January 5, 2000

When I first began taking Cytomel I noticed a dramatic improvement.  I lost some weight, the water retention was not as severe, fewer muscle cramps, less bone pain and I “felt” better.   Finally a little pill that would actually take the nasty symptoms away and make my life better.  I felt there was hope after all.

My follow up appointment with the Blonde Bimbo was on January 5th, 2000.  In her report about that particular appointment she writes and I quote, “I reviewed Widebertha on January 5, 2000 with regards to her hypothyroidism post iodine 131 and possible mild Graves’ ophthalmopathy.   She has now been on combination therapy with Levothyroxine 112 mcg. and Cytomel 12.5 mcg. daily since her last visit here in October.  In addition she has been taking Moduret 1 tab p.o. o.d. (once daily by mouth).  She feels much better on this combination.  She notices that her energy level is better, she is less stressed, her leg cramps have resolved, her weight has gone down considerably before Christmas, and is still about 1.4 kg. lower than it was on her last visit.  She has no symptoms suggestive of hyper or hypothyroidism at present.  She continues to be amenorrheic and does notice some problems with memory and concentration.  In terms of her eyes she denies any proptosis or diplopia.  Her periorbital edema is improved somewhat.

Blood pressure today was 140/80, pulse was 72 and regular. On head and neck exam she had normal range of movement of both eyes. She still has some periorbital edema on the left but improved from previously.  Her thyroid is unchanged to palpation and reflexes are normal.

Lab work from her last visit shows her to have an estradiol level of 140 and an FSH of 66. As of December her potassium is 4.5, T3 is 1.9, free T4 is 12.6 and TSH is 3.7.

Widebertha is euthyroid on her current thyroid hormone replacement therapy and as she feels better with the combination I would see no problems with continuing this.  I would recommend that TFT’s be rechecked in about six months’ time.

It also appears likely that she is menopausal which may account for some degree of her symptoms particularly the irritability and difficulty with concentration. I have discussed with her briefly the pros and cons of hormone replacement therapy. Given the fact that she has had some focal neurological symptoms in the past with her migraines this may not be the best idea and certainly if hormone replacement therapy was considered it may be worthwhile to consider a transdermal route to avoid any hypercoaguability. I have left her to discuss this with you further.

With regards to the eyes, it is difficult to know whether the edema is improved due to the Moduret or to the change in thyroid hormone replacement.  I have told Widebertha if she wishes to she can try a trial of discontinuation of the Moduret and see how her eyes do.  I have cautioned her however that her blood pressure should be rechecked off the Moduret if she decides to stop this.

I have not arranged to see Widebertha again at present but would certainly be happy to review her on request.”

The following was included in every one of the Blonde Bimbo’s reports to Squirt, “Thank you again for asking me to see this pleasant lady.” Of course I was a pleasant lady; I was too dumb to be anything but a pleasant lady. I agreed with everything the Bimbo said and did; I did not know better at the time.

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