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A case of Hashimoto’s Thyroiditis

By Kenneth N. Woliner, M.D.
Posted: Thursday, June 10th, 2010

“My sister says I need a holistic doctor because I have a whole list of problems!”

Teresa wasn’t kidding. The old records she brought (organized in a dozen individual manila folders) were almost an inch thick. I opened up, “Perhaps we should just start with one thing. Tell me about this thyroid condition of yours.”

“I haven’t felt right since starting Synthroid four years ago. It’s like I’ve been drinking caffeine all day. I’m wound up, but really, I’m over-tired, so I’m not able to concentrate. “The worst part is that my doctors haven’t been listening to anything I have to say. I read on About.com’s thyroid web site about Armour Thyroid, but they won’t prescribe it. One Endo even said that his medical school didn’t teach about T3 and he didn’t know how to test for it, much less prescribe any medication that had T3 in it!”

“I sense your frustration. Doctors need to keep on learning after they graduate from medical school. I take at least 4 weeks of conference a year so I never have to say to a patient, ‘I still don’t know the answer to your question.’

“So what other symptoms do you have?”

“What don’t I have do you mean? Muscle cramps, tinnitus in my left ear, canker sores. Dry skin, swelling of my ankles, hair loss. Joint pains, especially in my wrists. Even though hypothyroid patients are supposed to be constipated, I have diarrhea, especially when I eat bread. And even though I am frustrated with my doctors, I’m not depressed! If I had a dollar for every time I was given prescriptions for Ativan or Lexapro …”

“Don’t worry. Even though I’m an M.D. and could write for those drugs, when I find the cause of my patients’ conditions, I don’t need to cover up their symptoms. We’ll get to the bottom of what’s going on with you. By the way, thyroid and celiac disease are often seen together. Did anyone test you for gluten allergies?”

“No. What’s gluten?”

“Gluten is a protein found in wheat, rye and oats. Allergies to it can cause diarrhea and many of the other symptoms you’re having, especially the canker sores. I have a trick of using liquid folic acid to heal those ulcers inside your mouth, so you can get some relief while we wait for some tests to come back.”

Two weeks later, Teresa returned to go over her labs. “We’re going to audiotape this visit (or use the dictaphone app on your iPhone) because we have a lot to go over. I’ve found a half-dozen other things to talk about including the thyroid and celiac disease we mentioned last time.”

“That figures. Within a day of seeing you and starting that folic acid mouthwash, my canker sore went away. And since I stopped eating wheat, I haven’t had any diarrhea either. So what else did you find?”

“You have two types of thyroid conditions. One is HASHIMOTO’S THYROIDITIS, an autoimmune thyroid condition caused by your body attacking itself. The other is called the REVERSE T3 SYNDROME, where your body doesn’t properly convert T4 thyroid hormone into the more active T3 thyroid hormone. Since Synthroid is a T4 only drug, it is absolutely the worst medication for you to be on. You were right all along; you would do better on Armour Thyroid, or any other thyroid medication that has T3 in it.

“What’s more important, Teresa, is that both of these conditions cause the Syndrome of Peripheral Thyroid Hormone Resistance, in which thyroid blood tests become less accurate. Instead of solely relying upon the TSH test you’ve had in the past, I’m going to include information from your history and physical exams to titrate your thyroid dosage.”

Identifying Teresa’s celiac disease proved to be a lynch pin to alleviating most of her symptoms. At her 6 month visit, Teresa’s list was whittled down to just a few minor concerns.

“Now if I could only get my sister in to see you … She’s a mess!”

2 Responses to “A case of Hashimoto’s Thyroiditis”

  1. Anna M. Breitwieser says:

    Brilliant! Dr. Woliner is so intelligent, so thorough with everything. My only wish is that he lived closer to Pembroke Pines. All Physicians should be as sharp and knowlegeable as he is.. Bless him in caring….

  2. Robin White says:

    Interesting. I have Hashimoto’s also. I am on Naturethroid. I also have Tinnitus. I am extremely interested to know if that symptom went away. My TPOs have come down with LDN, and gluten free eating, but my tinnitus is still there.

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