I love my job. I sit and listen to peoples' stories and try to make sense of all their problems amidst a sea of irrelevent or minor symptoms.
Sometimes I get confused, and blood tests frequently don't help at all.
Take thyroid disease, for example. The textbooks teach that the level of circulating thyroid hormones (which are called T3 and T4) are inversely related to the Thyroid Stimulating Hormone (TSH). If your T3 and T4 are low, your TSH will be high: this suggests an underactive thyroid gland. If the T3 and T4 are high and the TSH is low, then you have an overactive thyroid gland. That's easy, huh!
Well, I was very confused the other month, when a lady turned up with a highish TSH and T4 and a normal T3.
Now that doesn't make sense to me. I spoke to a colleague at the hospital and it didn't make sense to her, either!
So I did what Jobbing Doctor is best at........nothing.
After a month I saw her again, and she is pleased I hadn't changed her treatment. The reason was that she knows she's on the right treatment, as her legs have started to get hairy again, and her eyebrows are growing.
Pah! Who needs blood tests!
.jpg)
8 comments:
did you question her compliance? I thought results like these suggest that they have only taken thyroxine regularly just prior to having the blood test, hence the negative feedback control of TSH hasn't had time to take effect. Her symptoms may be better now because she is actually taking the thyroxine.
A really good point, but I have known her for 20 years and have no reason to doubt her compliance.
Thanks for the suggestion.
JD
JD
I agree with anon, only compliance and amiodarone likely to cause this.
What i usually do is just keep checking until you get a normal reading then stop checking until next year!
Another possible cause is recently starting thyroxine or increasing the dose. TSH takes several weeks to respond to T4 levels, so this can cause the pattern you've described. Your desciption of the lady's hair having grown back suggests to me one of those situations might be the case.
Another possibility might be "unwitting poor compliance" - if she was innocently taking other medication at the same time or some other factor has been interfering with the uptake.
Finally, something to bear in mind in the case of inconsistent results for any immunoassay test is interfering antibodies, though that seems unlikely in this particular case as her results are now in range.
Docdoc
Why do doctors always blame the patient instead of questioning the validity of the blood tests?
You'd be better off asking the patient how they feel instead of blindly relying on unreliable TFTs.
I was very interested to find this story, thanks to a website which helps hypothyroid patients like me.
Sadly, there are thousands of patients like myself who are having to resort to self-medicating with natural thyroid because our GPs are relying on a TSH test to tell *us* that our thyroxine levels are fine, when we are still presenting with hypo symptoms, despite taking Levothyroxine.
Instead we get saddled with all sorts of other drugs to cure our ailments when a simple "listen to the patient and diagnose by how they feel" would be much better, ie. deal with our thyroid issues properly.
Did you know that the RCP has condemned hypo patients to a life of misery by stating that only T4 meds are allowed to be prescribed? We're not "one size fits all", so why are we being treated as if we were?
Just wanted to say that I have since found your previous post from 2008, which elicited some strong responses.
Let me say now that I appreciate all the work GPs do, and I don't blame them at all. After all, you are General Practitioners, not specialists. I think we are just railing against a system where some of us don't even get to see a doctor (most of my recent consults were done via the phone), and when we do see one, we don't feel they are really listening to us.
What I'd really like is for the RCP and NICE to allow us the opportunity to try alternative treatments such as natural thyroid - I'm even prepared to pay a prescription fee to get it!
I think it's fabulous that you're open to working with your patients that way (i.e.- listening and working with them as opposed to (not) listening and issuing orders). I, also, was referred to you and found this interesting! Luckily, here in the U.S., patients are really creating a change for thyroid issues and becoming much more vocal and involved in their treatment, changing the way many of us relate to our doctors. If you get the chance you should check the website out. While (unfortunately) natural thyroid has been black-listed there, there IS an OTC T3 supplement from New Zealand you may be able to get... RLC Hypo Support. Always something to look into. www.stopthethyroidmadness.com
Congrats, again!
Post a Comment