Just came across this item in the BMJ about diagnosing hyperthyroidism. Sadly, only a small part is accessible to us but there is enough to get the flavour:
10-Minute Consultation
New diagnosis of hyperthyroidism in primary care
BMJ 2018; 362 doi:doi.org/10.1136/bmj.k2880 (Published 24 August 2018) Cite this as: BMJ 2018;362:k2880
My rapid response is to ask whether anyone who needs to read the sentence below (from the main article) should be allowed within a hundred metres of an undiagnosed hyperthyroid patient!
Hyperthyroidism describes excess hormone production from the thyroid gland.
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helvella
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Hyperthyroidism describes excess hormone production from the thyroid gland.
Can I quibble about this? In reality doctors think hyperthyroidism is described by a very low TSH - they often don't actually care how much T4 and T3 the thyroid itself is producing.
"Hyperthyroidism is a biochemical diagnosis. Establishing the underlying aetiology is essential to determine appropriate management."
I had almost identical symptoms to the patient described. This describes the actions of my GP and subsequent Endocrynology unit.
Tests were done, treatment begun. 1st treatment failed. 2nd treatment succeeded. Now dependent on Levothyroxine, getting my muscle strength back and my bone density too.
I have a family history of serious thyroid disease and I had lost 10kg in one month. I had previously requested a thyroid blood test. It was the weight loss that made my GP take action.
The process is sound. That women are not believed, well...
Happy International "When is International Men's Day?" Day.
I think it’s more that this seems to be one of a series of ‘10 minute consultations’. Is there a 10 minute consultation for every condition known to man?
In a way you have to feel sorry for doctors coming under such pressure to stick to the ten minute appointment that they have a handbook on how to do it.
A lot depends on the first doctor you come across recognising that you might have Graves or whatever condition is bothering you and following the steps given in the 10 minute consultation which as you say make sense and are pretty much how I was treated too - but only once I was lucky enough to find a GP who recognised that the shaking, sweaty, heart pounding, wreck who barely had the muscle strength to get up off a chair in front of them was a definite candidate for Graves.
The first GP I saw with similar symptoms leaned back in her chair, looked at me like I was some sort of specimen and told me I was ‘needing my holiday’.
I came out of that consultation almost crying with rage, frustration and despair because I knew I was ill. The GP in question wouldn’t have benefited from the 10 minute handbook because she didn’t recognise Graves in the first place to find the necessary page.
A person’s treatment is only as good as the GP you see taking you seriously and that lady clearly didn’t take me seriously at all - I assume she must have thought I was stressed.
Sadly that's the first thing they think is wrong with you stress and anxiety. I have to say we are fortunate that the GP doesn't always stick to the 10 minute rule.
Agree about the 1000 metres but I suspect the GP I saw who finally diagnosed Graves knew what I had the minute she saw me.
On the other hand I try keep to the 1000metre rule with the partner the who no more than three months before that visit and with very similar symptoms thought I was needing my holiday.
Having read the sample case there is no way I would even hint to a GP that I thought stress at work or a house move could be the root cause of my problem.
I also feel sorry for women younger than me who are immediately labelled menopausal / neurotic / stressed / depressed. I don’t know for sure but I have a feeling that men of a similar age don’t have that problem.
When I first asked about the constant shaking it was suggested that it was the steroids taken for a chest infection 🤔My whole body was shaking and I couldn't hold a cup 🙄😏. Three months on I was diagnosed with graves.
That sounds just like me - only I arrived at the end of summer and was about to go on holiday so that was her suggestion. I suppose t was better than offering me antidepressants.
I wish there was a like button for that doctor's rapid response. At least that sentence points out that hyperthyroidism is excess thyroid hormone, not low TSH, which many GPs seem not to know.
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