The BMJ Open have today published a paper entitled, "Attitudes and perceptions of health professionals towards management of hypothyroidism in general practice: a qualitative interview study".
Although it's a very small study - only 19 interviewees - it does show that health professionals do worry about whether to treat some patients or not. The worrying thing is that it also shows that they only treat using blood test results and not symptoms - something we have known for a very long time.
More worrying is that this paper is suggesting that more pharmacists and practice nurses should be involved more in the management of hypothyroidism.
My concern is that if GPs are not sure about how to treat us, how are pharmacists and practice nurses going to fare?
I would love to see the questions asked at these interviews. I doubt they asked, "Would you consider prescribing T3 to hypothyroid patients who have symptoms that are not resolved on levothyroxine?" or "Are you happy that you are being forced to de-prescribe T3 for your patients who are perfectly well on it?"
The information exchanged between professional and patient was usually restricted by time and often centred on symptoms rather than patient education.
Any doctor saying that information exchanged (with hypothyroid patients) centred on symptoms is lying, in my experience. It has been reported on here a few times that doctors have said that they don't care about symptoms they only care about blood tests. In my own experience, any discussion of symptoms resulted in me being told the problems were all in my head.
Health professionals felt that incorrect levothyroxine adherence was the main reason behind suboptimal treatment, although other factors such as comorbidity and concomitant medication were mentioned.
This is typical and traditional patient-blaming.
.
I've just had a thought! Wouldn't it have been good to do some related research into patients' experience of thyroid diagnosis and treatment, then the researchers could have done a "compare and contrast" job on the results.
I felt that what they meant was, the patients wanted to talk about symptoms and the doctor wanted to talk about educating the patients (as if they don't understand all about their condition).
I agree - they should have asked the patients too! I'd love to do more surveys (I can think of lots I'd love to do) but they have to be done properly or the powers that be won't take any notice e.g. bias etc. Wish I had more time!
To be honest I wouldn't want to be educated by any doctor on the subject of hypothyroidism. I doubt very many of them know as much as the average person who has been a member of this forum for a couple of months or more.
Nor me, humanbean , Having been at a endo appointment only last oct, with a friend, to hear that this so called specialist had not known what NDT was and had never heard of RT3? How can a specialist not know the history of thyroid treatment? He was obviously not a Thyroid specialist. Perhaps we need to start asking about the 'expertise' our so called specialist have before we see them. But how could this chap educate patients when patient know more about it than they do?
The endo did agree to a SST test, as the lady in question had private test to show low adrenal function. And he also agreed to test LH and FSH, when we queried if her low TSH could be due to hypopituitarism. She went back for the tests. GP since denied knowing anything about any results, saying she had to wait for her next appointment with Endo. This was week or so ago. Different endo - no interest in anything about her, denied any knowledge of hormone testing, obviously not interested in following them up or redoing them, and said he could offer her trial of t3 for 1 month only so no point. I hope she reports them. I think she did with first one but didn't get anywhere.
This 'blame the patients' seems to becoming a reoccurring theme. There was something I saw recently, for the life of me cannot recall where, saying that Levo had to be stored in an air tight container to keep it's stability. (who was ever told that?) And on Vanderpumps web page I read that patient taking adrenal supplements are causing their own adrenal problems. Blame the patients. By any means!
I'm waiting for the 'you need to go back to an endo to decide if you need the t3 you have been taking for 8 years' and I will give it to them both barrels! Why would I want to go to endo's like that. (would be my local ones too!)
How are they getting away with treating patients like this. How can it be right on any level.
Just read "For hypothyroidism, non-adherence to levothyroxine therapy has been reported to be as low as 22%,46 but the traditional belief that poor adherence causes suboptimal thyroid treatment was not supported by this study."
8 of the 12 topics referred to "control" of hypothyroidism. What wasn't made clear is what the patients thought "control" of hypothyroidism involved, and what they thought was good control, and what they thought was bad control.
The same comment could be asked about the GPs involved - what, to them, does good control of hypothyroidism actually mean?
crabapple The paragraph in your edit doesn't surprise me at all. Doctors take it for granted that less than ideal results (as far as the doctors actually define ideal results) must be the fault of the patient. I'm glad this wasn't supported by this study, but angry that it almost seems as though such a result was expected as a matter of course.
I agree that there are assumptions underlying these two studies which have been not only raised but answered by research appearing on this site. I do not think they would be able to do a comparison between the two studies since the questions, the tone and slant of the studies differs so much.
The quote in my edit does not make it clear but the "46" refers to a footnote referencing a study "Crilly M (2004) Thyroxine adherence in primary hypothyroidism. Lancet" in which "the traditional belief...was not supported" but without reading it I cannot tell whose "traditional belief" this was!
Sorry but it makes me really cross that serious health problems like this are farmed out to anyone / everyone apart from the doctor.
Go see your pharmacist - we are told, now I’ve tried that and I’ve been in the pharmacy when people have been getting advice, in my case the pharmacist was so cagey about making a decision that I was told to go and see my GP.
I like my practice nurse but from experience I know that their training is limited to what they are told to say and do and they are not going to change your dose or go off grid and decide to do any blood tests other than what has already been authorised by your GP or possibly endo.
It’s going to reach the stage where ‘the cleaner will see you now!’
I don’t mean to be offensive to to people who clean but you know what I mean. I’m more than happy to see my chiropodist with foot problems, my dentist if I have mouth dental problems, I see my optician when I have eye problems because I have found that they have all trained for a long time and know a lot more about problems in their fields than my GP does and in my area my dentist and optician can refer patients directly to hospital.
As you say, if GPs aren’t confident about treating thyroid patients how on earth are pharmacists and practice nurses. Someone (you?) has got to put forward your list of sensible questions. I can feel steam coming out of my ears!
The cleaner probably knows more on the subject!! And he/she would spend more time with you,!! Seems to me that the blame lies at the patients door for non compliance (they think) ill educated on the management of their condition..😥😥
Better still why not hand it over to reception/admin staff? They give you the test results,.. normal no further action required 😉. "Ask no questions, tell/hear no lies.....😚
It's so funny but 30 minutes after posting this, I had a phone call from my surgery saying they want me to see their pharmacist for a medication review. I already know they want to take me off my Armour and T3 so I insisted that I see the doctor instead. She was shocked! I now have an appointment for four week's time! Gives me plenty of time to put my portfolio of evidence together!
I can see an appointment with your MP coming up. (not the GP ) They have a cheek after we've been healthy/stable on a particular thyroid hormone and then threatening to withdraw it. How dare they treat us like fools which we might have been before being diagnosed but after all many of us have gone through, they know nothing at all. We want doctors like Dr Skinner and Dr Peatfield. Especially Dr S with his 'putting patients in a parlous situation' etc etc..
And when they won't let the GP's and endocrinologist treat us with T3, are they really going to let the local chemist or a nurse issue the medication you need, like hell!! It just means a buffer to keep us away from the Dr's! It is pure neglect in that they are turning their backs on us completely. If they think we are going to go quietly....!!! No doubt they are hoping the lack of correct medication will either keep us all to ill to fight or pain dead.
Can you predict which patients will struggle to control their hypothyroidism? Example?
Since few doctors ever seem to test antibodies, and only test TPO antibodies when they do test, their powers of prediction will be based on the doctor's perception of the patient.
They may as well have asked the doctors to toss a coin to decide who will struggle to control their hypothyroidism.
Doctors simply don't seem to realise that results will fluctuate as a result of thyroid antibodies. They prefer to blame the patient instead.
Health professionals believed that poor adherence was the main reason patients struggle to lower TSH levels.
I believe that patients will struggle to lower TSH levels when they are under-medicated. Isn't that obvious to the medical profession? Are they really that stupid?
And how many people were correctly advised on how to take Levo?
The really disheartening thing about this, is the initial summary trotting out of the same old discredited mantras - keep TSH in the reference range, you'll get osteoporosis and bone fractures and atrial fibrillation and the galloping dogrot and goodness knows what else if you don't. There is no evidence at all that these people even read or understand the new work that proves their position untenable. Now we can show that virtually all the trials that think they demonstrate relationships of OP, and AF to TSH have been wrongly statistically done, in that they average the situation for everyone without understanding that there are subgroups within the whole that do not obey the average response. It really is low-grade thinking that's displayed here - a stubborn holding on to their version of the truth, never mind the challenges to it. It's a perfect example of group thinking regardless of fact. And the dominance of biochemistry over presentation of patients.
It's a continual marvel to me that the fundamental scientific principle of falsifiability is routinely ignored by the profession. We see it in other fields too, not least the cholesterol/dietary fat/heart disease hypothesis. Bad ideas (or should that be bad attitudes?) are remarkably tenacious, especially when underpinned by career and financial interests.
And now they want to downgrade the thinking further by pushing us to chemists and nurses with even less understanding or authority to provide real care, for what is a lifelong chronic, potentially life threatening condition. This whole situation is a pure scandal.
You are so right. It does make one's blood boil when you know the 'experts' aren't experts at all and bring out the old mantra's i.e. TSH to be somewhere in range and levo. Especially when we've finally figured out what thyroid hormone replacement makes us well and then threatened with the removal and back (for me) to ambulances and sever palps, and all the other distressing symptoms when on levo. Husband also had a terrible time as he couldn't understand what was wrong with his wife especially when she was now diagnosed and given levothyroxine.
To follow on from Hillwoman...I was hearing the other day about a S. African professor of nutrition who was hounded out of his post because he believes that low fat diets are bad for us. Similarly Dr. Holick in America was pushed out of his post because he said that sunshine was good for us (Vit D).
Dr Coimbra has successfully treated over 4,000 people with autoimmune diseases using high doses of Vitamin D but GPs believe that high doses are dangerous. As some say - go figure.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
) They have a cheek after we've been healthy/stable on a particular thyroid hormone and then threatening to withdraw it. How dare they treat us like fools which we might have been before being diagnosed but after all many of us have gone through, they know nothing at all. We want doctors like Dr Skinner and Dr Peatfield. Especially Dr S with his 'putting patients in a parlous situation' etc etc..
A GP Has A Duty To Know About Current Knowledge Of The Diagnosis And Management Of Hypothyroidism
