This leads me to question whether the patient really has thyroid disease. She may have had blood tests and symptoms that were borderline or conflicting, and one doctor agreed to try empiric treatment to see how she would respond. I have done this myself for a number of conditions and patient complaints in practice. Doctors and laboratory tests are not perfect. Sometime the patient knows best and is the one to decide if treatment is helping. Her lack of response to treatment, however, strongly suggests she does not have a thyroid problem.
Even if our patient was impatient and didn't give the medication enough time, she could not safely and comfortably forego the medication altogether if her thyroid was underactive and not making enough thyroid.
What about the history of high blood pressure and exercise-induced symptoms? Does the patient still have high blood pressure (hypertension) and exercise-induced palpitations? What is her resting heart rate and blood pressure?
A history of high blood pressure and exercise-induced symptoms worries me about possible underlying heart disease -- which I presume our patient has already been tested for. One of the earliest signs of overactive thyroid can be a rise in the pulse rate at rest, and it can often be felt as palpitations or a rapid heartbeat with exercise. In that case, a specific type of heart and blood pressure medication is usually prescribed to slow the heartbeat in cases of overactive thyroid while the thyroid medication is taking effect.
These medications are called beta blockers, with generic drug names such as tenormin or propanolol. These often life-saving medications commonly have side effects such as mental cloudiness, lethargy, feeling slowed down and even depressed. If that happens, I often tell my patient to try taking them at night to avoid some of these side effects. I also tell patients they may tolerate them better if they increase the dose slowly.
What is her blood pressure now? Some patients with high blood pressure can safely stop their medications for long periods of time if they make the necessary changes to their lifestyle -- such as engaging in daily exercise, limiting salt intake, eating more fruits and vegetables and trying to limit stress or sleep problems. We call this a drug holiday. Unfortunately most people with high blood pressure eventually need the addition of some medication -- even with the healthiest lifestyle.
What is the underlying cause of our patient's weight gain and fatigue?
Our patient appears to work almost 24/7 and admittedly was not sleeping for days at a time at the onset of her medical problems. I know myself how important sleep is to my overall health. A good night's sleep of seven to eight hours a night is now known to be critical to good health, a strong immune system and even to maintaining a healthy weight.