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November 30 Tired againUgh, I've been feeling really tired again lately. I usually feel like having a nap in the middle of the morning (like right now), and again after lunch. I'm not giving in, though. I've also overslept twice this week; William came in and woke me up both times, in time for them to get ready for school, luckily!
I saw the nutritionist again this week. My weight was stable since my last visit three weeks ago (54.2 kg), and now she says we can work on gaining 2 kilos. We made the following changes to my diet:
- Morning snack: -1 starch, +1 milk (because I felt like 2 starches and one protein was too dry)
- Lunch: +1 fruit OR starch. She suggested adding a citrus fruit, as the Vitamin C helps with the absorption of iron in food.
- Afternoon snack: +1/2 fruit OR starch.
- Dinner: +1/2 fruit OR starch. If blood sugar is good, increase to +1 fruit OR starch.
She also gave me a chart of how to plan a menu for complete proteins. For example, eat legumes with bread, corn, eggs, or nuts, or eggs with milk, bread, or potatoes. November 26 EpigeneticsEpigenetics: "Epigenetics refers to DNA and chromatin modifications that persist from one cell division to the next despite a lack of change in the underlying DNA sequence. Some epigenetic changes show transgenerational inheritance meaning that these changes can be passed from one generation to the next." (http://www.epidna.com/)
In other words:
- Genes in a cell can be switched "on" or "off" by environmental factors. This is why in identical twins, one may develop cancer while the other does not.
- Once those genes are switched on/off, they can be inherited in their new form.
In a ground-breaking experiment, researchers fed Agouti mice (genetically engineered mice that are especially prone to diabetes and cancer; they are normally fat and yellow) a special vitamin-enriched diet and let them breed. Their offspring were thin, brown, and healthy. Some of their genes had been de-activated by their mothers' diet. This should not be able to happen, according to traditional Mendellian genetics. Researchers are finding that such epigenetic inheritance can persist for up to several generations.
Environmental factors (diet, chemicals, stress) can thus affect not only the health of the organism itself, but also of the organism's offspring. November 23 Blood work resultsI got the lab results back from my blood tests on Tuesday. Looks good:
TSH: 12.3 (down from 28, normal would be under 4.5, though).
T3: 4.2 (up from 3.81, normal is 3.08-6.47)
T4: 11.6 (up from 8.4, normal is 10.3-21.9)
Ferritin: 19 (up from 3, normal is 10-310)
So basically, I'm now in normal range for everything except the TSH (thyroid stimulating hormone), which means that my thyroid isn't having to work as hard as a couple of weeks ago, but it's still working too hard. However, I am not going to increase the hormone dose, since the maximum effect should show up 6 weeks after beginning the therapy. It's only been 2 weeks, so it is likely that the values will continue to improve. I have another appointment on December 18 for blood tests.
The big pleasant surprise for me was that the ferritin went up so far, especially since I'd been missing so many iron pills. November 21 Some theoriesHere are some theories and ideas about what causes and/or helps in Hashimoto's autoimmune thyroiditis:
Selenium supplementation seems to decrease the presence of TPO antibodies:
http://joe.endocrinology-journals.org/cgi/content/abstract/190/1/151 Vitamin D is an active component in immune response. The active form of vitamin D produces and maintains self immunologic tolerance, some studies show that 1,25(OH)2D inhibits induction of disease in autoimmune encephalomyelitis, thyroiditis, type-1 diabetes mellitus, inflammatory bowel disease (IBD), systemic lupus erythematosus, and collagen-induced arthritis and Lyme arthritis. Link to research: http://www.vitamindcouncil.com/researchAutoimmune.shtml Iodine: "In genetically determined thyroiditis in animals, iodine enrichment has been shown to increase the incidence and severity of disease." (http://www.raysahelian.com/iodine.html) So... too little selenium? Too little Vitamin D? Too much iodine in the diet? November 20 Check-upI saw Dr. Sutter today, mainly to do a long-term blood sugar test, but at the same time they are going to run a TSH/T3/T4 check, and I asked for them to check my ferritin level as well. I will have to call the office on Friday to get those results.
The long-term blood sugar (which they do right there in the office, so I got that right away) was 5.2, which is the lowest it's been in years, so yay! The diet is good. The downside is, I lost some more weight: 54.3 kg with clothes, which is about half a kilo less than my last visit. Dr. Sutter said if I lose anymore, I'll be "underweight", so I need to keep eating.
I've been having trouble keeping my diet schedule lately. I keep missing snacks. Last night, I didn't get home until 7:30, so I just ate dinner, but didn't feel like staying up until 10:30 just to eat a snack, so those calories were lost. And similar things happen when I miss morning snacks and just eat lunch a little early.
I also asked about my iron supplement, and Dr. Sutter agreed I should take it before dinner. Problem is, I never remember to take the pills with me so I can take it early enough, and I also tend to forget to take the pill even when I'm home... until I've started eating, and by then it's too late. Bad me. I'll be interested to see how my ferritin looks. November 15 Don't know how many days...I've lost track of how many days it's been since I started the Levothyroxine, but I don't really feel a world of difference (not that I felt terrible before). Maybe it's also because it's such a low dose (0.05 mg). Other people take up to .75 mg. I'm sure my dose will also be going up after my next blood test, scheduled for 20 November. The one thing I do think is different is I'm less fatigued, especially at night. I've been staying up about half an hour longer than before. And I've been waking up about half an hour earlier (but not getting up, just lying in bed
 ). Also measured blood sugar after breakfast (2 Weetabix, 1 cup milk, 1/2 banana): 91. November 11 Day Four on LevothyroxineI'm pround of myself that I've been remembering to take the Levothyroxine every morning before breakfast. However, unfortunately, I've been forgetting to take the iron in the evening. So today, I took the iron with breakfast, 40 minutes after the T4. Hopefully that's far enough apart, and hopefully taking the iron with food will still allow it to be absorbed enough. It says in the iron package information that you can take it with food if it upsets your stomach otherwise.
I slept really well last night. So maybe my previous sleeping problems had nothing to do with the hormones, or else my body's gotten used to it now after three days. November 10 Day Three on LevothyroxineSlept better last night, but still not as well as previously. Felt pretty good today, but I still didn't feel anything was different. Measured blood sugar after lunch (1 cup brown rice, 1 cup ratatouille, 2 Tbsp. grated cheese): 79. I could have had another half cup of rice, but was too full. November 09 Day Two on LevothyroxineI did not sleep well last night. I could already tell when I went to bed that I was going to have a hard time falling asleep. The past few weeks, I'd been falling asleep within minutes, if not seconds, of lying down and turning off the light. But last night, I drifted on the edge of sleep for a long time, kept waking back up, and feel tired and unrested this morning. I didn't eat anything different yesterday, and otherwise nothing else was different from my normal day, either. So maybe this is a side effect of the Levothyroxine, or just my body getting used to it. November 08 Started LevothyroxinI began with the Levothyroxin replacement today. Brand name: Eltroxin. I'm starting with 0.05 mg per day. So far no difference. November 07 First visit to thyroid specialistI saw Dr. Engel today, a thyroid specialist. He asked me a few questions about my patient history, felt my neck, did an ultrasound of my neck, and explained the results to me. It was very low-key.
From the outside, the thyroid is soft and unremarkable. On the ultrasound, it showed a largely undifferentiated gland, with the right node being normal in size, and the left node reduced in size by half. Some parts of both nodes had slightly higher than normal blood flow. There were no nodules (lumps) or suspicious-looking tissue.
This confirms, together with the additional blood tests done by Dr. Sutter a couple of weeks ago, the diagnosis of Hashimoto's (although, interesting, Dr. Engel never once used the word "Hashimoto's", but instead referred to a hypofunction).
He prescribed 0.05 milligrams of T4, to be taken daily first thing in the morning on an empty stomach or at least 4 hours after eating, and 1/2 hour before any other food, vitamins, or medicine. This means that I will be moving my iron pill to the afternoon, to be taken before dinner, so that there is no interference with absorption of the thyroid hormone. November 06 First visit to nutritionistI saw a nutrionist today, for help in adjusting my diet. She added about 150 carb calories, but said I'm eating well overall. We are trying to get more calories in so that I can gain some weight back, or at least not lose more. I was 54 kilos at the visit this morning.
New diet:
Starch: 12 exchanges
Protein: 6 exchanges
Fruit: 3 exchanges
Vegetable: 2 exchanges (seems like not much, but things like cucumber and lettuce are free)
Milk: 2 exchanges
Breakfast: 1 milk, 1 fruit, 2 starches (added one starch here)
Snack: 2 starches, 1 protein
Lunch: 1 veg, 3 starches, 2 proteins (took away one fruit and replaced it with a starch)
Snack: 1 fruit, 1 milk, 1 starch (alternative: 2 fruit, 1 starch)
Dinner: 1 veg, 3 starches, 2 proteins (took away one protein and replaced it with a starch)
Snack: 1 fruit, 1 starch, 1 protein (alternative: 1 milk, 1 starch, 1 protein) November 05 Crashing...I am absolutely drained. Feel like I could fall asleep in about five seconds. I taught the first lesson of my new English class this morning, 1-1/2 hours, and I felt great, didn't even need to have a snack. I was energetic and up the whole time. Now I'm probably paying the price. Going to measure blood sugar in a bit (1-hour post-lunch), then I'm going to have to take a nap. I still have to drive up to Wollerau (20 minutes highway) this afternoon and teach 2 more hours, then go pick up my kids from Omi and Opa, then drive back home half an hour on the highway in the dark. Oh, and I still have to finish the laundry before I go. Luckily the last load's in the washing machine now.
 Later: Blood sugar was 118 (80-120). Forgot to mention before, my hands were also absolutely icy. Lay down for 20 minutes, didn't really fall asleep, but at the end of the time I could literally feel myself coming back up. Hands warmed up to merely chilly as well. It'd be interesting to know what my TSH, T3 and T4 values were before. I'm guessing TSH sky-high, T3 and T4 in the basement. Too bad there isn't a home test kit like there is for blood sugar. Now I'd guess my poor old thyroid has been cranked up into producing just a bit more, and that's why I'm feeling (fairly) normal again. Blood sugar is also back way down, an hour later (2-hour post-lunch) it's at 79. Maybe thyroid hormones are also necessary to kick the pancreas into gear, so release of insulin is delayed. ??? My own speculation. |
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