A Case History - Hyperthyroidism?

The Case: Recently I saw a white, married female, in her early thirties, who complained of a 2 year history of episodes, of as long as 4 days, of complete insomnia, night sweats, palpitations, flank pain, and day time chilliness with dry skin.

She had been on the birth control pill since the age of 19. She had a very strong family history of thyroid disorders, and had tried to get in to see an endocrinologist. He only looked at her borderline low TSH and on a phone call said she was fine and didn’t need to see him.

She strongly craved sugar, used it even late in the day, and her diet was almost entirely carbohydrates, though she was small and slim. There was no family or personal history of mental disorder or alcoholism. She had a high stress job, but was functional there despite the lack of sleep. She seemed to have superhuman energy at times, and might be found exercising at 4 AM. One of her sisters had similar complaints without the severe insomnia and had been discovered to be hyperthyroid. Her BP was normal but her pulse was fast at 88 per minute.

The Discussion:  Orthodox practitioners usually are not of much help in cases such as this one. Since the patient’s symptoms are often not properly analyzed and blood test results are interpreted very literally based on so called “normal” ranges, they will miss the diagnosis. There were basically no “abnormalities” on this patient’s chemistry testing, except that her red blood cells were slightly large. In this case the symptoms are somewhat contradictory. For example she is hot at night but cold during the day.

What are the diagnostic considerations, or what is also known as the differential diagnosis in this interesting case?

Initially I wondered whether this patient might be bipolar in a current manic condition. The very severe insomnia and high energy levels can be characteristic of that disorder. However, what argued against it was her continued functionality at work, and the absence of a truly euphoric mood, rapid speech, poor judgment with outrageous shopping sprees, and multiple unfinished grandiose projects that get started and then dropped. The absence of prior depressive or other psychiatric problems and absence of a family history of mood disorder and alcoholism also pointed away from bipolar disorder.

The next possibility was hyperthyroidism. Many of the symptoms fit, and the family history is very strong. She actually was the only member without a diagnosed thyroid condition, at least so far. Hyperthyroidism rarely presents with such severe insomnia, and these patients are usually hot day and night. Her rapid pulse fits this picture. We also should think about an autoimmune process, particularly since she is at such high risk for a Candida overgrowth. Her history is full of sugar, birth control pills, and antibiotics. All these things bring on yeast, and yeast can start an autoimmune process which could throw the thyroid out of balance.

Finally, the stress she’s under could have overstimulated the adrenal, causing excess cortisol production and accounting for the insomnia and flank pain, plus a cascade of other adverse hormonal consequences. The contraceptive pill alone has been known to induce early ovarian failure in young women, which could explain the hot flashes at night.

Those are some of the things to consider here. After the interview, the patient was very relieved to be having many of her own suspicions and concerns validated and pursued. A surprising number of hyperthyroid patients end up in psychiatrist’s offices just because they happen to have tests within the “normal” range.

Had she not visited us, that may well have been this patient’s next stop, with a cycle of powerful psychiatric drugs with their mine altering effects and side effects to look forward to. After discussion with the patient, it seemed that an atypical hyperthyroidism was the most logical place to start treatment. In reality, many if not most, patients don’t fit into the tidy diagnostic boxes that doctors want to put them in.

I prescribed an anti-thyroid medication and asked her to stop using all sugar, and also ordered tests for Candida, food allergy, blood sugar, diet typing, and hormones, and will see her again in a month. If her thyroid is slowed down by the medication as will be documented by a rising TSH level to be repeated just before her next visit, and she reports that she is sleeping and feeling better, then that will be the quickest way to establish the tentative diagnosis of hyperthyroidism.

This case was quite interesting and nicely illustrates the complexity of cases that we see all the time at CMRS that require careful evaluation and good listening skills, as well as experience and expertise in both orthodox and natural medicine. I’ll let my readers know how the case progresses.