Allow me to present to you my anger.

I’ve borrowed the title of this post from that of an upcoming spoken and musical performance I’ve seen advertised around town. The performance concerns anger on a much grander and more globally significant scale, but, well, even around here, where it’s all about meeee, it also fits rather nicely. 

Because I have anger. 

Please allow me to present it here. 

***

It's about the hypothyroidism. I’ve had it for half my lifetime, and I’ll have it for all of my life; it’s not curable, although it is treatable, rather effortlessly, with replacement thyroxine medication, the level of need for which is measured by a simple blood test. 

For almost seventeen years, then, I’ve been treated for this condition by generalists and, from time to time, depending on the willingness of a generalist to give me a referral (or, perhaps, on the unwillingness of a generalist to bother following it himself or herself), by endocrinologists. I’ve also mentioned the condition and that I take replacement medication to every gynecologist who has ever seen me. 

Not one – not one – of these doctors ever mentioned to me the link between thyroid levels and fertility. 

Not one ever told me that taking enough replacement medication to reach a thyroid level considered normal for the general population would not at all suffice for a woman trying to conceive or maintain a pregnancy. 

Not one ever told me that if I wanted to be pregnant, and keep the pregnancy, I should seek further treatment before trying to conceive. That if I didn’t, it could be difficult to conceive. And then that if I did conceive, it would be difficult – or perhaps impossible – to maintain the pregnancy. And going even further, that if I did maintain the pregnancy, there could be adverse permanent health effects on the growing child as well as on myself, and the birth could be traumatic and dangerous to both.

Not one, not ever.

Why not? Is it that this issue, this connection between the thyroid and a woman’s capability to conceive and then stay pregnant, is so obscure a doctor could not know to recognize it? I doubt it. Sufficient thryoid hormones are required for just about every body process and function, including ovulation and pregnancy. That is not an arcane detail. I don't expect every doctor I've ever seen to have specialized knowledge about what to do about it. I do, however, expect a doctor to inform me that I should seek specialized knowledge when the time becomes right.

Is it that the American system, in which health care is cut up and parceled out to individual specialists who don’t coordinate enough among themselves or with general care practitioners, doesn’t allow for comprehensive and holistic management of a patient’s health? Maybe. (“Do you go for regular gynecological exams?” asks the generalist. Yes. “Do you see somebody about your thyroid?” asks the gynecologist. Yes. From one doctor to the other, then, and vice versa, implicitly, perhaps unknowingly, through this unsuspecting intermediary – me: It’s your concern, not mine.)

In contrast to this suspected lack of coordination among doctors in the US, I recently received a copy of the several-page letter sent by my new endocrinologist to my generalist and my gynecologist, setting forth my thyroid- and fertility-related health background and several conclusions. Among them, that it could not be proved that the thyroid issues caused my miscarriage. Also among them, that my TSH level at the time of the miscarriage indicates that my thyroid levels were insufficient to support pregnancy. With a conclusion like that, who needs proof?

Not that I think all doctors here have a better handle on it. Even after the initial discovery of the seemingly (and eventually, actually) non-evolutive state of my pregnancy, after I had insisted that my blood be tested for thyroid hormones as well as for hCG, of the multitudes of doctors I saw while going in and out of the hospital every two days for a week and a half, only one remarked on it – my gynecologist, when I asked about it and got the shrug and advice to follow up with the generalist to change my dosage. And I was referred to the endocrinologist only because I had put up such a fuss to find out more about the autoimmune factors, not because the doctor thought I should find out more about the links with fertility. 

Only now am I getting the answers I need, the information that should have been given to me from the start, from the moment this condition was diagnosed. Only now am I realizing that perhaps, possibly, even probably, all of this – this blog and everything behind it and all of the pain and sorrow that came with it – could have been prevented if I'd been told, so that I could have sought the treatment I needed from the beginning. And for that, I am full of incredible anger.

***

So there you have it. This presentation might not have been as entertaining as the performance of the same name, but hey, at least you didn’t have to buy a ticket. 

Thank you for listening.