Sunday, October 09, 2022

Thyroid update 6

I’ve been feeling depressed this week, and of course, I don’t have a reason. Just last weekend I had a wonderful trip to the Grand Canyon with my sisters and mom. But then I drove home, and ever since it’s been tough to get out of bed. I go through the motions and feel exhausted with each passing minute — that is, until I boost myself into physical activity for an hour or two, wherein I feel inexplicably fine. I’m not … tired-tired. Just tired of myself. Low on motivation. Filled with existential dread. 

On Saturday I thought I’d overcome the ennui with a long bike ride, but I couldn’t motivate to prepare or boost myself out the door — not until mid-afternoon when it was just too late for anything long enough to slip into a flow state. Still, I pumped up the tires and wheeled my mountain bike outside. It was a gorgeous October day, 72 degrees under a fiercely blue sky. The aspens in our neighborhood are at peak gold right now. I pedaled along and felt uneasy and anxious. Finally, I realized … “The truck. This is what everything looked and felt like the day I was hit by that truck." 

Magnolia Road, about an hour before "the incident" on Oct. 10, 2021

As far as feeling depressed, there are probably more emotions to unpack following my first trip to the Grand Canyon without my Dad, but feeling dread about this particular anniversary makes some sense. 

Oct. 10, 2021, was a beautiful Sunday afternoon. I’d returned recently from another cathartic visit with my sisters in California, not unlike last week's incredible adventure in the Grand Canyon. I headed out for a bike ride, later in the day than ideal, which left me pedaling west up the steepest pitch of Flagstaff Road as the late-afternoon sun began to set. Amid that blinding glare, a man driving a vintage Ford F250 struck me in the back with the passenger-side mirror. 

 The impact was so strong that the mirror arm broke and swung around, shattering his window. I remember hearing the “thud” of impact more than feeling it, and thinking, “That asshole hit me, he really hit me." The left side of my body skimmed along the moving bed of the truck and toppled onto the pavement, bashing my left elbow. I thought the driver hit me on purpose. There was just no reason for him to pass so close when the right shoulder dropped off steeply and there was no oncoming traffic. The truck's brake lights engaged and skidded to a screeching stop. I looked up to see shattered glass sparkling on the pavement. The driver stepped out of his truck, leaving it parked in the middle of the road. His jeans and arms were smeared with blood, and he had blood on his face. He was bleeding from dozens of micro-cuts caused by shards of glass, but the sight was alarming. I wondered if the collision had been much worse than I realized. Was I dead? 

Instead, I stood up from the pavement and took a few steps back. I was frightened of this man, still believing he struck me deliberately, and now watching him approach me while covered in blood. He was clearly distraught. He didn’t see me, he gasped, not at all. He didn’t even know what he hit when his window broke; he thought it might be a deer. When he looked back and saw a cyclist on the road, he panicked. He was clearly a good guy who wanted to do the right thing, but I was in shock and couldn’t deal with this — not this, not now. Not in 2021, the worse year of all of the years. 

Since I could move all of my limbs — save for my left arm — without pain, and since my bike seemed undamaged, I insisted on calling an accident and accident and going our separate ways. I tried calling Beat, who was out of range, spent an hour sitting at a picnic table while reeling in the shock, and ended up pedaling most of the way home with my arm pressed against my torso. 

Do I regret not calling the cops? Maybe — physical therapy is not inexpensive. Still, seeking legal compensation would have achieved little but more pain for both the driver and me. At the time, I was thrilled to be simply alive — not just alive, but “uninjured.” But I wasn’t uninjured. Something happened to my back. Within days I felt a sharp, shooting pain near my lower thoracic spine. The muscles surrounding my spine were so tight that I couldn't bend over. Sitting became unbearable. I finally went in for X-rays but the doctor found no fractures — at least none that the X-rays could see. Still … it was a challenging injury. I sought out physical therapy. I’ve been in physical therapy ever since. 

Beat assures me back pain is normal for 40-somethings, but I didn't have a single problem with my back before this incident. Suddenly I couldn’t wear backpacks without pain. I bought a fanny pack. I couldn't drive long distances. I still can't, not without paying a price. I had to vacate the couch, perhaps forever. I still can't sit on soft surfaces without discomfort. While I realize that I’m still very lucky, the experience angers me. Health is so fragile; it can change in an instant. Scars accumulate, both physically and mentally. The privileged and carefree way I used to enjoy cycling up steep canyon roads — honestly still one of my favorite things — is forever tinged with these negative emotions, with resentment and fear. 

Still riding a year later. No, I still haven't removed the silly headlamp from my helmet.

This was all an unintentionally long exposition to lead into the thing I actually came here to write about, which is thyroid health. The last time I wrote one of these updates was in May 2019, when I was officially in remission from Graves Disease. I’d been battling the condition for more than two years, having been diagnosed in February 2017 with symptoms that were slowly killing me: tachycardia, high blood pressure, severe shortness of breath, fatigue, and most concerning of all: brain fog. I genuinely believed I was facing early-onset dementia at age 37. 

These are symptoms of hyperthyroidism, a common result when the autoantibodies associated with Graves Disease attack the thyroid gland, causing it to overproduce thyroid hormones. For several months I had to take a high dose of methimazole — three pills, three times a day. The medication prevents the conversion of thyroid hormones in the liver and has a number of less-than-ideal side effects, but it worked. Within a year I’d mostly tapered from meds, took a low dose for another half year, and went off the drug in November 2018. If life were fair this would have been the end, but autoimmune disease is a life sentence. Even as my endocrinologist cut me from her schedule for being too healthy, she warned that the high number of Hashimoto’s antibodies in my system would doubtlessly activate someday, and I’d have to deal with it when the time came. But until then … live for today! 

It seems that time has come. What is Hashimoto’s thyroiditis? This more common presentation of autoimmune thyroid disease attacks the gland and causes it to produce too little hormone. It can have a lot of the same symptoms as hyperthyroidism: muscle weakness, brain fog, fatigue, and heart problems. Low thyroid hormone levels tend to impact metabolism, causing low energy, weight gain, and a buildup of bad cholesterol in the blood. The link between Graves Disease and Hashimoto’s thyroiditis is poorly understood, but it’s generally accepted that these diseases are two sides of the same coin. Just over two weeks ago, I went in for an annual physical. My bloodwork showed a concerning spike in my cholesterol — it’s nearly doubled since 2019. And my TSH has climbed above the official (much too broad in my opinion) “normal” range. I now meet the medical standard for hypothyroidism. 

My primary care doctor recommended waiting three months and testing again, but indicated that medication is likely in my future. In the meantime, for my cholesterol, she recommended adding “a handful of almonds” to my diet — which I find humorous. If I was 65 years old or in slightly poorer health, I’d probably be on cholesterol medication right now. But the alarm of high cholesterol is a good prompt to improve my diet, which was growing heavy on cheese and ice cream. Still, being on “a diet” isn’t a great mood booster, especially when it seems like an ineffective bandaid for a sluggish thyroid. 

 What I feel is similar to how I feel about the truck collision. I’m happy to be alive. I’m glad it’s not worse. I don’t want to deal with it even though I probably should. I’m angry. I already have this allergic asthma thing that’s getting worse, and now-weekly treatments for that, along with the bad back that I don’t deserve. I hear from friends with long Covid, complications of concussions, more severe autoimmune diseases, cancer. I feel empathy and fear. This could easily be me. It could be any of us. Good health isn’t a moral reward; it’s mostly luck. 

 And it’s true, I mostly came here to vent. But even though I have been much more sparse with my blog posting than I was in 2017, I’ll probably continue with these updates. If only for the angry eye-rolling from my future self who just didn’t realize how good she had it in 2022: 

 The Archives: 


  1. "Still, seeking legal compensation would have achieved little but more pain for both the driver and me." ... but may have encouraged him to look more carefully in the future and thereby save others grief and pain.

    1. You’re not wrong, but I can’t go back in time and change the decision I made when I was in shock. The man claimed to be a cyclist — and was apparently a regular poster on a Reddit cycling forum, so I believe it — and I suspect he is much more aware of these sun-glare blind spots while driving, as am I. My worst nightmare would be to hit a fellow cyclist.

      Do I wish I filed a police report to potentially claim my medical visits and physical therapy to an insurance company? Yes I do, although I can’t be certain the driver of this vehicle was well-insured. The resultant legal battle would have been awful, perhaps more so than paying these bills that we are privileged to be able to afford.

  2. It all sounds so familiar... unexpectedly losing my dad he was 61 and I was only 22, Mood swings from Hypothyroidism, back surgery that left my right calf muscle inoperative, Blood Clot disorder from a "mutated gene," taking pills to control blood clots that leaves me vulnerable to internal "bleeding out" from falls, bike crashes etc., high cholesterol (pushing 300) for which I take more pills that have side effects (muscle soreness and stiffness). I sympathize and have no advice other than keep moving in the outdoors, knowing that some days will be tough, but there will be good days too. Losing your dad truly sucks. I still grieve the loss of my dad and it's been 50 years. Climbing, hiking, biking in the outdoors does distract from the above, and likely saved my life. Box Canyon Mark

    1. Thanks Mark. Your experience gives me hope that it’s not all downhill from here. I can only hope to live a life as rich as yours in my 60s and 70s.

  3. "Good health isn’t a moral reward; it’s mostly luck." This is an important quote, and a bit of wisdom that can be difficult to impart on the lucky. Having joined the ranks of unlucky this past year, I share many of your frustrations - it is maddening when your mind and body don't want to cooperate with your desire. There is hope that I will be able to get back to my old self. But there is also some acceptance that my new self may be a bit different - if nothing else, the unstoppable passage of time and it's partner, age, doesn't help the "old self" side of the equation. For now I'm hanging onto hope that at least some (maybe most?) of that old self will be recaptured. I recently learned a mantra that is helping me with hope... "My best days are ahead of me." It sounds kind of cliché, but when I superimpose it on my vision of myself, it is uplifting.

    1. Vent away!

      I sympathize with so much of this post and am also currently going through a similar unexpected cholesterol issue, ha! I find writing stuff out really helps me process and unpack the shit I'm going through (anxiety and depression-wise). Every time I hit publish, I feel a tinge of regret that I just unleashed my word salad on the WWW, but here we are.

      Don't forget to give yourself a break, and never underestimate how much anxiety, depression, grief, etc., can exhaust you. I spent so much time in bed about a month ago that I don't know if my side of the bed ever got cold.

      Keep moving forward.

    2. Thank you for sharing your experiences. It is cathartic to commiserate with others. Even while so many people are going through similar battles, it’s easy to feel alone.

  4. Oh my thyroid buddy, I was hoping yours wouldn't cause you problems again. However, hypo is a weird thing. I've had to fiddle with my meds a bunch this year for no apparent reason. First I felt like a tweaker but frankly amazing, only to have the doctor state I had crossed over to hyper. So back to fiddling. I hope you can find the right combo.

    1. Yes, I am not looking forward to the endless battle to achieve T3/T4 balance. I’m also terrified of the hyper swing so I’ve opted to wait before starting on medication. But my TSH has been slowly climbing for years without any sign of leveling off, so it’s probably inevitable. I appreciate your struggle.

  5. Hey Jill, so sorry to hear you're still struggling, but good to hear you have a good medical practitioner who's helping you navigate the thyroid issue.
    Re cholesterol, since heading down the low carb, high fat, mod protein path 7 years ago, I've done a ton of research into the subject to understand how the metabolism works. Not all cholesterol is bad! Do you have a breakdown of your figures for Total cholesterol, LDL, HDL and Triglycerides? If your HDL (good cholesterol) is higher than your Trigs and your Total Ch to HDL ratio is low, then you shouldn't have much to worry about.
    I hope that helps?

  6. I know about "Existential Dread." Good choice of terms.

  7. My daughter Susan, now 55? was hypothyroid from birth. With many ups and downs does pretty well now, post menstrual. It is a tough road. Rich

  8. My partner is hypothyroid. I'm glad you have a good endocrinologist; we've had no luck with them at all. Their insistence on relying on TSH as the only measure of hypothyroidism is infuriating (she appears to be a poor converter of T4 to T3, but TSH levels are 'normal' so she gets told that her symptoms aren't real) and finding anyone to treat her properly has been so hard. I'm glad you get to skip that part.

    Also, as a life-long sufferer of high cholesterol, just take the drugs. I'm not quite as active as you, but at some point a doctor sat me down and told me that there was no diet in the world that would help my cholesterol. The worries about cramping from statins were unjustified—double-blind tests eventually showed any cramping to be purely placebo. I saw a cardiologist for an unrelated issue and he told me that my very, very high cholesterol was much more pressing concern.


Feedback is always appreciated!