Are you hypothyroid? I am. I was reading a book recently that literally called women to action to spread the word about hypothyroidism. Do you have any idea how common this is--especially in women? My opinion is that it is extremely under-diagnosed. The symptoms include weight gain, low heart rate, cold intolerance, cold hands and feet, mood problems, fatigue, brain fog, hair loss coarse hair, depression, abnormal periods, puffy face, and dry skin. What woman hasn't complained to her doctor about at least one or two of these?
Doctors are taught very little about hypothyroidism, its causes, treatment and lab tests in medical school. Basically we are taught to screen patients with a TSH if they have symptoms or are a certain age. If the TSH is 0.3 to 5.0, it is considered normal, and the patient cannot have a thyroid problem. If it is 5 to 10, the patient has subclinical hypothyroidism, and is not treated. If the TSH is 10 or above, the patient has hypothyroidism and is placed on Synthroid thyroid replacement. These lab values are printed on every lab printout for TSH results that I get. They are inaccurate and erroneous. In 2002, the American Association for Clinical Chemistry recommended changing the upper limit for TSH to 2.5; in 2003, the American Association for Clinical Endocrinologists recommended an upper limit of 3.0 mIU/L. I can bet your doctor doesn't now this. I didn't know this until a few years ago when I started having thyroid problems. I trusted the lab to tell me the normal range. Big mistake.
I realized at that time that most doctors don't have a clue about the nuances of hypothyroidism. We are taught in med school that it is very cut and dry. Treat for a TSH above 10. Treat with Synthroid (yes, specifically that brand of levothyroxine). At a TSH of 5 to 10, the disease is subclinical and should not be treated until it rises to 10. This makes no sense. The problem is that many patients have symptoms when their TSH is below 10 or even below 5. Subclinical is defined as "no symptoms." How can we call it subclinical when there are symptoms and we are basing the definition solely on a lab result? Again, this makes no sense.
I speak from personal as well as professional experience. I started having symptoms of a pounding heart, possibly palpitations, a few years ago. My TSH was 9.5. I was told this was subclinical hypothyroidism based on the TSH even though I was having symptoms and my pulse was low at 57. No, I am not an elite athlete with a remarkably low pulse. I was hypothyroid but told I didn't need thyroid replacement until my TSH was 10. So I guess I had "symptomatic subclinical hypothyroidism." I wanted to take Armour thyroid rather than Synthroid. Basically I organized my own regimen and then switched to a more integrative doctor.
The most common reason for hypothyroidism in women is Hashimoto's thyroiditis. This is an autoimmune disease where your body produces antibodies which attack and damage your own thyroid gland. This is what I have. I was told my antibody status was not important to know. Well, it is important. Wouldn't you want to know if you have an autoimmune disease rather than just ignore it? Most doctors don't know that it predisposes you to other autoimmune problems, especially Celiac Disease (gluten intolerance). This is important information as it can help you make changes in lifestyle, diet and supplements that may impact your disease. Knowledge is power.
I am now on a mission to help women (and their thyroids) be understood. If 24% of women 42 yo and older are on thyroid replacement, this is not a small problem. Hypothyroidism is under-diagnosed and ignored largely because it is a female problem. I can't help but think there is some latent bias at work here. Many of the symptoms are common female complaints often classified as whiny or hypochondriacal or normal aging. This is unfair. Often these symptoms are easily dismissed because they are common and vague. If you or a friend or loved one is experiencing these symptoms, get checked. Ask to see your numbers. If you are ignored, go elsewhere.
FYI: Mary Shomon, who is an advocate for hypothyroidism, has some excellent books about all this. Check them out.
I had an interesting conversation with a savvy patient the other day. She has experience in the healthcare industry, and we were having a lively discussion about the present state of American healthcare especially in light of the coming changes. We were discussing Western vs. Eastern models of health. In the West, we follow a Cartesian model which is disease oriented. In medical school we teach students to diagnose and treat these diseases. The orientation is largely aimed at identifying what is broken and what can be fixed. Eastern models take a holistic whole systems approach which tends to view the person as generally well; there is more right with the person's system than wrong. Our Western disease-laden approach creates dis-ease. Western doctors tend to see patients as their diagnoses. We are uncomfortable looking truly at the whole person. We are taught this from the start; as a student you are told,"Go check the labs on the post-op appy in room 205." (Appy is short for appendectomy.) You are your disease and/or your procedure. This extends all the way through to the insurance industry, which requires a diagnostic code and procedural code for billing and reimbursement. No, "worried well" (an actual code) will not get your doctor reimbursed, and you will likely get the bill for that visit. Does this make sense? Not to me. It's a big part of why I'm doing what I'm doing.
Anyway, back to my smart patient. She had an interesting take on one reason why modern Western healthcare keeps going down this path despite it being obvious that it doesn't work and will bankrupt us. Cancer. The Big C. We are all afraid of this, including doctors. Cancer is very real and no one wants to have it. She feels that one reason we are still running down the disease/dis-ease path is that we are all scared of cancer and need to keep spending more and more to test for it, treat it and cure it. Preventing it is not as sexy unless it involves a screening test like a PSA or colonoscopy. Now I'm not saying that screening tests have no value. On the contrary, they save many lives. But the crux of our healthcare situation is that we segment people up into their parts and the disease risk to those parts. We don't look at the whole being and try to prevent the problem adequately in the first place. I could just as well substitute obesity for cancer and discuss all the ways we could prevent this problem and all it's subsequent disease processes and diagnoses.
So now you can see why I put the word "whole" in my practice name. Wholeness is the thing we humans seek, need, crave. We are not the sum of our parts. We are not a list of diagnoses. We are whole beings from the time we are born until we die, and we should be treated that way.
Dr. Heather's musings about medicine, mindfulness and life.
Heather Krantz, M.D.
Mailing Address: P.O. Box 6913 Office Address: 1012 SW Emkay Drive
Bend, OR 97708 Bend, OR 97702
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