Have ever been diagnosed with a serious medical condition? If so, you probably remember the day you got the news and how after that day nothing was the same. In September of 2011, I began experiencing symptoms including: fatigue, weight gain, indigestion, insomnia, and depression. I was in my second quarter of graduate school and my classmates attributed my symptoms to stress. This explanation made no sense since graduate school felt way less stressful than my prior life in the corporate world.
Something was wrong, I just didn't feel like myself. I saw specialists who ran tests and found nothing. I went to acupuncture, took supplements, stopped eating dairy and wheat and continued to feel terrible. I was experiencing Peri-menopausal symptoms and wondered if that was the problem. One day during my annual physical, my doctor noticed a lump on my neck. I knew from the look on her face that this was not good news. She said it was a growth on my thyroid and I should make an appointment to get a biopsy; she explained that many women have these growths and they are often benign.
When the results finally arrived they were inconclusive. All I knew was that there was something growing on my thyroid and it could be a mass (cancer) or it could be a nodule. If it was cancer, the doctors assured me that thyroid cancer was a "good" one to have since it is very slow moving. All I heard was cancer. I had two options, one was to do nothing and get biopsies every 6 months and the other was to have surgery. How do people live with the anxiety of wondering whether they have cancer while getting painful needle biopsies every 6 months? The growth was large and a friend's husband encouraged me to schedule a consultation with his colleague who was one of the best surgeons in Los Angeles.
My friend (who is a nurse) accompanied me to the consultation. Dr. Armando Giuliano exudes self-confidence; he is also charming, handsome and kind. I felt relaxed in his presence (How relaxed can you feel when you are talking about surgery?) and confident in the fact that he knew what he was doing. He explained that during the surgery they would remove the nodule, perform a biopsy and try and leave at least half of my thyroid intact. His nurses were intelligent, caring and direct. The nurses explained that I would not be able to lift anything, do laundry or heavy cleaning for at least two weeks after the surgery; they warned me to take it easy. The young surgical resident told me I would be running again in 3 weeks. I made the decision to schedule my surgery in November. Prior to this time I had never experienced anything more serious than allergies.
The day of the surgery my brother and his husband picked me up at 4:00 in the morning, they waited with me and then came in right before the anesthesia was administered. They took photos of me in my “surgery outfit” and plastic hat. I made them swear not to post these photos on Facebook and they posted them anyway. The surgery was successful and Dr Giuliano was able to remove the nodule and only take out half of my thyroid. He had explained that it was much better to have half a thyroid than no thyroid at all. My dear friend wheeled me out to the hospital entrance to wait for my aunt to bring the car around. My aunt had gotten lost trying to find the right place to pick me up; poor sense of direction is part of our family heritage.
When we arrived at my aunt’s house my body began shaking uncontrollably. I had just read Peter Levine’s book, Waking the Tiger, (1997), where he talks about a gazelle being chased by a cheetah. The gazelle is terrified she will be eaten but eventually she gets away and goes into the forest and begins “shaking it off”. This trembling helps the gazelle discharge all the energy that built up during the chase and regulate her nervous system. If you watch dogs, they regularly shake their stress off. When I began shaking, I forgot all about Peter Levine, I thought it might be a reaction to the anesthesia. My aunt was getting ready to call the doctor, I decided to lay down and just let myself shake and follow my breath. I believe now that my nervous system was regulating itself after the shock of having surgery. A few days later I learned that the nodule was benign.
Prior to my surgery, I was given a referral to an endocrinologist. My primary physician warned me that this doctor did not have much of a bedside manner but she was the best in town. I decided to meet with this doctor and realized I needed more bedside manner. My next endocrinologist told me that with half a thyroid I might not need medication. I stopped taking the Synthroid that had been prescribed right after my surgery. I slept 12 hours a day and in between tried to keep up with my reading for graduate school. I was severely depressed, had trouble concentrating and gained weight. In a short period of time I went from running marathons to being unable to take a long walk.
Hypothyroidism is sometimes referred to as “low thyroid”. This means that your body is not getting enough thyroid hormone to function well. It’s often an unrecognized cause of depression. One of the challenges to treating low thyroid is that many doctors will consider thyroid test results alone and won’t consider the fact that each person’s body is different. These doctors go strictly by the thyroid ranges and will not adjust the dose if your results fall within the normal range. In her book, The Menopause Thyroid Solution, Mary J. Shomon (2009) explains how different doctors use different ranges for the thyroid test, and even within those ranges we are all different. The issue of blood testing is complex and it is compounded by the fact that many people don’t feel comfortable questioning their doctors.
After three months of feeling horrible, the doctor decided to put me back on thyroid medication. I spent the next six months on a roller coaster trying different types medications while my doctor kept telling me that all my blood tests were normal. My perimenopause symptoms got worse during this time. I dumped my endocrinologist and started seeing a holistic MD to treat my hormonal symptoms and manage my thyroid medication. As we raised my thyroid dose I felt the heightened sense of anxiety that is associated with hyperthyroidism (too fast thyroid). I lost weight, had trouble sleeping and found it difficult to relax. As a long time meditator, I was surprised by the fact that there was nothing I could do to calm down.
One day, I was having lunch with some friends and one of them mentioned that she had thyroid disease. I asked her if she liked her doctor, she replied that she loved her doctor but he did not take insurance. At this point I was more concerned with getting my health back than saving money. There is a 12 Step saying- “coincidence is God’s way of remaining anonymous” and that lunch changed my life. When I went to see Dr. Jordan Geller, we spent time talking with me about my overall health including: stress levels, sleep, diet and exercise. We gradually tried different types and combinations of medications with each decision being a collaboration.
It has taken perseverance and patience to get me to where I am today. I am back to running (no more marathons for now) and practicing yoga. I make sure to get 8 hours of sleep every night. My body feels best when I don’t eat refined sugar and keep complex carbohydrates to a minimum, this can be very challenging. Regulating my thyroid and my nervous system will be an ongoing process for the rest of my life. The hormonal fluctuations we experience as women make it difficult to keep the thyroid balanced. When I first got diagnosed I thought that surgery and medication would solve my problem and I would feel fine afterward; this does happen for some people. Thyroid disease has been my greatest teacher, I have learned to slow down and care for my body.
In our work as psychotherapists, it’s important that we understand the relationship between thyroid disease and mental health. Below is a list of the symptoms of hypothyroidism (slow thyroid) and hyperthyroidism (fast thyroid). These symptoms often show up for clients who may have undiagnosed thyroid disease and/or entering perimenopause. I encourage all my clients to get annual physicals and regular blood work. I am not suggesting you work outside of your scope of practice, just be aware that these physical issues can seriously affect your client’s mental health.
Symptoms of Hypothyroidism- Low (Slow)Thyroid
Constant fatigue or feeling of exhaustion
Puffiness in the face
Trouble getting started in the morning
Low body temperature
Sensitivity to cold weather
Low sex drive
Poor memory or concentration
Sluggish thinking or thought patterns
Infertility, repeated miscarriages
Unexplained weight gain or difficulty losing weight despite efforts at dieting
Symptoms of Hyperthyroidism- High (Fast) Thyroid
Rapid Weight Loss
High heart rate
High blood pressure
This is not a complete list, these are some examples of the symptoms you might hear about in sessions with your clients. Sources- Depression and Your Thyroid by Gary Ross. M.D and Peter Beiling, PH.D (2006) & The Menopause Thyroid Solution by Mary Shomon.