The under-diagnosis of hypothyroidism
DrRich posted a report on the under-diagnosis of hypothyroidism (underactive thyroid), which led to this exchange:
From: HeartDisease.Guide
To: All
A recent article in the Annals of Internal Medicine points out that there are probably 13 million Americans with undiagnosed hypothyroidism. Most of these are women.
When I was in medical school lo those many years ago, I was taught that thyroid function studies were to be part of the routine admission orders for any person (especially female-type persons) over the age of 40. Unsuspected hypothyroidism was something I saw fairly often. Now in the era of cost-containment, HMOs, and not looking for problems that aren't immediately biting you in the butt, all these individuals are going undiagnosed.
The problem with failing to diagnose subclinical hypothyroidism is that it can cause heart disease (among other problems). Probably because hypothyroidism increases cholesterol levels, people with chronic hypothyroidism are twide as likely to have heart attacks as those with normal thyroid function.
In my humble opinion, any woman with high cholesterol levels should insist on thyroid function studies, including a TSH level, even if the doctor initially says no.
DrRich
From:Cynaburst
To: HeartDisease.Guide
I just thought I would add my two cents here. I went undiagnosed with Hashimoto's disease (auto-immune thyroid disease) for several years because my TSH hadn't gone out of range yet. It seems that most doctors think that anywhere in the normal range for TSH is fine, when in fact, there are other indicators of thyroid disease, for example testing positive to antibodies, or low free T-4 and free T-3 levels.
I had to wait to get diagnosed until I came back from my honeymoon in Australia and the whole time I was travelling I was on the verge of collapse. My TSH was up to 9.35 and and I felt like I was going to die at any moment. It would have been much better if I had been properly diagnosed when I began showing signs of hypo 7 years before.
Anyway, point being, my cholesterol had been on the rise, and there was no further investigation done until I was in BAD shape, so the moral of the story is that Drs. should dig deeper and pay more attention to other factors besides TSH
From:HeartDisease.Guide
To:Cynaburst
Thanks for telling your story.
The real problem is, doctors are largely unaware of the magnitude of undiagnosed hypothyroidism, or of the problems it can cause, and are thus not motivated to "dig deeper" (even if they're motivated to dig at all.)
So, like many areas in medicine today where subtlety is the rule rather than the exception, unless the patient is insistent the diagnosis will likely be missed until overt problems develop. The best defense in these cases is the education of the individual who's most directly affected - the patient (or potential patient.) If you think you MIGHT be hypothyroid, INSIST on having the tests done.
DrRich
From:Marlysann
To: HeartDisease.Guide
I think we shouldn't give ALL doctors a bum rap here. I was diagnosed this past summer, from a routine physical. My TSH was 10.47......I'm on synthroid and now my TSH is .14 (lab of .38 - 6.15) My doctor says this is where he wants me. I go to a PCP and I think he did a good job of discovering why I was so tired.....a TSH is a regular part of their complete physical. I think more clinics should include it....sure glad mine does.
From:HeartDisease.Guide
To: Marlysann
I'm not trying to give all doctors a bum rap. After all, some of my best friends are doctors.
I'm simply pointing out a truth: docs have been pressured into all kinds of "cost saving" behavior, and some things that used to be routine EVERYWHERE (like checking thyroid function in women over 30) are no longer done. By pointing this out, my hope is that some individuals who do not have enlightened PCPs can help themselves.
That PCP of yours? Hang on to him for dear life - even if he's tossed off the physician panel of your health plan for his "wasteful practice style."
DrRich
Come on in! The forum's fine!
