The importance of reading the small print

Twenty-six years ago I was diagnosed with hypothyroidism; underactive thyroid. This, apparently is common in menopause and while it is relatively easy to treat, with synthetic thyroid hormone; the difficult part is to get the correct dosage and monitor the levels and adjust accordingly.

The Mayo Clinic lists a bunch of possible symptoms of under active thyroid. Of those listed I experienced the following:

• Fatigue
• Increased sensitivity to cold
• Weight gain
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Thinning hair
• Enlarged thyroid gland (goiter)

I finally learned that if any of these symptoms change, it is time to talk to my doctor to make sure that the thyroid levels remain within the appropriate range. it is also important to closely follow the instructions for how and when to take the medication. First thing in the morning, on an empty stomach. I didn't learn that for a number of years after I started taking it. In fact, my mother-in-law was taking the same medication and she only discovered it should be taken on an empty stomach when she was in hospital—just a few years before she died.

Do not eat anything for at least one hour after taking, and there are a large number of medications to avoid taking within four hours of taking Synthroid. Among them are antacid, calcium and iron; not medications you would expect to be a problem but all of which impact how efficiently the Synthroid works. The sad thing is that I only became aware of some of these rules quite recently.

One of the biggest problems I encountered was a continuous fluctuation in my symptoms. Insurance Companies, for purely financial reasons, will not cover non-generic medications without a determined effort on the part of the doctor. I eventually had to find an endocrinologist who explained to me that generic medications do not always have similar potency and pharmacies constantly change their generic suppliers, again for financial reasons; they buy from the cheapest understandably. She gave me a prescription specifying NOT generic. After that my thyroid settled down and all was well up to this year. Though, unfortunately when I retired and switched to Medicare I discovered that they don't care how much you, or your doctor, stress the importance of using non-generic, they refuse to cover it. (I whined about Medicare here previously.) Only one of the many indications I have had that this country doesn't care about the elderly. Odd when you look at the average age of those people in the Congress and Senate who have the power to improve this. Of course, they also have enough money that they don't suffer, and to be fair they are also still working despite their age, with good health insurance cover.

I was very surprised at the beginning of this year, when my annual physical blood work indicated that my thyroid levels had suddenly jumped. Why, after being on the dole for twenty-six years, did my thyroid suddenly decide to work again? I do admit that I had started to enjoy no longer feeling cold all the time but didn't associate that with a change in thyroid levels.

It took six months of trying a reduced dose for 6 weeks and then having more lab work done, and repeat, to finally find the correct dose. I went from 88 MCG to 50 MCG, slowly in stages, to finally level out. During this time, apart from no longer being cold all the time, I noticed that my hair was getting much thicker and the aches and pains I accepted as normal, had reduced. Unfortunately I was still struggling with my weight. 

Interestingly enough, while my thyroid levels are now holding at an acceptable level, I am still enjoying being comfortably warm, my hair is not falling out and aches and pains are holding at what I consider to be normal for my age and stage in life. Fatigue is one of those things that is kicked, pushed and pulled depending on so many other variables, but I don't feel it is out of control either.

I have made a mental note to ask my doctor next time I see him, why would my thyroid suddenly start working again? My guess is that he doesn't know either. All Google does when I ask him, is list all the possible diseases that might prompt this to happen. 

One theory I have is that I did become much more consistent about how I took my medication. Working from home, and then being retired, my daily schedule was...well, I developed a schedule. For over a year I took my one little pill at the same time every day, before I hit the treadmill, and because I spend an hour on the treadmill, the only thing I imbibe during that hour after taking the pill is water, which is allowed. Perhaps the medical profession should make it a lot clearer the importance of this. And yes, the blurb that the pharmacy gives you with your medication does list most of the rules of engagement, but with no sense of urgency, nor with any dire warnings related to not taking these rules seriously. Plus, who reads all the small print? I agree we should but I know that I didn't. 

Finally, here is an interesting article about just that, the Patient Information Leaflet.

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