Course of Action

[inssp]

Greetings...I would like your advice on a course of action.  Male-43, diagnosed with Graves in 98 and treated with RAI.  No problems until 3-4 months ago.  Discovered that GP has mis-managed periodic TSH readings as they were all over the map.  Was in the Hypo range recently and dosage of Synthroid increased about a month ago.  Newer symptoms are tingling/numbness in hands/feet; periodic burning feeling in thighs, neck, back; periodic fasciculations (no specific area); some minor disorientation; and some mild muscle pain/cramping/stiffness.  I have had neck pain for several years and in 2000 diagnosed with herniated disc C5-C6.  Treated with traction which alleviated all symptoms (left arm pain).  My neck now, however, sounds like gravel rolling around when I rotate it, and requires frequent stretching/popping.  Also, either or both hands fall asleep while in certain sleeping positions.  I haven't noticed any weakness per se, played golf and mowed the yard this weekend with no problems.  Sleeping well also.

My question is this, my GP seems to want to try to resolve TSH before investigating anything else.  He also discounted the neck issues altogether.  Obviously searching the Internet can lead to all kinds of conclusions, none of which I am qualified to make.  Should I go directly to a neuro for an exam?  If so, how should I go about investigating one, and what do I do if I get the "we have an appointment open in August" response?

Thanks for the help!

[CCF-Neuro-M.D.-CS]

Some of the symptoms you have desribed can be seen during a hypothyroid state, and others could be seen with spine disease. Without seeing and examining you I can not state whether your GP's approach is correct. If you are concerned, then I recommend talking to your GP about a neuro consult. Your doctor should then be able to arrange a consult for you. Good luck.

[ontherecord]

Tell your GP that you want a referral to an ENDOCRINOLOGIST, who is much better equipped to handle Graves disease than your GP.  If your GP is reluctant to give you the appropriate referral, tell him that his mismanagement thus far is demonstrative of his inability to manage your condition and clearly evinces negligence.  He will most likely give you the referral if you push for it.  Then talk to the endocrinologist about the symtoms you are experiencing and he or she will able to tell you whether they are truly neurological in nature or just incidental to the treatment of the disease.  If they are neurolgical in nature, then you can always see a neurologist.  If you can't get appointments as quickly as you would like, you should call each day, in the AM, and see if there are any cancellations, which often occur on short notice.

[ontherecord]

Of course these comments of ours aren't the "official" opinions of the MedHelp staff.  In this particular case, we have an overconfident General Practitioner who is mismanaging his patient.  But in today's practice of medicine, doctors care more about protecting other doctors than they do about the well being of patients.  Clearly, the GP in this case has exhibited conduct that falls well below the standard of care that is medically accepted in the treatment of a patient with Graves Disease.  Furthermore, the mismanagement has in fact led to quantifiable harm (delay in proper treatment can and often does to an exacerbation of Graves disease).  Duty, breach, causation and damages.  Sounds like a clear cut case of medical malpractice.