[vanillasky]

#1059637

As some of you may know, my mother who is 87 has fallen ill with a very severe case of bronchitis.

She is doing better after taking her to the hospital and now we have her home so I followed up with her doctor.

To my surprise, when we got to the office, her doctor did not examine her. Instead the Physician’s Assistant came in. He seemed to know my case of Graves’ Disease. My mother said she didn’t remember telling them, but he knew and asked me how I was doing.

He assumed I was on Tapazole and asked me about my antibody count and asked WHY I was sooo thin :rolleyes: ( I think people are stupid) of course, a lot of us are thin. They would be too if they had hyperthyroidism.

Anyway, he asked me if I was going to remission. I have no idea and then he said that Tapazole is just a matter of endocrinologists saving money for the insurance company because instead of sending us to RAI or surgery, they try and get remission. Maybe he was out of place telling me this, but nevertheless, it put a bee in my bonnet. Could it be?

Does the insurance companies really dictate to the doctor that Graves’ patients must try ATD’s to get a chance for remission? And why don’t we just go for TT or RAI? He said it was just a matter of insurance $$$$.

Opinions please…………………

[rae5]

#1176350

Hi there, I was wondering the opposite.. I was diagnosed three months ago and my levels are still high/low. My Endo is already wanting to do RAI, asap. I was thinking this was rather rushed and was wondering why he wasnt wanting to try for remission first…. I don’t have health insurance so wonder about the question in your post, I wouldn’t be surprised if it really did come down to $$ and insurance companies!
Rae

[adenure]

#1176351

I don’t know about the insurance money, but I think it IS easier for a doctor to manage a hypothyroid patient than a hyperthyroid patient. Way less difficult and dangerous. Even with remission, hyperthyroidism can come back. One of my friends has had Graves for 10 years and was on PTU and methimazole off and on during that time. She had surgery scheduled 3 different times, but always canceled. Barely a month ago she ended up in the hospital with all the symptoms of a thyroid storm. They kept her overnight and (reluctantly) sent her home on a high dose of beta blockers. She just had a thyroidectomy on Tuesday. She knew she was hyper, but didn’t take care of herself and landed in the ER. Fortunately she was okay and she finally got the surgery done! Lucky girl. But, I think hyperthyroidism can be like a ticking time bomb.

Where if a person is hypo, it takes some seriously extreme hypothyroidism to cause a person major health issues. Also, Synthroid doesn’t have any possibilities of severe side effects that I know of (like ATD’s do to the liver and blood cell count). I think that’s why some doctors push for RAI or surgery. As far as preferring ATD’s over the more definitive solutions, I don’t know the reasoning behind that except maybe patients’ preferences or in hopes of remission. It does seem like people tend to have recurrences of hyperthyroidism though even if they’ve had long bouts of remission. I don’t know the numbers, but it seems that way.

[catstuart7]

#1176352

Agreeing with Rae5, it is the opposite. Most endos rush their patients to a final thyroid solution based on what I’ve read. It is rare to have one dedicated to helping you achieve remission. Ultimately it’s about you and which path your feel best following – each path meds, rai, or tt all have significant pros and cons to them.

[snelsen]

#1176353

It is my thought that the P.A. did not study endocrinology. He is so very wrong in his comment, in my opinion. ATD’s keep us safe, and in some instances, keep us from dying. Agree with the other comments. I think the standard of care for Graves’ is well documented by controlled studies. Many folks who have Graves’ hope that the ATD’s will “work.” And they do, to keep us safe.
The case of adnenur’s friend is pretty typical.

It is almost a ludicrous statement to say that the doctors are trying to save the insurance companies money. That is so the opposite of what could be the case.
Shirley

[snelsen]

#1176354

And. I am wondering why the doc did not examine your mom? But so glad she is OUT of the hospital!!
Shirley

[PolishTym]

#1176355

That’s a new one to me. I was initially interested in being on meds long enough to go into remission, but my endo warned me about the risks. From what I read, some doctors think insurance companies prefer RAI to get it over with quickly. My endo said, and there seems to be agreement, that it is easier to manage hypo than hyper.

[vanillasky]

#1176356

Thanks for everybody’s input. I agree with what most of you are saying about the PA. He is not a doctor, so what does he know? Seemed sorta arrogant to me about this whole situation and unusually interested in my case.

He was examining my mother, listening to her lungs and talking to me about Graves’ and I was wondering why my mother wasn’t getting his full attention.

@Shirley: I agree with you 100 percent. Why didn’t the doctor examine my mother? She seems to settle for this PA and not the doctor so he doesn’t bother coming into the room. It seems to me that he is more equipped to listen to her lungs and not give her half the time that she got from the PA who really seemed interested in my case! Things that make you want to go hmmm…………….

As far as insurance companies are concerned, I would think that the complications that could possibly arise from taking ATD’s as we mentioned above, would cost them more money if someone gets an infection, liver problem, etc.

So why not cut to the chase if indeed money was the issue? Who knows where he gets his information? I am not sure if I appreciated his candor or not. I just wish the doctor himself had tended to my mother in her case. Being elderly, she is pretty easy going and I’m a real stickler for doctors in her case but she never makes waves.

I personally think that the health care in this country really needs improvement. My husband’s kidney specialist says we rank number 36 in the entire world in health care. And so many have no insurance. Pretty scarey!

I also went to an eye doctor last week to see if Graves’ had affected my eyes. He said it did not at this point, but found cataracts in both eyes! I was shocked. I am only 54 and I always thought people were much older with this problem. He says in 2 or 3 years I will need surgery.

I worry about health insurance and hopefully in 2014, ObamaCare will help us shed some light on better health care in this country!

[Kimberly]

#1176357

This individual is probably not familiar with the guidance document released by the American Thyroid Association and American Association of Clinical Endocrinologists on the treatment of hyperthyroidism and Graves’ disease:

“Once it has been established that the patient is hyperthyroid and the cause is GD, the patient and physician must choose between three effective and relatively safe initial treatment options… the treating physician and patient should discuss each of the treatment options, including the logistics, benefits, expected speed of recovery, drawbacks, potential side effects, and cost. This sets the stage for the physician to make recommendations based on best clinical judgment and allows the final decision to incorporate the personal values and preferences of the patient.”

As others have said, I wouldn’t let this individual’s comments get to you!

(EDIT: you can read this document in full in the “Treatment Options” thread in the announcements section at the top of the forum).

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