Err on the side of caution

Err on the side of caution

yesSome complaints sound fickle. They come across as vain, frivolous, or downright silly. Like the young woman who wanted to know if it was her change in her skincare routine that was causing her breakouts. Hey? Or the middle-aged man who complained about his bulging belly causing his shirt buttons to come undone at work and causing a lot of embarrassment. Or the thirty-six year old woman who wanted something to enlarge her breasts.

Most of the time, when we meet such people, we (health professionals) tend to dismiss them with a kind word or cruelly with a wave of the hand. We attribute it to vanity. In this world of uncertainty, inflation, corruption and cancer, is it really that important to have a saggy belly or breasts?

Unfortunately it is.

Aisha’s* main complaint was the desire to lose weight. She explained to me that for a few months, she had added a few extra pounds around her abdomen and wanted to be herself again. She had given birth to a baby six months ago, and since then, her weight had steadily increased. Aisha was tired all the time and the two previous doctors she had seen had told her the same thing: weight gain was common after pregnancy. In addition, she had a small baby who demanded to be breastfed all the time. That alone was a recipe for fatigue.

Like the other doctors, I wanted to fire her, but because of the pleading way she looked at me. She looked like a normal thirty-year-old woman who had just had a baby: plump and sullen, but healthy. She was expensively dressed with gold rings on her fingers and expertly made up. Her face was pretty and her vital signs seemed fine. Wanting to send her off gently, I asked her to run some tests that I was sure would be a futile chase. In my mind, I wanted him to hurry up and get away from her because she had more important things to do than listen to her complain about her weight. 66kg Is that a weight?

I completely forgot about Aisha until she came back three days later with a triumphant look on her face. Apparently, she had already asked Dr. Google about the test results. Her tests showed that her thyroid hormones were very low. Aisha had hypothyroidism. Looking at her, I realized that she had missed a very important signal in my initial assessment. What she had dismissed as a fat neck was actually a diffuse swelling of her neck; a goiter A wave of disappointment swept over me, and I mentally banged my head. I decided to start over by taking the proper story.

His hair was falling out and he felt cold even during hot weather. He was sleepy all the time and had a hard time remembering names. He suffered from bouts of constipation. Everyone around her felt that it was due to the stress of a baby. He told me about her periods of absence. What I thought was irregular menstrual periods due to breastfeeding was actually caused by low thyroid hormones. Once again, embarrassment took over my big head. When had I become so complacent?

Aisha’s initial excitement about having a diagnosis fizzled out when we discussed her condition. The thyroid is a funny organ.

“And even though she’s small, she’s fierce.”

Every time I want to talk about the thyroid gland with a patient, this line from Shakespeare’s “A Midsummer Night’s Dream” comes to mind. That little butterfly-shaped gland in our neck seems to be to blame for so many of us feeling like shit: tired. Grumpy. Over weight.

Actually diagnosing hypothyroidism is simple: A basic blood test determines the amount of thyroid-stimulating hormone (TSH), a substance pumped out by the pituitary gland that regulates thyroid production. And yet, many doctors miss it.

An estimated 60 percent of people with the disorder don’t know they have it, because its vague symptoms (fatigue, weight gain, depression, menstrual irregularities, and slow thinking) are so similar to other disorders or generalized stress that doctors (like : yours sincerely) and patients routinely ignore them. Ironically, those same ambiguous symptoms lead many women with healthy thyroids to believe they have a problem, and many struggle to be diagnosed with a condition they don’t have and are then treated with synthetic hormones they don’t need.

Wanting to absolve myself, I immediately started treatment with Levothyroxine and ordered more tests to find out the extent of his goiter.

Fortunately, the ultrasound of Aisha’s neck showed that surgery was not an immediate option. Together with an endocrinologist, we mapped out a treatment plan for Aisha and designed an exercise plan for her to lose weight.

Six months later, he is back to his normal weight and his emotional state and energy levels are mostly back to normal. Her thyroid levels will continue to be monitored for a long time.

I learned a very important lesson that day; which is to never dismiss a patient’s complaint no matter how fickle it may seem. Imagine if she had fired her without the evidence? The symptoms of hypothyroidism are often ignored, which can have harmful results. If left untreated, the condition can increase bad LDL cholesterol, increase the risk of heart disease and infertility, and, in rare cases, lead to a life-threatening condition known as myxedema coma.

So now, when a patient comes to me with silly symptoms like: ‘my right hand looks bigger than my left hand,’ I order a bloody X-ray to confirm it. It is better to err on the side of caution than to have nightmares about misdiagnosis and possible death.

This sky, we must do am.

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