My letter as sent to the college, Dr. Derry, etc.:

To whom it may concern:

I wish to share my comments on the treatment of
hypothyroidism as practiced by physicians like Dr.
Derry.  I am fortunate to be treated by a physician
who shares Dr. Derry's very traditional approach to
medical practice. There was a time when physicians
were actually clinicians first and foremost, using
astute assessment skills which included observation,
palpation, auscultation etc., accompanied by
thoroughly listening to the patient's symptoms and
history.  In recent years, this has been largely
replaced by looking at minute amounts of chemicals in
the blood and then confirming or dismissing all other
information about that human being.  I believe this is
the very worst of "cookbook medicine".  It seems
illogical to me that it is acceptable to diagnose
depression and attention deficit hyperactivity
disorder by symptoms leading to prescription of drugs
that alter brain chemistry but yet, to listen to and
observe a patient with 80-90% of the classic symptoms
of hypothyroidism, and prescribe thyroid medication is
deemed dangerous and inappropriate, even though the
patient responds favorably by both subjective and
objective criteria.
    Statements have been made recently that people do
feel better while taking large doses of thyroid
hormone but they also feel better taking large doses
of cocaine.  Since when do the symptoms of
hyperthyroidism feel good?  I don't know too many
people who enjoy a racing heart, feeling hyperthermic,
having diarrhea, etc.  It may be true, that initially
some people feel an improvement due to increased
energy levels and perhaps that would occur in most
patients even if they were euthyroid to begin with.
Aside from temporary increase in energy levels,  I
can't understand how that "feel good" idea should be
able to completely ameliorate diverse problems such as
fibromyalgia, arthritis, dry skin, hair loss, sleep
apnea, carpal tunnel, memory loss, infertility,
erectile dysfunction, bradycardia, hyperlipidemia,
hypertension, hypotension, edema, congestive heart
failure, etc., but yet there are thousands of patients
who report relief of symptoms and conditions such as
these after receiving a thorough assessment, diagnosis
and treatment by Dr. Derry and others who follow a
similar approach.
   Perhaps someone with a truly scientific mind and a
quest for patient wellbeing should want to study such
a group of patients to ascertain both the beneficial
and harmful effects of such treatment using the
scientific method.  The evidence seems to speak for
itself and it defies the accepted beliefs that are
based on many other less than perfect studies.
    I recall a time when a normal range for total
cholesterol included an upper limit of 270.  Now 200
is considered acceptable even though many patients
with levels between 150-200 suffer acute MI's every
year.  Why is that?  It is partially because total
cholesterol alone is not a sufficient indicator and
many other components of cholesterol determine heart
attack risk.    I note that in February of 2001, the
American Association of Clincial Endocrinologists said
in their press release, that while a TSH of 3-5 was
within the "normal" range, levels in this range are
suspect for a thyroid gland that is failing.  That is
a good first step in recognizing that previously
established levels may not have been narrow enough to
accurately diagnose a subset of people with
hypothyroidism.
   Based on my personal and family experience,  I
believe there are quite a few people for whom TSH is
not the right indicator regardless of what range is
established.  I have for the past 10 years had a TSH
between 0.7 and 1.1, yet my free T3 and free T4 are
always near the bottom of their ranges, while total T4
is usually near the middle of the range.  I had 3
pregnancies complicated by difficult to manage preterm
labor beginning prior to the 20th week of pregnancy, 3
premature births, inadequate lactation, serious
postpartum depression lasting nearly one year each
time, dry skin, hard callouses on my feet, cold hands
and feet and a sense of being cold when others are
warm, slight edema of the hands face and feet/ankles,
poor concentration, constant fatigue along with
daytime sleepiness, and  hair that falls out easily to
the point that even my hairdresser told me I should
see a doctor!
   Most doctors call my labs normal.  Why did they
suspect hypothyroidism enough to run the tests?
Because of what they saw and what I was able to relay
about my symptoms.  When my tests are all technically
normal, I'm told that these symptoms mean nothing.
I travel a great distance to see a doctor who
recognizes that what he learned in medical school
about listening to patients was really true.  He
tested more labs than I've ever had done in my entire
life and then based primarily on the extensive history
he took and his observation and assessment of my
condition, he prescribed thyroid medication for me.
My cholesterol improved greatly.  My energy level is
better and I can now maintain my thoughts long enough
to write them down as I have here.  My skin is better
and the aches and pains in my hips and legs are gone.
My hands and feet no longer "fall asleep" everytime I
sit down.  My hair is healthier and not only has it
not fallen out as badily, but it is returning to its
original color.  My hairdresser noted that my hair got
darker with each pregnancy and it stayed dark for the
last 9-10 years but over the past 6 months on thyroid,
it has returned to its normal color.  I forgot to
mention that after I had symptoms for about 6-7 years,
I developed several thyroid nodules, one mostly cystic
and the other very small but more solid.  I have read
repeatedly that thyroid nodules are very common but I
find it to be an unlikely coincidence.
   My mother had a thyroid nodule suspicious for
cancer 25 years ago and most of her thyroid was
removed. Now that she is elderly, I'm much more
involved in her healthcare and have discovered that
despite maintaining a low TSH, she has most likely
been severely undertreated for many years since TSH
was frequently the only guiding criteria for her
dosing.  What I have found by demanding additional
tests is that when her TSH rises to 1.0, her free T3
and free T4 are below the reference ranges.  She has
many hypothyroid symptoms but her doctor fears atrial
fibrillation more than anything else.  It is
acceptable that she now has dementia quite possibly
related to longstanding hyperlipidemia and small
vessel disease in her cerebral circulation as
suggested by her head CT.  The doctor will test her T3
and T4 levels but it never matters how low they are if
the TSH is also low.  I think this approach is the one
that deserves question by a body of regulating
physicians who want to protect patient wellbeing.
   My father's sister died in myxedema coma with CHF.
She had not been diagnosed until the week that she
died.  I suspect her hypothyroidsm did not develop
overnight, but as Dr. Derry has seen many times, the
TSH often does not rise until many years after the
onset of classic hypothyroid symptoms.
   There are many unresolved issues surrounding the
diagnosis and treatment of hypothyroidism.  I
regularly review published studies on hypothyroidism,
searching for answers to my own subset of problems.
As with all research, I almost always find that the
studies arrive at the desired conclusions because
certain assumptions are made in the development of the
research hypothesis.  A study that assumes that TSH
tells the truth about the existence of hypothyroidism,
will miss the group of patients like myself who do not
fit the classic lab findings.  Likewise, studies which
assume that treatment with T4 only drugs to a level of
TSH that is in that 3-5 range do not convince me that
treatment of hypothyroidism does not relieve certain
symptoms of hypothyroidsm, such as hyperlipidemia.  If
you torture the data long enough, it will confess to
anything.  I don't believe the right research
questions have been asked to protect the health of
numerous hypothyroid patients.  Much was understood in
a previous era that has been lost in recent years
since laboratory testing has replaced clinical
expertise.
   Furthermore, patients who travel great distances to
see physicians like Dr. Derry, do not usually make
such a decision without quite a bit of knowledge and
research about available treatments.  We are being
denied appropriate care- care that has given us back
our health.

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