Diagnosis and Management of Hypothyroidism by Dr. Gordon R B
Skinner
MD, DSc, FRCOG, FRCPath.
- 2003 – A Louise Lorne Publications
This
controversial book provides a detailed account of Diagnosis and
Management of Hypothyroidism and reasserts the importance of
clinical observation in medical practice.
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Short Biography and reasons why Dr Gordon R B Skinner has
arrived at his present ideas.
While conducting both laboratory and clinical research Dr
Skinner became concerned that a number of patients considered
to have myalgic encephalopathy and related conditions might
well be suffering from hypothyroidism.
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| 'I am
convinced that if you take a decent clinical history and conduct
a proper examination, one could manage thyroid replacement without a single blood test and that’s more or less what we did when
I was a medical student in the first half of the sixties decade.'
Page 146, Diagnosis and
management of Hypothyroidism - 2003 - Louise Lorne Publications
In this page
you will find some quotes from Dr Skinner's book, for the
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Dr Gordon R B
Skinner's New Book titled 'Diagnosis and Management of
Hypothyroidism' Excerpts:
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Why are doctors unable to do the right thing in the UK?
Pages 134-135:
Doctors
have become big fearties and cowardy-custards and live in mortal
fear of Government and Government Committees, Members of
Parliament, The General Medical Council*, Healthcare
Commission*, Health and Safety Executive*, Data Protection
Agency*, the Department of Health and the Chief Medical Officer,
Medicine Control Agencies, People who write the British National
Formulary, Consultants in the NHS, Health and Safety Executives,
Distributors of Merit Awards, Principals in Family Practice,
Family Practitioner Committees, the Ombudsman, Patient Advocates,
the Legal Profession, Ethical Committees, Vice Chancellors and
Deans of Medical Schools, Race Relation and Gender Equality
Boards and the Media. Jean Calment, who was 120 years old and
died recently in France gave her reason for being the oldest
person in the world; she ‘feared nothing’.
*Added for
thyroideducation.com – not inside book.
Page 176
But it’s no a game for sissies (cowards).
This is the true meaning of professionalism which is doing the
best for your patients while risking the wrath of the General
Medical Council, the legal profession or any other of our modern
day masters who sit on their corporate bums pontificating while
we’re grafting away in the trenches; I said it before and I’ll
say it again; professionalism is putting the welfare of your
patients as a first priority irrespective of self.
Page 147
This is science gone mad from a
confused and a misplaced notion of the meaning of
evidence-based-medicine where the ‘evidence’ is not only
selected out by ignoring what the patients says but
misinterpreted once that selection has been made by the person
evaluating the patient’s status at that stage. If I have one
plea to colleagues; for God’s sake listen to the patient before
you drop a big one.
Pages 6-7
A medical practitioner should have
a certain level of intelligence but most importantly should have
a professional caring attitude for his or her patients;
professionalism has become a wrongly used word and usually means
getting together to charge minimum fees or being ridiculously
stuffy and obsessed by protocol whereas true professionalism is
doing the best for your patient at all times. As soon as I hear
the word professionalism and ethics, I assume it’s going to be a
load of old cobblers relating to some kind of fraternal bonding
but we all know that fraternities are refuges for the insecure.
Page 9
The crunch of the matter is to do
the job properly and to the best of ones’ ability. If we do the
job conscientiously providing NHS and private patients an equal
standard of care then there is no need to fear the General
Medical Council or litigation or colleagues or laboratory
results because if you do your best for your patients at all
times then your soul and spirit will be free of irrelevant
concerns and you can enjoy a great privilege namely to be
entrusted with the health and welfare of fellow citizens.
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On hypothyroidism
Diagnosis in the past
Pages 2-3
If you
had hypothyroidism, you were in better shape and more likely to
be treated in the immediate post-war era because doctors were
more inclined to listen to the patient and were not obsessed by
any available laboratory test – even when it’s a rotten test.
There is a prevailing misconception that evidence from a
laboratory test will stand up better in court and thus an
abnormal laboratory test provides a nice safety cushion to
protect us from the new master of medicine namely the legal
profession; I have seen ill patients who were textbooks of
serious hypothyroidism and had wound down to a virtual
standstill – including two cases of myxoedema madness – and yet
my colleagues would not prescribe thyroxine or (whisper it)
dessicated natural thyroid because the thyroid chemistry was
within ‘normal limits’.
Pages 24-25
The best
stuff is in old medical textbooks where yer man had all the time
in the world to tell us about it and no shortage of anecdotal
case reports. They encapsulate the image and excitement and
huge satisfaction of accurate medical diagnosis and curative
treatment. They usually gloried – and why not – in Sherlockian
instant diagnoses as the patient entered or was leaving the
consulting room. My own humble contribution to the litany of
fascinating ‘spot diagnosis’ concerned a patient who appeared in
my waiting room with a tumerous protuberance in his right upper
thigh which was not a hydrocele or spermatocoele or other such
inguinal or scrotal phenomena but an actual shooter which the
patient, who moved in dubious circles in East London, advised
that he carried around at all times; wise enough ‘cos you never
know when some joker might take a liberty.
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| About
Armour™ Thyroid*
Page 133 - 134
It is quite interesting that Armour thyroid
has flourished and is now increasing its sales in the U.K.
notwithstanding the ignorance and prejudice which besets this
well tried and tested old preparation. It’s still there because
it works well and in spite of mindless disclamation, it is
slowly winning through without promotion or champion; it’s no
aye the rumblin ‘cert that fa’s first and facts are (still)
chiels that winna ding. Aye and haste ye back.
*Armour™ Thyroid is Copyright ©
2005 Forest Pharmaceuticals, Inc.
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About the book
Page 199
It would be usual now to say that
if this book has improved the lot of even one hypothyroid
patient or at least drawn awareness to the hierarchical chaos of
modern-day medicine, then your author would be satisfied. I
don’t think so. Too many people continue to have suboptimal
health through perpetuation of a system which discourages a
reasonable level of intellectual, social and emotional
independence for professional persons.
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On non medical
'Symptoms' of hypothyroid patients.
Pages 28-29
In my experience, hypothyroid
patients, rather like my dear daughter Fiona, have an entrenched
objection to saying yes or no to any straight question,
preferring to provide an explanation of why she might have a
given clinical feature which can be a little trying as the time
wears on but it is important to continue to be polite and keep
listening – it’s not too much to ask really. Another curious
feature of hypothyroid patients – particularly in the midlands
of England – is to seek verification of every statement from a
partner who often accompanies the patient to a point when the
patient suffixes every statement with a ‘Isn’t that right?’
‘Don’t I?’ or Haven’t I?’ to the partner who has heard it all
before and whose attention has clearly wandered from the
consultation to what’s on the telly that night.
Pages 42-43
There is a classical
hypothyroid countenance which in some respects defies verbal
description and requires recognition which comes with experience
and a ‘feel’ for diagnosis which is a crucial component of the
art of medicine given that that’s still allowed in the face of
evidence-based medicine. The patient tends to look much older
than her years with dull sad expression without animation and in
severe cases the facial shape loses structure, definition and
expression and becomes rounder and squarer. Some patients look
a bit stupid and slow-witted; I remember a fellow from my
childhood in Glasgow who was known as “slow Willie”; I bet he
was hypothyroid.
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On his qualifications?
Pages 4-5
Finally you may ask what are my
qualifications to write this book. None (I suppose) except
experience at the sharp end of thousands of patients with
suspected thyroid disease. My initial training was in
Obstetrics and Gynaecology and then in Infection. During the
latter phase, I was asked to see a number of patients with
‘myalgic encephalopathy’ (ME) on account of a (then) general
belief that the condition was initiated and maintained by a
chronic virus infection. After some years, it became clear that
there was precious little evidence for this hypothesis although
many patients could trace the onset of their problems to an
infectious episode – most usually adult chicken pox, glandular
fever or influenza B Infection.
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| A Doctor's
job satisfaction
Page 123
The management of hypothyroidism
is a delight allowing professional fulfilment through
application of sound scientific principles and the art of
medicine; it requires consideration of many factors including
the physical, mental and emotional state of the patient, her
family and social circumstance.
Page 156
Thyroid replacement in hypothyroid
patients remains one of the most satisfying therapeutic
exercises in medicine. It is true to say that in the majority
of cases there will be no problems in management and the vast
majority of cases are returned to optimal health within one year
after which it is usually only necessary to fine tune the dosage
and many patients are able to fine tune their own dosage; I am
quite relaxed in general terms with the patient taking
responsibility for her own medication.
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Why is it that sometimes patients achieve
normal hormone levels after replacement but they show no
improvement?
Page 173
In summary,
many patients show no improvement on thyroid replacement for the
simplest of reasons namely that they are not getting enough
stuff because we have a preconceived notion of a correct or
average or safe dosage and – the old story- a servile belief in
laboratory numbers. I can think of no example in medicine where
restoration of health and reasonable activity with physiological
body function leads to sinister complications.
Pages
145-146
These (Thyroid Hormone Levels)*
are not measures of biological activity but of presence as the
detection system is immunological and not biological; an iota of
common sense will persuade colleagues that a person’s brain
computing relevant subjective symptoms is a better indicator of
thyroid overdosage than a biochemical reading.
*Clarification of context for
thyroideducation.com.
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On the diagnosis
of Hypothyroidism
Pages 19-20
Secondly, certain patients
volunteer no specific complaints and the problem is drawn to the
doctor’s attention by a marital partner, relative or friend or
even a professional acquaintance and the patient herself – while
acknowledging that she seems a bit unwell or out of sorts –
assumes or has (often) been told by her Family Practitioner –
that she is depressed (D), menopausal (M) or over eats (O). It
is frequently stated that hypothyroid patients are uncomplaining
and compliant but that has not been my experience. If one takes
a careful history, it will become clear that almost every
hypothyroid patient has sought medical attention on a number of
occasions but has often been given the big DMO rebuff which is
daft as very few women are depressed about nothing and the
menopause is not a disease – or at least it didn’t use to be –
but a physiological occurrence. However, it is true that as
patients become more and more hypothyroid, they can slip into a
slough of despond and spend their time sitting at home or even
lying in bed in a semi-stuperous state in severe cases and do
often become written off by relatives and friends alike as
hopelessly depressed and psychiatrically disturbed because after
all that’s what doctor said was wrong.
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