Facing roadblocks to treating my thyroid disease

November 17, 2022

When I had my thyroid tested over the summer, the numbers were…. weird. Typically you want your TSH to be at the low end of the range, your Free T3 to be high in the range, and your Free T4 to be in the middle (or a bit higher) part of the range. I have hypothyroidism so sometimes my TSH is high and my Free T3 and Free T4 are low. That means I need to increase my medication. Every year or two I become hyperthyroid (TSH is super low and Free T3 and Free T4 are way too high) and I reduce my medication. Then a year or two later I become hypothyroid again and I increase my medication. I’ve switched back and forth between 3 and 4 pills for years. So what went wrong?

The first thing that went wrong was that my amazing primary care practitioner (PCP) retired. He managed my thyroid and adrenal care, and I’ve been feeling lost without him. And not too long before that, a Facebook group where I used to get advice changed, and now they no longer accept member questions, so I can’t get advice there from knowledgeable patients. I feel like I’m on my own.

Next, over the summer I got my iron tested before getting an iron infusion and I asked to get my thyroid tested at the same time since it had been a while (I shouldn’t have to ask!) Oddly, my TSH was really low, but the Free T4 was low, too. And the nurse practitioner (NP) didn’t run the Free T3 at all. (Argh! That would have been helpful!) This made no sense. They shouldn’t both be low. Always, one should be high while the other is low. My only thought was that anemia can affect thyroid levels, so maybe things would even out after my iron infusion. Too bad I couldn’t ask my former PCP for his ideas.

Meanwhile, I had gained a lot of weight in a way that made no sense. My activity level had increased, if anything. My diet was really good. Sure, I have some chocolate here and potato chips there, but not a lot of either, and no more than I’d been eating before. I eat a lot of meat, eggs, and vegetables. I eat very few processed foods. Maybe I could cut back on quantities? I suppose I could, but again, nothing had changed, so I shouldn’t have gained any weight, never mind 10 pounds in a short time. Usually when I gain weight for no reason it’s because I’m hypothyroid. I’ve had a few other symptoms that could point to that, too. But I’m at 4 pills, so what’s going on? Again, asking my former PCP would have been nice.

Finally it was time to check my iron levels again, and I asked the NP to run the thyroid tests again, too, this time including the Free T3. Here’s where it gets especially weird. I’m no longer anemic, so I expected my thyroid levels to be better. When I saw the results, I immediately knew I was in a hypothyroid state. The TSH was within the “normal” range but not the “functional” range. For someone with hypothyroidism, you generally want your TSH under 1, and for me, it’s better under 0.5. It was over 1.6. The Free T4 was well below the middle of the range. And the Free T3, the most important number for me, was below the “normal” range altogether, when it should be near the top of the range!

I told a friend that I had good news and I had bad news. The bad news was that I’m in a hypothyroid state again, but the good news is that I now have a fix for my weight gain and other symptoms. But the more bad news is that I have no easy way to handle this. Before, I could have emailed with my PCP and he’d have told me to increase my dose. I could have asked some basic questions. Or I could have made an appointment to ask the myriad more complicated questions I have: Could the end of daylight savings time that week have impacted my results in any way? I’ve been lowering my adrenal medication (per doctor’s orders) and that could have impacted this, but in what way? If I’m at my historically maximum dose, this must mean that my thyroid is deteriorating. That’s expected with Hashimoto’s Disease (it’s an autoimmune disease, where my immune system attacks my thyroid) but after so many years of stability, this is surprising. What could be causing this sudden increase in deterioration?

But alas, I can not ask him these questions. I considered my options. There’s the doctor I saw once as a potential replacement for treating my thyroid and adrenal issues. He seems good, but he doesn’t take my secondary insurance, so he’s going to be expensive. Plus, he’s older (I’d guess early 60s) and I worry about him retiring soon. But last week, to my shock and delight, I got a call from my NP’s office (which is also my former PCP’s office) that they just hired a new doctor that they’d like me to see. She’s an integrative medical practitioner and yes, she has experience with thyroid and adrenal issues. And that practice takes all of my insurance. I could hardly believe it! But the soonest appointment wasn’t until the end of the month. Until I meet her, there’s no way to be sure she has the experience that I need.

Meanwhile, I’m overweight, losing my hair, getting zits, and exhausted. Yesterday I had my first migraine in several years. I want to just take that extra thyroid pill! I have no doubt it’s the right move. What to do? With my old PCP, I might have just taken it while I waited to hear back. I do have plenty of pills for that. But I don’t want to make a bad impression on the new doctor. Isn’t that absurd? But it’s the way the “game” works. And while I know it’s the right move, I also know that taking too much of this medication can be dangerous, so I do want to be careful. Plus, I want to know her thoughts about the impact with my adrenal meds. Should I lower those more first? Or take the higher dose of thyroid med first and then lower the adrenal med some more? I would guess the latter, but I’ve only been on the adrenal meds for a few years and don’t have as much experience with them, so I’m not completely sure. The thing is, I think I’ve been hypothyroid for months, so I guess I can wait a few more weeks. But just in case, I did make an appointment with that other doctor for the following week. That way if the new one isn’t helpful, I have a backup plan.

And just as I figured all of this out, I got an email from my NP: “Good news, all of the test results are normal!” Um, what?

There’s always something with chronic illness, isn’t there? This is this month’s problem (well, one of them.) Next month I’m sure there will be something else. But I’m grateful, because at least this is a known problem with a known solution, and that’s all too rare. Now if I can just find a knowledgeable practitioner to help me address and treat it. Wouldn’t that be a novel approach?


Where have all the integrative doctors gone?

October 13, 2022

It started out bad. Then it got worse.

It took me years to get the right doctors. Through hard work, luck, determination, and some more luck, I finally managed it. My primary care physician (PCP) was kind, thoughtful, and smart. He knew a lot about how to treat thyroid conditions beyond the most common conventional approach. He knew how to treat adrenal insufficiency. He was fantastic. And then he announced his upcoming retirement.

It was 6 months away, and I was immediately worried. He promised that he would help me find someone, but we kept hitting dead ends. This doctor didn’t take my insurance. That doctor didn’t know much about thyroid treatments. That other doctor also didn’t take my insurance. Another doctor didn’t recognize adrenal insufficiency as a medical condition (WTF?!?) We hoped that his replacement could treat me, but they were having trouble finding someone to take his place.

Then my women’s health doctor left very suddenly. At my last appointment, we’d been talking about how she’d been at that practice for 25 years and planned to stay until retirement. Two months later, I got a letter that she’d had to leave due to a family emergency. She hoped to one day return to practicing medicine, but wasn’t sure when, or even if, that might happen.

Like my PCP, my women’s health doctor was fantastic. She always asked me questions about my entire body. She wanted to know all about what was going on with me. She was kind, caring, insightful, and smart. She knew how to properly treat with bioidentical hormones, and she also understood why those could be problematic for me, even though I still needed them at times. And she was gone.

Her letter included a list of doctors and practices to try. I called the first one on the list. They didn’t use bioidentical hormones at all. I called the next one. They didn’t take my insurance. And on it went.

My PCP officially retired. His replacement was a nurse practitioner (NP) fresh out of residency. She had no knowledge of thyroid or adrenal treatments. She agreed to keep writing my prescriptions, but was clear that she didn’t want that to be long term. And if I had questions, she wouldn’t be able to help me. Fuck. These are tricky conditions and the medications often need to be adjusted in ways that can be hard to determine. I’ll definitely have questions.

The hospital won’t let an NP be a PCP (insurances in the U.S. require everyone to have a PCP).) She’d suggested I speak to the administrative assistant about being assigned an official PCP in the office. The admin, who I’d spoken with more times than I can count, remembered me, and we had a chat. Another doctor had also left the practice. They had wanted to hire 2 or 3 new doctors and I asked how that search was going. She told me they were having trouble finding people, and that few were even applying. Then I asked if she knew how things were going to replace the women’s health practitioner I’d been seeing. She told me they weren’t even trying. They had wanted to replace her at first, but there are few in the country who do what she did, with her specialized knowledge, and they couldn’t even get applicants. So they stopped trying, and instead were focusing on the search for new doctors, which was also not getting very far. What’s going on here?

This isn’t any old office, you see. It’s an integrative medicine practice. Integrative medicine is even in the name. That’s why I wanted to go there to begin with, and it’s why I had liked these two practitioners so much. It’s also, without a doubt, why my health improved so much. I’ll let you read back over old posts for those details, but suffice it to say, I need an integrative approach. Alternative medicine helps, but only to some extent. Conventional medicine helps, but only to some extent. I need both, and they need to be combined, not separate.

For now I’ve found a doctor who, while not as great as my PCP, can help with my thyroid and adrenal stuff. He takes my primary insurance but not my secondary insurance, so I still need to get the new NP to order tests so I don’t have to pay a small fortune. I’m not exactly confident in how well that will work. And he appears to be in his 60s, so I’m not sure how long I can see him before he retires. And without these medications, I’m totally and completely screwed.

So my question is, what happened to all of the integrative practitioners? Are there any left? Are doctors no longer taking that approach, or maybe they are but they aren’t in Massachusetts? What are the patients who need them supposed to do? I’m scared, and I don’t know what to try next.

On the bright side, it’s autumn in Massachusetts and totally gorgeous, so here’s a picture of a tree for you. Enjoy! And if you can offer any tips for finding an integrative practitioner in Massachusetts who takes Medicare and MassHealth, and who has knowledge of Hashimoto’s and adrenal insufficiency, I would be INCREDIBLY grateful!


When I’ll feel Covid-safe around people

August 26, 2022

Two-and-a-half years into this damn pandemic, I’m still spending a whole lot of time alone, and it’s hard. I miss people. I miss regular socialization. I miss dating. Actually no, I don’t like dating. But I miss the potential for a relationship. I miss sex. I miss casually hanging out at a friend’s house, going to the theater, visiting to a museum, not having to rely on New England’s unpredictable weather to determine if I’ll get to see people. I miss parties and Meetup groups and all the other random in-person indoor stuff that I took for granted.

Yet, so many people are out in the world, acting like there’s no pandemic anymore, or like getting Covid is no big deal. Most others seem to be somewhere in the middle, being somewhat cautious but still socializing and attending work and school in person. A lot of my family and friends in the middle have been asking me when, if ever, I’ll be willing to go out again. I think they expect this question to trip me up, to prove that my expectations are unreasonable.

But the truth is, I have a mental list going of things that will make me feel safe enough to join my family for Thanksgiving dinner or to go to a play, and they aren’t at all unrealistic. I just wish they would happen sooner than they probably will. Here are some of mine and I’d love to hear yours, so I know what other excellent possibilities are out there.

  1. Widespread mask use. This wouldn’t make me feel comfortable in all situations, but in many. Today I called a dozen hair salons and the only ones that have people wearing masks are out of my price range. The others say they don’t have any protocols, no masks. WHY NOT?!?!? The pandemic is not over and they’re only prolonging things and making it harder for people like me. If everyone wore masks I still wouldn’t go to the theater, but I’d feel more comfortable at the grocery store. Please please please wear masks, people!
  2. Masks that 100% (or maybe 99%) protect the wearer. Speaking of masks, this would be huge. I’d feel much better about the 90% of unmasked grocery shoppers in the store with me if I knew that my own mask would provide all the protection I needed. Then I wouldn’t have to rely on others so much to protect my own health. Of course, these would also have to be affordable and widely available. And if they were reusable, that would be even better!
  3. Accurate tests. If at-home tests gave fewer false negatives, and if they gave positives as soon as someone was contagious, I would 100% be hanging out indoors with family and friends. Would I go to crowded events with strangers? Nope! But at least I’d get to be around people I love. And it would open up dating possibilities, too. I still wouldn’t want to go to restaurants, etc. on dates, but at least as we got to know each other, I’d feel safer being indoors alone and maybe even kissing *gasp!*
  4. Vaccines that prevent contracting Covid and/or transmission of Covid. Back in 2020, we thought vaccines would save us. We talked about herd immunity. The problem was that the vaccines we got don’t prevent anyone from getting Covid or from passing it along to others. Don’t get me wrong, I’m thrilled we got vaccines that reduce the likelihood of hospitalization and/or death. I just want more. If we had vaccines that stopped people from spreading Covid, I’d be hanging out with my vaccinated family and friends, because I wouldn’t have to worried about them giving it to me or about me giving it to them. If we had vaccines that stopped people from getting Covid at all, I’d be feeling much safer as I go out in the world, and then I’d probably go back to being in public spaces again.
  5. Vaccines that prevent long Covid and disease latency. It’s hard for me to explain to most people that I’m not worried about dying from Covid. I’m most worried about getting long Covid. And right now, the vaccines help me avoid dying, but they don’t help me avoid long Covid. I wish they did. Honestly, if long Covid didn’t exist and if we didn’t have a concern about disease latency (when symptoms might appear years or even decades later, like with post-polio syndrome), then I wouldn’t be so concerned and I’d be happy to at least be around family and friends, and I would consider being out in public spaces more. For me, this would be a gamechanger in a way that I find hard to explain to most people.
  6. A near miss: a cure for long Covid. To be honest, I’m not sure how much this would help at this point. Before I was worried about disease latency, a long Covid cure would have been enough to get me out and about again but now, unless it would also cure any future symptoms, I don’t think it would do the trick for me. There’s just too much at stake with the disease latency risk. I watched a loved one deal with post polio syndrome for years and the possibilities with Covid latency feel too real to me.

So that’s my current list. I think that some of these are more likely in the short term than others. #5 would be amazing, but I’m not holding my breath for that one any time soon. #4 feels more likely, but only if we don’t lose momentum in terms of funding research and innovation. The ship has sailed on #1. Let’s face it, too many people are selfish assholes. They don’t believe they’ll get sick and don’t care of others do. But #2 and #3 feel like they have potential, even in the near future.

Experts are already working on creating more accurate tests. Imagine what a gamechanger that would be! Sure, I still wouldn’t want to hang out with a lot of strangers, but it would open the door to feeling comfortable with family and friends. I’m thinking about all of the people I’d want to see who, right now, I’m not visiting with indoors. It would be amazing!

I don’t know if anyone is working on creating masks that better protect the wearer, but I sure hope that they are! I’d love to have more control over my own safety. Not only would I be able to spend more time with family and friends, but I’d feel more comfortable around strangers, too. No, this wouldn’t be the perfect solution, but it would open up the world for me and at this moment, that would be enough.

Even before the pandemic, I struggled with loneliness. I’m an extrovert who lives alone and who, due to health issues, often doesn’t go out for days at a time. I’m at an age where my friends are mostly married and have kids in addition to working full time, so they are understandably busy with their families when they aren’t at work. I get it, but it also makes it harder for me to spend time with them. That left me spending a lot of time home alone, taking walks alone, and doing activities alone. And that was before the pandemic. Now I’m so much more isolated and damn it, I just want to be around people! I want to spend the weekend with friends out of town, hug my mom, kiss a date, go to a party, and feel safe wandering the aisles of the craft store. Is that so much to ask?

For now, though, I’m sitting at home. Today I’m seeing a friend – via Zoom. It’s not the same, but it will have to do. And despite what so many others think, I’m not planning to sit at home alone forever. I am not wrapped up in fear with no foreseeable way out. I see a way out. I just need scientists to make it happen. Please.

What about you? In what ways do you think there could be a safe way for those of us who are at higher risk to socialize again? I’d love to hear your ideas!


I’m ok but not really

July 15, 2022

Maybe it’s my imagination, but lately it seems that people are asking, “How are you?” more than usual. I’ve hated this question for decades. I feel stuck when people ask: do they really want to know? If so, how much should I share? This issue isn’t new to anyone with chronic illness. I’ve written about it before, as have a lot of other folks. But these days, I’m dealing with something else: normalizing my own not-okay-ness.

Let’s start with my real answer to “How are you?”, what I’d say if I were being honest with them and with myself, and then I’ll break things down.

I’m fine. Ok, I’m not really fine, but I’m fine enough, you know? I’m getting by. I’m surviving day-to-day and it’s good enough. I mean, sure, it’s not really good enough, but it’s as good enough as it can be right now, you know? It’s doable. I’m overwhelmed. I’m exhausted. I’m doing an elimination diet that is stressful and overwhelming. I’ve going to in-person occupational therapy twice a week which is a lot logistically, and that’s before you account for doing the exercises at home every day. It’s supposed to be twice a day but I. Just. Can’t. I’m still trying to do my physical therapy every day. I’m exhausted, did I mention that? I haven’t slept well these last few… days? weeks? And I’ve been having nightmares since the pandemic began, too. I’m anemic and my thyroid levels are off. Those two are probably related. I’ve waited months and I’m finally getting an iron infusion next week, since supplements don’t work (no, I don’t know why I can’t seem to absorb certain nutrients) and I’ve had bad experiences with the infusions in the past so I’m really nervous. The last two times I brought someone with me but with the pandemic, I can’t do that this time. I wish I could bring a dog to cuddle. Anyway, I’ll be glad to get that over-with, but it can take weeks, or even months, to feel the effects. Oh, and I got my period this week so I was extra emotional and I lost a lot of blood. I had to spend time washing blood out of clothes and going to the bathroom every hour or two to deal with it. I’m sure that’s not helping with the anemia, either. Did I mention the new pain I’m having? And the two new diagnoses I got this week? I might have forgotten that. And it’s summer and while for some reason I hoped it would be different this time, it’s not. The heat and humidity bring additional pain, and it sucks. And Covid cases are soaring and people still aren’t wearing masks which is so damn disrespectful. Plus several friends have told me big secrets recently and I really want to talk those things through with someone but I can’t because they’re not my secrets and eventually it’ll all come out but it could be a long time and meanwhile I keep worry about these people that I love so much. All I want to do is sit on my couch and read a good book, watch movies, and crochet. But I can’t. I have to do my occupational therapy and physical therapy and prepare meals and go to appointments and do housework and try to do at least a little bit of volunteer and paid work. But you know, I’m fine. Because I feel like I have to be. I’m getting by, one day at a time, and that’s enough, right?

That’s what I want to say. But I never do. Some people hear bits and pieces. I’ll tell a friend that my heavy period is probably making my anemia worse and is probably why I’m extra fatigued this week. Several folks know about the stress around the elimination diet. A few know about this and others know about that and some don’t know anything because I just don’t even want to deal with answering a bunch of follow-up questions. And through it all, when a good friend who also has chronic illness asked this week how I was doing, my answer was still to say that I was fine. Sure, this was partly because I just didn’t want to talk about all of the crap I’m dealing with. It was partly because I didn’t want to bother her with everything. But it was also partly because I truly believed for a moment that I was fine, or at least fine enough.

Even I can tell that I’m really not fine. Come on, look at that answer above. That is not a “fine” answer. But I’m continuing to live my life, and it’s giving me the illusion that I’m ok. I’m so tired that I’m not processing my feelings, I’m just pushing them aside. It’s the exact opposite of what I’ve been learning in therapy but at the same time, even my therapist agrees that sometimes I need to compartmentalize. Sometimes it’s helpful for self-preservation.

And maybe that’s what believing I’m “fine” is all about right now: self-preservation. Because if I think too much about the many ways that I am so obviously not at all “fine” then I may loose my shit. And frankly, I’m too tired to have the really good crying session that I probably need right now.

I think that sometimes we need to give ourselves the illusion that we’re doing okay as a way of surviving it all. I feel like it’s ok to do this, as long as it doesn’t last too long, and as long as I recognize what it is that I’m doing. At first I really believed I was ok. Now I see it for the facade it always was, but I’m still using it, holding up the shield of fine-ness while knowing the shield is fake. Eventually everything will break through (probably at my therapy session next week, the first in several weeks due to my therapist’s vacation) and then I can hopefully go back to seeing the truth. But until then, I’ll keep hiding behind my fake shield, because at least it’s helping me to get through each day.

Does anyone else do this? Do you ever truly believe you’re fine, even for a minute, when it’s obvious that you’re really not? Does it help? I’m curious to hear others’ perspectives and experiences.


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