Why oh why didn't I take the blue pill?

Most of us have heard the term "doctor shopping".  It's a pejorative term for people that go from doctor to doctor looking for additional drug prescriptions.  It never occurred to me before August that I would ever engage in this behavior, or that I should engage in this behavior.

To make a long story short for those who haven't been around, my thyroid failed four years ago.  I did not then understand why I was getting fat and feeling depressed for no particular reason.  A little over two years ago I went to the local VA clinic in an attempt to have them fix my horribly messed up right shoulder.  Routine bloodwork showed that my thyroid was shot, so the VA put me on a minimum dosage of thyroid replacement (50 micrograms - levothyroxine).  Two years of begging got me nowhere with VA docs in terms of either fixing my shoulder or putting me on an effective dose of medicine. 

50 micrograms - WORTHLESS!!!!

You see, docs don't generally give a hoot about whether you feel good or not.  What they care about is following standard practice guidelines, which may or may not have been developed with patient quality of life in mind.  In the case of thyroid medication prescription guidelines, patient quality of life is a total non-factor.  That's not an inference or a guess.  Through my university I have access to virtually every medical journal on the planet.  I've read the actual guidelines published by the American Association of Clinical Endocrinologists and the American Thyroid Association.  I've also read the research debates regarding how those guidelines were created.  Patient quality of life never even comes up in the discussions.  These groups are infinitely more interested in things like calcium retention and cholesterol counts.  And unfortunately for patients, thyroid levels that are sufficient to sustain calcium uptake and minimize cholesterol are nowhere near high enough to help patients actually feel better.  So the conservative approach to prescribing, meant to avoid potentially fatal 'thyroid storms', keeps you alive - but generally overweight and miserable. 

By Christmas of last year my cholesterol was fine, but I weighed nearly 215 pounds.  And of course, I felt like crap.  When I left the Navy I weighed 175 pounds.  But hey, my numbers were within established guidelines.  My TSH stayed at about 4.3 - anything under 5 is acceptable (higher TSH numbers mean less thyroid function).  I should note, however, that the human population average for TSH levels is 1.2.  So my TSH levels were nearly four times what the average person's are, but prescribing guidelines said I didn't need a higher dosage. 

Once I decided to join the Army I got real serious about losing weight.  At my height, anything over 200 pounds is considered overweight.  So this past year I've been working my butt off.  And I have been able to lose about 12 pounds.  Nonetheless, I could not consistently get below 200 pounds no matter how hard I tried.

I also gave up on the VA - entirely.  While I'm working there this semester as a volunteer psychotherapist, I stopped going to appointments, and let my prescription for thyroid medication lapse.  Hearing the same tired excuses for why I should be fine just became too infuriating for me.  By now I know ten times as much as my former primary care provider about thyroid disorders, but the prescribing guidelines rule all in a socialized medicine setting.

I went the whole summer without any medication.  That's really not good.  Sarah finally convinced me last month to go to the local community health clinic and get a new prescription.  So I went.  I explained my concerns to the P.A., and told her in no uncertain terms that if she offered me a prescription for the same dosage I was on before, that she was wasting her time and mine.  I wouldn't fill it and I wouldn't come back.  So she agreed to bump me up to 75 micrograms and I got my prescription filled.  Since I hadn't been on any medication for several months, I went through persistent nausea for the first few weeks, but it was very, very worth it.  Within two weeks I'd dropped ten pounds without doing a single thing beyond taking my daily pill.  This was the type of result I should have had two years ago when I first went to the VA.

I still weigh 20 pounds more than I used to.  And I work out regularly and eat better than I used to.  So, when I go back to get my blood tested in a few weeks I will no doubt find that my TSH levels are lower (better) than they used to be.  But I seriously doubt they're at the population norm.  Thus, I'm going to tell the P.A. that either she ups my dosage to 100 micrograms, or I'll go to another clinic and tell them that 100 micrograms has been my dosage all along, but I'm new in town and need a new prescription.  It's not an empty threat.  The white pill was worthless.  The blue pill's been good to me.  But now my goal is the yellow pill, and if necessary I will keep shopping doctors until I get it.  And I won't feel bad about it for a single second if that's what it takes to get the right dose. I am done letting the VA ram guidelines down my throat.  I'm not a number and I won't bother with docs that treat me like one.