Saturday, February 17, 2007

No Pointy Things! (At Least For Now)

Finally got in to see the endocrinologist. I had okayed a morning appointment, despite having an early-out day for the kids, because thus far he's always been prompt. I figured I had about twenty minutes leeway.

Sigh. I should have realized that the last minute appointment shift meant I was being wedged in-between existing appointments. I had to call another mother from the exam room and beg her to please pick up my kids - which fortunately she did (Thanks, SB!)

So - the unrinalysis came back negative for Cushing's. The newer, more extensive bloodwork showed some interesting things that can be worked with, though (why is it that every time they draw blood, they take more than they did the last time? This is getting alarming.).

First - IGF-1 is not only normal, but low-normal, GH is still normal. If I have acromegaly, you can't prove it by my bloodwork thus far. Dad is still dubious, but he'll have to be patient.

What they did find was a) high insulin levels and b) thyroid antibodies. When you combine (a) with normal blood-sugar, you get (TaDa!) insulin resistence! aka metabolic disorder. aka, a great way to end up with Type 2 diabetes if you're not damned careful. When you combine (b) with high TSH and low thyroid hormones (well, borderline), you get (TaDa! Again) Hashimoto's Disease! Hashimoto's Disease doesn't get any other names, but really the first one is pretty cool. Hashimoto's Disease means my immune system is attacking my thyroid. They're still not quite sure what's up with the cortisol, or if the adenoma is doing anything at all, but with all the rest of this going on, Dr. Williams wants to deal with these first, and then go back and see what's left afterwards.

The Finer Points:

Insulin resistance means that my cells don't respond as well to insulin as they should. Consequently my pancreas is working overtime, shoving more insulin into the system, trying to keep my blood-sugar under control. Thus far it's doing a superlative job - my blood sugar levels are almost weirdly level under any conditions imaginable. Feed me sugar? - 100. Starve me for a day? 80. Run me around like a mad woman? 85. Diabetics would kill for numbers like mine. Unfortunately the pancreas will eventually poop out from all this extra effort, and that's when you end up with diabetes. Plus heart disease along the way, since one of the other effects of insulin resistance is high cholesterol levels (and really crappy HDL/LDL ratios) combined with high blood pressure - interesting that I've been fighting high cholesterol my entire adult life, despite generally good eating habits. The "best" way to control insulin resistence is with diet and exercise - a low-saturated fat (but moderate/high fat otherwise), low-sugar diet, careful weight control, and good muscle mass go a long way. Except that people with insulin resistance gain weight easily, lose it slowly and only with great effort, and tend to be low-energy and fatigued most of the time, which makes said "best" management pretty damned difficult. I've been put on metformin, which is supposed to increase my body's sensitivity to insulin - which should then make the above mentioned weight loss, dietary changes, and increased exercise much easier to manage. How I'll react to the metformin over time, we will see, but I will say that even one dose seems to have improved my energy levels noticeably (Perky? I don't do perky? What is this?).

Hashimoto's Disease on the other hand, can't be treated with diet and exercise. It's a progressive auto-immune disorder, which means I'm stuck with it for life, unless some clever researcher somewhere has a breakthrough. Right now, my thyroid levels are hovering at the low end of normal, so we're leaving it alone while we deal with the insulin resistance. Eventually, however, I'll need to start taking replacement hormone (thyroxin), and unless that researcher gets on the ball, I'll be taking it forever. Symptoms for Hashimoto's include: weight gain(!), fatigue, depression, physical and mental slowness, cold sensitivity, and any general symptoms for hypothyroidism - plus neck swelling and pain if the thyroid decides to get sensitive about getting eaten (mine hasn't thus far).

I'm noticing this overlap of weight gain and fatigue between these suckers. You mean I haven't just been being a lazy bastard when I don't want to crawl out of bed in the morning? My slow crawl up to 217 pounds wasn't because I lack self-control? This is going to take rearranging my thinking a bit. I've been beating myself up for so long about my own lacks, it could take a while to adjust to the idea that my body betrayed me - I didn't fail it.

Anyway, the game plan at the moment is to treat the insulin resistance for the next few months, then recheck everything and see where we are. I'm scheduled for a repeat MRI to check the adenoma in July, to be followed by another round of blood tests, and a re-evaluation.

Trust me to be weird - I can't just get one unusual thing, let alone one common thing. I've got to get them in batches.


Anonymous said...

And I thought my journey throught hospital was unusual!!! You've listed lots of new things I didn't know about, and I've read around this a lot. Keep with it and I hope all goes well.

Take care


PerpetualBeginner said...

Thanks, Jason. My endocrinologist is quite weirded out by me. I don't think he's ever had a patient present with so many different things going on at once - certainly not one in her thirties. Usually you only see serious disease stacking in older patients who have time to accumulate more.

Richard said...

I am sorry to hear you have Hashimoto's syndrome. My mother had as well.

It is true that in North America they do not treat it. They just let the body do its work and then supplement you with thyroid hormone.

However, North America is not the whole world and in Europe, they DO treat it. My mother was treated in Poland. While her body did manage to destroy 3/4 of her thyroid, she was left with 1/4 of it and it was outputting more hormone than expected, so she her hormone doses were lower. One advantage of having even a little bit of thyroid left is that if you run out of synthroid is that your body still produces some hormone.

I believe it was two years of treatment for her.

I'm sorry I can't provide more information, googling has not turned up any useful information and my mother died 6 weeks ago of non-Hodgkin's Lymphoma - so, asking her for details is a bit difficult.

Alecia E. said...

Came back through to check up on any updates about your pituitary tumor. I read this when you first posted it (waaaay back in Febraury) I apologize as I meant to comment on this but didn't. I hope that your health has improved with the thyroid meds. A good friend of mine in Texas was recently diagnosed Hashimoto's Disease. It took her a while to finally get the diagnosis. She did lots of research on the Net and knew she had a history of thyroid problems (she suspected Hashimoto's but her internal doctor said no - she didn't have it). She was going through lots and lots of testing and so I suggested she see my endocrinologist. Turns out, he said that's what she has (Hashimoto's). Before she went to the endo she had several possible diagnosis (Including Lupus!).

Well - I hope, for your sake, your pituitary tumor turns out to be the nonfunctioning kind. Keep us posted when you can!

Marilyn said...

You are not alone. I too am in my 30's and have been diagnosed with the same combination problems. I've been on syntroid for about 6 months now (as my Hashimoto's has destroyed my thyroid). I've been taking the metformin (1500mg a day) for about 3 months now. The good news is that I am feeling better than I was prior to the metformin. The less-than-good news is that I have yet to regain my pre-illness energy levels nor has it helped me lose the 20 pounds I've put on in the last year. However, I still hold out hope.

It's good to know that I am not alone, and wish you success.