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Medical Edge Newspaper Column from Mayo Clinic

‘I’M AFRAID I’M TOO TIRED TO CARE FOR A CHILD’

DEAR MAYO CLINIC: I was diagnosed with hypothyroidism five years ago. I have been on medication since, and my levels look normal. The problem is that I haven’t felt better. I am constantly exhausted, extremely sensitive to the cold and have tingling in my fingertips, joint pain, muscle pain, headaches and some weight gain. I have been so exhausted after work that I need to nap even though I get eight hours of sleep.

I’m frustrated, and I am willing to do whatever it takes to figure out what the problem is. I am getting married, and we want to start a family, but I’m afraid I am too tired to care for a child. Please help me! — Valparaiso, Ind.

ANSWER: A diagnosis of hypothyroidism means the thyroid — a butterfly-shaped gland at the base of the neck — is not producing the right amount of hormones to regulate your metabolism properly. Symptoms often include those you are experiencing.

We assume your medication is the standard treatment for hypothyroidism: a daily dose of synthetic thyroxine in a tablet to replace the hormone the thyroid gland makes. When taken in the correct amount, this treatment usually eliminates all hypothyroidism symptoms. An incorrect dosage could be the source of your problem. However, you mention that your hormone levels look normal. That makes me suspect your symptoms may not be thyroid-related.

To determine thyroid function, physicians use a blood test that measures thyroid-stimulating hormone. The pituitary gland produces TSH in an effort to stimulate your thyroid gland into producing more thyroid hormone. When TSH levels are high, your thyroid isn’t functioning properly.

The test for TSH is very accurate in detecting and monitoring hypothyroidism. So if the test results show that, with treatment, your TSH is within the normal range, it is unlikely that thyroid dysfunction is the source of your symptoms.

If you are taking your pills as prescribed and getting regular blood tests to monitor your thyroid hormone levels — and those levels are consistently normal — we would encourage you to investigate with your physician other medical conditions that may be causing your symptoms. A sleep disorder, depression, chronic fatigue, fibromyalgia and other hormonal problems are among the possibilities.

— Dr. Vaheb Fatourechi, Division of Endocrinology, Diabetes, Metabolism, Nutrition,
Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on Hypothyroidism
Appointment Information
More Information on Hypothyroidism

DEAR MAYO CLINIC: I am considering donating a kidney to a friend, but I am concerned because my mother developed diabetes when she was 40 years old. Does this automatically disqualify me from being a living donor? I am a healthy 43-year-old woman. — Lubbock, Texas

ANSWER: Transplant centers have varying donor policies, but I don’t know of any center that would exclude you solely on the basis of having a parent with diabetes.

At Mayo Clinic, potential donors undergo a two-day evaluation to determine eligibility and to educate them about kidney donation. There are five basic criteria that a donor must meet: 1) no significant kidney disease and sufficient kidney function to donate; 2) no disease (such as diabetes) that frequently causes kidney failure; 3) no disease such as cancer or hepatitis B that could be transmitted to the recipient; 4) no problem that makes anesthesia and surgery risky, such as heart disease; 5) acceptance of the risks of removing one kidney.

You will be tested for diabetes as part of your donor evaluation. But even if you do not have the disease, you can still develop diabetes later in life. I recommend that donors who later develop diabetes see a kidney specialist to ensure that they take any necessary precautions to protect their remaining kidney function. Fortunately, much of the kidney failure resulting from diabetes is preventable with careful blood sugar and blood pressure control.

— John J. Dillon, M.D., Nephrology, Mayo Clinic, Rochester, Minn.

Additional Resources:
Information on Organ Donation
Living Organ Donation
More Information on Organ Donation

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.