Doctors: This is How You Kill a Thyroid Patient

Find out about some of the crucial mistakes doctors make regarding thyroid diagnosis and treatment.. istockphoto

Doctors are human. Just like your patients, you make mistakes. You feel impatient and rushed. You feel frustrated. You don't know everything -- you can't -- and may feel uncomfortable acknowledging that. But in the roller coaster ride that is medical care, you have the power. You can cure, you can heal, you can help. But sometimes, you make things worse, and you can even kill a patient -- both literally, and figuratively.

To the doctors out there who need some cautionary advice: this is how you kill a thyroid patient.

1. You Don't Listen

A middle-aged woman comes into your office complains about weight gain, fatigue, anxiety, and depression. Half-listening, you hear "fat, frazzled, and forty." You reflexively reach for the prescription pad, and send her off to the pharmacy for an antidepressant. You're not listening. That woman is telling you about physiological symptoms that could very well point to an undiagnosed case of thyroid disease, or other conditions. As far as thyroid disease, it is not treated with antidepressants. Miss the diagnosis, and your patient is likely to gain more weight, get even more tired and anxious, and her depression won't get better - it will probably get worse. Wait long enough, and she might even go into a myxedema coma, or even die.

Or a woman complains that she has a feeling of a "lump in her throat." She seems anxious and stressed.

After a cursory examination, you decide that it's "globus hystericus," a psychosomatic symptom of neurosis, and send her off to a psychiatrist. Too bad you didn't order an ultrasound, that might have detected the cancerous thyroid nodule pushing on her esophagus, the tumor that is there, growing, potentially spreading, maybe even threatening her life -- but not visible to you or palpable.

2. You Are "Under the Influence"

Every week, the drug reps show up in your office, with lunch trays, mugs, pens, prescription pads, drug samples, brochures, little plastic models of the thyroid gland, and pitches about the benefits of the drug they sell. And when you allow them into your office, you rent them space in your brain, and in your decision making process. Research shows that even accepting a cheap coffee mug can change your prescribing habits. That means that instead of making decisions based on your knowledge, based on what's best for your patient, based on science -- you are "under the influence,", and basing your medical decisions on a feeling of obligation for what...a coffee mug? Put your obligation back where it belongs: the patients, and make the decision, like some ethical doctors, to ban drug reps from your office, and to refuse freebies from drug companies.

3. You Are Behind the Times

I'm sure in medical school you heard the story of Ignaz Semmelweis. He was the doctor who realized that the simple act of a doctor's washing his hands before delivering a baby could greatly reduce post-partum infections and maternal mortality.

Semmelweis was laughed at by fellow doctors, and was committed to an asylum. Only after his death was his profound discovery accepted.

Then there was the longstanding idea that ulcers could be cured by avoiding spicy foods and drinking milk. Some doctors did not accept that, and prescribed antibiotics to patients to treat ulcers. They were laughed at by other physicians, even as their patients got better. Then, in 2005, Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine for discovering that peptic ulcers were primarily caused by the Helicobacter pylori bacteria, and that antibiotic therapy was the appropriate treatment.

And in the field of endocrinology, there was the whole debate about diabetes. Years ago, integrative physicians would check fasting glucose levels, and if the levels were above 90, they classified patients as "pre-diabetic" or "insulin resistant," and recommended dietary changes and exercise to prevent progression to full type 2 diabetes. Meanwhile, endocrinologists said that the cutoff for diabetes was 120, and if a patient had a level of 119, they were often sent away with no advice or information, except to come back when the level was above 120 and they were officially diabetic. "Pre-diabetes" was not recognized as a condition, or as a risk for full diabetes. Until it was, but only recently.

The point? What is accepted as medical fact is not fixed in stone forever, and as new things are discovered, after the "behind-the-times" medical establishment vilifies them, the "facts" can change. As Mahatma Gandhi said: "First they ignore you, then they laugh at you, then they fight you, then you win."

There are a number of similar situations currently facing thyroid patients.

Science, practice, and guidelines take time to catch up to actual knowledge. Don't be behind the times.

4. You Don't Understand Hypothyroidism in Pregnancy

Dana Trentini, HypothyroidMom, was already a thyroid patient and a mother when she again became pregnant. She told her doctor time and time again that she didn't feel well, but the doctor assured her that her TSH level -- sometimes going as high as 10.0 -- was fine. Dana suffered a miscarriage. Her doctor was absolutely 100% wrong, and the bad advice she received could be the reason that Dana lost that baby. Dana has transformed her own tragedy into a mission to help educate other women, as she explains in this post from her blog. Bottom line:

Unfortunately, the majority of endocrinologists do not know how to manage thyroid disease during pregnancy, and the majority of obstetricians do not know how to manage pregnancy in thyroid patients. Medical world: here's your wake-up call. Babies are dying, or having cognitive problems that affect them throughout their life, because you aren't doing your homework.

5. You Rush to RAI or Surgery

The man who comes to see you is losing weight, can't sleep, feels anxious, and has diarrhea. He certainly does look hyperthyroid, right? So you run a TSH test, and his levels are very low. Your recommendation? Radioactive iodine (RAI), to permanently ablate the thyroid gland, and make the patient permanently hypothyroid. But did you check antibodies, to determine if the man has Graves' disease? Have you also run Thyroid Peroxidase Antibodies (TPO) to see if this fellow actually has Hashimoto's disease, and is having a temporary "Hashitoxicosis" hyperthyroid phase that will eventually resolve itself and return back to normal, or even hypothyroidism? If you do confirm that it's hyperthyroidism as a result of Graves' disease, have you considered using an antithyroid drug, which can result in remission in as many as a third of patients? Unfortunately, some of you don't. You just rush them to RAI, and these patients end up permanently hypothyroid, with all the symptoms and complications that an underactive thyroid can create, when they might have been able to achieve a remission.

Or, your patient has a suspicious thyroid nodule. You perform a fine needle aspiration (FNA) biopsy, or the patient has one done. The result is inconclusive, indeterminate -- they can't say it's thyroid cancer, but they can't say it's benign either. Next step? You send the patient off to the surgeon, to schedule a thyroidectomy. The patient has to undergo a surgery, the thyroid gland is removed, and the gland is sent off for pathology evaluation. And... in the majority of these suspicious nodules are benign. Now, your patient is permanently hypothyroid, missing an essential gland, and reliant on thyroid hormone for life. Why don't you know about the Veracyte Afirma Thyroid Analysis Test, which virtually eliminates almost all inconclusive or indeterminate results, and therefore, eliminates most unnecessary thyroid surgeries?

Doctors: This is How You SAVE Thyroid Patients!

Please listen to patients. They have information to share that can help you make a good diagnosis, and offer effective treatment. Get rid of the drug reps, mugs, pens, and other doodads, and make better decisions about what's really good for your patients. Keep up with the times, and don't think that everything you learned in medical school is not going to change. Learn about how to manage hypothyroidism and pregnancy, to protect the mothers and their babies in your care. And for goodness sake, stop rushing patients into RAI and surgery, without doing your due diligence.

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