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Hypothyroid Update: Common Sense Triumphs over Bureaucratic Boobs

Posted Sep 01 2008 7:14pm
As you know, I was recently diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism. I dug deep into this condition as a cause for my recent increase in lipoprotein(a) and homocysteine (it seems both are affected). Dissatisified with the first two Endocrinologists I saw I did some research and found the best local endo I could. I used the following criteria.

1. I wanted someone on the staff of a research and teaching hospital. I figured these were the types who saw the most varied and largest patient load and had an interest in the unusual as opposed to the "crank turners" who follow standard procedure.

2. I wanted someone who had graduated no less than 10 years ago and no more than 15 years ago. I wanted someone who was experienced yet was exposed to modern concepts and not yet set in their ways.

3. I wanted someone with an expressed interest in lipids, not just diabetes as most are.

4. It would be nice if the doc was in my insurance plan!

Well I found my guy at the Medical College of Wisconsin where they are actually doing research on the endocrine system's effect on lipids. It took some arm twisting and a little rule bending but I not only got in to see the doc I wanted but lucked into a cancelled appointment the following week (instead of having to wait 6 weeks).

The doc was excellent. He told me things the other two endos never covered.

1. My TPO and TG antibodies are indeed above the reference range but nowhere near what they see in bad cases and, most importantly, far below what they see for those suffering polyglandular auto-immune disease. That little tidbit was never mentioned before and would have been nice to know earlier.

2. He will treat me based on my symptoms not just my TSH level. How about that for forward thinking.

3. He was not opposed to Armour Thyroid although he did specify a preference for T4 only therapy. That is what is known as "open-minded."

4. My thyroid is actually small for my height and weight and is consistent for mild Hashimoto's Thyroiditis and subclinical hypothyroidism. Another little tidbit never mentioned.

5. He understood the difficulty in adjusting for sporadic hyperthyroid hormone spikes as my thyroid deteriorates and explained how we will ignore the "noise" inherent in any feedback system and focus on the trendline. Not much you can do about it but at least we had the discussion and I felt secure that the doc understood and appreciated my predicament.

Wow, I finally found the thyroid equivalent of a Track Your Plaque doc like Bill Davis! But it gets even better on the non-technical end.

Seems the Medical College has all kinds of strict rules about who the bureacratic "gate keepers" will allow in to see the docs even with an appointment. Seems the computers would not acknowledge my existence even though they had a record of me from 30 years ago when I was in for migraine headaches (those actually cleared up years later). Apparently, their auditors had not yet verified my new insurance. I was told I would not be allowed to see the doctor until I was "in the system." Just then a nurse appeared to tell the recalcitrant clerk, "The doctor wants to see this patient." When the clerk refused she gave a stern look and said, "I am taking this patient!" After additional objections from the clerk the nurse leaned in and in a forceful tone repeated, "I am taking this patient!" I thought it might come to blows.

Wow again. The nurse took me (minds out of the gutter please), the doctor saw me, and after being interrupted several times by a bevy of disturbed bureaucrats the computer gods were placated. Thank God there are still doctors and nurses who are not only competent but caring enough to put people over procedure. Outside the staff at Track Your Plaque, I was beginning to think the breed was nearly extinct!


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