March 26, 1999

Today was to have been my last appointment with the Blonde Bimbo.  Her report concerning this appointment reads as follows, “I reviewed Widebertha on March 26, 1999 with regards to her hypothyroidism post Iodine 131.  She has now been taking levothyroxine 175 mg daily for the last two months and she feels much better with improvement in energy and a decrease in myalgias.  She has had one period that was heavy and a second period that was more normal in flow.  She has been a bit more anxious over the last week and a half but this may relate to intercurrant stressors.

On examination today her blood pressure was 160/100.  I understand it is much better at home.  Pulse was 72 and regular.  She continues to have some very mild left proptosis.  Range of movement of her eyes was normal and her periorbital edema has almost completely resolved.  Reflexes were normal with no delay in relaxation phase of deep tendon reflexes.  Recent values showed her to have a free T4 of 24 and a TSH of 0.2 with the lower limit of 0.3 on the assay.

Widebertha is euthyroid at the present time on her current dosage of levothryroxine.  I have given her a further prescription for this and have recommended to her that she see you in about six months for re-evaluation.  I haven’t arranged to see her again at this point but would certainly be happy to re-evaluate her on request should she have any difficulties.”

The big mistake I made was to believe that last sentence she had written.  Quite frankly, as experience proved, the last thing she wanted was to see me again.  Heaven help you if your thyroid levels fluctuate!  Endocrinologists cannot handle a TSH that keeps changing.  I guess medical school has not equipped them with the ability to handle with grace and dignity a patient who has continuing problems.

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