If you have been abused, it's all in your head?

[vocalEK]

Copied directly from "Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement" ncbi.nlm.nih.gov/pmc/articl...

5c. How do co-existent psychosocial, behavioral, and mental health conditions (such as addiction, somatization disorder, and depression) affect the management of levothyroxine therapy?

■  Recommendation

The treatment goals of hypothyroidism are the same for patients with psychosocial, behavioral, and mental health conditions, as for the general population. However, referral to a mental health professional should be considered if the severity of the symptoms is not sufficiently explained by the severity of the biochemically confirmed thyroid dysfunction or another medical condition, or if the mental health condition is impairing effective management of levothyroxine replacement therapy.

Strong recommendation. Low-quality evidence.

Discussion of the clinical literature

Underlying mental health problems, such as depression, personality disorders (e.g., borderline personality), and addictions, may complicate treatment of hypothyroidism and become frank barriers to informed consent and may impact perception of health state and adversely affect rational decision-making capacity. Patients in these categories should have a formal capacity assessment by a mental health expert (e.g., psychiatrist, clinical psychologist or social worker, licensed addiction therapist) to rule out underlying mental health conditions.

One mental health disorder that has been hypothesized to be overlooked in the context of hypothyroidism is somatization disorder, which warrants evaluation and possible treatment by a mental health professional. Somatization disorder involves a range of physiological sensations and complaints manifest in response to a complex psychological or abuse history (246–249). It is not a factitious disorder or malingering. It has been hypothesized that patients with somatization disorders, who have been treated for hypothyroidism, may persistently complain of a range of symptoms associated with hypothyroidism despite normal laboratory testing (250). Such patients are typically driven to a range of multiple practitioners, who may do multiple work-ups, and even unnecessary procedures. Such patients are frequently at risk for a range of iatrogenic harms, such as risks from unnecessary surgeries. They may also pay large sums of money for nonstandard alternative therapies to deal with their physiologic complaints in an attempt to “prove” they are real (as to the patient, they are), and they may become belligerent and combative when told they are euthyroid. Patients with somatization disorders are frequently misdiagnosed and mismanaged and have complicated medical histories. Frequent misdiagnosis may occur because they seek out so many subspecialists. Somatization disorder is overwhelmingly diagnosed in females, with current hypotheses that it may be a disorder of affect regulation (251) or a complication or manifestation of a history of physical or sexual abuse (252). Recent data suggest that one in three women worldwide have been sexually or physically abused in their lifetimes (domesticviolencestatistics.org). Somatization disorder should be managed in conjunction with a mental health care provider to rule out other underlying psychiatric problems, including personality disorders.

In patients with persistent complaints of hypothyroidism as well as chronic pain and malaise, all organic causes should be ruled out, followed by referral to a mental health practitioner to screen for somatoform disorder. Patients suspected of somatoform disorders should be provided with sensitive discussion in which the referral is explained, in which trust is maintained. Patients should understand and appreciate that their symptoms are not factitious and are real and they may have causes that are rooted in psychological trauma, rather than an organic problem with physiologic causes.

********************

These are my observations.

I am not saying that there is no such thing as somatization disorder, but I am saying that this gives doctors who insist in undertreating their patients a convenient excuse.

The Guidelines fail to provide a clear description of what it means to have met part (i) of their stated goal for treatment (to provide resolution of the patients' symptoms and hypothyroid signs), and the second half of part (ii) (with improvement in thyroid hormone concentrations):

Levothyroxine replacement therapy has three main goals. These are (i) to provide resolution of the patients' symptoms and hypothyroid signs, including biological and physiologic markers of hypothyroidism, (ii) to achieve normalization of serum thyrotropin with improvement in thyroid hormone concentrations, and (iii) to avoid overtreatment (iatrogenic thyrotoxicosis), especially in the elderly.

Instead, the guidelines imply that any doctor who gets his patients' TSH within the lab range has successfully done his or her job.

[Hidden]

You couldn't make up the lengths to which thyroid trained medical professional will go in order to prove that they are right and the patient is wrong.

My problem, no thyroid after surgery for benign multi-nodular goitre, could not be easier to diagnose and could not be easier to treat - NDT, daily for life.

BUT, my diagnosis is Primary Hypothyroidism and I am lumped into the same basket as every other patient with an underperforming thyroid gland where the treatment does vary from patient to patient.

I am disgusted that I am supplied with levothyroxine alone, which is NEVER going to give me anything like a symptom-free life. For anyone to suggest that, because I have these symptoms at the same time as perfectly normal blood results whilst on levothyroxine alone, I should be referred to a psychiatrist, I find utterly despicable.

One of the suggested solutions to me getting NHS NDT is for me to demonstrate that the improvements I would get to my health would be far greater than the improvements other people with my specific problem would get.

Quite how I could do that when possibly every other person without a thyroid would also gain improved health by taking NDT when there are probably tens of thousands of such patients in the UK is not explained .

[humanbean]

Strong recommendation. Low-quality evidence.

Why is anyone making a strong recommendation based on low quality evidence?

The reason for diagnosing as many people as possible with mental illness is because the Powers That Be (PTB) think it will save them money. They just stop diagnosing and treating people, job done. The only people who will not be diagnosed with a mental health problem will be newborn babies and the dead.

Most, if not all, healthcare policies in the US pay benefits to people who are physically ill or physically injured. If someone has a serious accident, for example, that they will never recover from, they might get benefits for life from their policy. But if someone has a mental health diagnosis of any kind then they get will get benefits for a maximum of about 18 month - 2 years.

So under those conditions the obvious thing for the PTB to do is to declare as many people as possible as mentally ill. Saves a fortune!

And of course, US healthcare is coming to the UK in the next year or two. Boris has said it won't, but I can tell he's lying because his lips were moving.

[vocalEK in reply to humanbean]

Yes, that anomaly struck me as well.

[vocalEK in reply to vocalEK]

Oh, and after the stories I have read in this group, I am more afraid that UK healthcare might be coming to the U.S. Especially where surgery is concerned.

[humanbean in reply to vocalEK]

It used to be rather better when the NHS had more staff. However, I suspect the govt have been deliberately starving the NHS of funds to make it cost less and therefore more attractive to future investors.

[vocalEK in reply to humanbean]

Future investors? Is the NHS about to take itself private? Do an I.P.O.?

[humanbean in reply to vocalEK]

The govt won't admit that that is their plan, but I think there is no doubt it will happen - and I'm not alone in believing this. The private sector already has its snout in the trough.

keepournhspublic.com/

[AmandaK]

This is shocking. Then again, I read somewhere that the US viewed introversion as a mental health problem so anything is possible. And note how women are singled out - smacks of the Victorian regard for women seen as hysterical and the Medieval/Early Modern view of women as witches. Nothing has changed.

A recent Radio 4 programme looked at the Diagnostic and Statistical Manual for Mental Disorders, which was produced in the US but also used in the UK. Apparently, in the US medics are not allowed to prescribe certain drugs unless the condition they are being used to treat the patient is featured in the DSM. The outcome is that innocuous issues have become medicalised. And, of course, that favours big pharma.

It's therefore worrying that the DSM is being used in the UK (where the link between the drugs to be administered and the condition to be treated isn't made) and even moreso given that it's likely that the US will hijack the NHS in the future, despite Trump and Johnson saying the opposite. Then again, since when have we believed anything these two leaders have said?

In fact, at a local chemist I picked up a leaflet advertising NHS blood tests for particular conditions for people to pay for should they wish - yet the blood tests are available for free on the NHS so why are they encouraging people to pay for something that can be obtained for nothing?

I didn't see it but there was a programme last night about this subject so maybe I should watch it and hopefully be proved wrong.

[humanbean in reply to AmandaK]

What was the name of the program and which channel did it appear on?

[AmandaK in reply to humanbean]

Sorry about the delay in responding - I couldn't find any reference to it! However, I think I must have seen some kind of trailer as I've just discovered that it was screened on 28 October on Channel 4's Dispatches programme, so it should be available on catch up.

[AmandaK in reply to AmandaK]

The programme is called 'Trump's plan for the NHS'.

[humanbean in reply to AmandaK]

Thanks, found it :

channel4.com/programmes/dis...

It is available for a limited time - until 27 November 2019 if my arithmetic is accurate.

[SilverAvocado]

What infuriates me about so many of these statements is that they are unfalsifiable and circular. There is nothing solid there.

I noticed a few other alarming bits branching off abou abuse, statements and implications I picked up:

- If you have somatizaton disorder you might still think you're hypothyroid even when your blood tests look good.

- Somatization disorder is caused by physical or sexual abuse.

- Women are particularly vulnerable to somatization disorder.

- One in three women have been abused.

- Patients with somatization disorder are sometimes taken seriously by specialists and given treatment for their claimed illnesses, this is a mistake.

- People with somatization disorder cannot tell the difference between being sick and being well.

- Some patients have complex medical and psychological histories. If something is complex, there's no point in thinking any more about it!

For me, a few questions raised by all of this:

Can we ever believe anything these capricious women tell us about their symptoms? (sarcasm, in case it isn't clear :p)

Once I have a history of abuse, is it then impossible to have lingering hypothyroid symptoms? Or for my self reporting to ever be evidence I have any illness at all?

Is there any way for a doctor to tell the difference between a person who has lingering hypothyroid symptoms, and someone who just thinks they do, perhaps because they are a woman or some other form of fantasist? Or is it simply the case that all patient reported hypothyroid symptoms should be dismissed?

But also I wondered... If we follow the flimsy logic through... If my blood tests look fine but I say I still feel ill... My doctor should then conclude that I am not in fact still hypo but have been sexually abused? And of course this is expected in almost all their female patients anyway, so maybe it's safest to assume it before I open my mouth anyway.

[humanbean in reply to SilverAvocado]

Brilliant post, SilverAvocado

[SilverAvocado in reply to humanbean]

Thank you It really is horrifying that doctors are being primed to think that patients may be mistaken about their symptom reports, and to be told that women are even more likely to be wrong!

Then we wonder why doctors treat people so atrociously and the whole system is misogynistic

[Wetsuiter]

Is there any way for a doctor to tell the difference between a person who has lingering hypothyroid symptoms, and someone who just thinks they do, perhaps because they are a woman or some other form of fantasist?

Thank you silver avocado for simply clarifying my thoughts (whilst i was still spitting feathers)

[SilverAvocado in reply to Wetsuiter]

I try my best Thanks for letting me know it was useful!