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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by mist on November 28, 2001, at 15:24:27
My doctor recently ordered a panel of thyroid tests for me (at my request—usually they just do the TSH which doesn't give a complete picture of thyroid function and can be misleading). One of the tests came back abnormal. The others were supposedly in the normal range, although according to what I've read what's considered normal in evaluating thyroid conditions is debatable and can vary from individual to individual.
I have some symptoms of hypothyroid, including depression (the one that concerns me the most). Based on these symptoms, family history, and my test results, my doctor referred me to an endocrinologist. However, I have to wait almost a month to get in. I am badly depressed to the point that I can barely function on a daily basis or go out. I'm hoping if I treat the thyroid problem I'll get some relief from my longstanding depression. As I understand it, if depression is caused by hypothyroidism, taking thyroid hormone can in some cases relieve it pretty quickly. I would rather go this route before trying any further medication.
My main question is why do I have to wait so long to see the endocrinologist? Is it because I have an HMO? Is the doctor putting other patients before me because they have another type of health plan that will be more lucrative for the doctor? Is it common to have to wait this long to see a specialist under these circumstances?
Posted by akc on November 28, 2001, at 16:29:38
In reply to thyroid, depression, doctors, and HMOs, posted by mist on November 28, 2001, at 15:24:27
I doubt the doctor is putting people with other health plans before you. Usually it is just hard to get in to see a specialist -- especially the first time. Specialist seem to reserve spots according to certain formulas -- if they do surgeries, then those first, then established patients according to diagnosis, then finally new patients. And if the specialist is especially good or if the specialist is one of a few in a particular HMO (i.e., sees lots and lots of patients), then it is even more difficult to get into. So being a new patient -- that pretty much explains the delay. It has to be so frustrating.
It is funny -- I had a cat with a thyroid problem that was never tested. The test was expensive, but she had all these other signs that she had a thyroid problem. So the vet suggested we try the thyroid medicine and see what would happened. I was assured that for a short term test, it wouldn't hurt her, and depending on her response, it could very much help her. Sometimes I wonder why we just don't take that approach with us humans. I wonder what the risk would be.
akc
Posted by mist on November 28, 2001, at 16:55:18
In reply to Re: thyroid, depression, doctors, and HMOs, posted by akc on November 28, 2001, at 16:29:38
> It is funny -- I had a cat with a thyroid problem that was never tested. The test was expensive, but she had all these other signs that she had a thyroid problem. So the vet suggested we try the thyroid medicine and see what would happened. I was assured that for a short term test, it wouldn't hurt her, and depending on her response, it could very much help her. Sometimes I wonder why we just don't take that approach with us humans. I wonder what the risk would be.
>
> akcakc, actually I was kind of hoping my doctor would do that and in fact I think I read somewhere that some do (although don't remember for sure). But one risk is that if you don't need the hormone you could become hyperthyroid and overwork your heart, increase the risk of osteoporosis, etc. but for a short time I can't imagine it would do lasting harm if any. i would be willing to try a tiny bit if I had some and increase based on symptom change but i also like the idea of seeing a specialist. i guess i'll just drag myself through the next few weeks until i do.
thanks for the info on docs.
-mist
Posted by susan C on November 28, 2001, at 17:22:33
In reply to Re: thyroid, depression, doctors, and HMOs » akc, posted by mist on November 28, 2001, at 16:55:18
Dont know much about HMOs, dont know much about geography...sorry simon and garfunkle...if that is who sang that song...
I agree with akc, as if I am not careful it can take me a month to get in for an annual exam...and i am not in an HMO. i asked about it recently, and the explanation was, because usual appt is for ten minutes, but an annual exam can be 40 min or longer. So, I could see going to a specialist for the first time could take even longer. My pdoc spent 90 minutes the first visit...
I have also had several opinions from docs that 'trying' thyroid, slowly, is an option. My pdoc and eventually I did not choose it because there weren't clear enough indicators that it could really be a problem.
I think you should get a gold star for effort. And one more suggestion, request to be put on the waiting list for a cancellation. Maybe, between now and your appointment, something will open up.
mouse on the sidelines with pom poms
susan C> > It is funny -- I had a cat with a thyroid problem that was never tested. The test was expensive, but she had all these other signs that she had a thyroid problem. So the vet suggested we try the thyroid medicine and see what would happened. I was assured that for a short term test, it wouldn't hurt her, and depending on her response, it could very much help her. Sometimes I wonder why we just don't take that approach with us humans. I wonder what the risk would be.
> >
> > akc
>
> akc, actually I was kind of hoping my doctor would do that and in fact I think I read somewhere that some do (although don't remember for sure). But one risk is that if you don't need the hormone you could become hyperthyroid and overwork your heart, increase the risk of osteoporosis, etc. but for a short time I can't imagine it would do lasting harm if any. i would be willing to try a tiny bit if I had some and increase based on symptom change but i also like the idea of seeing a specialist. i guess i'll just drag myself through the next few weeks until i do.
>
> thanks for the info on docs.
>
> -mist
Posted by Noa on November 28, 2001, at 18:00:39
In reply to Re: thyroid, depression, doctors, and HMOs, posted by susan C on November 28, 2001, at 17:22:33
I was also going to suggest asking them to call you if there is a cacellation, of which there are often many, I think.
As for waiting so long, I think a few factors could affect this. Are you waiting for an HMO approved specialist? It's possible there is only a short list of endos on your plan. If so, you could choose to get an initial consult outside your plan and just pay for it yourself, although because of other factors, you could have to wait just as long. You could explore that to see if it would expedite things. Just don't cancel your appointment. Depending on where you live, endos might be in short supply in general. My neice needed to see a pediatric endo last year, and had to wait 6 months for an appointment because of the scarcity of these specialists. Or perhaps this one is in high demand because they are good?
I did hear news last year that medical schools are training fewer specialists because there was thought to be a glut in specialists during the past decade. Can't verify that.
Anecdotally, I heard from a recent med school graduate that the most popular residency (specialty training) is in opthalmology because of how lucrative the laser surgery business is.
I found my endo online actually! At a site where consumers can recommend good endos. (see the thyroid and depression folder)
I, too, commend you for your perseverence. I definitely think pusuing this angle is a good idea. It is always possible that it isn't the answer, but you do have to pursue it to find out. And if you are hypothyroid, if it turns out that it is not the *only* treatment strategy you will need, it could at least be a major component. It was for me--I was not responding well to antidepressants until my thyroid condition was adequately treated. Good luck.
Posted by mist on November 28, 2001, at 21:33:02
In reply to thyroid, depression, doctors, and HMOs, posted by mist on November 28, 2001, at 15:24:27
akc, susan, and Noa -
Thank you for your support, advice, and information.
The endo I'm supposed to see doesn't have a waiting list for cancellations but I can call them daily to see if there are any.
I'm going to see if my primary care doc can give me a little thyroid hormone to try in the meantime. I doubt he will but it's worth a try.
Posted by Bill L on November 29, 2001, at 7:25:06
In reply to thyroid, depression, doctors, and HMOs, posted by mist on November 28, 2001, at 15:24:27
I was in the same situation as you. I waited and finally saw an endocrinologist at Johns Hopkins which has a reputation as being one of the best hospitals in the world. He did a couple of tests but a "free T3" was not one of them. Furthermore, he said that he would not recommend thyroid supplementation as long as the TSH is ok.
He did say that some of the psychiatrists at Hopkins disagree with him and will sometimes give supplmentation to augment antidepressants even if the TSH is normal. The strategy is to give it a trial and see if it works. I believe that the theory is that even if blood tests are normal, the hormone may not be adequately getting into the cells.
When doctors do decide to supplment, most will use T4 or maybe T3 or both (thyrolar). Some like Armour thyroid more since it is natural and has all of the thyroid hormones.
From what I have read, IF one's TSH is ok, supplementation might make antidepressants work better, but supplmentation will generally not get rid of depression by itself. On the other hand, if one has high TSH, then supplementation alone can relieve depression.
My recommendation to you is to certainly keep your appointment to see if you have a thyroid problem. But in the mean time, I think that you should ask your regular doctor about starting on antidepressants right now if you have not already started.
> My doctor recently ordered a panel of thyroid tests for me (at my request—usually they just do the TSH which doesn't give a complete picture of thyroid function and can be misleading). One of the tests came back abnormal. The others were supposedly in the normal range, although according to what I've read what's considered normal in evaluating thyroid conditions is debatable and can vary from individual to individual.
>
> I have some symptoms of hypothyroid, including depression (the one that concerns me the most). Based on these symptoms, family history, and my test results, my doctor referred me to an endocrinologist. However, I have to wait almost a month to get in. I am badly depressed to the point that I can barely function on a daily basis or go out. I'm hoping if I treat the thyroid problem I'll get some relief from my longstanding depression. As I understand it, if depression is caused by hypothyroidism, taking thyroid hormone can in some cases relieve it pretty quickly. I would rather go this route before trying any further medication.
>
> My main question is why do I have to wait so long to see the endocrinologist? Is it because I have an HMO? Is the doctor putting other patients before me because they have another type of health plan that will be more lucrative for the doctor? Is it common to have to wait this long to see a specialist under these circumstances?
Posted by nightlight on November 29, 2001, at 10:47:27
In reply to thyroid, depression, doctors, and HMOs, posted by mist on November 28, 2001, at 15:24:27
Dear mist,
Hang in there! I hope your doc does give you a trial, if it is deemed safe to do so.
Waiting a month! I hate that kinda stuff. I begin to obsess over the treatment, whatever it may be, and it invades my every thought. I have had refractory depression for yrs. and each time I decided to try something new, I wanted it in my system immediately! Patience goes out the window.
Very hard for me to control. (I have recently been diagnosed ADD, so at least I get some immediate support from a stimulant while I wait for the A-D to kick in).Around here it is DERMATOLOGISTS who are booked 6-7 months ahead. I think it must have s/t to do with the popularity of Accutane and the fact that most skin disorders (like psoriasis) are rarely cured, only 'managed'.
Are you taking any other meds for your depression?
nightlight.
Posted by mist on November 29, 2001, at 22:48:22
In reply to thyroid, depression, doctors, and HMOs, posted by mist on November 28, 2001, at 15:24:27
Bill L and Nightlight:
I appreciate your responses.
I think I'm going to wait until I try the hormone (if one of the docs prescribe it) before taking other meds, except klonopin which I started taking a few days ago. It seems to help take the edge off the most distressing part of the depression. ADs take a long time to kick in and I was very frightened by the side effects I got from the ones I tried. They are a last resort for me.
Fortunately my doctor did the Free T3, Free T4, antibodies, and other tests, at my request. If one of the docs prescribes a T4 med and it doesn't work I'll try to get something with T3 in it too. -mist
Posted by hvixen on May 30, 2006, at 13:57:58
In reply to Re: thyroid, etc. (to Bill L and nightlight), posted by mist on November 29, 2001, at 22:48:22
I recently had thyroid cancer and my levels were off and now I have no thyroid. I had to have radiation I131 treatment and come off my synthroid cold turkey and became hypothyroid. The depression from that is horrible and my endocrinologist said it could take months of taking my medicine to feel normal again. It all depends on the endocrinologist you see on how fast you can get in though mine I got in on a week the one they were going to refer me to I had done had my biopsy and met with the surgon and had surgery date set up before I had an appointment..
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