In a message dated 3/14/2009 9:48:21 A.M. US Eastern Standard Time, [log in to unmask] writes: My brother also has gout with no thyroid problem so could be totally independent. Thanks again -- great advice -- dave >>>> Dave, glad to help! Be careful about docs who say that your brother has no thyroid problem, though. "Thyroid problem" is the real operative, here. Most doctors don't think that there is a "thyroid problem" until the TSH (thyroid stimulating hormone) is ridiculously high. This is obviously wrong because someone could have no pituitary, no thyroid function, no TSH, but have big "thyroid problems." Likewise, there are a lot of people whose cholesterol or lipids are high, whose thyroid lab is "normal" (That means that they fit in the middle 95.5% thyroid test scores of all those sick people we send to the lab because we think that they have thyroid trouble.); but whose lipids become very normal on thyroid hormone alone. Did they have a "thyroid problem?" I used to do case supervision at a local state children's hospital. Virtually all the kids there had long term intellectual and emotional problems, and most were too violent to manage outside the institution. I found cretinism (early onset hypothyroidism) and undiagnosed hypothyroidism in kids whose TSH was "normal." None of the symptoms were explained by anything else, and many were quite dramatic. A large number of kids never had a body temperature as high as 98.6 F until they had a major illness. There was a little girl there who started breast development at age 8, her menarche at age 9, and was lactating at age 10. The Medical Center was consulted, and they said that she was lactating because she had "intellectual and social stresses." Every child at that hospital had "intellectual and social stresses," but she was the only one giving milk. On the other hand, early menarche and lactation are not rare symptoms of hypothyroidism in little girls. They had a 19 year old boy there who had about the same physical, psychological, and sexual maturity of a 9 year old. A 12 year old boy weighed over 200 pounds, had sleep apnea, had several other signs of hypothyroidism and a low body temperature. I started treating the kids with low dose thyroid replacement, and there were some reasonable improvements. But, a local pediatrician became indignant, wrote an open letter to me and the head of the hospital and demanded thyroid replacement stop. The treated kids were taken off thyroid medicine because their TSH was "normal" and they couldn't have had a "thyroid problem". Most of the children got more lethargic, easier for staff to manage, and lost whatever modest gains that they made. One of the biggest complaints I hear on sites like this is that the doc involved will not treat a patient who is obviously hypothyroid, because the lab is normal. No thyroid problem? It is very important to remember that 85% of any diagnosis, from pregnancy to gunshot wound, is purely History (What's been happening to the patient before he came to the office?); The Examination (How does he appear to the, hopefully, well trained eye?) is worth about 10% and Labs are only good for about 5%. Most docs use the clinical lab, instead of clinical acumen, to tell whether their patient has a thyroid problem. This assures that a lot of thyroid problems are missed and the host of resulting problems helps make ours the most expensive, but not best, medical system in the world. My definition of "having a thyroid problem" has evolved to include people whose history and symptom complex are suggestive of a thyroid problem, whose labs are not incompatible, and who respond to thyroid replacement when the associated problems are addressed. Doc Don _www.dmichaelmd.com_ (http://www.dmichaelmd.com) **************Need a job? Find employment help in your area. (http://yellowpages.aol.com/search?query=employment_agencies&ncid=emlcntusyelp00000005) _______________________________________________________________ Control Your Self-Serve Thyroid Account Rules - mailto:[log in to unmask] Subscribe - http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=thyroid&A=1 Unsubscribe - mailto:[log in to unmask] Our Home Page - http://www.Emissary.Net/thyroid/index.html Thyroid Archives - http://LISTSERV.ICORS.ORG/archives/thyroid.html _______________________________________________________________