In a message dated 8/27/2006 10:17:57 A.M. US Eastern Standard Time,  
[log in to unmask] writes:

When we  are told we have autoimmune hypothyroidism, does this definitely
indicate  the gland will decline in function more and more until it is
totally  destroyed?  In that case, it would seem best to ramp up the  thyroid
hormone replacement, and just suppress the remaining endogenous  function
altogether.  Quality of life on full replacement would then  be optimized.  
>>>>>
Friends,
 
Holly's attitude toward thyroid replacement makes a lot more sense that  what 
I have heard from the bulk of my colleagues. Basically, we should  treat 
patients, NOT labs. The most common complaint I hear on site such as this  are 
from victims of docs who treat the labs. 
 
The presence or absence of antibodies; "Abnormal" or "Normal" TSH,  Free T4, 
or Free T3 does NOT tell us if a given patient needs thyroid  replacement.
 
Our DIAGNOSIS dictates the proper treatment of a given patient. A good  
Clinician will tell you that History (How has your patient been doing before  they 
came to you?) provides 85% of the information for the Diagnosis; the Exam  is 
worth about 10%, and the Laboratory is only worth about 5%. Unfortunately,  
docs too often make the Labs the final and sole authority in the Diagnosis. 
 
Sometimes, making an accurate diagnosis means that a patient must have a  
careful therapeutic trial of thyroid replacement. There is no Clinical Lab  that 
is able to replace Clinical Acumen. When the doc tries to use the lab  instead 
of thinking, the patient suffers. 
 
The so called "normal range" really only represents the middle  95.5% of the 
sick people we send to the lab to get their  thyroid checked.  (Two Standard 
Deviations either side of the  mean score.) "Normal" is not a Medical 
Diagnosis, it is a Statistical  one. 
 
Doc Don 









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