Thyroidectomy and Weight Gain
Why Is the Thyroid Important?
Most people don't realize that the thyroid is one of the most important parts in human body. I discovered this only after I no longer had one.
Your thyroid is a small gland located at the base of your neck, just below your Adam's apple. Although small in size, it is one of the largest endocrine glands in your body. The thyroid gland consists of two small, cone-shaped lobes roughly the size of your thumb nails. It lies against the trachea and larynx. The thyroid is involved in the following tasks:
- controlling how quickly the body uses energy
- making proteins
- controlling how sensitive the body should be to other hormones
- regulating the metabolism rate in your body
In other words, the hormones produced by the thyroid are directly involved in supplying energy to every cell in the body. This is an over-simplification, but it's how my doctor described it to me so that I could understand why it was so important for me to take my thyroid medication. Imagine if the cells in your heart and cells in your brain no longer received energy? What would happen to you then?
There are two main disorders of the thyroid that sound very similar but are quite different: hyperthyroidism and hypothyroidism.
- Hyperthyroidism is an over-active thyroid, which means your body produces too many thyroid hormones. This can cause an enlarged thyroid commonly called a goiter, protruding eyes, weight loss, sweating, diarrhea, palpitations, and sore, weak muscles. This tends to affect more women than men and can be an auto-immune disease called Grave's Disease. This is usually treated by the patient drinking radioactive iodine.
- Hypothyroidism is when the thyroid does not produce enough hormones, resulting in weight gain, palpitations, fatigue and lack of energy, baldness, and intolerance to hot and cold.
As you can see, neither disorder is pleasant. In addition to these two disorders, one can develop nodules on the thyroid that are mostly benign, or thyroid cancer, which mostly affects women. You can also develop a goiter from an iodine deficiency or a bacterial or viral infection.
My Thyroid Story
All my life I've struggled a bit with my weight, having to eat way less than anybody else to not pile on the kilos. Of course, to a twenty-something year old this was never fair. You just read the label on the food item and you put on weight. A couple of times over the years, doctor's had looked at my thick neck and thought I might have a problem with my thyroid. They took blood, but my thyroid hormone levels were always within the normal range so they never pursued it. In 2006, I developed an irritating cough. Every time i started to talk, I'd start to cough. This got worse and worse, until I was actually choking and unable to breathe when I spoke. As a teacher, gagging in front of the class with your eyes nearly popping out as you tried to breathe was not a good look. I went to my doctor who felt my neck, looked at my throat and thought that I had an enlarged thyroid. However, blood tests still put my thyroid hormone within the normal range. An ultrasound showed that I had tumors on my thyroid. A fine needle biopsy was inconclusive. I was referred to a thyroid surgeon to investigate it further. It was thought that somehow my cough was related to my thyroid.
The thyroid surgeon looked at the ultrasound of my thyroid and decided that he was only looking at the tip of the iceberg. He felt that the bulk of my thyroid was sitting in my chest. Nobody had checked my chest cavity before, as a thyroid doesn't usually belong there. When I'd had all my drama with breast cancer, nobody then had noticed a thyroid in my chest cavity. The MRI on my chest showed that my thyroid was severely enlarged, covered in large tumors, and the weight of it had caused it to drop into my chest cavity, pushing itself in between my heart and lungs and compacting on my trachea. In effect, it was slowly suffocating me to death. The surgeon said if it wasn't removed in the near future, I'd be dead within a year. Charming. He also said it was a hereditary disorder, and I've since found out my late uncle had a goiter removed when he was sixteen. Apparently, I'd been growing this thyroid since I was eighteen, hence the struggles to maintain an ideal weight. I did not have hyper- or hypothyroidism. My TSH levels were normal. Another doctor said it was an auto-immune disease where your thyroid fights itself and against the body. I was confused. I didn't appear to fit any of the textbook thyroid disorders.
The date for the operation was set. The surgeon said it would be a very tricky surgery, as if they damaged my vocal chords I wouldn't be able to speak again. Also, as my thyroid was so large he wasn't sure they'd be able to remove it through my throat. There was a good chance they'd have to crack open my chest cavity and remove it that way. He was also afraid that my trachea would collapse once the thyroid was removed and he warned me that there was a good chance I'd have to go into ICU after the op. With those encouraging words, I was ready for the surgery. The surgeon took eight and three quarter hours to remove my thyroid in a total thyroidectomy. He also had to transplant my parathyroid glands. He was determined not to crack open my chest, and rather persevered through a small incision he'd made on a crease on my neck. Eventually, he used obstetric forceps to remove my thyroid.
It took a while to get my TSH levels right in my body. The TSH is the different thyroid hormones your body needs to work. Since the operation, I have put on 20kg. When my levels are a bit low I get tired, lethargic, depressed and sometimes I get a tingling feeling on my face and leg cramps or back muscle cramps. When I feel good and energetic, then my TSH levels are too high. Then my nails break and teeth chip, and I get palpitations - a result of having too much thyroid hormone. So you have a choice. Low energy and good nails, or normal energy and broken nails. However, I'm not very good at taking medications and I often forget. When I don't take my thyroxine for a few days, my memory starts to go, I start to slur my speech and I feel very tired, it is almost an effort to sit up straight. Maintaining my weight so that I don't pile on even more kilos is a real challenge.
If you are scheduled for a total thyroidectomy, be prepared for weight gain. Doctors will tell you that if you maintain your TSH levels you will not put on weight. Unfortunately, this is what science tells them should happen. In reality, this is not what happens even if you take your thyroxine diligently. For some reason, you still put on weight, you still get tired easily, even if your blood work shows that this should not be happening. Doctors will refer you to Weight Watchers and other weight loss programs. You will be told to exercise to lose weight. But no matter how hard you try, nothing will work and doctors will not understand and will make you feel as if you are not trying hard enough. As far as they are concerned, you have enough hormones in your system—so weight should not be an issue. Doctors will make you feel inadequate and bad about yourself. They will not accept that even with the right levels of TSH you are gaining weight. Your metabolism will never recover, even with thyroxine. I know that I sound negative, but this is the reality and you need to be prepared for it.
However, after the initial weight gain following the thyroidectomy, you can maintain your weight or slow down the weight gain by doing the following:
- Exercise. Keep up an exercise regime. It won't make you lose weight but will stop you from putting on more.
- Diet. Cut down on the carbs and try and eat healthy foods in moderation. Once again, you won't lose weight by doing this, but you also won't gain so rapidly.
- Sleep. The most important thing to do for you to be able to function properly is sleep. You have to sleep a minimum of 8 hours a night. This definitely recharges your energy levels more than anything else.
Someone once told me that it can take up to 5 years after a thyroidectomy for your body to return to a normal state. Plus your pituitary gland goes into overdrive thinking you still have a thyroid. Unfortunately there is nothing you can do until the pituitary gland returns to normal.
The tragedy is that people don't understand what is happening to you. They associate being overweight with over-eating and not exercising. They don't believe you when you tell them that you watch what you eat and that you have a regular exercise regime. They'll tell you that anybody can lose weight. People who have had their thyroid removed struggle to lose weight—and that is the reality. Doctors don't even get it. They believe if you take your medication then you should not gain weight. The science of it doesn't fit with what happens in real life. Obviously, you thyroid is more important and does a lot more than even doctors know. After your thyroidectomy, even when your TSH levels are right, besides the weight gain you will still experience periods of low energy, memory loss, brittle nails, dry skin, muscle cramps, and depression. There are many medical forums on the internet where you'll find people who've had a thyroidectomy begging for advice on their weight gain.
If you have had a total thyroidectomy and have found something that stops weight gain and helps lose the weight, please post it here.