Mary: a thyroid case

Mary is a generally healthy woman who first consulted me at the age of 39 for advice regarding her fatigue, constipation, trouble losing weight, feeling depressed and general no energy feeling. She previously presented to another physician with similar symptoms about 5 years ago, but became discouraged when she was told that her test results were normal, and that perhaps she should see a therapist, and work on reducing her stress. She felt that she had a good relationship with her husband and family, and that her lifestyle and activities were not excessively taxing on her body, but that she should be able to function and feel normal with her life and work. I reviewed her previous lab results, and ordered additional tests for thyroid function, given that her symptoms were so suggestive of low functioning thyroid, and she was not prematurely menopausal. I discovered that even though her screening thyroid labs were normal, she was producing high titres of anti-thyroid antibodies in her body, in essence, attacking her thyroid function, consistent with Hashimoto's thyroid disease. I initially started her on conventional synthetic T4 (bio-identical thyroid precursor hormone, typically used in conventional western medicine), which helped her symptoms only for one day. We changed her treatment to include T3 (active thyroid hormone) and T4, and now she is feeling much better on all counts.

Mary's situation demonstrates that not all symptoms are psychological or stress-related, just because the screening lab is normal. We need a high index of suspicion to dig deeper, and that furthermore, not everyone responds the same way to all medications, even bio-identical thyroid hormone replacement therapy. I had a high index of suspicion for thyroid disease not only based on her symptoms, but also because it is a fact that the incidence of thyroid disease is generally 8-10 times higher in women than in men.