Has Your Get Up and Go Got Up and Gone?
Are you tired of hearing that “nothing else can be done for you?” Are you tired of hearing “you are depressed and would feel better if you lost weight”? Are you tired of getting rushed in and out of your doctor’s surgery…each visit, walking out with a new prescription for one of your many symptoms and being given NO ANSWERS. Your medication dose increases/decreases…but you continue to suffer the effects of low thyroid function – but nobody listens?
So what’s important when it comes to diagnosing thyroid problems? Is it the symptoms of thyroid problems, family history, physical presentation, or should more or less weight be given to the serum thyroid function tests, i.e. TSH, fT3, fT4?
Before answering, let’s look at the patients’ and the doctors’ points of view.
In order for a patient to tell their doctor about their symptoms of thyroid problems, the doctor needs to spend time with them, as well as listen to their story.
But many doctors do neither, so it can’t be very important, right?
Patients may subconsciously be persuaded to feel that maybe it isn’t that important and take the doctor’s word or their actions as reasonable – and after all, doctor knows best – doesn’t s/he?
What about the doctors? They listen to patient’s problems all day long. Some problems are real, some are not and some are unfathomable. They don’t have time to sort out what’s real and what’s not, so, the best way is to rely solely on laboratory testing (because lab test never lie, right?).
So doctor and patient accept that the laboratory tests are the way to go.
This has huge implications for those with symptoms of thyroid problems. A huge problem of under-diagnosis exists for such patients when a doctor relies on TSH as the only marker for thyroid dysfunction. Truth be told, this test is very inaccurate and serves better as a secondary marker for the diagnosis of thyroid problems.
Far superior ways to assess thyroid problems are:
- symptoms of thyroid disease
- signs of thyroid disease
- family history of thyroid or autoimmune disease (especially your mother)
- low basal temperature upon waking
- Iodine deficiency So here’s the solution: Thyroid Patient Advocacy feels the time is long overdue for the medical profession to change their current way of thinking and are campaigning to get the current protocol regarding the diagnosis and treatment of hypothyroidism amended. In TPA’s efforts, all endocrinologists and GP’s are being urged…2. To use the following laboratory tests as a guide in the assessment and treatment of those with symptoms of hypothyroidism: TSH, free T4, free T3, TPO antibodies and Tg Antibodies. 4. To listen and give more credence to patients’ subjective reports of symptom continuance or resolution, rather than make laboratory results the sole guide in dosing. Moreover, TPA advocates that doctors should have freedom of choice in prescribing T4-alone, combination of T4/T3, T3-alone or natural thyroid extract.
- To start combined treatment at a safe low dose of T4/T3 synthetic combination, or, if thyroid extract is prescribed, doctors should familiarise themselves with the equivalence of this medication compared with thyroxine and begin treatment on an appropriate safe dose, adjusting the dose according to the patient’s clinical needs every few weeks.
- To screen patients with thyroid deficiency for low adrenal reserve, a condition that may be more common than generally expected. Patients with weak adrenals may have difficulty tolerating the dose of thyroid hormone they need, and may experience apparent “hyperthyroid” symptoms, even at low insufficient doses. In other patients with low adrenal reserve, the problem may be the opposite: the patient may remain hypothyroid even at higher doses of thyroid hormones. Thyroid hormones cannot normally be used by the cells and may instead build up too high in the blood, leading both doctor and patient to believe that a particular dose is too high and that the treatment doesn’t work. The solution to both problems is treatment of the low cortisol condition, prior to the thyroid treatment, or simultaneously.
- Once the diagnosis is made, it is again the symptoms of thyroid disease and physical presentation that are the ultimate markers of improvement. Laboratory tests are still unreliable on their own, and should serve as secondary markers (but be assured, thyroid function tests do have a purpose).