Letter to a Doctor Requesting More Aggressive Treatment

[Guest guest]

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> Amen, amen, amen.

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> Thank you for writing about our frustrations so well.

Well, if it's useful for anyone, I'll include a sort of template

version of my letter to Dr. nick here. Y'all feel free to use it

(you'll need to customize it) or any part of it if you like.

Gail

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Dear Dr. _____,

Thank you for conveying my test results and your recommendations for

my thyroid medication to me so quickly, as always.

I know arriving at an optimal therapy for hypothyroidism is often a

painstakingly slow process, and I definitely appreciate your

willingness to make my feeling well one of your most important

treatment goals, along with a reasonable TSH, etc., but I have been

experiencing the fallout from having felt unwell for so long, I am

writing to request that you consider a more aggressive treatment regimen.

Without belaboring the point, although I am not an established

orchestra conductor, I have no less need for optimal treatment. In

fact, here’s just one small example of how inadequate physical energy

affects my life. [i described a situation in my life] hence the

massive amount of guilt and self-recrimination, leading to depression.

Aside from that, there is my daughter’s experience of me as “Tired,

Grumpy Mommyâ€, lost job opportunities (I can be specific), marital

tension caused by not having the energy to keep house properly, and

other things that cause intense frustration and a sense of defeat and

exhaustion as I feel as if I am constantly, endlessly climbing uphill,

watching lost opportunities, tasks and people go neglected, and my

life go unlived around me. I believe my Psychiatrist, Dr. ______ would

agree that not only is my depression (largest factors on the Beck

Depression Inventory fatigue followed by self-criticism) secondary to

chronic lack of physical energy vs. a separate problem, but that he

has also known me to be a reasonable, rational, responsible patient,

one whose instincts and impressions he has come to trust. I hope you

will contact him if you think it useful.

In any case, I believe I am reasonably well informed as to the risks

of being over-medicated for hypothyroidism (bone loss, heart stress,

other symptoms of hyperthyroidism). I am also all too aware of the

suffering involved in being under-treated. Also, I’ve never, during

the entire course of my thyroid treatment, been anywhere close to

experiencing any symptoms of hyperthyroidism. In fact, the only days I

felt noticeably good were the first two days I was on synthroid with a

handful of days in between, yes, in the last few years.

Since you say that “the patient will let you know when they’re wellâ€,

and hopefully you are coming to know me as someone who does her best

to balance compliance and respect for your experience with trust in my

own knowledge of my body and assuming the ultimate responsibility for

my health, I would like to request the following. [whatever you want

to request] If there is another way we might work together that would

target the risk spectrum more towards overtreating vs. undertreating

but still be medically responsible, I am open to other ideas, but am

writing to impress upon you the urgency of doing something along those

lines if you are willing. The cost to me personally and to my family

is too great to remain undertreated for the present unless it’s

absolutely necessary. I was also under the impression a suppressive

range for TSH (to suppress growth and thyroid over-activity) was more

in the 0.1 range, not 1.0. Don’t we want to put my thyroid “to sleepâ€

in any case, not just aim for replacement? Many thyroid patients elect

to receive treatment from GPs in order to find someone willing to

prescribe Armour or use compounded T3 or be more symptom- vs.

TSH-focused. I would like to continue working with you if possible

because you are so knowledgeable in your area of expertise but also

open-minded, but at this point I would gladly risk sacrificing some

bone density in order to be able to function in my life a little

sooner, so I hope we can reach an understanding.

I have always appreciated your kindness and your patience in taking

the time to talk at length with me about issues related to my care as

well as well as your considering me feeling well as a primary goal of

treatment. Thank you for reading this.

If you’d like to talk with me about this, I do my best to be available

via phone all evening and tomorrow during the day. I look forward to

hearing from you!

Sincerely,

Your name, [add any professional credentials here]