This case involves a patient in Minnesota with a preexisting thyroid disease who was prescribed a statin medication by the defendant due to slightly elevated cholesterol levels. Since he was administered the drug, he suffered a series of side effects, including diabetes, bowel disorders, and poor circulation that eventually necessitated the amputation of part of his foot. He saw a few doctors until one of them eventually realized that he was suffering from the majority of the possible side effects of the medication. It was alleged that the statin was contraindicated to administer the drug for a patient who already had thyroid disease.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case?
- 2. Have you ever had a patient develop the outcome described in the case?
- 3. Was it reasonable for the physician to prescribe a statin to a patient with thyroid disease?
Expert Witness Response E-000988
This patient presents with common outpatient internal medicine conditions similar to many of my own patients and those of family medicine residents that I supervise. I have often encountered patients with side effects of statins. The alleged side effects here appear to be of an extreme nature but are conceivable. Statins are not contraindicated in patients with thyroid disorders. It is unclear based on details provided whether the statin was or was not appropriately prescribed. Guidelines on statin use have shifted over time, but most likely the NHLBI’s ATP-3 guidelines were the “standard of care” at the time of this case. These guidelines provide risk-based recommendations for statin initiation, so the patient’s risk would need to be determined to say whether statin use was in accord or contrary to guidelines. It may also be that the patient’s risk places him in a gray area where statin use would be discretionary and would depend on patient preference.
Expert Witness Response E-000147
I do routinely treat patients similar to the patient described in this case. I have never had a patient develop type 2 diabetes from taking statins who also has hypothyroidism, nor have I seen those complications described in the medical literature. It was therefore reasonable to prescribe statins to a patient with thyroid disease. There may be information in the medical record that indicates a violation of the standard of care.