Sunday, July 26, 2009

Endocrinology Appointment

This past Monday I had my first appointment with the endocrinologist. My mother has a variety of rare hormonal issues (thyroid and adrenal), so I opted to see her endocrinologist (Dr. W), who is the chief of endocrinology at one of Boston's major hospitals. Why mess around with someone else, with whom I'd have to spend 10 minutes just updating on my mother's conditions, when I can go straight to the big gun, who already knows the family history, and actually knows it better than me?

The doctor was great, giving me plenty of time to ask questions. When we say the GYN, she told me my body was making antibodies against my thyroid gland, and she did give me the lab report with the results, but I hadn't really looked at the numbers. There are two thyroid antibodies that they tested for. The thyroglobulin autoantibodies were described by Dr. W as being less sensitive, while the thyroid peroxidase autoantibodies are more sensitive. For both of these the numbers (U/mL) should be under 60. Apparently, I'm an overachiever. The less sensitive on came in at 113, while the more sensitive one came in at ... (are you sitting down?) ... 4553.

Apparently these antibodies can affect things other than the thyroid. Anything foreign in my body (e.g. a fetus or sperm), could also be affected by the antibodies. Although the levels of the thyroid hormones themselves came back fine, Dr. W recommended that I go on a low dose of thyroid hormone. He says they don't know why this works, but it often does. When asked if the medication would lower the antibody levels, his reply was a shrug and "Hope springs eternal." He has had other patients in a similar situation with normal levels of thyroid hormone and abnormally high antibodies who had trouble conceiving, then were able to after being on a low dose of the thyroid hormone.

Dr. W said that given the history and the high levels of the antibodies, I should definitely expect to have an underactive thyroid at some point in the future. Even without the antibody issue, I already figured this would be the case, because of the history. On the basis of her history, Dr. W decided we should test my adrenal gland as well, which I'd never had done before. He'll email me with the results of that test, which haven't come in yet.

In my mother's case, her thyroid gland went over- and underactive at the same time, and her adrenal gland failed completely. She had already experienced (very) early menopause. This combination of polyglandular issues is quite rare, which is why she sees such a high-level specialist. Luckily, with medication, she's quite healthy. The early menopause definitely hasn't happened to me yet, and I'm six years older than she was at the time. As far as other symptoms, my hair is thinning at a much faster rate than hers has, and I definitely have some dry skin issues, but not nearly as severe as hers.

The interesting thing about all of this is that we never knew what caused my mother's endocrine problems. We're wondering now if this antibody issue could have been what precipitated mom's endocrine nightmare. By knowing about it before it becomes a crisis (which it did with her), maybe it will be more gently discovered and managed in me.

So I'm now taking 25mg a day of Levothyroxine. A replacement dose would be 100mg/day. I have never in my life been on any regular medication, other than birth control and my chewable multivitamin. (Yes, the multivitamin has plenty of folic acid in it.) I've never been able to swallow pills (even very teeny, tiny ones), so I used the Depo Provera shots for birth control. The Levothyroxine doesn't have any side affects, so I'm pretty much expecting that I will be on this drug, at roughly this dose, until my thyroid eventually fails and I end up on a replacement dose. Which means a pill a day for the rest of my life. This may not seem like a big deal, but it's definitely very new for me.

I hope that over time I'll be able to just swallow the pill, but in the meantime, I picked up a pill crusher with my prescription. This is different from a pill cutter in that it actually pulverizes the pill into a fine powder. In the past we've always used a mortar and pestle to crush pills, but it's much harder work. When I fractured my right shoulder earlier this year, Elric had to crush my giant ibuprofen pills for me every night, as it was too painful for me to do. The pill crusher is pretty amazing. It works very well, very quickly and easily. I should have bought one long ago!

Hopefully, the medication will make the difference we need and let us get pregnant. And hopefully August will be the month for it.

Saturday, July 25, 2009

Not this month.

We've been waiting on tenterhooks for the past week, with each passing day suggesting that maybe, just maybe, we have had success this month. Previous cycles indicated that I would know anywhere from Monday to Saturday of this past week, so when Saturday afternoon arrived without a new cycle beginning, I had really started getting my hopes up. The plan was to give it an extra couple of days, then take a pregnancy test on Monday. I wanted to take the test early, on Sunday, but Elric encouraged me to stick to the plan, reminding me that it wouldn't change things either way.

And of course it was all moot, as the new cycle began tonight. And so we try again.