Years ago, I learned from a professor that if you listen to a patient long enough they will tell you what their real problem is and how to fix the problem. Listening to a patient, however, is a lost art in today’s medicine. Today, it is common for the patient to listen to the doctor and do as the doctor says. I had a male patient who over the course of a year or two felt so-so, but he has not felt great. I tried everything I could think of but he would still feel bad half the time. Then, he happened to tell me a story about how as a child he loved salt and could never get enough of it. Then, it hit me. I checked his labs – his sodium level was 143; the normal range being anywhere from 136 to 145. Although his level was fine, this normal range is based on a “Bell Curve.” This means that there may be people who need higher or lower sodium levels to feel better. So, I decided to give him an I.V. of normal saline. Within minutes, he was a new man. He felt alive, he felt great, and his sodium level was 148. I ended up putting him on salt tablets and it’s turned his life around. I learned my lesson that what may be so-called ‘normal,’ may not be normal for everyone.
The same principle applies to thyroid labs. Most doctors follow a patient with thyroid disease by following TSH levels. If the TSH is normal than a person’s thyroid medicine is correctly prescribed. The problem is that the actual thyroid hormone is Free t3. My practice is filled with people who have been told their TSH levels are fine yet they still have no energy, loss of hair, dry skin, fatigue, etc. In my practice, I check the Free t3 level and it is usually very low or in the low to normal range (from 2.0 to 4.2); When the t3 is low, I typically put them on actual t3 and as I get that level up anywhere from 3.5 to 4.2 or higher, their symptoms go away. Patients are not numbers; they are people with unique genes and different metabolisms. These labs are the Bell Curves to set so-called ‘normal’ ranges; and maybe you are not in the 80% of the population to which this ‘normal’ range applies to. Maybe you are in the 20% that may function best when your labs are not at the so-called ‘normal’ range. If you are not feeling right, remind your doctor that you are not a number but a real, living, unique human being. You are not a number – yet!
John D. Young, M.D.