Hi. I'm new to the forum but have looked through the threads in this section and read the FAQs as background. I have also read quite a bit about hypothyroidism online (about, Mayo Clinic etc...).

Background
I just had my annual physical along with blood work. My TSH and T4 came back abnormal after being in the normal range for the last few years. TSH this time is 7.84 and has been 3.38, 3.46, and 3.65 for the previous three years. My T4 is 5.3 and was hovering around 6 previously.

I talked to my doctor on the phone today (I'm not scheduled to see her for a month) and she wants to start me on medicine for hypothyroidism. When I read about the symptoms it does kind of make sense (increased fatigue, memory decline, decreased motivation, joint pain, constipation all over the last six months or so). My numbers seem to indicate treatment is the correct course but I am somewhat anxious having never worried about my thyroid and now contemplating being on medicine for it for the rest of my life.

My Questions
-- Do my numbers clearly indicate treatment?

-- Could the test results be off because I've been drinking soy milk for the last month?

-- How does this happen all of a sudden? I couldn't find anything in the literature I read that satisfactorily answered this.

-- Could it be related to low-carb dieting?

-- Could the soy cause hypothyroidism?

-- Do I really have to stop eating certain things like fresh spinach for example?

Thanks for reading and also for your patience in dealing with someone who is new to the world of thyroid issues (no one in my family has this).

1) Yes, that is a quite high TSH. If you're feeling badly you should supplement your thyroid hormone.

2) Well... probably not. I don't know how strong of a thyroid supressing effect soy has, but I doubt it is that strong.

3) Autoimmune thyroiditis (Hashimoto's) is probably the answer.

4) No relation to low carb.

5) I doubt there has been much study between soy and thryoid. Its just briefly mentioned that some foods are goitrogenic but I've never seen it discussed as to how extreme the effect is.

There is however, a big relationship between thyroid disease and gluten intolerance.

6) No. Chances are your numbers are because of eating soy or spinach. Your numbers are probably due to an autoimmune reaction that is attacking your thyroid. Your doctor can test for the antibodies.

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Don't get upset over having to take the thyroid hormone. Its better than feeling horrible all the time!

-- Do my numbers clearly indicate treatment?
Absolutely yes. It feels saddening to face going on a medication for life, but the good news is, thyroid meds are cheap and you have a lot of options.

-- Could the test results be off because I've been drinking soy milk for the last month?
Not by that much, no.

-- How does this happen all of a sudden? I couldn't find anything in the literature I read that satisfactorily answered this.It's not usually sudden, but it does kind of sneak up on you, and worse, it tends to seesaw (hyper/hypo) when the thyroid is having problems, which is confusing (not to mention annoying).

-- Could it be related to low-carb dieting?
Very low-carb dieting may affect your production of T3, actually, which is a shorter-acting thyroid hormone. With a diagnosed thyroid problem, the recommendation is to keep your net carbs above ~50/day or maybe 60. If you go as low as 20-30 your metabolism may drag - this is why Atkins did not work for me, at least I think it is why. Possibly Atkins would work for me better now, since now I take T3 as well as T4.

-- Could the soy cause hypothyroidism?It can interfere somewhat and cause subclinical problems, but it cannot cause full-blown clinically diagnosed hypothyroidism. The isoflavones have an effect, but they aren't that strong. I mean, if you were downing a gallon a day or something, maybe it's worth going off the soy and retesting.

-- Do I really have to stop eating certain things like fresh spinach for example?No, but when you start on medication, you'll want to titrate your medication to fit your lifestyle. For example, you know that soy and cruciferous veggies have an effect; if you want to eat them regularly, do so, and the doctor will fine-tune your meds with some follow-up tests and you'll be fine. Perhaps your meds will be just slightly higher than if you didn't eat those things, or maybe it'll be the same anyway.

My T3 conversion process is broken despite my carb intake. :\

Thank you for the feedback. I appreciate it. It is helpful to hear from folks who have been there. One additional question I have after reading more on the forum and in other spots online:

-- Do most people find it difficult to find the right medicine/dosage?

I'm seeing so many posts, so much frustration around this topic...

It is tough for some of us. Others have no issue at all. For me, my body doesn't make enough T3 yet when I take it exogenously it tends to affect me too strongly in some ways. So, I'm just trying to figure out what to do. I'm lucky in that my doctor is really open to letting me try different things.

It gets tiresome having to have it tested all the time, but once you work out a good dosage, it tends to keep working for a good while. Still, it's best to check it every six months at least, even if everything seems fine.

Nancy LC, argh. Are you eating enough calories? Low cal can also slow down conversion (I think). For me, cycling carbs and cals (high/low) seemed to work best...keep that thyroid guessing!