Hot Flashes and Sluggish Thyroid

[SimplySagacious]

Originally Posted by suzy_q2010

There is clinical judgment involved in treatment decisions for people on the borderline at the extremes of ranges. There is no debate about the ranges, because those are set using statistical methods. The range is what it is for a particular lab using a particular chemical method.

If a patient has symptoms but thyroid function studies are completely normal then hypothyroidism is unlikely to be cause of the symptoms. I'm sorry, but it is extremely unusual to have a system with complex feedback mechanisms be working properly with normal test results and have the "body to not be utilizing the hormone correctly." If that were true, the body would not be able to respond to the hormone in medication, either - whether that is plain levothyroxine or desiccated thyroid.

Having symptoms "disappear" is not proof of hypothyroidism either, since many of the symptoms are very subjective and subject to a high rate of placebo response.

I never said it was proof. You are either being dishonest or obtuse. Test results outside the range aren't proof either. It's more complicated than that.

I am not going to relate every possible scenario or provide technical explanations in forum posts. Endocrine system problems are too complex for that, much of which is not even understood yet. Further, hypo itself is a symptom of an underlying cause. Replacement hormone is merely a treatment for that symptom. It doesn't treat the underlying cause.

Your argument is with the OP's doctor, and you are basing it on her anecdotal interpretation and recollection of events. I think all can see the irony in her not having a problem if replacement hormone is over-prescribed (which many believe it is, and is also an ongoing debate) --- as well as the irony in you distrusting the doctor based on her anecdote. There is no point is continuing this discussion with you regardless if it's coming from dishonesty or obtuseness.

[jaminhealth]

Originally Posted by SimplySagacious

I get your general point. Doctors are increasingly relying on numbers alone. Diagnostics require a more comprehensive approach than that. Your doctor took into consideration your history of trying antidepressants that didn't work and, no doubt, many other factors. If your symptoms had not disappeared, he would have stopped the medication and tried something else.

But mostly the doctor who finally helped me was from the old medical schools before labs were gospel. He was right up there with the older docs who worked with patients and symptoms. He worked PT into his 90's and he had a great following of patients who loved him. He saved me. And he was not money driven, he made ENOUGH for a nice life. I"ve been around so long that I know the docs who had their practices before the tech world (this stuff costs money) and those of today. When I need to go to a dermatologist, we have one in our town who is late 80's and he never put all the tech into this office, he knows his work. He keeps his costs down.

[suzy_q2010]

Originally Posted by SimplySagacious

I never said it was proof. You are either being dishonest or obtuse. Test results outside the range aren't proof either. It's more complicated than that.

I am not going to relate every possible scenario or provide technical explanations in forum posts. Endocrine system problems are too complex for that, much of which is not even understood yet. Further, hypo itself is a symptom of an underlying cause. Replacement hormone is merely a treatment for that symptom. It doesn't treat the underlying cause.

Your argument is with the OP's doctor, and you are basing it on her anecdotal interpretation and recollection of events. I think all can see the irony in her not having a problem if replacement hormone is over-prescribed (which many believe it is, and is also an ongoing debate) --- as well as the irony in you distrusting the doctor based on her anecdote. There is no point is continuing this discussion with you regardless if it's coming from dishonesty or obtuseness.

Test results outside the range are evidence of thyroid dysfunction. Subjective symptoms with no evidence of thyroid dysfunction are not. Those symptoms have long lists of potential causes other than thyroid disease, and if thyroid disease is not the cause then treating the symptoms with thyroid medication is potentially harmful because doing so would delay proper diagnosis and treatment.

The endocrine system, in particular the hypothalmic-pituitary-thyroid axis, is well understood.

Replacement therapy is used because it works and it's inexpensive. Treating the underlying cause may either not be possible or may be prohibitively expensive. It does not mean that physicians do not understand those causes.

OP found a doctor who gave her what she wanted. That's fine. Proselytizing about thyroid replacement therapy based on symptoms alone is not.

Originally Posted by jaminhealth

But mostly the doctor who finally helped me was from the old medical schools before labs were gospel. He was right up there with the older docs who worked with patients and symptoms. He worked PT into his 90's and he had a great following of patients who loved him. He saved me. And he was not money driven, he made ENOUGH for a nice life. I"ve been around so long that I know the docs who had their practices before the tech world (this stuff costs money) and those of today. When I need to go to a dermatologist, we have one in our town who is late 80's and he never put all the tech into this office, he knows his work. He keeps his costs down.

The treatment for many diseases used to be bleeding the patient. Would you want to go back to those days?

A reputable doctor now will not treat a patient for hypothyroidism without evidence that the patient is hypothyroid. Symptoms like fatigue and hot flashes, with no other confirming tests, are not sufficient evidence.

[jaminhealth]

SQ: I don't care about bleeding and I didn't go there. I'm talking about my thyroid experience.