A 46 year old Costa Rican female saw me for a second opinion because of a hot nodule. She was told to have surgery in her country. She denied symptoms of hyperthyroidism, but had borderline elevated Free T4, T3, and non-detectable TSH. After a long period of discussion she refused Radioiodine therapy, and planned to return to her country with untreated toxic nodule. She claimed fear of radiation, and even more important to weight gain without a thyroid gland. Even after reassurance about the safety of RAI and the weight neutral aspects of post radiation therapy of thyroid hormone replacement, she refused.

My last chance to get her treated before trouble occurred, was to tell her what was in her future without therapy. Fatigue, nervousness, irritability, feeling hot, increased sweats, insomnia, fast strong irregular heart beats, poor memory, inability to concentrate, mood swings, racing mind, delusions of grandeur, tremor, hair loss, weight loss, increased appetite, muscle weakness, increased bowel movements, short of breath, heart murmur, osteoporosis, itching, menstral problems.

The worst is cardiac dysfunction, Atrial fibillation, adverse cardiac results and even death. Also reduced bone density and fractures.

The rapid irregular heart beat that is called Atrial fibrillation, is TWICE as likely to occur if the TSH is below 0.1. This lady's TSH was <0.01!

All the ATA members polled recently felt treatment was needed for her case. I have one more chance to today to convince her she needs therapy. Wish me luck, for her sake.


Yours truly, and goodbye,