In a message dated 7/20/2001 7:06:01 PM US Eastern Standard Time,
[log in to unmask] writes:

<<  I work with hundreds
 of cardiac and pulmonary patients who have undergone thyroid testing as part
 of their workup and are shown to be negative for hypothyroidism. >>

I used to believe that one when I was young, too. Then, I was called in on
consultation by Internal Medicine on a young man who attempted suicide with
an insulin overdose. He, too, was "shown to be negative for hypothyroidism,"
and suffering from some exotic "Cardiomyopathy and diabetic bowel pathology"
that left him seriously disabled. A former dance instructor, he was now
getting winded going to the bathroom. His sluggish gut made the use of
Propulsid and bowel drugs necessary.

When I asked what had happened, "I'm sick and tired of being sick and tired,"
was his reply. He had been recently tossed off a waiting list to get a
(baboon) heart transplant, and his life was a living hell.  After an hour of
listening, I gave him the symptom list from Broda Barnes book. He had most of
the symptoms, and his body temp was about 97. Lab work didn't look as
seriously ill as he did, but a careful trial of thyroid replacement seemed to
help.

After several months, he was in my office talking about his walking "3 miles
a day to build my heart back up."

"You look too healthy to need a heart transplant," I observed, and I sent him
over for an echo cardiogram. I got the results in the afternoon. His cardiac
function was almost normal. I sat at my desk, shaking inside, for the rest of
the day.

I shared the finding with his cardiologist, and I enclosed the chapter from
Braverman's text book. The cardiologist never acknowledged my letter, and
lowered his Armour from 3 grains to 2 grains a day, and the patient started
to decompensate again.

That would have been the end of this story, but a few weeks ago a minister
who I have been working with for years was taken off part of his thyroid
medication, and went into the hospital for heart failure. Again, the usual
"thyroid testing as part of his work up, and was shown to be negative for
hypothyroidism." No one asked how he felt, he has been sleeping 14-16 hours a
day, temperature was 97.4 on Friday, and for good measure, the cardiologist
told him that he "had a heart attack from too much thyroid medicine." (Off
the thyroid replacement, the chart noted that he was indeed hypothyroid, and
a fraction of it was restarted.)

I called the first patient, who readily agreed to talk with the minister, if
needed. The minister cannot seem to understand how his cardiologist may not
be seeing the basis of the problems. Patients are frequently paralyzed when 2
docs disagree.

In brief, there is no blood test that can show someone "to be negative for
hypothyroidism," and cardiac failure due to hypothyroidism is not rare,
except in the minds of docs who do not look for it. I was chatting with a
Cardiac Care Nurse whole also sees a lot of congestive heart failure that
might be related to hypothyroidism, but docs will not give the patients the
benefit of the replacement.

Doc Don

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