And you wonder why I hate doctors.

The BBQ Pit
81

Well…the thing about doctors is that they always think you’re lying. If you report anything to them that doesn’t jive with what they’ve been taught and accepted as gospel - then you’re lying. It’s as simple as that for them.

I learned this many years ago when I was being treated for major depression (which, coincidentally enough, had been triggered by undiagnosed severe hypothyroidism. By the time the thyroid disorder was discovered, it was too late to stop the plummet into a profound depression, which was to persist for many years). Anyway, my psychiatrist asked about my alcohol use and I was honest in describing it to him - I wanted to be helped, I was desperate! I told him that I drank a couple glasses of wine two or three times a week, which was true.

A few weeks later, when we were discussing why the prescribed anti-depressants didn’t seem to be helping, he told me it was because of my alcohol abuse. I was :eek: - wait, what? I don’t drink that much! He explained very patiently that he knew I was lying about how much alcohol I consumed because patients always lie about that so he automatically doubled what I told him. So I guess he was assuming that I was drinking at least 4 to 6 glasses of wine, six days a week. I was floored, I was astonished! I said, “I’m sorry! I’m new at this - I didn’t know I was supposed to lie!”

For what it’s worth, I’ve been on synthroid for 15 years now - and it does not make you as good as you were before your thyroid took a dump! But most doctors are less interested in how you feel than they are in your lab tests. If your lab tests say you’re okay, well, then - you’re okay - pay the receptionist on your way out!

82

She was treated for very mild case of low thyroid NOT Hashimoto’s Also we were disbelieved that her weight was so closely linked to hormones. When we told one doctor about the pregnancy weight loss, she thought we meant she thought we meant 50 pounds under her weight plus the expected weight gain. When we explained for example that if her weight were 200 before getting pregnant then she weight 150 at 9 months pregnant. The doctor told us we were telling it wrong and we really meant 50 pounds under starting weight + baby. So tell me again how we were believed?

83

This is still very confusing…how much did she weigh just prior to becomeing pregnant? How much at 9 months, and finally, what was her weight a few weeks after the baby was born?

84

This reminds me of when my spouse had pancreatitis. They didn’t pay attention to him saying he was a teetotaler, he had to be lying. I was repeatedly interrogated by multiple medical people as to his alcohol consumption - which was zero. I was asked if he could have discarded bottles in the trash… uh, no, I take out the garbage. No, there weren’t unexplained bags or bottles in the dumpster, no he wasn’t discarding them at work because he was unemployed and I had the use of our vehicle during the day because I worked and …

They just would not believe that he was a non-drinker with pancreatitis. Nevermind that a significant percentage of acute pancreatitis episodes are NOT connected in any way to alcohol. Nevermind urine and blood tests taken at admission were zero for alcohol. Nevermind that the patient, family, and friends reported him as a non-drinker… he HAD to be an alcoholic!

Eventually they seemed to come around to believing us, but it really left a bad taste in my mouth.

Along with the doc who kept trying to feed him asprin DESPITE the prominent “asprin allergy” bad on the patient, the multiple notations in the chart…

85

Sympathize with your situation, OP.

However, doctors are not gods. They make mistakes DAILY. That happens when they see as many as a hundred patients a week and sometimes as many five hundred or more in a month,especially in major cities. You can’t expect them to always correctly diagnose a rare aliment that they may not have seen before and which they may never see again in their lifetimes.

Perhaps they should have suggested that you take your wife to the top endocrinologist in your area. Or in the country. Did they? If they didn’t and they simply guessed at what was wrong, then they did you both a disservice. That’s very unfortunate as it probably caused your wife a great deal of suffering.

However, health care really is a two way street. If you aren’t satisfied with what your GPs were telling you, then looking online for the top person in their field might have been in order a little sooner. Being a cancer survivor myself, I know that if you want the best care, YOU have to go and look for it. It’s rarely available close to where you live; and if it is it will cost you dearly.

Now that you know what’s wrong (if that indeed is the only thing) then it is incumbent upon you to make certain that your wife keeps receiving the best medical care possible. That is going to mean a lot of effort and expense in the future

Is that fair?
No, it’s not.
Outstanding health care should be available to us all.
But until somebody has a Eureka! moment and invents Elysium-style machinery which cures everything, getting diagnosed correctly and staying well is going to be a lengthy and painful battle for us all.

Including, ironically, doctors.

86

Have you ever had a doctor snap at you for asking a question? I have, more than once, and usually when the doctor was wrong.

Yes, we have do our own research, because we cannot trust our doctors, but that doesn’t mean we can’t bitch about it.

How would you take it if an electrician cross-wired a breaker, or a plumber tied the sink waste pipe into the toilet waste line? Okay, diagnosing a metabolic disorder is probably a bit trickier, but at least my electrician doesn’t tell me I must be lying about my eye-sight when the lights aren’t working.

87

Heh. Like you,I never return to docs who refute my input. But my GP listens to me when I tell him the fuckwad he referred me to was, well, a fuckwad. And my GP never refers me to said fuckwad again. I also tell him about the good referrals, and he makes sure that good referral is retained.

And, my GP always listen ps to my input as to what I feel is wrong with me, or reviews info I have gathered from sources such as MedLine. I mean, it’s MedLine, for gods sake.

88

This does not make sense. Nearly everyone with “low thyroid” has Hashimoto’s. There is no reason why a confirmation of anti-thyroid antibodies should result in a change in treatment (which is why, as I said earlier, most of the time we don’t check for those antibodies).

One doctor may have started a different dose of Synthroid than another, but that’s because there’s no good evidence-based answer for where to start it. You just have to check labs every month or so until you get the right dose.

89

I hate doctors too.

But that’s because I have to work with them. :mad:

I wish docs who refer patients with enlarged thyroids for fine needle aspiration or surgery would check those antibodies more often.

I see a fair amount of enlarged thyroids removed because of concerns about malignancy, and it turns out that the enlargement is diffuse and caused by Hashimoto’s.* Maybe if they had the antibody results, some patients could be spared surgery.

*Hashimoto’s can also cause nodular enlargement that simulates tumor.

90

I’m really sorry to hear she’s suffering with this – it’s a horrible disease. I know … I have it.

Now that you finally have a diagnosis, let me know if you guys have any questions. Wishing her well. Keep being her advocate - -she’s going to need you.

91

please allow me to disabuse you of this notion. Hashimoto’s is more than just low thyroid levels, it’s an autoimmune disease where antibodies are attacking the thyroid. It cannot be cured and treatment can include bothT4 (the levothyroxine she was already on, likely at far too low a dose) and T3, which she was not on. T4 has a half-life of one week, whereas T3 has a half-life of 24 hours. She may also need to be on vitamin D supplements and is more susceptible to nodules which can become cancerous. She will need to be under the care of a qualified endocrinologist for the rest of her life. She may also never beable to get her weight down significantly, and weight gain is in fact a serious symptom of Hashimoto’s. I gained a lot of weight, as have most of the women I know with this disease.

92

This is so ridiculous. Want to know how much of my weight gain is due to my Hashimoto’s? One hundred percent. Yep, every single bit of it.

You see, the weight gain wasn’t my first symptom: extremely dry hair, brittle nails, and severe joint pain were. These all came on while I was planning and getting ready for my upcoming wedding, for which I was eating less and exercising more, as most brides-to-be do. A lot more. Didn’t matter – I still gained more than 30 pounds.

Then the chronic fatigue set in, the migraine headaches, the constipation, the sinus infections, and the severe depression. With all those new symptoms came another 20 pounds.

This was after spending 41 years eating whatever the hell I wanted and never weighing enough to give blood … without even trying. I eat the most healthy diet I’ve ever eaten in my life, but I still struggle with my weight because of my disease. I have to exercise four times as hard as a healthy person to lose what they could lose by cutting a single slice of bread out of their diet every day.

So please stop with the overeating thing; you’re wrong about that.

93

It’s not that I (as a doctor) don’t believe people who gain weight too easily or have a hard time losing it. I know exactly how hard it can be. There just isn’t much I can do about it.

Weight control is the end result of a complex set of physical and psychological factors. While in the end it’s calories in vs. calories out–a favorite refrain of those who want to believe it’s all just a personality flaw–it’s an interaction between diet, exercise, non-exercise physical activity (and drive for same), basal metabolic rate, and how little food your body and brain will let you eat before you become miserable, among other things.

We don’t understand any of that very well. We do know that everyone seems to have a “set point” that they are driven to get back to, and that those who become overweight push their set points upward more or less permanently. That’s why prevention is so important, and why the public health push is largely aimed at childhood obesity. Basic science research is starting to get a handle on the hormones and neurotransmitters involved, but IMO we’re a decade from knowing anything really useful about them and probably another decade from effective medications to manipulate them. (I hope I’m wrong.)

In the meantime, there is very little I can do for someone who is overweight. I can:
–check your thyroid, and offer replacement therapy if it isn’t working. Unfortunately, this might make someone mostly stop gaining weight but it rarely results in significant weight loss, probably due to that same “set point” idea I mentioned earlier.

–I can check for a vanishingly small number of other conditions. I can’t remember the last time I found one.

–I can review someone’s diet and exercise routine and recommend keeping a food diary. It pisses a lot of people off to even bring this up, but a lot of the people it pisses off actually have atrocious eating habits and usually don’t realize just how bad they are. (That’s not true of everybody, obviously.)

–I can refer for weight loss surgery. In the carefully selected cases that they do, it seems effective.

–I can refer to a managed diet program. Some people have good luck with these.

–I can refer you to an endocrinologist, though they’re probably going to do the same tests I just did.

And that’s it, in terms of helping you lose weight. Any doc who tells you he can do any more than that is practicing outside the realm of evidence-based medicine. I wish that weren’t the case, but it is.

We really need to get past the idea of blame when it comes to weight gain and weight loss. Yes, some doctors need to stop treating obesity as a simple personality flaw, and they need to be more up front about the fact that they can’t really do much about it. But patients need to understand that the fact that I don’t have any answers doesn’t mean I’m blaming you, or that I’m holding back. There isn’t some set of tests and treatments that I would do if I didn’t believe that your only problem was too much pie.

I’m NOT defending all of the doctors described in the OP. Some were clearly wrong, and some were clearly assholes. But when a doctor claims to have an answer to this, especially if he claims to be the only one with the answer, you’d better look out, because the place where you’re likely to lose weight will be your wallet.

94

You still don’t get it.

The problem wasn’t how to take the weight off, but what was causing the inappropriate weight gain to begin with. When we understand our bodies better we can help ourselves in ways doctors like you take the opportunity for away from us. When we’re taken seriously and not dismissed by our doctors, we take our own health and recovery more seriously. When we are diagnosed early it can prevent the onset of many of the symptoms associated with late® stages of our disease.

Armed with information, we can join support groups and learn what has worked for other people suffering with the same thing we are and get encouragement to keep fighting and not give up. We can find out what questions to ask that may help you treat us more effectively. We can take steps to alleviate other symptoms like constipation, headaches, and muscle and joint pain so that exercise isn’t as difficult. It’s particularly helpful to us to know these are all actually symptoms related to the same disease so we don’t waste time, money, and other resources chasing after cures for them that won’t help if the underlying condition isn’t properly addressed (like antianxiety medication or prescription sleep medication that wouldn’t be necessary if our T4 were at the right dose). We can learn things like not to take our thyroid hormones at the same time we take our calcium supplements because calcium inhibits its absorption. We know to tell you that the dosage you have us on isn’t working because other symptoms remain, which we wouldn’t understand to talk to you about if we didn’t have the diagnosis.

I hope this insight helps you treat your patients differently going forward.

95

I’m not sure what part of that I’m supposed to disagree with. Of course a doctor should help his patients understand the disease process and how the treatment works.

My only point regarding the diagnosis of Hashimoto’s is that the OP and many subsequent posters act as if there is some sort of plain ol’ primary hypothyroidism, and then there’s Hashimoto’s, which is some sort of super-duper hypothyroidism. That’s not the case. In a developed country, overt primary hypothyroidism=Hashimoto’s, with a very, very small handful of exceptions that are mostly really obvious (previous thyroidectomy, radiation to the neck, etc.).

I agree that doctors are bad about explaining that. Heck, a lot of them probably don’t understand that.

(Incidentally, I should probably mention that in addition to being an MD I have been treated for Hashimoto’s since 1995, and I have had weight problems my entire life.)

96

A million times no. We are NOT claiming anything of the sort. We are claiming that doctors out there tell you to take the fork out of your mouth and maybe run some labs and might give you some levo because it’ll shut you the fuck up because we all know the reason you gain weight is because you eat over 4000 calories a day and if you tell me any different you’re a fucking liar.

You may very well be right that it doesn’t matter why you have low thyroid because all treatments are the same. I would think an autoimmune disease would be slightly different than a thyroid that doesn’t produce enough T* but that’s not even the point.

The point is I’m not overweight because I eat McDonalds supersize every meal and never exercise. It’s because my thyroid is being eaten away.
*My second-hand knowledge is that with Hashimoto’s, adding T above a certain level doesn’t help because the body or cells or something can’t process above a certain amount due to the antibodies.

97

That should not be the case.

Autoantibodies in Hashimoto’s target cells in the thyroid gland, causing atrophic changes and affecting storage/release of thyroid hormones from the gland. Exogenous hormones (i.e. levothyroxine given as replacement therapy) won’t be inhibited by the autoantibodies.

98

Actually, you’re fat because your metabolism is fucked up. Your metabolism is fucked up because your thyroid is fucked up. His point is that, even correcting for the thyroid issue as best as modern evidence-based medicine allows, he can’t really unfuck your metabolism. And if he can’t unfuck your metabolism, the only realistic options he has to offer are to eat less and move more.

Yeah, that means eating a LOT less and moving a LOT more than someone with a normal metabolism, and probably still being fat. And that fucking sucks. I spent the first 20 years of my life watching my grandmother live on something ridiculous like 800-1200 calories a day, while riding an exercise bike 5 miles every day, and still having a dress size up in the 20’s. My mom has had all kinds of thyroid interventions and bariatric surgery, and her weight is starting to creep back up despite her eating habits and activity levels not really having changed in the couple years since she was at peak weight loss. I eat less and more healthily than a lot of skinny people I know who have similar activity levels, and I’m well up in the “morbidly obese” range.

And my doctor can’t fix that for me. She can refrain from attributing every single problem I ever have, from allergies to tooth decay, to my weight. She can check to see if there are other, fixable factors and fix them in an attempt to keep my body chemistry from getting even more fucked up. But that’s pretty much all she can do–she can’t unfuck what’s been fucked. Believe me, if there was some special “what if I were to shake your hand thusly?” treatment only available for certain patients, I’d be the first person in the practice to get it. So that means my options are to a) keep doing what I’m doing and stay as fat as I am now or b)take the fucking fork out of my mouth waaaaaayyyy earlier than pretty much everyone else on the planet has to and be somewhat less fat.

99

My sympathies, OP. And although obviously doctors are humans who make mistakes, it is pretty terrible that it wasn’t just one doctor, but several, and it took three years just to get the hormone replacements.

Calories in, calories out is definitely true, but that “out” is not quite as simple as that. It can’t be, or things like pregnancy (not including the extra weight of the baby and uterus) would never affect weight, chemo patients who manage to eat a decent diet wouldn’t lose weight, etc.
Of course some people are just lying or fooling themselves, but you always knew your wife wasn’t, and it is so horrible to be accused of lying.

No, mentioned upthread was that about 10% of American women have low thyroid problems. I don’t know if that’s true or not, but that’s where your number comes from, not that 10% of weight gain comes from thyroid problems. You misread.

100

But it’s NOT a mistake and that’s my point. A mistake was when my mom’s doctor thought she had breast cancer because of her mammogram. Not “maybe a false postive.” but “Holy fucktwats! Time to start hacking and slashing.” Luckily the radiologist came in, took one look at the film and asked, “Did you breast feedyour children?” It was crystallized milk which I guess is kind of common.

I’m talking about doctors that refuse to listen to their patients and when they here anything that contradicts their own little view of reality they pull a Dr. House and say you’re lying. As I’ve said in a different thread, the worst thing about doctors is most are not empiricists - they’re engineers. Forget what the data and patient tell them, it’s all about looking stuff on a chart and putting you in a box based on their prejudices. It like $200/visit WebMD except I think WebMD is more accurate because they actually believe you…