kicked out of practice

[wondering]

My parents have long suffered with Hypothyroidism and it took me to get my dad to go to a different Dr. to get treated and feeling better. Both him and my mom still see their PCP for general stuff. Well my mom had been going downhill lately with all the signs of Hypothyroidism and her recent bloodwork came back with..

TSH 1.55
Free T4 .9 (.9 -1.8)
Total T3 75 (60-180)

Her labs were emailed to her and I sent the following reply to her Dr. My parents just received a letter from this Dr. telling them he will no longer accept them as patients.

====
Dr. XXXX,

I am XXXXX son and would like to follow-up on her recent bloodwork that was emailed to her.

I am concerned with her Thyroid labs and am trying to understand your reluctance to provide her with Thyroid hormone replacement therapy in light of her low levels of T4, T3 and obvious symptoms. My understanding is you prefer to base treatment solely on results of TSH and hope you will reconsider this line of thinking.

Please bear with me… TSH is a relatively inactive hormone that’s primary, if not sole, purpose is to signal the Thyroid gland to release Thyroid hormones (primarily T4 and T3). Using TSH as the guide to whether or not Thyroid activity is low assumes that the Pituitary is functioning properly. Often, this is not the case, especially in older adults. Why then, not treat base on the levels of Thyroid hormones themselves?

Surely, you have patients on Testosterone therapy. When you decide whether or not to prescribe Testosterone to a patient do you not base on Testosterone levels instead of Luteinizing Hormone levels? The evaluation of Testosterone and LH levels together merely provide an understanding if the patient is primary hypogonadal or secondary hypogonadal. Whatever the cause… whether the issue is poor signaling to testes or inability of testes to produce adequate levels of Testosterone the result is the same – low levels of Testosterone requiring treatment. Why the different thinking when it comes to Thyroid? Primary or secondary Hypothyroidism is still Hypothyroidism

I am concerned we are treating a lab result and not a patient. A patient that is suffering. It is likely no coincidence that my mothers LDL has increased as her Thyroid levels have continually dropped. I truly believe my mothers health is being compromised by being left untreated as was my fathers for years.

Below are just a couple articles on why relying solely on TSH testing results in many Hypothyroid patients being left to suffer.

Hope to hear from you.

regards
XXXX

[DrMariano2]

Every physician has their limits to their knowledge. And each one can only go so far. Each physician generally will not go farther than they believe is safe.

When it comes to thyroid hormone treatment, how far any physician goes varies tremendously.

For example, I generally don’t go as high in dose as advocated in the book “Hypothyroidism Type 2 – the epidemic”, knowing what the interactions are and the risks are of high dose thyroid hormone. These days, I’ve found that don’t need to since there are many other things to attend to when optimizing thyroid hormone signaling.

Hostility toward a physician is generally not helpful.

In general, it is far better to move on and seek another physician if one is not satisfied.

[Author]

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