion, except for dropping one bombshell. Oprah said she is "cured" of her thyroid problem.
Oprah has never clearly explained what specific thyroid problem she was diagnosed with, but has suggested that she started out with an overactive thyroid, which then shifted to underactive. In both conditions, however, she said she gained weight. This shift from hyperthyroid to hypothyroid, with weight gain, is consistent with the autoimmune disease Hashimoto's thyroiditis. She said that she received treatment -- we can assume it was thyroid hormone replacement medication -- and that she decided to stop treatment.
As anyone who has a thyroid condition knows, thyroid conditions are treatable. But most thyroid disease is not "curable." And there is a difference. You can give thyroid hormone medication to help replace missing hormone, but that treats the symptoms. It does not cure the underlying problem. Whether it's thyroid cancer, Graves' disease, Hashimoto's disease, nodules -- again, treatments typically resolve the symptoms, and allow patients to return to normal as much as possible. But rarely do we see a "cure" of the underlying disease itself.
So all week, I have been getting letters from readers, wanting to know what Oprah is talking about. If she really is "cured," how did she do it, and why isn't she sharing it with the millions of other thyroid patients who haven't been cured. Did she ever even have a real thyroid problem in the first place? Could she have a thyroid problem that is in remission right now? Or, is she getting astonishingly bad advice, and making bad decisions -- and it's likely to have a negative on her health and her efforts to lose weight going forward?
So, given that Oprah isn't being forthcoming regarding her thyroid diagnosis or how she has achieved her "cure," we are left to speculate the answer to a question: What really IS going on with Oprah and her thyroid? Here are my theories.
1. Oprah May Be in the TSH Normal Range
It's obvious that Oprah still has clinical signs of hypothyroidism. She is overweight, her face is puffy, her neck appears to be somewhat enlarged, and she says that she is struggling with fatigue, and some depression -- all these symptoms are consistent with a thyroid condition. But since Oprah is claiming that her thyroid is "cured," it's possible that her thyroid tests that previously showed abnormal levels are now showing levels in the "normal" range.
Does this mean Oprah is cured? No really, because someone with a thyroid condition who has test results that are "borderline" can fluctuate in and out of the TSH "normal range."
It also depends on what TSH reference range Oprah's doctors use. The outdated range -- .5 to 5.5 -- is still the range used by most labs and many doctors. While the newer, recommended range of .3 to 3.0 has not been adopted by many physicians. That means, patients with a TSH of 3.0 and higher are often told that their thyroid is "normal."
Also, if Oprah has Hashimoto's disease, she may have thyroid symptoms for a number of years, with "normal" or borderline TSH levels, and elevated antibodies. But research has shown that treating patients who have elevated thyroid antibodies -- even if the TSH level is normal -- may help relieve symptoms, and slow or stop the progression to overt hypothyroidism.
2. Oprah May be In Remission
It's possible for someone with Hashimoto's to go into remission. As an autoimmune disease, Hashimoto's can be considered relapsing and remitting in some patients -- when antibodies elevate, symptoms become more troublesome, but if antibodies are lowered, symptoms abate.
It's not common, but some patients who are extremely dedicated to holistic approaches can, with nutritional, lifestyle, and mind-body approaches, calm their autoimmune reaction, and move into remission with Hashimoto's disease. Typically, however, it's a process that requires a serious commitment of time and effort, work with knowledgeable holistic experts, major dietary changes, and a variety of supplements.
Could Oprah's program of trips to Hawaii, lots of soy milk, "expressing herself" and opening up her throat chakra -- and other approaches she may be implementing but has not publicly shared -- calm her autoimmune disease and move her into a remission -- meaning that her TSH tests are normal and antibodies are lowered or normal? It's possible.
But, let's be clear. That's not a cure. It's a remission.
Is remission likely? No. In fact, Oprah's overconsumption of soy foods, her high-stress lifestyle, and the fact that she's also going through menopause -- a time of added hormonal shifts -- is likely to put further strain on her thyroid, and worsen her thyroid problem over time.
3. Oprah May Have Transient Thyroiditis
It's not common, but some people have a condition known as transient thyroiditis. This is a temporary inflammation of the thyroid -- sometimes caused by a virus -- that resolves itself over time.
Transient thyroiditis doesn't typically go on for several years, or cause 40 pounds of weight gain, so it's not especially likely that this is why Oprah is claiming she's cured.
4. Oprah May be in Denial
As humorist Jody LaFerriere said in her Open Letter to Oprah, "I take my medication because that's what it is…medication meant to treat a disease. Perhaps that's part of the problem – you don't know you have a disease. I find it hard to believe a smart lady like you would not take it seriously if presented in that way. Unless you also believe that you don't need to treat things like kidney disease, gum disease, or mental illness?"
It's not likely that if Oprah were diagnosed with another autoimmune disease -- like multiple sclerosis, or rheumatoid arthritis -- that she would refuse medication. But she seems to be comfortable refusing medication and treatment for thyroid disease. The reason? I suspect it's because thyroid disease has a stigma -- the same stigma that we see time and time again, when comedians and advertisers use "thyroid problem" as a euphemism for "fat," or doctors assume that women who ask if they might have a thyroid problem are really just overweight, lazy, middle-aged women with "Fork in Mouth Disease," looking for something to blame or a pill to take.
Oprah's refusal to cover thyroid disease on her show, time and again, suggests that she has some sort of a mental block about thyroid disease. And her refusal to continue medical treatment for her thyroid disease again suggests that she can't or won't accept that she has a disease that requires treatment.
So, she may be refusing to take medication against medical advice -- and refusing to take prescribed thyroid medication can have a number of negative side effects.
Or, she may be borderline, where a doctor offers her the option of a "wait and see" approach, and she's waiting to see what happens. But again, refusing medication, or waiting to see what a borderline problem does is not being "cured."
What Should Oprah Viewers Think?
Oprah's viewers should understand that thyroid disease is rarely curable. Unless Oprah explains in detail what she's done to "cure" her thyroid condition, her claim that she is cured is questionable.
Stress reduction, mind-body treatments, and good nutrition are all incredibly helpful approaches to help achieve wellness. But for most people with thyroid disease, these approaches are part of an overall integrative program -- one that needs to include medical treatment and holistic/nutritional treatments -- for wellness.
And, finally, if you are overweight, and you have a thyroid condition that you're not treating, you are sabotaging your diet and weight loss efforts. You may find it difficult or impossible to lose weight until you get your thyroid properly treated. In fact, without proper thyroid treatment, you may continue to gain weight, despite diet and exercise.
The bottom line: Oprah may be a powerful and wealthy celebrity, but she's getting, and giving, unwise medical advice to millions of women with thyroid conditions. If you suspect you have a thyroid problem -- or you've already been diagnosed -- educate yourself about thyroid disease, but think twice about doing it at Oprah.com, reading O magazine, or watching Oprah.
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Photo: Getty Images Entertainment/Alli Harvey