# Should Borderline Hypo Always be Medicated?



## scarlett71 (Aug 15, 2013)

Hello, everyone,

I'm new here....My daughter is 14 and has recently been found to have a borderline underactive thyroid.

Her TSH is 6.0, but T3 and T4 are normal, blood sugar is normal, and cholesterol is normal....She is about 10 pounds overweight but otherwise has no symptoms of hypothyroid.

A pediatric endocrinologist prescribed 50 mcg synthroid for her, but currently she is refusing to take it because she read the side effect information from the pharmacy and is afraid her hair will fall out.

I have researched a little about this, and feel that giving this med to a healthy girl with no symptoms (other than extra 10 pounds), is a treatment that's a little too aggressive.

I feel that she should just be monitored regularly and if the TSH continues to up, then the med would be appropriate.

Anyone have any thoughts about this issue, or have any experience with it?

Thanks..!


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## JPGreco (Mar 2, 2012)

If she truly is symptom free I wouldn't medicate personally. As for the overweight, is she active? Does she follow a healthy diet? Has she always been overweight or does this coincide with recent thyroid changes? 10lbs can come from any number of things, stress, soda, and just hanging out with her friends who may not eat the healthiest. Yes, she may be more susceptible to weight gain due to a slower thyroid, but that is no reason to medicate.

I would watch her closely, say, 6 month blood tests unless new symptoms begin to appear. She can cut weight by being more active and watching what she eats. Soda especially should be eliminated from her diet, as it should be for all young girls. Aside from the calories, it is harmful to their bone mass/density (well it is to everyone, but girls are susceptible to calcium deficiencies more than boys).

Also, being just slightly hypo I would look for a quality holistic doctor as she may be able to find foods that naturally boost thyroid function and start incorporating them into her diet since she would only need a minor boost.

Good luck to your daughter.


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## scarlett71 (Aug 15, 2013)

JPGreco said:


> If she truly is symptom free I wouldn't medicate personally. As for the overweight, is she active? Does she follow a healthy diet? Has she always been overweight or does this coincide with recent thyroid changes? 10lbs can come from any number of things, stress, soda, and just hanging out with her friends who may not eat the healthiest. Yes, she may be more susceptible to weight gain due to a slower thyroid, but that is no reason to medicate.
> 
> I would watch her closely, say, 6 month blood tests unless new symptoms begin to appear. She can cut weight by being more active and watching what she eats. Soda especially should be eliminated from her diet, as it should be for all young girls. Aside from the calories, it is harmful to their bone mass/density (well it is to everyone, but girls are susceptible to calcium deficiencies more than boys).
> 
> ...


Yes, she does eat junk occasionally when with her friends (and I am not around...LOL).....The 10 lb weight gain has happened gradually over the last 2 years since she started her periods.

I already banned soda from my house for the last few years, but occasionally she will get some from a friend or when she is at other activities with her swim team.

She gets a fair amount of exercise through her swim team (daily practice) and walking her dog almost every day.

Yes, we do have another follow-up appointment with the pediatric endo in 6 months, and I have not yet asked him in detail about why he decided to prescribe this med, so I need to do that very soon.

How would I go about finding a holistic Dr in my area...?? I am so new to this...:ashamed0001:


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## lainey (Aug 26, 2010)

There are adults on this board with TSH values between 1 and 2 who are looking to be medicated.... Your daughter was at 6 --- I wouldn't question it, I would do it.

A normal TSH is CRITICAL for physical and intellectual growth in children. You would be surprised-- symptoms can be very subtle.

Did the endo run any antibodies tests?

When in doubt, give it a few weeks and run the thyroid labs again. If she's still hypo, as she is now, have her start the meds.


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## scarlett71 (Aug 15, 2013)

lainey said:


> There are adults on this board with TSH values between 1 and 2 who are looking to be medicated.... Your daughter was at 6 --- I wouldn't question it, I would do it.
> 
> A normal TSH is CRITICAL for physical and intellectual growth in children. You would be surprised-- symptoms can be very subtle.
> 
> ...


Please excuse me because I am new to this, but why would someone with levels of 1-2 be seeking medication..?? 
I would think that 1-2 would be well within a "normal" level.

No, no antibody tests were done--should I request them?


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## StormFinch (Nov 16, 2012)

scarlett71 said:


> Please excuse me because I am new to this, but why would someone with levels of 1-2 be seeking medication..??
> I would think that 1-2 would be well within a "normal" level.
> 
> No, no antibody tests were done--should I request them?


There are a number of reasons to have a normal TSH and still have symptoms. For example, I have both Graves and Hashi's. For many years my TSH would jump around from low to normal to high to normal. It's because I have both stimulating and blocking antibodies, which no one ever bothered to check. Although it took years for my lab numbers to finally show that I needed to be treated, I still had symptoms of both diseases all that time, and ended up with osteoporosis in my early 40s due to the Graves episodes. Having full blown hypo or hyperthyroidism is definitely no fun. Please have your daughter's antibodies checked. I wish someone had known to check mine.


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## JPGreco (Mar 2, 2012)

I will recant my reply because I assumed borderline hypo meant that tsh was just outside of normal and I never asked for the range.

Not that a hollistic doctor wouldn't be a bad idea, as diet can affect all kinds of things, but starting on the medication wouldn't be a problem if tsh is way outside of range. For the most part, people tolerate the synthroid very well. The most common issue isn't side affects, but rather which particular medication works best, synthroid, armor, etc. Everyone reacts slightly different.


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## joplin1975 (Jul 21, 2011)

scarlett71 said:


> Please excuse me because I am new to this, but why would someone with levels of 1-2 be seeking medication..??
> I would think that 1-2 would be well within a "normal" level.
> 
> No, no antibody tests were done--should I request them?


Remember that TSH is produced by the pituitary gland...not the thyroid. It can be informative but because it is not a thyroid hormone, it can lag behind actual symptoms. Add in antibodies, which work to skew the results, and the usefulness of the TSH is rather limited. Those people with TSHs of 1-2 probably feel badly because the thyroid hormones their bodies need (t4 & t3) are low. That's why getting free t4 and free t3 tested is so important. As are antibodies - if you have high levels of antibodies, TSH is sort of an after thought.

But, again, getting an ultrasound is important too. My TSH was similar to your daughters...everyone said autoimmune, which it was...but it was also cancer. Thyroid cancer in teens is rare but increasing. Eliminate the bad stuff first, then tackle the autoimmune stuff.


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## hashimotocoaster (Mar 22, 2013)

Have the doctors determined the cause of her hypothyroidism? I wouldn't call a TSH of 6 'borderline,' personally. http://thyroid.about.com/cs/testsforthyroid/a/newrange.htm

Is there a family history of autoimmune disease? Having her antibodies checked would be a great idea--that way you can determine if the cause is Hashimoto's, or a transient thyroiditis, or whatever.

I agree that having enough thyroid hormone is VERY important. When you're young, you can shrug off a lot of things, but it will eventually catch up with you. I wish I'd been tested/treated in my teens. If I were you, I'd work on finding a cause and go from there, but I would lean toward replacement hormone. She may only need it temporarily, depending on the cause, and she may find she feels better on it (with a TSH of 6, I can't imagine she feels great, but then again: youth!). Her hair will only fall out if she's on entirely too much. I would ask the doctor about starting her on 25 mcg (not 50)--just to make sure--then re-testing in 6-8 weeks. Good luck.


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## bigfoot (May 13, 2011)

As someone dealing with a host of medical issues recently, I look back on, say, my college years and realize that something was not right. The last year of college I had bouts of feeling ill, with a host of weird signs & symptoms. I have no idea what my lab values were, except that any testing I had done was "normal" as relayed by the doctors. As someone in their late teens and early twenties, I stubbornly passed it off as just needing more coffee and sleep. Guaranteed something was amiss, but neither myself or my parents would have had any idea what to look for. But I find it interesting that many of my signs & symptoms correlate to what I've been going through lately. I'm sure there is a connection there somehow.

How does that saying go; "I wish I knew then what I know now."

Like others have mentioned, thyroid hormones are some of the master hormones and are responsible for far more than just weight loss. Proper growth, body functioning, cognitive abilities, etc. are all crucial. As far as what to do right now, I think the idea of seeking a naturopath or holistic doc for a consult is a good idea. And then weighing your options at that point of western or eastern medicine (or a blend of both). And I think running a Free T3, Free T4, Reverse T3, TPO Antibodies, Thyroglobulin Antibodies, and Thyroid Stimulating Immunoglobulin (TSI, *not* the same as TSH) is imperative. I wouldn't just slap some Synthroid on a high TSH value and call it good. _She is young and the doctor(s) should be finding out *why* this is happening, first and foremost._ It could be a transient issue, it could be a sign from an underlying illness, it could be an autoimmune component like Hashi's or Graves', it could be diet (high soy, iodine, goitrogens, etc.), another medication's side-effect, family history... and so forth.

And I just wanted to give you a big high-five for coming here and looking into things. Your daughter obviously has a very good parent!

hugs3


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## scarlett71 (Aug 15, 2013)

Thanks so much everyone for the advice.

If I seem hesitant about medicating her, just keep in mind that I am very new to this and just really don't know what to expect.
My daughter has always been a very healthy energetic girl with no problems and this hypothyroid diagnosis was just a complete surprise because she shows no signs of any illness or sickness.

I am definitely going to ask for antibody tests and ultrasound just to be safe.

Will the Dr be most likely to agree and do the tests if I request them, or in anyone's experience will I run into problems trying to get them?


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## bigfoot (May 13, 2011)

It could go either way. If the doctor resists, go all mama bear on them and ensure they are run. It is very important to get a baseline right now, and even more so before starting any treatment. Monitoring just the TSH is like practicing medicine from the Dark Ages. I wouldn't take "no" for an answer. If they won't budge, go elsewhere.


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## scarlett71 (Aug 15, 2013)

bigfoot said:


> I wouldn't just slap some Synthroid on a high TSH value and call it good. _She is young and the doctor(s) should be finding out *why* this is happening, first and foremost._ It could be a transient issue, it could be a sign from an underlying illness, it could be an autoimmune component like Hashi's or Graves', it could be diet (high soy, iodine, goitrogens, etc.), another medication's side-effect, family history... and so forth.


I agree totally...more investigation needs to be done..



bigfoot said:


> And I just wanted to give you a big high-five for coming here and looking into things. Your daughter obviously has a very good parent!
> 
> hugs3


Thank you....


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## scarlett71 (Aug 15, 2013)

bigfoot said:


> It could go either way. If the doctor resists, go all mama bear on them and ensure they are run. It is very important to get a baseline right now, and even more so before starting any treatment. Monitoring just the TSH is like practicing medicine from the Dark Ages. I wouldn't take "no" for an answer. If they won't budge, go elsewhere.


So, in your opinion, should I get these antibody tests and ultrasound done before she starts taking the meds.....?

That is, if she will even take them--right now she's refusing them because she's afraid of hair loss...


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## bigfoot (May 13, 2011)

What the heck, I would do it now beforehand. She isn't really having many (if any) signs & symptoms, and is functioning fine on a daily basis. And I would get them drawn first thing in the AM.

I can totally understand the idea of not wanting to do anything, since she is feeling well. And maybe that's the exact route you take anyway. But it would sure be nice to know what is going on.


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## scarlett71 (Aug 15, 2013)

bigfoot said:


> What the heck, I would do it now beforehand. She isn't really having many (if any) signs & symptoms, and is functioning fine on a daily basis. And I would get them drawn first thing in the AM.
> 
> I can totally understand the idea of not wanting to do anything, since she is feeling well. And maybe that's the exact route you take anyway. But it would sure be nice to know what is going on.


I'm going to contact Dr first thing on Monday so we can get these tests done ASAP....I would love to be able to get them done before school starts in a couple of weeks..

Yes, I agree it would be nice to know exactly what's going on....... But in my personal experience it seems to be getting more and more difficult to find that out from a doctor.....**SIGH**


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## lainey (Aug 26, 2010)

> My daughter has always been a very healthy energetic girl with no problems and this hypothyroid diagnosis was just a complete surprise because she shows no signs of any illness or sickness.


Question: why did you have her at the pediatric endo in the first place if she had no symptoms? Generally, they don't check thyroid function unless they suspect a problem--unless it came up because it was run as part of a regular physical.

The extra 10 pounds could be a symptom. Also, in a girl of 14, the "fatigue" that many report also mimics normal teenage behavior. Other than that, you might see heavier periods (but girls that age are often irregular), slower growth on the charts (also a subtle difference unless she is really small for her age) and perhaps minor mood issues (also normal for a teenager). Kids also tend to have lower blood pressure and slightly higher hear rate, so once again, the differences over the adult symptoms may not be noticeable. As for being physically ill--lots of infections, for example, hypo doesn't necessarily cause that either. In other words, it's not a surprise that you might not "see" it.

So, a couple of things.

First, I will speak about hair loss. Lack of thyroid hormone slows the turn-over rate of many things in the body--including bone production/loss and hair growth/loss. When patients report "hair loss", in most cases what has happened is that the normal "shedding" rate (we lose hair, all of us, every day as a natural replacement process in the hair follicles) returns after a period of being much slower. People often misinterpret that as having your hair "fall out"--it always has, and if it has slowed because of being hypo, it may appear to increase for a short period. An example of a similar process is when women are pregnant, due to hormones, the shedding slows. Post-partum, it returns to normal, and there is a period where hair loss increases--but noone certainly goes bald! Perhaps if you explain this to your daughter this way, she will get past that. Many of the other side effects you read about online are a consequence of too much medication. Generally you start at a low dose, and then blood work is repeated to make sure that the levels don't drop too low--the idea is to avoid these symptoms. Otherwise, replacement medication is just that--replacing a hormone that your body doesn't make--and side effects are minimal.

Yes, you can be hypo for a lot of reasons. In many cases in the Western world, it is due to autoimmune malfunction. However, antibodies or not, if the TSH reads hypo, that is what it is. All that blood tests for antibodies do is show the source of the malfunction--her thyroid blood tests show that it is actually functioning poorly. Whether or not there are antibodies, the treatment remains the same--thyroid replacement.

Being on the medication or not does not affect the basic blood tests for antibodies, nor influence the ultrasound. However, should they find a structural problem with the ultrasound (such as a nodule), they may wish to do an uptake scan. Medication does interfere with that. An uptake scan also serves to measure thyroid function--so if, for example, your daughter actually has a thyroiditis (which would give the "temporary" results people have spoken of) her TSH values may be off, but her uptake (thyroid function) could well be normal.

As for why adults with a TSH with 1-2 would be looking for meds, I will bite my tongue a bit and say that everyone feels different at different TSH levels. Every one has a different "normal"--on the internet, you will see a lot of lobbying for people to be at the lower end of the bell curve, but don't forget that statistically, some people do well on the higher end of the bell curve. Also, you don't typically read on the internet about those people who are medicated and doing fine, it is primarily those who are having problems, so use good judgement when comparing their symptoms and numbers. As an example, personally, I function quite well with a TSH of between 5 and 6 (don't feel really sick until I am over 10) and am medicated to about 2 to 3--a contrast to the low numbers often advocated online.

In short, before doing medication, you need a little more investigation:

1. Repeat blood tests with full antibodies (TPO, TSI and Tg--look them up in Labtests Online)

2. Ultrasound (painless, non-invasive)

3. Based on the results from above, further investigation such as an uptake scan may be necessary, or not, it really depends on the outcome.

As a parent, getting it done before school gets going would be more of my objective, than waiting the 6 months to do it again. You would want a better picture of what is going on.


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## Velcro (Jul 26, 2013)

Also, if the fear of hair loss is the only reason to not take it, then you should know that a problem with the thyroid in general can cause hair loss.


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## StormFinch (Nov 16, 2012)

Lainey, she didn't mention it in this thread but did in her other one. The bloodwork was part of a school physical.


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## lainey (Aug 26, 2010)

Ahhh, such is the problem when people cross-post.......

I don't usually read the newbie folder.


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## scarlett71 (Aug 15, 2013)

Sorry about the crossposting, lainey.....But I do have update on what's going on with my daughter.

She is still refusing the meds due to fear of the possible hair loss side effect of the med, and says she won't take it no matter what consequence I impose....**SIGH**

I tried to explain about the hair shedding process, and that the medication could be adjusted if excessive thinning of her hair occured.
She has beautiful, long, thick blond hair, and I guess I understand her fear somewhat.
I really am truly at a loss as to how to address this refusal of the meds.....I am open to any suggestions.

I'm very sorry if I offended anyone by what I said about someone with 1-2 TSH seeking treatment......I am just so new to this situation, and so worried about what this means for my daughter...:ashamed0002:

I talked to her Dr, and he is planning to do the all the antibody tests when she goes to get her levels checked again in 6 weeks, but I'm going to call and try to get it done sooner since she isn't taking her meds anyway, and I would really like to know what I'm dealing with here.:confused0006:

I asked him about the ultrasound, and he said that when she was examined he did not feel any nodules, so I guess that means that she won't get an ultrasound until I push the issue, .....And I am planning to push the issue...

Also, I told the Dr she refuses to take the meds because hair loss is listed as a side effect, and he told me to "just talk to her about it and I'm sure she'll come around"....**SIGH**.........He probably doesn't have any children....LOL


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## jenny v (May 6, 2012)

I don't know if this will help, but I've been on Synthroid for years and never had any hair loss as a result of it. The hair loss I did experience came from my thyroid being out of whack and me not being on any Synthroid at the time. If she is refusing to take the meds and her thyroid is getting worse and worse, she could experience hair loss because of that!

Hair loss sucks, esp. for us women (not that it's any easier for men!), so I can understand her fear. But hair loss is a very common symptom of both hypo and hyper thyroid problems, so it could happen even if she doesn't take the meds.


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## lainey (Aug 26, 2010)

I have 2 teen girls and a pre-teen, so I know how obstinate they can be.

My oldest daughter just started Accutane--I don't know if you have seen the side effects list for this, but it is very extensive, not including the whole issue of birth defects and pregnancy. What we did is go into RxList and a couple of other sites, and look at the reporting data together. I carefully reminded her that in aftermarket use, they do report ALL of the "side effects" that everyone reports, even if it is just a few people relative to the number taking the medication. Sometimes they will list the percentages (what is .1% of 100,000 for example?). Anyway, she got a better idea of the math involved and the relative risk. She also asked around, and discovered some friends and acquaintances that were taking it and they shared their experiences, so that she would have a better idea of what to expect. You can preview some information in the forums, for example, and expose her to people who have had positive experiences.

That said, yes, just continuing to be hypo is a risk for hair loss, it is a common "symptom" that people complain about before treatment--in this case, because the hair becomes brittle and breaks because it is in poor condition.

I never had any hair loss, actually the condition of my hair improved after treatment, it started growing again, became less dry and more glossy--I am a sandy blonde, and other than red heads, us blondes do have a lot of hair.

I guess she missed the part about weight loss--I don't know how she feels about the extra 10 pounds, but I know that as far as my girls are concerned, they would be all over anything that helps control their weight. That said, this is a very tricky issue with girls that age, and something you may not want to suggest depending on your girl--you know her best--but just throwing that out there as another angle. Also, if she does sports, she may not be aware that her stamina and ability to condition should improve, as will toning and muscle mass.

She may have small nodules that cannot be felt. In general, 95% of nodules are benign, and a high percentage of people in general have them (around 40% of the population) so it's not a reason to get excited if they find any necessarily. I'm surprised at the doc, there's no reason not to get a baseline.

At the moment, I would back away until the next labs, and go from there. Be very clear with the doc that she refuses to take the meds and why. He should not belittle her nor blame you, he should speak to her as an adult and not expect you to force her as you would a small child--that will only make the battle worse (if he's had kids, he'll get it, but not all do). She needs to be a partner in improving her health.


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## JenneyCat (Aug 11, 2013)

I've been thinking about this over the past few days and meant to come on here and give you my thought. Could you ask your Dr (or do some research yourself) for a thyroid drug where hair loss is NOT a side affect? I'm not sure if one exists, maybe someone here knows and then she wouldn't have to worry.


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## scarlett71 (Aug 15, 2013)

jenny v said:


> I don't know if this will help, but I've been on Synthroid for years and never had any hair loss as a result of it. The hair loss I did experience came from my thyroid being out of whack and me not being on any Synthroid at the time. If she is refusing to take the meds and her thyroid is getting worse and worse, she could experience hair loss because of that!
> 
> Hair loss sucks, esp. for us women (not that it's any easier for men!), so I can understand her fear. But hair loss is a very common symptom of both hypo and hyper thyroid problems, so it could happen even if she doesn't take the meds.


She is not experiencing any hair loss now, but I tried to explain that if she doesn't take the meds, and her TSH level starts getting higher, she might start losing hair..

She responded by saying that if her TSH has gone up when she goes for next visit next month, she will "think about" taking the meds......I guess that's a start, anyway....


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## scarlett71 (Aug 15, 2013)

lainey said:


> My oldest daughter just started Accutane--I don't know if you have seen the side effects list for this, but it is very extensive, not including the whole issue of birth defects and pregnancy. What we did is go into RxList and a couple of other sites, and look at the reporting data together. I carefully reminded her that in aftermarket use, they do report ALL of the "side effects" that everyone reports, even if it is just a few people relative to the number taking the medication. Sometimes they will list the percentages (what is .1% of 100,000 for example?). Anyway, she got a better idea of the math involved and the relative risk. She also asked around, and discovered some friends and acquaintances that were taking it and they shared their experiences, so that she would have a better idea of what to expect.


Yes, my niece takes Accutane......Was your daughter hesitant to take Accutane at first because of the side effects list?



lainey said:


> You can preview some information in the forums, for example, and expose her to people who have had positive experiences.


Yes, that's a good idea....



lainey said:


> I guess she missed the part about weight loss--I don't know how she feels about the extra 10 pounds, but I know that as far as my girls are concerned, they would be all over anything that helps control their weight. That said, this is a very tricky issue with girls that age, and something you may not want to suggest depending on your girl--you know her best--but just throwing that out there as another angle. Also, if she does sports, she may not be aware that her stamina and ability to condition should improve, as will toning and muscle mass.


Hmmm.....Based on what I have seen, she seems not to really be bothered by the extra 10lbs.....She is 5'7", so 10 pounds extra is not too noticable....She does do competitive swimming and gets a good amount of exercise.



lainey said:


> I'm surprised at the doc, there's no reason not to get a baseline.


I'm going to push for one at next month's visit....



lainey said:


> At the moment, I would back away until the next labs, and go from there. Be very clear with the doc that she refuses to take the meds and why. He should not belittle her nor blame you, he should speak to her as an adult and not expect you to force her as you would a small child--that will only make the battle worse (if he's had kids, he'll get it, but not all do). She needs to be a partner in improving her health.


I agree totally....I believe that's a good plan for now.


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## scarlett71 (Aug 15, 2013)

JenneyCat said:


> I've been thinking about this over the past few days and meant to come on here and give you my thought. Could you ask your Dr (or do some research yourself) for a thyroid drug where hair loss is NOT a side affect? I'm not sure if one exists, maybe someone here knows and then she wouldn't have to worry.


Hmmm....Yes, I think I will ask the Dr, and do some research myself.....Thanks, that's a wonderful idea, too...!!arty0049:


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## Madison Marie (Sep 3, 2013)

Have you considered that those ten extra pounds are not normal given her activity level? I have been hypo and sitting around a TSH of 6 for over ten years. I suspect it may have even started in my teens. I was slightly chubby as a teen, but I was active so it never got out of control. In my early 20s it kept creeping up, maybe 5 to 10 pounds per year. I was borderlne when diagnosed and refused to take my medication. Ten plus years later I greatly regret that decision. When diagnosed I had no symptoms and thought I knew better. Now, I have an enlarged thyroid with two solid nodules and I have been unable to work for over a year due to my symptoms. I am miserable and wonder if I had taken it seriously if I may not be going through this now. Please don't let her ignore it. Untreated thyroid problems can do damage to the body.


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