I was reading (again) the transcript of an interview with Dr. Antonio Bianco from May, 2023 about integrating combination T4/T3 treatment, published on Medscape. 1
I was initially encouraged by the use of some terminology like “impaired cognition” rather than “brain fog” or other euphemisms which tend to diminish the impact that symptoms have on a patient, though the “patient prefers” and “feeling” memes instead of objective evaluations were still in full supply. It’s totally understandable that a patient may use subjective terminology to try to describe their symptoms — “brain fog” or “fatigue”. It’s not reasonable for a trained, licensed physician to use subjective terminology instead of objective descriptions when discussing a patient’s symptoms.
It is possible to help a patient evaluate their symptoms and report them objectively. There are many tools available, most were developed to document symptoms in cancer patients but are applicable across the health spectrum. One Symptom Tracker was developed based on the validated Quality of Life (QoL) outcomes used by the Risk Factors for Decreased Quality of Life in Thyroid Cancer Survivors study.2
Though “signs” and “symptoms” are often used interchangeably, a sign refers to something which can be observed or measured such as a reported lab value. Symptoms are the subjective experiences reported by the patient, such as “brain fog” or “tired”.
Using a precise description and applying a numeric score to a symptom, then comparing with a baseline, can validate the symptom and bring it into the realm of being a useful diagnostic indication for evaluating response to treatment. 3 An example might be “Teaching a full day of third graders without falling asleep at 1:00 pm.” where 0 is no problem prior to thyroidectomy and current severity is 4 on a 0 to 5 scale. This also allows the patient and provider to set goals together. In this example, a score of 1 on the 0 to 5 scale might be both tolerable and attainable with a combination of medication adjustments and life style support.
So the next time someone says “I have brain fog,” or “I’m tired,” get real. Help them describe their cognitive impairment or fatigue in specific terms, apply a 0-5 scale and compare it to a point in time before they experienced this symptom, i.e. “before surgery” or “before changing my dose” etc. Treat the patient, not just a set of lab numbers.
Thyroid Cancer Advocates 