Mary Shomon: From your book and prior articles, we know that you both
have been involved with thyroid work for over 25 years -- personally and
professionally. What is your stance on patients getting a second opinion?
The Shames: As health professionals, we are extremely supportive of personal empowerment and self-care. In addition to books, friends, and the Internet, we feel it is essential to maintain a beneficial relationship with your doctor. A good practitioner can assist you in proper diagnosis and optimalmanagement of your thyroid issue, saving you years of distress, expense, and hardship.
But, keep in mind that all doctors have their limits. Their time, knowledge, and clinical experience are not infinite. It is standard medical practice to call in another opinion when needed. Usually it is the doctor who decides when another view is needed on the case. In the thyroid arena, it is becoming more and more common that the patient is making this decision. As a doctor - nurse team, we are entirely supportive of this more recent and much-needed development.
Mary Shomon:What do you feel would make a patient start thinking along these lines?
The Shames: For thyroid patients, it generally starts early in the diagnosis phase, or later in the treatment discussions. For example, at the onset of a possible thyroid problem, a knowledgeable practitioner takes a complete history, listening carefully to nuances, and identifying patterns. Then, he or she performs the proper physical examination and orders appropriate laboratory tests, to ascertain exactly what is causing the symptoms. In this way, you can accurately determine which treatments will be most helpful to you. Don't sell yourself short. Make sure from the beginning that your situation is properly diagnosed. If your regular doctor does not check for thyroid as closely or as carefully as you would like, by all means speak up. This is especially true if you have any thyroid disease in your own or any of your family's medical history.
If you have obtained information from friends or web sites related to your condition, it would be a good idea to share this with your practitioner to obtain further input. In these instances, be alert to the response of your practitioner. If your doctor acts as if your questions are a bother, or doesn't answer directly, consider whether you are receiving optimal treatment. You may need to augment this doctor's care with an additional opinion. If your doctor doesn't know the answers to your questions, ask if he or she can find out for you, or direct you to the proper resource. You may need to shop for this additional attention, just as you would shop for the right mechanic, contractor, or other service you value.
Mary Shomon: Why do you in feel a prospective thyroid patients need to shop around?
The Shames: Many primary physicians do not seem to be aware of the excessive prevalence of low thyroid in the population, or of its collective toll on the nation's health. As we have noted in our book, investigations by university medical centers, as well as by the Mayo Clinic, have determined that the prevalence of thyroid conditions is quite high -- compromising the health of as much as 10% of the population, and appears to be very much on the increase. It has taken a long time for the medical commu nity, which is largely focused on critical care, to become aware of this dramatic situation.
Since the condition is usually not severe or life threatening, it may simply not grab the attention of busy doctors. Also, since the thyroid system controls so many aspects of physical and mental functioning, the patients' long list of complaints can seem unrelated and excessive to the clinician. The patient may have a skin problem, a stomach problem, fatigue, weight gain, hair or nail problems, emotional ups and downs, feel chilly some of the time, and hot at others.
When confronted with this seemingly global array of symptoms, the physician is often skeptical, and, rather than suspecting low thyroid, may believe that this patient may have a psychiatric problem like depression. Now the stage is set for a diagnosis of depression, or something similar, with a prescription for Prozac or Zoloft. This misses the true underlying diagnosis of low thyroid, which is causing the symptoms that include depression. If you feel strongly that you are one of the millions of thyroid sufferers being misdiagnosed in this way, then you may well need to shop around and get a more detailed second opinion.