THYROID DISEASE FROM THE PHARMACIST PERSPECTIVE

DrugMonkey is a writer and a pharmacist; he’s also a brutally honest, discerning and delightful fellow. We adore him hard at Dear Thyroid.

I love this monkey for many reasons: He’s a brilliant writer, edgy and raw, unafraid to expose the underbelly of the pharmaceutical industry and its impact on “we the consumers”. He’s also one of the most genuine, supportive and kind individuals I’ve come across. We’ve become friends, for which I am eternally grateful. DM was there for me when I was at my sickest point, struggling with thyroid psychoses and being borderline thyrotoxicosis. He helped me get through it, something I didn’t think I had the strength to do.

He Blogs DrugMonkey, one of my favorite reads. He writes openly about being a pharmacist and his customers, sharing things we need to know about: insurance, generic vs. brand name drugs, recalls, supposed upgrades to medications commonly used, and so much more. Here are some links to categories worth reading (I was going to choose a few articles. There are just too many gems to choose): An Insider’s View of the Profession, Wacky Customers and Other Work Rants and General Weirdness—plain hysterical and worth the read.

As one of our resident experts, we had some questions for him that he generously answered in true DrugMonkey fashion.

How long have you been a pharmacist?
16 years. I guess the fact my pharmacist's license would be old enough to drive now makes it impossible to deny my membership in the club of middle age any longer. Sigh.

Have you worked in private/small pharmacies as well as large/chain pharmacies? If so, what is the difference?
I did rotations through small places when I was in college, and have been in chain stores that did over a thousand scripts a day. The main difference in the profession these days is how independents have reacted to the profit squeeze put on pharmacies by the insurance industry. I know it's hard to believe when you plunk down $200 for your month's pills, but there is far less money to be made filling prescriptions than there used to be. Chains have responded with volume, looking to fill more and more prescriptions per person, and with expanding their front end to the point where they are mini-mass merchants. Independents have done this to some extent as well, but have also gotten into things like custom compounding or proprietary dietary supplements to try and support the bottom line.

In the time-frame you've been a pharmacist, how many thyroid patients would you say you've encountered?
Here's something everyone suffering from thyroid disease should know; you are far from alone. Every pharmacy everywhere in the country has the entire range of thyroid replacement meds on their fast mover rack. I'm sure the answer to your question is in the tens of thousands.

What do you know about thyroid disease?
It's common. Like I said earlier, you are far from alone if your 'roid is giving you trouble. It's treatable. Thyroid isn't fibromyalgia, where you throw something against the wall and hope it sticks, and you don't really know if what your throwing against the wall is sticking. Repeat; thyroid isn't like that. Left untreated, it can mess you up in ways you wouldn't think of. More on that later.

What percentage of thyroid patients, in your experience, have insurance vs. those without insurance?
Hmmm.....what any individual pharmacist will see varies a lot based on where they work. Not only the neighborhood, but the type of store. People without any insurance are more likely to gravitate to mass merchants like Wal-Mart where they can get their meds the cheapest. Over 90% of the prescriptions I fill are billed to someones insurance, but I'm sure if I was plugging away for the sons of Sam Walton, that number would be different.

What thyroid horror stories have you heard?
I've seen people misdiagnosed and struggle for a long time. Hypothyroid can at times look like depression, and I've had customers go through a slew of the Prozacs, Zolofts, and Effexors before their diagnosis got nailed down. The New York Times just had a story yesterday that featured an oldster who was put on anti-psychotics when the problem was hypothyroidism. It didn't surprise me to read.

What thyroid recovery stories have you heard?
I had a customer who at one point gave up on her career as a real estate agent because she never felt like going out of the house. A couple years ago she finished her first marathon. She's also smoking hot now. Last I heard she had a total boy-toy of a man. Sigh.

What are your thoughts on Synthroid vs. Armour?
I never dispensed much of the Armour until I moved to California. Either one is a perfectly acceptable treatment for hypothyroidism, so when I say Armour thyroid stinks, I'm literally talking about the way it smells, and not making a comment about its effectiveness. Nothing stinks like a bottle of Armour Thyroid. The Armour is made from dessicated pig hormone, so it's definitely not for you if you're a vegan type. It contains a combination of all the different thyroid hormones, whereas Synthroid is a synthetic version of only the main one, levothyroxine, or T4. It's a plausible theory that you would get better results using a thyroid blend, and there is no shortage of anecdotal reports that say just that, along with a scientific paper or two, but we may never have solid proof, as proving things takes money, and there isn't enough money to be made by settling the question.

Bottom line; if you're taking Synthroid and it's working, keep taking it. Do not make a switch if things are fine. If the Synthroid isn't cutting it for you though, it might be worth asking your doc about the Armour.

What are your thoughts on the various treatments available to thyroid patients with Parathyroid disease, Hypothyroidism, Hyperthyroidism and Thyroid Cancers?
Let me hit home the point again that thyroid disease is treatable. Totally treatable. If you're hypo, your missing hormone can be replaced. If you're hyper, the absolute worst case scenario is taking down the thyroid gland and giving you the right amount of replacement hormone. Parathyroid? Treatable. Thyroid cancer? Serious, but not as scary as other types.

Just know that you'll get there, eventually. It'll be frustrating, because you'll feel bad, and there will be no news for days at a time, and you'll wait for weeks for an appointment for 10 minutes of attention and you'll leave still feeling bad. But you'll get there. Not nearly fast enough I know, but just hang in.

What health insurance issues should thyroid patients be aware of?
Where to start. Good Lord where to start. You need to know your insurance company's primary goal is not making sure you get the best treatment, it's to get you to stop filing claims they have to pay. Sometimes the best way to get you to stop filing claims is to cure you. Sometimes the best way is to throw down a gauntlet of prior authorization requirements, outright denials, and pointless paperwork for you and your doctor to run through. Dealing with your insurance will very likely be the most frustrating part of your path to a cure.

What do you think is the best health insurance for thyroid patients?
Medicare. I am very sorry to have to say this, but the private health insurance system in this country is rotten. It's broken and needs to be destroyed. We could make a Xerox copy of the Canadian health care system, spend less than we spend on Medicare and Medicaid alone, cover everyone, and have money left over to make improvements. You may eventually get the care you need out of your private health plan, but you will drag them kicking and screaming and fighting you and your doctor every step of the way. I wish I could tell you some are better than others. I can't. They all suck and it makes me sad.

By the way, if you are employed in an area of high demand and are fluent in English, you are almost a shoo-in to be accepted for permanent Canadian residence. Not that I've looked into that for myself or anything....

You work with a lot of endocrinologists, when assessing an endocrinologist, what advice can you give thyroid patients?
This will be counter intuitive, but don't necessarily go with your gut. I've seen doctors who totally knew their shit sow distrust among their patients with just an awful bedside manner. I've also seen doctors with very good people skills whom I would not ask for directions to the gas station. It's hard for the average schlep to evaluate medical competence. That's part of why your experience will be so frustrating.

What are your thoughts on holistic and alternative remedies for thyroid patients?

There are times when alterna-medicine can hold its own and stand toe to toe with the traditional Western type. Thyroid disease is not one of them. The diagnosis is straightforward, and progress can be measured objectively, making it right in Western medicine's sweet spot. Alterna meds may be of some value in symptom relief, but please, please, please don't depend on them for a thyroid cure.

What else would you like to add that you believe we need to be aware of to become our own patient advocates?
Make your health people prove and explain everything. "I'm hypothyroid? Oh, what were my lab numbers?" "Why are you giving me these stinky pills again?" "How long should it be before I see results?" You're paying for their advice. Make them give it to you.