There's an interesting article in the Washington Post by physician Daphne Miller, suggesting that Maybe It's Time to Slow Down the Pace of Medical Treatment. She's talking about doctors -- including herself -- who are opting out of traditional sorts of practices, and focusing on spending more time with patients. She believes that more time allows for better diagnosis and treatment, and offers some stories from her own practice. She even reports on studies that suggest that reducing patient load and increasing time may improve quality of care, reduce visits to the emergency room, and improve the overall satisfaction of both patients and doctors. But of particular interest to thyroid patients is a paragraph that describes how this doctor -- along with a cardologist and endocrinologist -- came up with a very unorthodox approach to a woman's hyperthyroidism:
Recently, I saw a woman with autoimmune hyperthyroidism who, despite the warnings from her endocrinologist, wanted to forestall any treatments that would lower her thyroid levels. What she had discovered was that her overactive thyroid was helping her melt away the extra 60 pounds that she had been struggling, for more than 20 years, to lose. After taking time with her (and conferring with her cardiologist and endocrinologist), we agreed that the extra weight was probably the source of her pre-diabetes, hypertension and severe sleep apnea and that, although this approach was unorthodox, we would monitor her for ill effects and let her thyroid disease help treat her other health problems. In my previous incarnation as a 15-minute doctor, I would simply have viewed her as a noncompliant patient and insisted that she take her thyroid medication.What do you think? Rather than taking a traditional approach to treating hyperthyroidism, do you think this is too unorthodox and even potentially dangerous? Or is this a situation where having time means that the doctors can smartly weigh the overall pros and cons of taking action, in the context of the patient's overall health? Take our poll now to share your opinion.
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Unorthodox, yes. But if the hyperthyroidism is not too severe and cardiac conditions are not contraindicative, then a short period of monitored hyper- prior to beginning treatment may well have benefits that outweigh the risks.
Treating hyper- as a “no brainer” means that your choice of treatment is unthinking. That is never good medicine.
There is not enough information for this case to be sure whether it is good or bad. Presumably the doctor is monitoring what needs monitoring and has made a considered choice taking the patient’s views into account.
I was hyperthyroid for 2 months with subacute thyroiditis and my doctors told me there would be no treatment. My doctors did not appear to be at all concerned. It was extremely unpleasent with rapid irregular heartbeat, hot, unable to sleep, and felt like I was going to faint if I walked a block. I question if this patient is really hyperthyroid or if her doctors have misdiagnosed her based on TSH. I would not have been willing to endure hyperthyroidism to lose weight.
Yes, it’s totally unconventional, maybe even a little bit risky. But after reading this Doctor’s story, I think it’s the way it should be. The patient recognized the dangers and also the benefits, and she her Doctors closely monitored her status. If the patient can demonstrate a good knowledge of herself and recognize symptoms that put her in the danger zone (and don’t most if not all of us thyroid patients follow our symptoms and status very closely?) then she and her Doctors can judge when she needs to have intervention. Health Care in this case, is at the discretion of the patient and her Doctors which is as it should be.
The biggest problem I see with this situation is that autoimmune hyperthyroidisim (Graves disease) is not merely a “thyroid” disease. It is caused by TSH receptor antibodies that ALSO affect the thymus, pituitary, ovaries, bones, muscle (heart included), brain, eye muscle and perhaps many other organs.
High levels of untreated hyperthyroidism due to high levels of TRab antibodies can cause acropachy (thickening bones), psychosis, opthalmopathy (TED), thyroid nodule development, pretibial myxedema (skin thickening), cardiac mitrial valve prolapse, osteoporosis, et al.
Too many doctors don’t understand that Graves disease is NOT SIMPLY a thyroid issue! When will they understand this?
And don’t forget that the risks of developing a SECOND autoimmune disease is higher when the first is left untreated; Lupus being the most common secondary development.
I think this doctor is playing a very risky game with this patient by not addressing her illness. And besides, this weight loss is absolutely superficial. The weight will come right back on when the thyroid cools down if other interventions are not begun.
Cancer causes weight loss too – would you recommend a patient not be treated simply because the weight loss is lovely? I dont think so. Graves disease is a lot more than just a fast thyroid.
If it was just a “thyroid” problem, I might think differently. But knowing all the permanent damage Graves disease causes to other organs – many of which can’t be reversed, I vote no.
This woman is fortunate. Before my thyroid was removed I had the same issue of my thyroid going from hyper to hypo – and back again. Now, with mediation they are working to bring my levels UP to where the level should be – somewhere around .3 I’m at .1 now (after 2 years of trying to regulate my levels after surgery). Unfortuantely, I can’t seem to loose the weight I put on as a result of my thyroid going bad! Why couldn’t I get the weight loss side effect of my hyperactive range?
I’m sorry – typo – I meant to say “with MEDICATION” – not mediation! (Too funny!)
How does one become 60 pounds overweight if you are hyperthyroid? To me this is a disconnect.
Sadly, it is a ‘false’ weight loss. As previously stated, it all comes back. I lost 40 lbs. in 3 weeks time and knowing something was wrong still did NOT go to the doctor because I wanted to see if I could lose more weight before ‘they’ fixed whatever the problem was. I waited 6 months, partly because of that underlying fear of not wanting to know what was wrong and I did not lose any more wight, but I did get sicker. I was so weak and my heart rate was so fast and blood pressure so high that they wanted to transfer me from the clinic to the hospital by ambulance. And I am only mentioning the life threatening symptoms, and yes they thought I was dying. Once they confirmed Graves disease and started treatment the weight all came back and unfortunately it was all fat since I had lost my muscle mass with the initial rapid weight loss. And sadly, I couldn’t help myself with exercise because I was too weak at this point. I realize this woman is under supervision while the weight loss is occuring but the disease is STILL progressing as well. The weight loss is not worth it. Get the disease under control and then do the weight loss the painfully excruciatingly slow, but correct and healthy way.
I tend to agree with Bk. As someone who was diagnosed with such severe Graves disease when finally diagnosed (they approximated that it had been going on for over 7 years before it was caught and therefore untreated all that time), the lab would actually stop counting and put “OVER (?)and !!!!!” (Don’t remember the numbers, it was 40 yrs. ago) and I have had declining health ever since. So I have to agree with Bk….After many years of untreated Grave’s, then treated for Grave’s for years, my immune system destroyed my thyroid completely and now I have to be monitored with blood work every 3 mos. while on meds to replace the hormone. But as Bk said, other diseases/disorders developed…MVP, etc. and 2 other more serious autoimmune disorders.
Coincidently, the last 2 times I was in the endo’s office my blood work showed I needed a MUCH lower dose of replacement each time, was in effect hyperactive…and I asked, “How can that be, I’m gaining and/or not losing weight?” She explained that in some people (and this has been historically true for me over years), the hyper patient craves and eats more sugar, etc. and it more than makes up for the hyperactive thyroid condition. So I just thought I’d “put it out there” that extra weight is NOT always an indicator, or “goes with” slow thyroid, but in a minority of people can actually go with HYPERthyroidism if it’s making you crave fattening foods, or just FOOD IN GENERAL. As though your sped up metabolism is sending the message to the brain to “fuel the body”.
I’m not a doctor, though over my 62 years there have now been 6 in my family, and a few nurses. Here’s to the nurses. It was at a family party, a nurse in the extended family who suffered herself from Graves, spotted the beginning disfigurment in my eyes, and told my mother to get me to an endo fast.
So, let’s remember, medicine is not perfect. AND as Kevin Rhoads says, “There is not enough information to be sure whether it is a good or bad choice” IN THIS CASE. However, her endocrinologist did give warnings. Hopefully the 3 doctors are going to monitor her closely, her heart, etc. Personally, after my experience, I’d lke to know how much and what she is consuming foodwise, because maybe the brain is just getting a constant message to fuel up with food as mine did.
Now, I’m being monitored every 3 mos. I’ve never asked, but maybe they do it that often now because of the other disorders and age. It’s just a nuisance to go to the lab and have 7 tubes drawn esp. with chronic anemia. But being watched more closely, I’m mentally sharper than many/most of my peers
) At least that’s what they tell me.
Because of the life losses I endured from lack of diagnosis and treatment, I am such a proponent of thyroid monitoring, I swear the entire adolescent population should be screened for endocrine imbalances just as we do eye tests for children when they begin reading in school. Unfortunately there are not enough endocrinologists or CNP’s to even impliment that. But just imagine the human potential that has been/is being lost by the percentage of the population that goes uncaught and untreated…..