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Dr. David Derry Answers Reader Questions
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Index of Q&As with Dr. David Derry



Topic: Hypothyroid and Weight Changes

A Reader Writes:

"Can I be hypothyroid and not have one of the main symptoms, weight gain?? I have many of the other symptoms and one of my blood tests had a TSH level of 3.95, which is now considered borderline high. But no problem with weight gain whatsoever. My holistic doctor put me on a small dose of thyroid, and my energy and mood were better than they have been in years. But I was told by an internist that my thyroid is normal and taking thyroid may suppress the function of my own thyroid. I am so confused. I have many symptoms (fatigue, constipation, low basal temp. 95.5 - 96.3 usually, run down, breaking brittle hair, dry gritty eyes, have had joint pain in the pas t, didn't have my period for 4 months, depression, difficulty concentrating, forgetful, no sex drive, insomnia, light headedness). No weight gain however."

David Derry Responds:

Dear Patient

If you have a low body temperature and those other symptoms, you then know your thyroid is not functioning well. Therefore, you are low thyroid and all of the other symptoms are also related to low thyroid. Once you have a main characteristic of hypothyroidism such as a low temperature then all the other symptoms have to be from the same problem. Certainly depression, difficulty concentrating, memory problems and no sex drive are all low thyroid. Usually only people who have high will-power and drive will not gain weight while becoming low thyroid. As well because of the hypothyroidism your appetite is diminished and you lose interest in preparing meals because you feel so bad all of the time. A more severe form of low thyroid would likely lead to more severe anorexia-type symptoms than just loss of appetite.

Once you have a main symptom to identify that you are low thyroid then it is easier then to identify that all other symptoms and signs are also hypothyroidism. Thus if you become anxious or have panic attacks with a rushing pulse this is not reason to think you are now hyperthyroid, as anxiety and panic disorders are common in hypothyroidism. The fact that these symptoms disappear with thyroid treatment confirms that. Also in general there are many more people who are low thyroid than hyperthyroid.

As thyroid hormone controls the adrenals through the pituitary hormone ACTH (1) then your adrenal function should come up to normal function as your thyroid hormone levels rise to effective levels. When you regain normal thyroid function your ability to gain weight will improve. You likely drive yourself hard to overcome this low thyroid condition and this often makes people like you lose weight even though you are hypothyroid. It will return to normal naturally when you get treatment. However, will power is an important mask of chronic low thyroid conditions.

Hope that answers your question about your weight.

David

(1) Eartly,H. Leblond,C.P. Identification of the effects of thyroxine mediated by the hypophysis. N Engl J Med 249:249-271, 1953.



About Dr. Derry:

Dr. Derry is no longer practicing medicine.

These answers are personal opinions. Please discuss any ideas you get with your physician.

Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.

My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”

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