To swell and back: The real culprit in my midlife weight gain
I thought calories must be responsible for my changing body, but discovered it was all down to my thyroid
About three years ago – not long after my mum’s sudden death – I noticed that I was putting on weight. I wasn’t eating any more than usual, and I am very active. I couldn’t understand what was happening.
My solution was simple: Eat less and move more. I started doing more exercise – upping it from my usual 45 minutes a day to an hour or two. I’d never counted calories before, but I cut down my intake to a strict 1,000-a-day regime. But the weight gain continued.
As I continued to put on kilograms I began to feel tired. Assuming that the fatigue was caused by overdoing the exercise, I dialled it back a bit. I tried a no-fat vegan diet for six months. My body shape was fluctuating every day – sometimes swollen with a belly so distended I looked pregnant, sometimes close to the lean physique I had complacently enjoyed all my life. I tried a keto diet – eating only meat, green veg, nuts, seeds and fats, but no sugars whatsoever. I stuck with it for eight miserable months. No change.
I was 44 years old. I bought some scales for the first time in my life but, looking at pictures of myself from that time, my body was by no means overweight. On the scales, I was bang-on average for my height and age. What had started off as a mild weight gain was turning into a mental problem. I was developing body dysmorphia.
Like a lot of naturally slim, athletic people, I had always been dismissive of eating disorders, but I now have great empathy for anyone who is suffering from any issues to do with their body image and eating. It is hell – the obsession, the fear of eating too much, or eating the wrong thing, the constant guilt and self-loathing. I noticed that minor injuries weren’t healing. I had always been a very fast healer, but now, bruises, cuts and even blisters would take weeks to go. My hair started falling out – my hairbrush was always full and the shower plug kept getting blocked. My eyebrows, always quite thick, had thinned out.
During this time, my relationship with my husband – which had been difficult at times – reached a new low. I had no libido, and he was bemused by my reaction to the changes in my body (“But I still fancy you, so what’s the problem?”). I wondered if I was overreacting to a natural ageing process.
Eventually, after a month spent doing CrossFit five days a week, and cycling or climbing on my day off, I spoke to a nutritionist who told me to stop everything. I am eternally grateful to him for his intervention. He spotted immediately what was wrong with me: I had an endocrine issue. He suggested that I go to my GP to get tested for hypothyroidism, an endocrine system disorder where the thyroid gland does not produce enough of the hormones needed to regulate metabolism. In the meantime, he suggested I reduce my exercise to 30 minutes a day, max, and eat properly.
When I went to my GP she insisted my weight was fine, and that I needed to learn to accept that my metabolism would naturally slow down in my 40s. But I pushed for a hypothyroidism test and she finally agreed.
Hypothyroidism is a rare condition, affecting 15 in every 1,000 women (and just one in 1,000 men). Last week, TV presenter Anna Richardson revealed how she put down her tiredness, irregular periods, brain fog and gaining 6kg in weight to the menopause – and even tried treating the symptoms for three years with hormone replacement therapy – before she was diagnosed with an underactive thyroid.
The thyroid gland, a small, butterfly-shaped organ in the neck, controls the release of thyroid hormone thyroxine into the body. T4 (thyroxine) goes around the blood and gets transformed into a more radical element called T3, which then stimulates pretty much all the metabolic reactions in the body – from digestion, to energy release, to powering your muscles. If the thyroid gland is malfunctioning (underproducing T4), the pituitary gland (the tiny gland in the front of the brain) compensates by producing TSH (thyroid stimulating hormone) to try to activate the thyroid gland.
So it stands to reason that if your thyroid hormone levels are low, TSH will be high. Rather than check T3 or T4 levels, the standard blood test looks for TSH instead. My results came back: TSH normal. All other hormone levels normal, so I wasn’t peri-menopausal either, which also presents similar symptoms.
I wasn’t happy. To me, my symptoms were clear. I decided to use my private health insurance. I called an endocrinologist in London and, based on my symptoms, he was certain I had hypothyroidism. The test results came back: T4 low, T3 off-the-scale low, TSH normal. Having battled with midlife weight gain and tiredness for two years, I was finally diagnosed correctly. I found out that my pituitary gland, for some reason, was not recognising the low level of thyroid hormones. I underwent a scan of my pituitary gland to ensure that it wasn’t affected by a tumour (it wasn’t), and I was given a prescription for T4 (thyroxine) and T3 (liothyronine) replacement tablets.
Thyroxine (T4) is a synthetic version of the main hormone secreted into the bloodstream by the thyroid gland. When she saw my results, my GP happily prescribed it. However, she refused to prescribe liothyronine (T3), saying she believed it was ineffective. In October 2017, the National Health Service (NHS) announced it would stop prescribing liothyronine (T3), a hormone pill taken by more than 13,000 patients with underactive thyroids, after the manufacturer raised the price by more than 5,000%.
Last week, a report for the Uk department of health and social care found evidence that local healthcare commissioners were refusing to pay for the medication, despite national guidance stipulating that they should. I opted to buy a two-month supply of T3 over the counter in the chemist. The pharmacist looked up at me and said: “Do you really need this?” I showed her my prescription. “If you buy it privately it’ll be £1,600.”
Liothyronine is insanely expensive in the UK, and I can understand why the NHS is loath to prescribe it. But you can buy a month’s supply over the counter in France, Greece or Spain for just €3 (£2.67). Many hypothyroid sufferers now face regular trips to the Continent to stock up on their lifechanging medicine. I am still prescribed T4 by my GP, but get a friend to buy my T3 in Greece.
My body is still liable to gain weight if I don’t watch my diet, but I have accepted that as part of growing older. My libido is back (although my marriage didn’t make it – for other reasons than the thyroid issue, although I’m sure it acted as a catalyst). I heal well and I feel as energetic as I ever did. The endocrinologist tests me every six months to ensure that my levels are not dropping or rising too high, and adjusts my doses accordingly. Thyroid levels do fluctuate, even when you are on a regime of tablets. They are hormones, after all, and always in flux.
There could be many causes for my condition: Was it brought on by the sudden, traumatic death of my mum? Was it genetic (she had had chronic fatigue, but I don’t think she was ever checked for a thyroid disorder)? Was it as a result of problems in my marriage? I will never know for sure. I’m just glad I had the tenacity to get to the bottom of it.
What is hypothyroidism?
Hypothyroidism is a disorder of the endocrine system in which the thyroid gland, found in the neck, fails to produce enough of the hormone thyroxine, which affects almost all of the body’s systems. It plays a crucial role in heart and digestive function, metabolism, brain development, bone health and muscle control.
Deficient levels of thyroxine can lead to tiredness, weight gain, low mood, dry skin, hair loss and sensitivity to the cold. Severe and prolonged deficiency can also cause heart muscle damage.
Also known as low or underactive thyroid, hypothyroidism affects fewer than two in every 100 women, and just one in 1,000 men. Most cases of underactive thyroid are caused either by the immune system attacking the thyroid gland, or by damage caused to it by previous treatment for thyroid cancer.
Many symptoms of an underactive thyroid are the same as those of other conditions, so it can easily be confused for something else. The only accurate way of diagnosing hypothyroidism is by a blood test to measure hormone levels.
Conventional treatment for hypothyroidism is hormone replacement with a synthetic form of thyroxine, taken daily in pill form: T4 (thyroxine) is considered the standard treatment, while T3 (liothyronine) is stronger. Combining T3 and T4 has been shown to improve efficacy in some patients.
– © Telegraph Media Group Limited