In a message dated 3/14/2009 9:48:21 A.M. US Eastern Standard Time,  
[log in to unmask] writes:

My  brother also has gout with no thyroid problem so could be totally  
independent. 
Thanks again -- great advice -- dave

>>>>
Dave, glad to help!
 
Be careful about docs who say that your brother has no thyroid  problem, 
though. 
 
"Thyroid problem" is the real operative, here. Most doctors don't think  that 
there is a "thyroid problem" until the TSH (thyroid stimulating hormone) is  
ridiculously high. This is obviously wrong because someone could have no  
pituitary, no thyroid function, no TSH, but have big "thyroid  problems."
 
Likewise, there are a lot of people whose cholesterol or lipids are high,  
whose thyroid lab is "normal" (That means that they fit in the middle 95.5%  
thyroid test scores of all those sick people we send to the lab because we think  
that they have thyroid trouble.); but whose lipids become very normal on 
thyroid  hormone alone. Did they have a "thyroid problem?"
 
I used to do case supervision at a local state children's hospital.  
Virtually all the kids there had long term intellectual and emotional problems,  and 
most were too violent to manage outside the institution. 
 
I found cretinism (early onset hypothyroidism) and undiagnosed  
hypothyroidism in kids whose TSH was "normal."
 
None of the symptoms were explained by anything else, and many were quite  
dramatic. A large number of kids never had a body temperature as high  as 98.6 F 
until they had a major illness. 
 
There was a little girl there who started breast development at age 8, her  
menarche at age 9, and was lactating at age 10. The Medical Center was  
consulted, and they said that she was lactating because she had "intellectual  and 
social stresses." Every child at that hospital had "intellectual and social  
stresses," but she was the only one giving milk. On the other hand, early  
menarche and lactation are not rare symptoms of hypothyroidism in little girls. 
 
They had a 19 year old boy there who had about the same physical,  
psychological, and sexual maturity of a 9 year old.
 
A 12 year old boy weighed over 200 pounds, had sleep apnea, had several  
other signs of hypothyroidism and a low body temperature.
 
I started treating the kids with low dose thyroid replacement, and there  
were some reasonable improvements. But, a local pediatrician became  indignant, 
wrote an open letter to me and the head of the hospital and demanded  thyroid 
replacement stop. The treated kids were taken off thyroid medicine  because 
their TSH was "normal" and they couldn't have had a "thyroid problem".  Most of 
the children got more lethargic, easier for staff to manage, and lost  whatever 
modest gains that they made. 
 
One of the biggest complaints I hear on sites like this is that the doc  
involved will not treat a patient who is obviously hypothyroid, because the lab  
is normal. No thyroid problem?
 
It is very important to remember that 85% of any diagnosis, from pregnancy  
to gunshot wound, is purely History (What's been happening to the patient 
before  he came to the office?); The Examination (How does he appear to the, 
hopefully,  well trained eye?) is worth about 10% and Labs are only good for about 
5%.
 
Most docs use the clinical lab, instead of clinical acumen, to tell whether  
their patient has a thyroid problem. This assures that a lot of thyroid 
problems  are missed and the host of resulting problems helps make ours the most  
expensive, but not best, medical system in the world. 
 
My definition of "having a thyroid problem" has evolved to include people  
whose history and symptom complex are suggestive of a thyroid problem, whose  
labs are not incompatible, and who respond to thyroid replacement when the  
associated problems are addressed.
 
Doc Don
 
_www.dmichaelmd.com_ (http://www.dmichaelmd.com)  


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