Challenges of hypothyroidism

This is the forum to discuss thyroid issues when talking with doctors.

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by JudithT on Mon Jan 30, 2012 1:40 pm

Re: Challenges of hypothyroidism

I'm a thyroid patient myself as well as being the British Thyroid Foundation's newsletter editor so I've experienced my own frustrations at times in talking with my doctors. But from my own experience I also know that most of them really want to help their patients, if at all possible.

Hypothyroidism, particularly, can be frustrating, so in the Autumn issue of the British Thyroid Foundation newsletter we ran a two-page series of interviews with endocrinologists about how they evaluate and manage particularly challenging cases.

-- The symptoms of hypothyroidism are nonspecific. Stay open to the possibility that your ʻthyroidʼ symptoms could be symptoms of something else.

-- Non-thyroidal causes may include anaemia, adrenal problems, autoimmune disorders, diabetes, parathyroid disorders (a high blood calcium can produce symptoms similar to hypothyroidism), vitamin D deficiency, and sleep apnoea.

-- Vague physical symptoms such as tiredness, lack of energy, mild depression and anxiety can be the result of negative life events. Talking with a counsellor may help.

-- If a patient has persistent symptoms that are typical of hypothyroidism, even if the TSH is less than 10 and other thyroid values are normal (i.e., subclinical hypothyroidism), our doctors agreed they would usually give the patient a trial of levothyroxine.

-- Most doctors will ʻtweakʼ the dosage if a hypothyroid patient on levothyroxine with high-normal TSH still feels unwell. Patients do however need to be aware that an increased dose may involve more risk of damage to the heart and bones. If the increased dose does not help, the cause may be something else.

-- T3 is prescribed in selected individual cases. There is however a potential for doing harm so it needs to be carefully monitored. The
present formulation also has limitations due to its short halflife. (Several of our experts mentioned that this could change if T3 were available in a 24-hour release version.)

As one of the doctors we interviewed said: 'The doctor needs to listen, examine, and if appropriate, investigate. The listening part is most important. Most diagnoses are made from careful historytaking, but besides that it is often crucial to have an insight of that person as an individual, their emotional response to their symptoms, and their expectations. Managing expectations can be a challenge. Usually such patients have seen a variety of other doctors, may have been given contradictory advice, and feel a sense of helplessness and desperation. I think it helps to explore their ʻagendaʼ and outline what an endocrinologist can and cannot do...'