Thyroid redux

[ysobel]

Draft of message to my doctor (and yes I plan on finding a new gp).
Comments welcome

#

My concern with the test result was not purely the TSH number itself, but
the fact that eight months ago it was 1.49 and now it's 3.38, more than
double. That doesn't seem good.

(My understanding of what's "good" for TSH numbers is that there's a lot of
variance between sources -- some say anything over 2 is concerning, some
don't think it's a problem until it's higher than 4. That's part of why I
asked for a referral -- there's no clear answer, but an endocrinologist
would have a better idea of how to judge what if anything is going on,)

If you still don't think it's worth being seen by an endo, I am okay with
waiting a month and getting re-tested, as long as the full panel of thyroid
tests are run -- not just TSH and T4, but also T3, thyroid peroxidase
antibody (TPOAb), thyroglobulin antibody (TgAb), reverse T3 (rT3).

I would also like to reiterate the need to test vitamins B and D. I am not
worried about *intake* so much as *absorption*, especially since I have a
family history of D deficiency.

I'm not trying to be a pest; I'm trying to figure out why I have
debilitating fatigue. This is not just "oh I'm kind of tired" fatigue. This
is "I can't get anything done" fatigue. This is "going to church wipes me
out for the rest of the day" fatigue. This is *not normal for me at all*,
and if we can figure out why, we can maybe treat it.

It's true that most young people don't have vitamin problems -- but I am
not exactly young any more, and most people my age are able to do stuff
without being exhausted all the time. I'd like to figure out what's going
on.

Comments

[azurelunatic]

Not only have you got a family history of D deficiency, you also have a disability which reduces the amount of time you can spend outside in the sun.


(He sounds like such a tool.)

[ysobel]

He used to be good -- and he's still decent with stuff that is empirically obvious, e.g. the trigger finger -- but "fatigue" is vague, and he seems to have stopped giving many fucks, plus he tends to assume everything is normal. (My hair starts thinning in my 20s? "Just part of the aging process" even though none of my immediate family has the same thing going on. Fatigue? "Just a symptom of depression." Extreme fatigue? "Season change.")

[azurelunatic]

Sounds like a great GP for someone who is generally healthy as a horse, then...

[synecdochic]

oh, man, he sounds like a trash fire. Can you self-refer to an endocrinologist or see somebody else in the practice?

Anyway, my gut instinct is that this email is way too conciliatory -- you're not talking to your manager that you have to appease, you're talking to a medical professional who works for you. Suggested rewrite:

I'm less concerned about the absolute values on the TSH and more concerned that the value has doubled since my last tests eight months ago -- they've gone from 1.49 to 3.38 since the last test.

The symptoms I've been having, particularly the debilitating fatigue, have seriously disrupted my quality of life. I'm not willing to accept that it's something I have to live with until September or October without a full and detailed investigation of all possible causes. My symptoms are not normal.

Please provide me with a referral to an endocrinologist. As you know, I have multiple conditions and disabilities that make it unwise to assume that the profile for an 'average' person my age will apply to me. I'm perfectly willing to believe that the root cause of the symptoms I'm having are something other than hormonal balance or vitamin absorption, but I'd like to rule those factors out, particularly since I have a family history of vitamin D deficiency and thyroid problems. I'd like to investigate the situation in more depth with a specialist who can evaluate all the factors that may be contributing to the issue.

If you're unwilling or unable to provide that referral, please let me know that in writing so I can begin pursuing my other options as soon as possible.

[ysobel]

I may be able to self-refer. If he keeps being a shithead on this I will look. Am also shopping for a new gp regardless, but that takes time.

I like your rewrite -- thank you! I tend to be way not forceful enough.

May also explicitly add that fatigue is not a symptom of FOP.

[synecdochic]

Yeah, I know you tend to not be forceful enough, which is why I always rewrite things for you. ;)

But yeah, mentioning that it's not a symptom of FOP is probably a good idea.