Forums >Health and Nutrition>Coaching and Thyroid issues
Feeling the growl again
You also seem very concerned that she deliver a maximal performance before she graduates, which includes medicating her to bring about the fastest result. Do you think this model of training is maintainable? Do you suggest medicating her indefinitely to boost her performance? If you had to build a training plan that allowed her to run without medication, but perhaps at a cost to her to performance, what would that training schedule look like and how would it differ from her current training?
If the following sounds harsh it is not intended as such, but as someone dealing with issues very similar to this girl I cannot help but comment.
Your above quote seems to imply that medicating someone is inherently bad. How do you justify this? What is your evidence?
Thyroid deficiency is not a "normal" state, is not healthy, can lead to long-term issues if left untreated, and have a significant impact on one's quality of life. Is she indeed has Hashimoto's, her thyroid function will continue to decline as will her ability to maintain any reasonable energy level. Yes, treatment for this is a lifelong daily thyroid pill but you seem to suggest that this is a bad option without providing any evidence of this. My father tried this; by the time we finally convinced him to see a doctor he was told that he was lucky he had not already died from ignoring the problem and not wanting to seek medication for it.
Like many things, runners feel thyroid issues early because they can see even small differences in their body's ability to perform to its peak ability and/or recover. This does not necessarily mean that they should wait until the same point as a sedentary person to seek treatment.
Like this young girl, apparently, the first sign for me was a gradual decline in running performance, energy to run, and abilty to recover. Over time daylong fatigue set in, with the inability to make it through a lot of days without a 2-hour nap after work. The solution you seem to suggest would be that I had just given up on doing a significant amount of running and schedule in the nap time?
"If you want to be a bad a$s, then do what a bad a$s does. There's your pep talk for today. Go Run." -- Slo_Hand
I am spaniel - Crusher of Treadmills
I've never heard of Hashimoto's thyroiditis, nor am I personally challenged by thyroid issues.
However, my wife and 2 sons (18 & 8), all have thyroid issues, and up until 2 years ago, the diagnosis of their challenges was a mystery.
We were able to see their symptoms, treat their symptoms (as best we could through medical care), but never knowing what they had nor why tests showed up odd.
In turns out that they have a gene mutation that causes the regulator (HPGD) of a specific enzyme (PGE2) to not work properly. In turn, they had symptoms that led doctors to believe that they had cyctic fibrosis, cancer, juvenile rheumatoid arthritis, etc.. After about 16 years of hellish tests, stress, surgeries, and troubling misdiagnosis, we stumbled upon a gene mutation that lead to symptoms that were similar to theirs. Within 60 days of my final search on "wrongdiagnosis.com", we had a full family genetic test and full closure to their challenge.
It turns out that there are only a few (maybe 15 families diagnosed in the world???) that have been identified with this gene mutation, and our family happened to be a part of some significant research relating to the mutation.
My point is that some of these thyroid issues look like other challenges, but may not be.
As it relates to this HS girl, I don't know what's best. I hope her family gets answers soon, and I hope her family looks through all aspects to determine whether the diagnosis is correct. (I also hope that her best interest is in mind, as opposed to optimal results on the track. Some things take time to resolve).
Brian
Life Goals:
#1: Do what I can do
#2: Enjoy life
I'm presently undecided on the issue, but I think it's something that needs to be considered. A coach, parent, and athlete have to honestly evaluate the pros and cons of taking a more natural approach. I consider it due diligence to look at it thoroughly from both sides. None of Coach's posts have yet favored a natural approach to solving the problem; or perhaps more disturbingly, Coach has not yet been willing to discuss (at least with us) how her training might be altered to address the problem. I understand that plenty of athletes, coaches, and parents are competitive enough to get a performance boost through a few fairly simple prescriptions, which is made especially easy when it's not so much boost, but rather a way to get somebody to feel normal again in response to training load.
Thyroid medications are not currently banned substances. This is a controversial issue. Some runners in the Oregon Track Club are reportedly on them. It's safe to assume a few other world class athletes are medicating thyroid issues, too. The same arguments you have are believed to hold true for them -- that their training and performances would not be possible without the help of these medications. It's up to the World Anti-Doping Agency to decide whether these substances make an athlete simply normal again or more than normal. Thus far they have not banned them, so I'm not inclined to cast a stone at anyone prescribed it.
Most high school females will never run a 22 minute 5k. A 20 minute 5k is likely to win a few small meets depending on the schools and will lead to high placement at a few invitationals. My math here is going to get fuzzy, but I think you'll follow the thought process. This girl performed in the top 3 percentile, slid back in performance to the top 5 percentile, and is now trying to use medication to get back to the top 3 percentile immediately and presumably improve from there. To the athlete, coach, and parents this is the spectrum of running they live in. But to most of the rest of the world this girl is an outlier. The idea to get a prescription for her limiting factor might seem appropriate to those involved, but we have somebody performing better than most girls already and now she's seeking a prescription to do even better, even reportedly against the findings of her doctors thus far.
"Thyroid deficiency is not a normal state." So what causes thyroid deficiency? It's complicated, sure, but this thread seems to move quite quickly towards medicating it rather than figuring it out. Perhaps an underlying concern here is that the girl's lifestyle may be causing it and the athlete, coach, and parents are unwilling to change her lifestyle so that she can be in a "normal state." I don't begrudge an athlete from wanting to do well, but it's noteworthy that they did not actively seek treatment for this condition until it limited her ability to run a 20 minute 5k in high school.
How do we know it isn't her training? Allow me to rewrite one of your paragraphs to simply highlight that any number of things thyroid, training, or beyond could be the factor needing to be addressed.
"[Overtraining] is not a "normal" state, is not healthy, can lead to long-term issues if left untreated, and have a significant impact on one's quality of life. [If she is overtraining,] her thyroid function will continue to decline as will her ability to maintain any reasonable energy level. Yes, treatment for this is a lifelong daily [change to her training methods,] but [this possibility has been ignored as an] option without providing any evidence of this." Now insert other factors like diet, sleep, or stress.
I just think we need to look at it from all sides and, if they decide to medicate, at least know that they explored the ramifications of doing it this way versus other ways. How do they know they can't get equal or better results in a non-medicated way if this treatment is where they're putting 90% of their focus?
Spaniel, if I simplify your case to the extreme based only on what you've typed in this one response, you've essentially said that you chose a prescription over 2 hours of additional sleep per day. That was your call to make. Maybe if she can simplify the picture, then she'll be able to boil it down to a choice like this. (Personally, I'd rather work 2 fewer hours per day, make time for that nap, and not have to take any meds. But this is America and capitalism won't thrive if we don't work and go to school!) When you're Spaniel, an adult, and going for the Olympic trials, it's easy to want the treatment. When she's in high school going for peak performance that makes the difference between placing well and getting a scholarship, it's easy to want the treatment.
perhaps more disturbingly, Coach has not yet been willing to discuss (at least with us) how her training might be altered to address the problem. I understand that plenty of athletes, coaches, and parents are competitive enough to get a performance boost through a few fairly simple prescriptions, which is made especially easy when it's not so much boost, but rather a way to get somebody to feel normal again in response to training load. This girl performed in the top 3 percentile, slid back in performance to the top 5 percentile, and is now trying to use medication to get back to the top 3 percentile immediately and presumably improve from there. To the athlete, coach, and parents this is the spectrum of running they live in. But to most of the rest of the world this girl is an outlier. The idea to get a prescription for her limiting factor might seem appropriate to those involved, but we have somebody performing better than most girls already and now she's seeking a prescription to do even better, even reportedly against the findings of her doctors thus far. "Thyroid deficiency is not a normal state." So what causes thyroid deficiency? It's complicated, sure, but this thread seems to move quite quickly towards medicating it rather than figuring it out. Perhaps an underlying concern here is that the girl's lifestyle may be causing it and the athlete, coach, and parents are unwilling to change her lifestyle so that she can be in a "normal state." I don't begrudge an athlete from wanting to do well, but it's noteworthy that they did not actively seek treatment for this condition until it limited her ability to run a 20 minute 5k in high school. How do we know it isn't her training? Allow me to rewrite one of your paragraphs to simply highlight that any number of things thyroid, training, or beyond could be the factor needing to be addressed. "[Overtraining] is not a "normal" state, is not healthy, can lead to long-term issues if left untreated, and have a significant impact on one's quality of life. [If she is overtraining,] her thyroid function will continue to decline as will her ability to maintain any reasonable energy level. Yes, treatment for this is a lifelong daily [change to her training methods,] but [this possibility has been ignored as an] option without providing any evidence of this." Now insert other factors like diet, sleep, or stress. I just think we need to look at it from all sides and, if they decide to medicate, at least know that they explored the ramifications of doing it this way versus other ways. How do they know they can't get equal or better results in a non-medicated way if this treatment is where they're putting 90% of their focus? Spaniel, if I simplify your case to the extreme based only on what you've typed in this one response, you've essentially said that you chose a prescription over 2 hours of additional sleep per day. That was your call to make. Maybe if she can simplify the picture, then she'll be able to boil it down to a choice like this. (Personally, I'd rather work 2 fewer hours per day, make time for that nap, and not have to take any meds. But this is America and capitalism won't thrive if we don't work and go to school!) When you're Spaniel, an adult, and going for the Olympic trials, it's easy to want the treatment. When she's in high school going for peak performance that makes the difference between placing well and getting a scholarship, it's easy to want the treatment.
perhaps more disturbingly, Coach has not yet been willing to discuss (at least with us) how her training might be altered to address the problem. I understand that plenty of athletes, coaches, and parents are competitive enough to get a performance boost through a few fairly simple prescriptions, which is made especially easy when it's not so much boost, but rather a way to get somebody to feel normal again in response to training load.
This girl performed in the top 3 percentile, slid back in performance to the top 5 percentile, and is now trying to use medication to get back to the top 3 percentile immediately and presumably improve from there. To the athlete, coach, and parents this is the spectrum of running they live in. But to most of the rest of the world this girl is an outlier. The idea to get a prescription for her limiting factor might seem appropriate to those involved, but we have somebody performing better than most girls already and now she's seeking a prescription to do even better, even reportedly against the findings of her doctors thus far.
I believe you need to both re-read the OP's posts, and study up on thyroid disease, before you begin attacking this coach and parents for supposedly wanting this girl to just perform more than be concerned about her health and well-being. The OP already shared that the girl's antibody levels are extremely elevated, indicating a high likelihood of thyroid disease. Training does not cause elevated antibodies against your thyroid, yet you are asking for a training plan to mitigate this issue? That is nonsensical.
Whether she is in the top 3 percentile or the bottom 3 percentile is completely meaningless. If Haile G. suddenly found himself struggling to run a 30min 10K and was diagnosed with hypothyroidism, would your response be that a 30min 10K is still in the top 1% so he has no reason to seek treatment, despite his normal time being sub-27? Where she compares to others is completely useless in determining whether this girl has an issue requiring treatment.
"Noteworthy that they did not seek treatment for this condition until it limited her ability to run a 20min 5K"? How on earth would they know to seek treatment until they have such an indication that something may be wrong? You don't seek treatment until you know there is a problem. This seems like an unwarranted and poorly thought out attempt to villify this coach and parents.
Show me any data that overtraining leads to elevated anti-thyroid antibodies and elevated TSH, since you just rewrote my words to claim it does.
So a person requiring excessive sleep due to hypothyroidism should just adjust their schedule so they can sleep 12 hours a day. This sentiment is ignorant of medicine and biology. Excessive fatigue can be a serious symptom of hyopthyroidism, and if left untreated your metabolism can drop to the point that your heart simply stops while you are sleeping. This is exactly what they told my dad was in danger of happening to him if he had continued untreated. By your way of thinking, I assume if you break your favored arm you learn to write with the other rather than get it treated?
Your whole purpose here is based on the philosphy that medication is inherently bad and only "natural" is good. This smacks of Suzanne Sommers' pleas to stop women from getting likley curative treatment for their breast cancer in favor of untested and ineffective herbs. Provide data that any natural "remedy" is effective at treating hypothyroidism.
MTA: If I seem harsh now I am, as I don't like the apparent twisting of what is being said to fit the "natural" agenda you seem to be pushing. I did not "choose a prescription over 2 hours of sleep"....I chose a prescription that would correct a diagnosed deficiency in my body and lift a chronic fog hanging over my work, family life, and generally anything that required me to have a modicum of energy. Yes, I chose a pill so when my little girl came tugging on my arm I had the energy to go play with her. I don't think still having the ability to run a 16:45 5K when sick means anything.
It's easy to throw stones when you haven't had to deal with it. For someone who has, it's about a lot more than 2min in a 5K, that's likely only one manifestation of this problem in the girl's life.
The Crap Whisperer
Being the best tiny spec that I can be!
Oh roo roooo!
When I was diagnosed with hypothyroidism my levels were 5.5. At that point I was barely able to function as my "normal" self. Running aside, I couldn't focus or concentrate and was falling asleep at my desk. I was worried about my job. My relationships suffered too. I was overly emotional and irrational...I felt depressed. I could sleep for 12+ hours and have to drag myself out of bed. I attributed all of this to stress. I finally went to the doctor when I started having female issues (another symptom) and after talking with her she tested my thyroid. I was treated with Levothyroxin and after a couple of months it was a night and day difference. My levels were down to 3.5 and I couldn't believe how bad off I had been without really realizing it. I will still wasn't feeling 100% and asked the doc to treat further and now I am down to 1.3 and feeling much better. Regarding my running...I trained for a couple of halfs through all of this but it was a struggle. Luckily I wasn't focused on time for those races or I would've been very disappointed. Anyways, Levothyroxin changed my life and I will gladly take that tiny little pill every morning. I hope this girl gets the treatment she needs soon.
This is exactly it--you have always felt like that and so you don't know that it's NOT how you're supposed to feel. I had struggled for years w/extreme sleepiness during the workday, lack of ambition and anxiety and depression but didn't realize any of that was not "normal." My TSH was 11 when I was finally diagnosed (no insurance for part of the time preceding this, and even when insured, no doc willing to look at thyroid issues, hence untreated for quite a while.). A synthetic thyroid hormone replacement is not the answer for everyone, and it's not the WHOLE answer for everyone, either, but it's a place to start. Unfortunately, some folks, like the one poster above, don't realize that replacing the thyroid hormone your body should be making but isn't is a whole different thing from the meds one might take for high blood pressure or high cholesterol.
Agree 100%. I was incidentally found to have a TSH of 4.9 - not really that high, and I was totally like "psh, whatever, I'm fine". Except for the minor fact that I also wound up needing to have my thyroid removed due to thyroid cancer (which I noticed because of running...long story), and thus didn't have a choice but to go on meds because I kinda don't have a thyorid anymore. And..wow...like others have said, you don't realize how bad you were feeling until you feel better. I was sluggish and had zero motivation for running over the summer, and looking back would definitely call myself depressed. I blamed it on the heat, laziness, poor training, weight gain...4 weeks out from surgery, I'm running (and feeling) better than I have been in months. TSH is 3.5 and doc wants to bring it down even further. I sometimes wonder how long it would have taken for me to be diagnosed as hypothyroid if the whole cancer thing hadn't happened...I definitely blew off the symptoms and attributed them to me just being a lazy POS. Not true. I'm not particularly HAPPY that I have to rely on taking a pill every. single. day. for the rest of my life, but I will certainly take that over the alternatives.
I also pretty much second spaniel's entire reply. Extremely well put.
This study indicates that thyroid level change can be exercise-induced, especially in cases of inadequate calorie consumption. The study better indicates changes during exercise than in the weeks or months after. Column 1 one page 833 probably gives the most relevant discussion.
http://www.nel.edu/26-2005_6_pdf/NEL260605A14_Ciloglu.pdf
My primary concern is that we may have tunnel vision on one symptom. Thyroid levels could be this way because of some other function of the pituitary gland, an endocrinological disease, or many other things, all of which are likely to just be symptomatic of something else causing the problem.
You used a broken arm analogy. I'm not saying that a problem should go unfixed. If the arm is broken, let's fix it. The difference between our arguments is more like this: Say I break my arm because I fall from a tree. My solution is to set the arm, let it repair itself, and avoid falling from heights. Another solution is to replace the bone with a steel bar so that I can continue falling from trees without breaking the arm. This solution does not address the original cause, nor does it prevent further likely collateral damage since I haven't ceased doing something destructive. If the thyroid is acting like it is as a response to something, then simply medicating it is an uniformed decision, though it may visibly work for improving running performance and reducing fatigue.
"You don't seek treatment until you know there is a problem." I haven't run a 14 minute 5k. In fact, I'm pretty fatigued when I do over 80 miles per week or when I try to do intervals twice in a week. Maybe I should have my thyroid checked. Sure, but I'm probably going to find about a million other things I could be doing better before I'm going to settle on it being something out of my control. Are we sure training, sleep, and diet are all in correct enough balance that we can begin to blame a symptom for being the problem itself?
I fail to see why anyone would not do their due diligence before putting a person on a prescription medication. It's funny to think that in an effort to keep my mind open to all sides of the issue, I'm now compared to Suzane Sommers. You asked me to name other natural remedies. Okay. Here they are:
1) Ideal sleep. Improves pituitary gland function.
2) Ideal diet. Increases the odds the thyroid gland will produce chemicals at their correct percentages and without going overboard.
3) Ideal training. Allows the body to optimally adapt to the stresses placed upon it.
I qualify these with "ideal" in each case because the proper amount of any is a boost while an improper amount is a detriment and it's very complicated to come up with what is ideal for each individual. If the girl is pretty sure it's none of these things, then okay, medicating might make the most sense out of her available options. I just ask that we make sure these basic things are thoroughly evaluated before medicating. Call me old fashioned.
Haile G receives treatment for asthma. Does that make me like him less as an athlete and ambassador? No. Spaniel had his thyroid treated. Does that make me like him less as an athlete and an RA poster? No. Galen Rupp has his thyroid treated. Does that make me like him less for getting the American record in the 10k or for being an all around nice guy? No. (Discussion here: http://www.letsrun.com/forum/flat_read.php?thread=1337043&page=0). Virtually everyone who gets medicated for it has a positive story.
I'd like to see more research about the standard deviation in thyroid tests for an individual based on sleep, diet, and exercise preceding a given test for it. I know I have weeks where I eat gallons of ice cream and get 4 hours of sleep per night while still training. I feel like crap. What would my thyroid test reveal? Now if I did everything right the next month and then took the test, how different would my thyroid levels be? What if I binged or avoided iodine? I can understand why the doctors would want to exercise patience in their testing before prescribing anything.
#artbydmcbride
I am going to side a bit with xenoplastic, only because the girl is still in high school, and I assume her own doctors know more about what they are doing than internet 'experts' with only their personal experience. Which while perfectly valid may only sound similar but may be quite different from the girl's symptoms and numbers the OP is talking about.
Runners run
This study indicates that thyroid level change can be exercise-induced, especially in cases of inadequate calorie consumption. The study better indicates changes during exercise than in the weeks or months after. Column 1 one page 833 probably gives the most relevant discussion. http://www.nel.edu/26-2005_6_pdf/NEL260605A14_Ciloglu.pdf
Thanks, that was interesting. I will look at some of the referenced articles when I have time.
However, the data really do not support your point. While it showed a statistically significant increase in TSH during exercise, this was from 1.69 to 1.89 which is not clinically significant. In other words you can reliably measure it in a study population, but in the context of a single patient that change has absolutely no meaning in terms of the way it will make them feel. I am sure an endo would be unlikely to even adjust a does if there was a 0.2 change in TSH from one reading to the next. The athlete in question's level is 3.5, a change of an order of magnitude greater over normal than what was shown in that study.
Nobody has said that if this is not thyroid-related those causes shoud not be checked....myself and at least one other thought to suggest anemia....however you still seem to be disregarding the antibody results. Certainly the TSH alone was not enough to be convincing but both together lend credibility. Villifying the OP as uncaring about the welfare of his athlete when he has presented such evidence to back up his specific concern, and not knowing what other avenues have been exhausted, seems unwarranted. Even the physicians consulted did not say that it was not a problem, only that they were apparently willing to wait for "complete failure" of her thyroid, which is what garnered the resulting response from many of us.
MTA: To sum it up, I guess, I have no issues at all with eliminating other potential causes (as I did). What gets me is the need to insinuate nasty motivations by this coach and her parents off very minimal information and assume they have not done these things and are up for a quick fix. I would have sounded much the same had I posted in the 6 months prior to seeing an endo, but anchoring on that would have ignored 2 years of other failed attempts at a solution (most of them non-medical).
I tend to agree. There may be more to the story than the coach knows (or cares to share). Maybe not, but maybe. The coach is not the patient, nor do I think that the coach is a blood relative of the patient.
But, 3 - 4 months seems to be a long time to get a 2nd opinion and with a couple of months for the new treatment to become effective, I can understand frustration from that perspective.
It may be that she'll have a rough season because it may take time to do all the proper testing.
The truth is that all of this 3.5, 5.5, and thyroid numbers being used has got me wondering what mine is. Never ever thought about it, and if I don't know (can't tell) how tired, depressed, or unmotivated I am, I have no idea whether I'm tired, drpressed or unmotivated.
But, if I were the parents, I would look into hospitals that invest in the lives of the child. We worked with Scottish Rite Hospital for Children here in Dallas, and they spent 9+ years working with us and never giving up on us until they found and treated the challenge properly.
But, 3 - 4 months seems to be a long time to get a 2nd opinion and with a couple of months for the new treatment to become effective, I can understand frustration from that perspective. It may be that she'll have a rough season because it may take time to do all the proper testing.
Endo wait lists can be that long. I think it took me nearly 3 months to get in...after I found one that would even take a new patient. And I live in a major metro area.
They seem to not want to take questionable or more minor cases....but GP's usually are not comfortable treating....so you are left between a rock and a hard place.