Recently I had a patient at the reception who was interested in who was right from the two previous endocrinologists.
One doctor diagnosed her with autoimmune thyroiditis and prescribed treatment.
The second doctor agreed with the diagnosis, but categorically not with the treatment, and he also said, that the colleague is illiterate, and the treatment is wrong, because the patient did not have vivid external manifestations of this disease:
- flaky, pale, dry skin, with simultaneous swelling of the legs and hands;
- puffiness of the face;
- fragility and fading of the nail plates;
- hair loss;
- enlargement and swelling of the tongue, sometimes with dental prints on the lateral surfaces;
- flatulence and constipation.
The treatment was associated with the appointment of hormone replacement therapy, and the patient was pleased with the cancellation of the need to take hormones.
I carefully examined the lady, listened to her complaints, collected a full anamnesis (the entire history of her diseases), analyzed the results of her examination.
And also agreed with the diagnosis - autoimmune thyroiditis (AIT) - and with the treatment prescribed by the first doctor.
Thyroid stimulating hormone (TSH) is produced in the pituitary gland (that is, in the brain) and stimulates the thyroid gland to produce thyroid hormones. The patient's level was 4.2. The upper limit is 4, that is, this level can be called subcompensated (in official recommendations, this level is from 5 to 10).
The first doctor prescribed hormone replacement therapy in a very small dose (25 μg) with a gradual increase in the dosage (during avoidance of excessive activation of the sympathoadrenal system, which is often disguised as panic attacks) under control analyzes.
Why was this done, I emphasize, in the absence of a bright clinic of hypothyroidism?
With one very correct goal - to reduce the level of TSH.
When the TSH level reaches the lower limit of the norm (about 0.4), then the release of the altered thyroglobulin will stop, antibodies to which are excessively and progressively produced and damage the thyroid tissue. In other words, it was a very sensible assignment.
I always advise my students to explain to patients why you are prescribing certain drugs. And, of course, treat fellow doctors with respect.
I practice calling doctors (if they leave phones for their patients). A question asked to a colleague can remove all doubts and resolve difficult situations.
This is the guarantee of the health of patients.
Your Doctor Pavlova
