Too Much Thyroid Medication
I recently saw a women who was close to 60 years old. She came in from outside Illinois to consult with me about the palpitations she was experiencing. What was interesting about this case is that she was taking thyroid medication, and that neither her family doctor nor the cardiologist that she was then referred to bothered to consider and check the possibility that her symptoms resulted from too much thyroid medication.

Instead the cardiologist put her through a comprehensive battery of cardiac tests including Holter monitoring and stress echocadiography. Nothing was found. I am about 80% certain that this patients’ symptoms will resolve with a reduction in her thyroid medication dose.

A downward adjustment in dose along with a blood thyroid test is the first two things that ought to have been done for this patient by the family doctor, before a referral to the cardiologist. I think I just wanted to point out that the clinical listening and diagnostic skills and experience of physicians varies quite a bit. There is no such thing as standardization when it comes to medical expertise and judgment. I suggest that patients keep this in mind, and consider this carefully when they conclude that they should or should not do something because they completely trust the doctor they are seeing. I am not saying there is anything wrong with trusting your doctor. Just make sure you have one that is trustworthy. I saw a similar case years ago whose palpitations lead to a full cardiac workup including an angiogram, which is a dangerous and highly invasive test. No one bothered to take a dietary history, and I discovered the patient’s symptoms were all caused by excessive caffeine use.

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.

The Many Clinical Faces of Hypothyroidism in Gynecology
For years I have been aware of the unreliability of standard thyroid blood tests, including the TSH in making the diagnosis of hypothyroidism…an underactive thyroid gland. Generally characteristic symptoms, low body temperature, and response to thyroid medication clinches the diagnosis: sub-laboratory (not subclinical…the patient has the corresponding symptoms!) hypothyroidism.