The best evaluation tool is an accurate personal medical history: Thyroid health, Part 2

Sep 22, 2023 | 0 comments

Author’s note: Many subjects will be covered in this four-article series about thyroid health and healthy metabolism. In Part 1, we covered iodine requirements, associated drugs, self-care, medical and home treatment, and medical repercussions are covered. Although it is hard to cover every piece of information, a broad overview will be provided in each section. Low thyroid issues are prevalent in many patients. Today, Part 2 will address, in-depth, more information about your thyroid. Part 3 will be about T2 & T3 & T4 and doctors’ information. Part 4 will conclude with the “Bad News”.

By Garnett Stewart

The “master gland” is your thyroid gland. It gives the body orders to metabolize. Think of hormones as brakes or accelerators of your engine.

There are numerous common signs of thyroid hormone deficiency, such as short attention spans and memory loss, digestive problems, brittle hair and nails, excessively dry skin, dull hair, hair loss, facial edema, difficulty sleeping through the night, weight gain, and acne-prone skin.

The most helpful tool in medicine is and has been your personal medical history. The dictionary describes empirical as a best guess. Empirical medicine is an instinctual decision tree using years of education and experience collected by the medical provider combined with a good medical history and a targeted physical examination.

The old-fashioned empirical diagnosis method, where the doctor talks to the patient about his or her medical history, is still the best method for diagnosing thryroid problems.

Empirical diagnosis procedure: Touch your patients, listen to the body and vital signs, look at eyes and throats, elicit pain responses in the abdomen and extremities. Touch lymphatic areas. Abnormal findings direct the path of medicine but you must investigate these. It is an active hands-on process.

So, expat friends: As I approach my seventieth birthday, there are fewer medical professionals who are familiar with empirical medicine. We are fading into extinction. Present-day physicians are more likely to review test results before initiating a treatment.  They can delay care. They don’t interact physically while building your targeted medical history. It seems to be mostly computer keyboard use for notes instead of hands-on medicine.

There is a scarcity of listening everywhere. It’s because doctors frequently concentrate on test results. And because we are not giving good histories. But I’m learning that even our private sector doctors are very data-driven.

We, the patients, must be excellent historians and our own advocates.  We must provide a medical history, a list of allergies, and a list of medications that we take and know which do not work. Be concise.  It astounds me how few of my doctors’ gaze at my running Spanish list.

I’m hope to inspire everyone to start keeping a record of their allergies, prescription list, and medical background. What drugs do not work is should be included. This takes time and hard work to make a comprehensive list. Translate it to Spanish. Keep it up to date! Try to create it one page in English and the other side Spanish.

A good diet is essential for thyroid health.

A personal story about thyroid medicines: Fortunately, when I was 18 years old, my empirical doctor diagnosed me with HYPO Metabolism and began administering low-dose T4 inactive levothyroxine. Three months later, he commented that I was “brighter,” “more energized” and had “thinner” features.

Subclinical hypothyroidism is the name given to this condition. He told me about the lab’s findings later. He treated me not the lab.

The results revealed slightly low levels of T3 and T4 and a slightly elevated TSH. No strong indication of abnormality was revealed in the labs. This is a diagnosis with an endocrinologist but I am doubting a general medicine doctor will decide this today. After just three months of taking thyroid medication, I appeared lighter and more energetic. I felt invigorated and had reduced weigh and fat.

Read the abstract of a 1989 description of empirical medicine. My doctor proceeded to administer medication to me notwithstanding the findings of the lab tests. He therefore used the results but overruled the findings in lieu of my physical examination and history. He increased my dosage. But no one talked about daily iodine! See part one article again.

A helpful hint: exam times are 20 minutes and the documentation time is half. Your doctor needs to question you. Answer yes and no to the questions. Stick to yes or no. Allow the provider to ask for more details.  I cannot get my senior patients to do this  Time is of the essence. Loquaciousness is never useful.

Please send the name and contact information of any physicians you find who practice empirical medicine. I will publish these medical professionals’ information after confirming their practice standards.

An update to last week’s column about salt: A reader wrote to tell me that Ital Deli offers iodized sea salt.
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Garnett Stewart is a permanent resident of Ecuador. She is a retired Adult Medicine Nurse Practitioner with a specialty in Cardiology and Cardiovascular Surgery and is the author of several published articles. She holds Bachelors and Masters degrees in nursing. Her undergraduate university studies focused on biochemistry and biophysics. She can be contacted at Ecuador.advice@gmail.com

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