Hypothyroidism: Is It Possible or Probable? Part 3

Time to finish up this segment, but first a quick recap.

It all starts with your doctor's ability to pull out useful information from research and textbooks to know what to look for to make a confident diagnosis of hypothyroidism. They can add to their level of confidence by performing a good history, a full exam and necessary testing. This will give you and your doctors clues to what might be causing it, what to do about it and how to see if things are getting better.

OK, example time.

While there are many different presentations that a person with hypothyroidism can show, we are going to keep it simple here. 3 women all come in with fatigue, stubborn weight loss, painful joints, signs of thinning hair, normal TSH levels and were told that their thyroid was not the problem (as indicated by their lab work). They were given pain meds and told to eat less and exercise more.

All 3 women go for a second opinion, which they get after a good history and full exam were performed.

Woman #1. Her problems started after she gave birth to her first child. She is a long time soy milk drinker, eats microwaved dinners for lunch at work, long time birth control user, irregular menstrual cycles, and states that her breast are tender to the touch.

She might need some hormonal testing. It is "probable" that her issues are stemming from an estrogen imbalance, so steps in reducing any excess exogenous estrogen intake and making sure that her elimination system is working as needed would be a great place to start.

Woman #2. She says that her problems have been a gradual progression. She is a type A personality, gets stressed at work and home and only has time for a coffee for breakfast. She took her last doctor's advice and eats 1200 calorie diet and jogs for 1 hour 5 times per week. She did loose weight according to the scale, but she feels that her belly fat has actually increased.

She might need some testing for stress hormones. These can really limit the ability of the thyroid to produce hormone, as well as for that hormone to be utilized. She would need to make some major life changes (including the diet and exercise program) to better manage levels of stress.

Woman #3. She claims to drink tap water, use fluoride toothpaste, only really eats salads and salmon to try to loose the weight and has dental fillings.

She might need to get testing for heavy metals. These also can disrupt the thyroid and thyroid hormone. Getting rid of the fillings, eliminating outside sources of toxins and ramping her body's detoxification system would be a good start here.

All 3 woman have very different stories, but the same symptoms. While non of them are textbook hypothyroidism, all are suffering from direct and indirect influences causing what should fall under the blanket diagnosis of hypothyroidism (but you can call it whatever you want). Wouldn't it make sense to address those problem areas that are affecting the thyroid? Most treatment programs are geared towards just the thyroid. If you ask me if I think that would work, I would say it is possible, not probable.

To treat every person with the diagnosis of hypothyroidism the same would be a mistake. To rule out thyroid problems because of normal TSH lab test would be a mistake as well. By truly understanding what is going on with the individual, you are truly working from probability instead of possibility.

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Hypothyroidism: Is It Possible or Probable? Part 2

Let's pick up where we left off last time. We were looking at how a doctor decides to make a diagnosis of hypothyroidism by gathering information from research articles. This happens despite the fact that doctors are not very qualified to analyze the quality of the study from which they are gathering the information. Just as many people take a blind leap of faith in their doctor, your doctor is a taking a blind leap of faith in the research team that performed and published the study.

So how can you feel comfortable that a doctor can make a diagnosis with a high confidence of probability? By following some very fundamental rules of making a diagnosis:

1. The human body is a closed, contiguous system. Everything has some effect on everything else. Though an easier route to take, you should not look at individual parts of the whole (concentrating on a "problem thyroid gland" instead of looking at how the thyroid gland is affected by other parts, as well it affects other parts).
2. A single physical exam finding, lab test, symptom, etc. means nothing on its own. Gathering all the pertinent information will develop a better picture of what is truly going on in the person (making a diagnosis on a low TSH without correlating it with other findings is diagnosing from possibility, not probability).
3. Most people don't follow the textbook. Doctor's study disease processes (pathology) and are looking for a certain presentation that a person with a certain disease "should" have. This is rarely the case. Most people have only portions of what they "should" have according to their diagnosis, along with some extra findings that don't exactly fit the mold.

If your doctor always keeps these things in mind, s/he will turn over more rocks to uncover significant findings, relate it back to the entire person and piece them together to come up with the answer to the most important question of them all..."So what's your story?"

Once your doctor knows "your story," they can make their diagnosis from a standpoint of probabilities.

One final note: I said last post that I was going to making things more clear, while I kind of rambled on without giving an example. I promise to be behave and make it all a little more simple in Part 3.

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Hypothyroidism: Is It Possible or Probable? Part 1

So, you think you have hypothyroidism? You feel sluggish, you can't drop that body fat, your joints ache, your hair is thinning and you're depressed and anxious. You almost hope that you have a thyroid problem so you can get a quick fix.

You cruise by your trusted doctor to see what s/he thinks...could it "possibly" be hypothyroidism? A better question would be is it "probable" that you have hypothyroidism.

Before hearing the verdict, it is best to know how your doctor thinks so you know how to interpret their interpretation of their physical, history and lab testing.

Doctors think in terms of possibilities and probabilities and they get their numbers to make certain calls from research articles (and their own experience). If an article claims that 80% of the subjects demonstrated X if Y happened, that gives doctors a pretty good sign to tell someone that it is probable that X is there because Y happened (as long it was a well performed study, with a significant amount of participants, variables controlled, replicated several times in other research studies and the authors had no financial gain to have an outcome one way or the other...so see if a drug company is paying for the study or not).

If the study had less than 50% of the participants demonstrating X if Y happened, then the doctor will say that there is a possibility that you have X because Y happened.

So how good are doctors at statistics? The studies done on how good a doctor is at understanding the statistics of a research paper shows that they score very, very poor. But aren't research papers the very place where doctors learn when to make a correct diagnosis?

Oops.

While the general public might not know this, drug companies certainly do. They have been known to stop research that does not have favorable outcomes for them, as well as play games with the numbers to make it look better than it really is. Do you think the doctor would read the 20 pages of statistical data or the 2 paragraph conclusion at the end that has whatever the author wants to pull out of the numbers as s/he wants? This is called trolling, since the author goes trolling through the numbers to pick out what they want.

So how can you and your doctor do better than just guessing? By collecting and comparing all the pertinent information and making a good clinical judgment. This means not just running labs and relying on them as the end all be all. Doctors should get a full history, perform a full exam, and then order test to help fill in the blanks. You should be documenting changes that you noticed before, during and after treatment to relay back to the doctor.

This way any judgments that are going to be made on possibilities and/or probabilities will be compared to other pertinent findings, making them more accurate.

In Part 2 of Hypothyroidism: Is It Possible or Probable, I will clear this up a little better.

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