Re: Re: Improper termination of medical investigation of hypothyroid symptoms

[Guest guest]

couple of comments/thoughts - feel free to use or ignore!

Gill

I have written the following to send to this doctor. If you think this is OK, I will send it. If alternations need to be made, please let me know asap.

luv - Sheila

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Dear DoctorSadly, my Internet Hypothyroid Support forum (and other UK forums) is made up of members who have been failed by the NHS and they are being given no diagnosis. What is obvious to "good doctors" is so novel to others that it's regarded as heresy, and their patients are treated accordingly.

The majorioty of my members report that when they visited their GP complaining of many symptoms, they were given a (should this be TSH - that's all I got) thyroid function test only without any symptoms, examination, signs, questions being taken into consideration. If TFT's (TSH?) are returned within the normal reference interval - they are told "you do not have a thyroid problem, the blood test shows thios", and they are dismissed. Alternatively, patients are sent to various specialists, which have included psychiatrists, physicians, gynaecologists and rheumatologists at an average cost under PBR tariff of £160 per visit, frequently resulting in a further consultant to consultant referral to endocrinology at yet further cost.

This comes mainly from the BTA and the Society for Endocrinology, when they wrote on their website :"The Clinical Committee of the Society of Endocrinology and the British thyroid Association recommend the use of sensitive and specific blood tests as the only method for the precise diagnosis of thyroid dysfunction and for the monitoring of treatment with appropved medications". I have received strong and clear affirmation from the members within my forum (almost 700) that (according to most doctors they have seen) there is only one way to interpret the BTA statement: and that is that blood tests are ONLY required to reach a diagnosis.

Because I know that doctors follow to the word the recommendations laid down by BTA, I wrote to Professor A Weetman (ex President of BTA) asking if they would add to their statement "...nevertheless, regard must be taken of other signs and symptoms, including a full clinical examination presented by any potentially hypothyroid case" as this is the recommdation laid down by the DoH and the GMC. His response was "... the GMC has very clear guidance on history taking and, where necessary, examination in Good Medical Practice, available through the website of the GMC. All doctors should comply with this guidance and it would be tautologous for the BTA to repeat this fundamental advice". Until this is added to the statement on the BTA website, thousands of sufferers of hypothyroid disease or its mimics will remain undiagnosed and untreated, doctors will carry on reaching a diagnose by TFT's only (but I do appreciate, not the "good doctors), and patients will continue to suffer unnecessarily. The work of TPA-UK is made difficult when we find yet further misleading and incorrect statements on the BTA website , e.g. their statements on Armour Thyroid and synthetic T4/T3 combination therapy, because doctors are taking these statement as fact. TPA-UK asked the BTA to amend their website according to the facts that were sent which cited almost 300 references. The BTA have not had the courtesy to acknowledge receipt, neither have they, 6 months later, changed one work of their misleading and incorrect statements on their Website - such an organisation should be seen to be working with patients, and any statements they make should be backed up with the necessary citatitions.

Yet further concern to patient organisations is the article written by Professor A Weetman (ex President of the BTA), published in 'Clinical Endocrinology' and 'Medscape Students' where he wrote "The majority of patients who demand thyroid hormone treatment for multiple symptoms, despite normal thyroid function tests, have functional somatoform disorders", Pritchard wrote the short paper entitled "Improper Termination of Medical Investigation of Hypothyroid Symptoms" in the hope this would be helpful to those doctors who are not aware (and there are many) of the mimics of hypothyroidism, and that they must not terminate further medical investigation if blood results are returned within the normal range, until they have found the cause for the symptoms their patient is suffering.

I am not medically qualified, but I am being forced into a position where I am trying to help hundreds of sufferers because of a massive failure by doctors to recognise this disease and its mimics. Unfortunately, even though I appreciate there are excellent doctors and endocrinologists, there are also many doctors who do not appear to care about their patients and who are not interested in keeping their professional skills, or their research up to date. I am sure you are protective of the people in your profession, as I am protective of the people left to suffer. I am working at the "pit-face" so to speak, and deal with hundreds of people suffering from this insidious and debilitating disease on an everyday basis.

Kind regards,

Sheila

www.tpa-uk.org.uk

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Effectively all he is saying is that one should not diagnose someone with psychosomatic disease without considering other possibilities (hypothyroidism or otherwise). No good doctor does this. Improper termination of medical investigation of hypothyroid symptomsDear DoctorI have attached a short, but interesting paper written by Pritchard (a US Researcher) which we feel would be of benefit to all medical practitioners. We would be pleased to receive any comments you feel would be of interest.Many thanksSheilaThyroid Patient AdvocateAOL Email goes Mobile! You can now read your AOL Emails whilst on the move. Sign up for a free AOL Email account with unlimited storage today.No virus found in this incoming message.Checked by AVG - http://www.avg.com Version: 8.0.169 / Virus Database: 270.6.18/1658 - Release Date: 07/09/2008 15:30

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[Guest guest]

Thanks Gill - I have added your comments. I have left the TFT's but added that many doctors test TSH only. Will see if there are more comments before I send it.

Luv - Sheila

Improper termination of medical investigation of hypothyroid symptomsDear DoctorI have attached a short, but interesting paper written by Pritchard (a US Researcher) which we feel would be of benefit to all medical practitioners. We would be pleased to receive any comments you feel would be of interest.Many thanksSheilaThyroid Patient AdvocateAOL Email goes Mobile! You can now read your AOL Emails whilst on the move. Sign up for a free AOL Email account with unlimited storage today.No virus found in this incoming message.Checked by AVG - http://www.avg.com Version: 8.0.169 / Virus Database: 270.6.18/1658 - Release Date: 07/09/2008 15:30

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[Guest guest]

From what I understand we are complaining about doctors getting a normal TSH and NOT investigating further. If they are sending patients to psychiatrists, physicians, gynaecologists and rheumatologists then they are investigating further.

Are we complaining that doctors just dismiss the symptoms and just offer Prozac and do not investigate further or are we complaining that they do investigate but should not just accept the diagnosis of hypothyroidism.

It could be that it would be wise to investigate all the symptoms if a full TFT were done and found to be normal and if it is then found to be none of those things, to go back to considering thyroid, not automatically say there is nothing wrong and all in the mind.

The symptoms of hypothyroidism, as is often said, mimics other illnesses. Would it not be feasible to investigate those other illnesses as well just in case and eliminate them before thinking again about thyroid.

Lilian

[Guest guest]

I understand what you are saying , I was merely pointing out that the argument about the cost of sending someone to various specialists when they need thyroid treatment (as amended by Gill) is a contradiction in Sheila's letter. It is a valid point to be address at another time to different people but not, I think, in this letter.

In Sheila's original letter where she sent a copy of your paper, she is saying that doctors are not following up when there are non specific symptoms.

The doctor replied that good doctors do.

Sheila's answer is meant to convey that they do not. If she adds the bit about sending patients to various other consultants, then surely the doctor would wonder what the point of her letter is in the first place.

If the amendment about sending to various specialists is added to Sheila's letter it would read in the first part she is complaining that doctors DO NOT follow up and in the second part she is complaining that they DO.

The fact that they send people to the wrong specialists when they should be delving more into hormones is more a matter of medical knowledge than medical practice.

Lilian

[Guest guest]

I agree with Lilian, and have taken that out. It would confuse the doctor. A good point.

Luv - Sheila

In Sheila's original letter where she sent a copy of your paper, she is saying that doctors are not following up when there are non specific symptoms.

The doctor replied that good doctors do.

Sheila's answer is meant to convey that they do not.

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[Guest guest]

Typo's put right now, I copied that from my response direct to the doctors Email addy and for some reason, the spell-checker wouldn't work for me. I have put this into Word now and it has worked fine, so thanks all of you who pointed out the spulling mistooks.

Luv - Sheila

Hi Sheila, nice letter, couple of nit picks- I saw a typo in para 2. I too only got TSH - it was very high, but I only got it because I told doc I had family history- I got the depressed diagnosis

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