What Exactly Are They Teaching in Medical School?

In the May/June issue of Health magazine, there's a familiar but frightening story. The article by Barbara Bailey Kelley describes a woman who had constant fatigue, constipation, constantly feeling cold and difficulty swallowing. According to the article, this group of symptoms had the woman "hopping from doctor to doctor. None could identify a medical problem." Three years after her symptoms appeared, the woman was checked into a hospital, where a coterie of specialists -- an allergist, heart specialist and psychiatrist -- examined her. The psychiatrist wondered if she was suffering from depression. After a battery of tests which, WHEW, finally included a thyroid-stimulating hormone (TSH) test, they FINALLY discovered that she was very hypothyroid, in fact, her thyroid had almost shut down completely.

Okay, calling Dr. Kildare! Marcus Welby! The entire staff of St. Elsewhere, Chicago Hope and ER! Where are the doctors who recognize thyroid disease's symptoms quickly?

On an AOL chat a few weeks ago, a group of us were speculating what would happen if a woman with a basketball-sized goiter walked into the ER at "ER." We decided she'd be told she was stressed out, and sent home with a prescription for Prozac, AND a big fat bill from the emergency room (that her insurance company would probably deny!!!) Now how bout that storyline for dramatic tension? (Of course we all agreed we'd keep the goiter if it meant George Clooney'd be our endocrinologist!)

In any case, doesn't it seem like anyone who's spent more than five minutes reading anything about thyroid disease would have a problem recognizing the familiar litany of symptoms the poor woman in the article described? In fact, I sometimes have to watch about becoming too evangelical myself when friends say, "you know, I've been feeling a bit tired and run-down lately, and..."

"COULD BE YOUR THYROID!!!" I announce.

"Hey doc, I'm constantly tired, I'm gaining weight, my skin's dry, my hands and feet are cold, and there's this gigantic lump on my neck..." "Hmmm, could be that you're depressed, stressed, or maybe PMSed!"

Or my post-partum friend, when describing how tired she was, "I'm up and down all night with the baby, I can barely keep my eyes open and..." "COULD BE YOUR THYROID!!!" I announce. So every year, thousands of women go into their doctors and say, "I'm tired, I'm gaining weight, my skin's dry, my hands and feet are cold, I'm dragging myself around, and..." "COULD BE YOU'RE DEPRESSED (or STRESSED or PRE-MENSTRUAL or MENOPAUSAL)!!!" the doctor announces. PUHLEEEEASE??? Don't get me wrong. I love some doctors. I love my doctor, who's an MD/acupuncturist in an osteopathic family practice. But even my doctors took awhile to diagnose my tiredness, dragging around, inability to lose weight, and so on and so on. But I only went a few months without a diagnosis. How many people go years, or maybe forever, without a simple diagnosis and treatment? AND WHY?

The various thyroid associations and foundations attempt to raise visibility about thyroid disease. There's the Gland Central Campaign sponsored by the Thyroid Foundation of America and the American Women's Health Association. Gail Devers, three-time Olympic gold medalist in track and field, is spokeswoman for the effort to raise awareness of thyroid disease. There's an article discussing it at the Reuter's Health News web site. Make sure you stop by and register at the site.

Also at the Reuter's site, then a discussion of the "Thyroid Neck Check" with its oh so jolly theme, "Stick your neck out, America," sponsored by the American Association of Clinical Endocrinologists (AACE). Those endos are such jokesters, aren't they?

I've got to believe that they spend at least a few minutes on the mighty thyroid at med school. At least we know there's an entire chapter on Endocrine Disorders in the online full-text version of the Merck Manual, a key medical reference for doctors.

But if all these associations are so busy trying to make the public aware of thyroid disease, and they at least touch upon the subject in the med schools, why is it that doctors are sometimes so easily stumped when presented with a list of symptoms that seem to SCREAM thyroid disease?

This is a question I'm going to ask several doctors directly, and I'll report back on the answers soon. And, as part of a new feature, "Questions We All Want to Ask the Doctors about Thyroid Disease," email me your questions, and we'll see if we can get some answers.

Previous Features