Doctors tags

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Recently, after we watched a semi-scary movie about being suc­ke­red, a friend brought up my blog post of last July where I desc­ri­bed a terrifyingly-real horror movie.

The plot: stun­ningly con­vince hun­dreds of millions of indi­vi­duals world­wide that what is obvious, isn’t. i.e. it’s all in your head, you are ade­qua­tely trea­ted on Synth­roid, Levoxyl, Eltro­xin, Nor­ton, et al,  and not only that, we’ll ban­daid your con­ti­nuing pro­blems with more medi­ca­tions.

A second plot: also com­ple­tely hood­wink those with top notch higher medi­cal edu­ca­tions and expe­rience by chur­ning out the the exact same poppy­cock, and reward their stu­pi­dity with gifts.

The cen­tral villian: Big Pharma, follo­wed by the doc­tors who bought the lie

Exactly a year ago this month, Science Daily came out with an article, citing two York Uni­ver­sity researchers who esti­ma­ted that the U.S. phar­ma­ceu­ti­cal industry spends almost twice as much on pro­mo­tion as it does on research and deve­lop­ment, con­trary to the industry’s claim. In other words, the researchers esti­ma­ted that $57.5 billion in US dollars was spent on phar­ma­ceu­ti­cal pro­mo­tion in 2004 – the year they were stud­ying. Yes, I said BILLION.

Brea­king that down, Big Pharma spent appro­xi­ma­tely $61,000 per phy­si­cian in pro­mo­tion of their pro­ducts.  And they conc­lu­ded that both figu­res were UNDE­Res­ti­ma­tes.  In other words, they conc­lu­ded that the US phar­ma­ceu­ti­cal industry is marketing-driven rather than “life-saving”.

And adding fuel to the fire: most doc­tors believe every thrust of that mar­ke­ting. I recently par­ti­ci­pa­ted in com­ments with other won­der­ful patients in res­ponse to a DO/Endocrinologist, Dr. Tho­mas Repas, who has clearly bought the Big Pharma mar­ke­ting when it comes to levothy­ro­xine. You can read his posts and our com­ments here, here, and here.   Dr. Repas is exactly the kind of doc­tor who has  sta­rred in our horror movie, and the kind of doc­tor that patients have lamen­ted about for years.  Read the  Give Me a Break list of com­ments made by doc­tors, as well as further com­ments on the January 1^st blog.

But Dr. Repas is in good com­pany. Doc­tors have belie­ved the Big Pharma lie about T4-only medi­ca­tions, and against desic­ca­ted thy­roid like Armour, Natu­reth­roid, etc. for 50 years.  In the patient-to-patient  Stop the Thy­roid Mad­ness book, you can read about the first table­ting of Synth­roid in 1955 and the stra­te­gic and suc­cess­ful pro­mo­tion of T4-only, in spite of the fact that T4 was known to be uns­ta­ble for decades.

And today, more than 50 years later, very few of us have been untouched by the Big Pharma push for levothy­ro­xine T4-only treat­ment.  My own mother was suc­ke­red, and I was suc­ke­red.  And until patients star­ted to make a huge push for desic­ca­ted thy­roid treat­ment the last few years, nearly every sin­gle doc­tor around the world had been suckered.

We still have a way to go. But we’ll get there, bit by bit.

In honor of 2009,  a year we hope to see bold chan­ges in the medi­cal sys­tem, Stop the Thy­roid Mad­ness pre­sents the Fif­teen Most Anno­ying Phra­ses From the Mouths of Doc­tors. (Note that the word “Armour” has been used for sim­pli­city sake; any prescription-grade desic­ca­ted thy­roid pro­duct can be inser­ted there.)

Here’s rai­sing our New Year’s stem­med glas­ses to change!

15) I’ll see you in eight weeks.
14) Here’s a script for [insert any non-thyroid medi­ca­tion to ban­daid con­ti­nuing hypo symp­tom]
13) The free T3 lab test is not neces­sary.
12) Your symp­toms do not warrant a thy­roid medi­ca­tion.
11) You’re tired because you are [insert any label like “a mother” “meno­pau­sal”, etc]
10) That has nothing to do with your thy­roid.
9) I can find nothing wrong with you.
8 ) You need to eat less and exer­cise more.
7) Your TSH is too low.
6) The TSH test is [insert any posi­tive desc­rip­tion, like “a relia­ble mar­ker” or “sen­si­tive mea­sure”]
5) I do not believe in Armour.
4) Armour is [insert any nega­tive adjective/description like “uns­ta­ble” or “hard to regu­late”]
3) You’re depres­sed.
2) You are hyper.

.…and tah-dah, the #1 most anno­ying phrase that comes out of the mouth of a doctor:

1) You are normal.

Just as I was finishing up the post below about a short sum­mary on the Endoc­ri­no­logy Today web­site, I saw a link at the bot­tom of the page that inte­res­ted me.  It took me to a blog post on the same site from Decem­ber 10^th tit­led “Why can’t it be my thyroid?”.

And a slew of thy­roid patients around the world, as well as a gro­wing body of doc­tors,  would com­ple­tely disa­gree with this post.

Namely, a DO explains the pro­blem of patients arri­ving in doc­tors offi­ces with “innu­me­ra­ble pos­si­ble symp­toms of hypothy­roi­dism” inc­lu­ding “fati­gue, cold into­le­rance, dec­rea­sed energy, weight gain, depres­sion, hair loss, low libido, mens­trual irre­gu­la­rity and others.”

Yet, he bemoans, these patients have a “nor­mal TSH” which is “well within the nor­mal labo­ra­tory refe­rence range.” He also refers to their nor­mal free T3 and free T4, and sta­tes there is no his­tory to sug­gest pitui­tary dys­func­tion or that the TSH is unreliable.”

He then pro­ceeds to pat him­self on the back because he 1) will treat some patients with a high-normal TSH and other cli­ni­cal fea­tu­res,  2) he will treat to a low-normal TSH of less than 2.0, but like the good-boy-doctor, “still within the nor­mal labo­ra­tory refe­rence range” and 3) he will not induce iatro­ge­nic hyperthy­roi­dism, even if symp­toms per­sist. (yikes)

“Iatro­ge­nic hyperthy­roi­dism”??  Since “iatro­ge­ne­sis” refers to harm­ful medi­cal pro­ce­du­res, he’s pro­bably refe­rring to a TSH below the range, which in his mind, equa­tes to hyperthyroidism.

***Then comes the obser­va­tion that has made many thy­roid patients shi­ver, since so many doc­tors have said it: because he feels that adding T3 to T4 has more nega­tive results than posi­tive, he explains to his patients “that there may be cau­ses of their symp­toms besi­des the thyroid.”

THUD.

So here is my 6-point res­ponse to any doc­tor who might share these beliefs:

1) There’s hardly a thy­roid patient around who hasn’t had a so-called “nor­mal” TSH in spite of clear and obvious hypothy­roi­dism.  The TSH lab test fre­quently lags behind what is rea­lity in the body, and has been doing so since it’s crea­tion in the early 1970’s (see Chap­ter 4 in the Stop the Thy­roid Mad­ness book for his­tory).

2) Having a “nor­mal” free T3 and free T4 means nothing. It’s “where” the result falls in that range that means something. i.e. patients all around the world are noti­cing that having a free T3 mid-range or lower in the pre­sence of hypothy­roid symp­toms is usually a BINGO lab result poin­ting to hypothyroidism.

3) Exactly because doc­tors tend to dis­miss clear hypothy­roid symp­toms as “something else” thanks to a lousy TSH refe­rence range, a bur­geo­ning num­ber of thy­roid patients are falling into adre­nal fati­gue with its low cor­ti­sol, which ser­ves to mess them up even more.

4) A huge body of thy­roid patients who are on desic­ca­ted thy­roid hor­mo­nes (aka Armour, Natu­reth­roid, etc), and who finally have a com­plete remo­val of symp­toms with a nor­mal tem­pe­ra­ture and hear­trate, also have a sup­pres­sed TSH lab result, and not one iota of “iatro­ge­nic hyperthyroidism.”

5) When it appears that adding T3 to T4 is having nega­tive effects, the pro­blem is most likely adre­nal fati­gue that needs correc­tion, and/or low ferri­tin, NOT deci­ding that the symp­toms must be from another cause or T3 doesn’t work.

6) “Fati­gue, cold into­le­rance, dec­rea­sed energy, weight gain, depres­sion, hair loss, low libido, mens­trual irre­gu­la­rity and others” may be sha­red in other con­di­tions, but you are most likely mis­sing CLEAR symp­toms of hypothy­roi­dism, both in the undiag­no­sed patient with a so-called nor­mal TSH, or with a patient trea­ted with the lousy thy­ro­xine, which lea­ves most ever­yone with con­ti­nuing hypothy­roid symp­toms.

“I’m sorry. It IS your thy­roid” is exactly what patients need to hear.

I was infor­med today that a very popu­lar and well-liked doc­tor in Texas, who treats many hypothy­roid patients, was dis­ci­pli­ned recently.  And for what?  Under the column tit­led NONTHERAPEUTIC PRESCRIBING, it sta­tes:  The action was based on Dr. Lau­nius’ presc­ri­bing Adi­pex, Adde­ral and Armour Thy­roid to patients when such medi­ca­tions were not indi­ca­ted. www.tmb.state.tx.us/news/press/2008/101608a.php

Adi­pex and Adde­rol are both cen­tral ner­vous sys­tem sti­mu­lants, and I can’t com­ment one way or the other. But the men­tion of Armour thy­roid as “not indi­ca­ted” is poten­tially worri­some, espe­cially with simi­lar dis­ci­pli­nary actions brought upon well-liked and wise doc­tors like Peat­field and Skin­ner of the UK, Derry of Canada, and  Sprin­ger in the US – all who dared to make obvious symp­toms more impor­tant than ink spots on a piece of paper.

Take Kymm, a 45 year old woman.  She has mani­fes­ted hypothy­roid symp­toms for 15 years since the birth of her daugh­ter.  Yet during those entire 15 years, her TSH lab result has been com­ple­tely “normal”…i.e. hypothy­roi­dism has never been “indi­ca­ted” based on the typi­cal and wides­pread gold stan­dard of diag­no­sis: the TSH.  But she has never, ever been nor­mal with 15 years of easy weight gain, chro­nic depres­sion, thin­ning hair, rising cho­les­te­rol, and other clear hypothy­roid symp­toms. And she has in fact star­ted on Armour…and is soaring.

Kymm is not an oddity.  Thy­roid patients on inter­net groups report going years with a nor­mal TSH, no diag­no­sis, yet clear symp­toms which are igno­red by their TSH-obsessed doc­tors.   So their doc­tors may have avoi­ded dis­ci­pli­nary action, but did they truly prac­tise the art and science of healing??

How many doc­tors can I stran­gle with my bare hands?? Grrrrrrrrrrr.

Today, I am once again appa­lled and sad­de­ned by the end­less body of thy­roid patients who con­ti­nue to plum­met into the abyss of adre­nal fati­gue, day after day after day. And it just never needs to hap­pen if doc­tors would simply pay atten­tion and be infor­med.

Belinda is the per­fect exam­ple. She didn’t par­ti­ci­pate in thy­roid patient groups any­more, living her life hap­pily, because she thought her post-RAI thy­roid treat­ment was under con­trol, being on 2 grains of Armour for a year. But sud­denly, she felt the need to return to her groups and seek feed­back. Because she has become more irri­ta­ble and moody, has a hard time falling asleep, and feels fre­quently anxie­tal. Labs are redone, and she finds her­self with a slightly over-range free T3 and a very sup­pres­sed TSH. Her doc­tor deci­des to lower her thy­roid meds, which in turn impro­ves her insom­nia and anxiety, but weight starts piling on. She’s con­fu­sed and won­ders how she can find her balance bet­ween being on too little with unwel­come weight gain and being on too much with uncom­for­ta­ble anxiety and insomnia.

What Belinda didn’t get, and what her doc­tor didn’t get, is that Belinda had now joi­ned the dubious cama­ra­de­rie of those with adre­nal fati­gue, a need­less con­di­tion of over-stressed and under-functioning adre­nals. As a result, T3 in Armour starts to pool in the blood, cau­sing anxiety, insom­nia, and all sorts of low cor­ti­sol symp­toms. Thy­roid patients just like Belinda have to first dis­co­ver what is going on, then face the com­pli­ca­ted balan­cing act of trea­ting adre­nal fati­gue AND hypothy­roi­dism. And it’s a path that never nee­ded to happen.

WHAT IS POTENTIALLY TAKING YOU DOWN THE DIRTY-YELLOW BRICK ROAD TO ADRENAL FATIGUE??

1) Being undiag­no­sed, or being dosed by, the faulty TSH lab test and its dubious “nor­mal” range, which will leave you with lin­ge­ring hypothy­roid symp­toms. (Belinda’s 2 grains tells me she was being dosed by the TSH)
2) Being trea­ted by T4-only medi­ca­tions like Synth­roid, Levoxyl, Eltro­xin, et al, which end up tea­sing your adre­nals to work har­der to take up the slack of an ina­de­quate treat­ment.
3) Lowe­ring your expec­ta­tions of what “nor­mal” is. No, it’s not nor­mal to have less sta­mina than others, to be on an anti-depressant to ban­daid your hypo depres­sion, to feel col­der than others, to require fre­quent naps, to feel the need to avoid peo­ple, to be bothe­red by lights or noi­ses, to be told by those you love that you are too defen­sive or over-reactive…and so on.

I hope anyone rea­ding this comes to an unders­tan­ding that you can­NOT enter your doctor’s office as if you are ente­ring the throne of a god. Your doc­tor, no mat­ter how edu­ca­ted or dedi­ca­ted, may not have a strong unders­tan­ding of the role of adre­nal func­tion in rela­tionship to bad treat­ment via T4-only meds or the TSH lab range. You may have to bring this know­ledge to your doc­tor, or find another one who is either lear­ned, or open-minded. Because your chan­ces of having adre­nal fati­gue are huge if you are on T4, if the TSH is worship­ped by your doc­tor whether on T4 or desic­ca­ted thy­roid, or if you keep wal­king into the doctor’s office and hang your own know­ledge on the hook outside his or her door.

(See Deborah’s story about cea­sing to smoke with adre­nal fatigue)