Second posting: Seriously, will no one heed my call? I need

Second posting: Seriously, will no one heed my call? I need help with a Hashimotos-chronic lymphocytic thyroiditis case, dammit!

Daniel Smith
Message 1 of 6 , May 6 6:02 PM
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Second posting, I know!  But no one took up the baton, so I am posting again.

46 year old woman presents to clinic with fatigue, adrenal exhaustion and hypothyroidism.  We have worked extensively to support her digestion and immune system and adrenal glands.  These are now well supported.  She is quite happy with the change.  She has been helped the most with adrenal supplements, and these along with Thornes thyrocsin have helped her make strides.  She now is able to function at her high stress triple A job without utter exhaustion.  She is still "wiped out" at 9 pm, but at least not at 4 pm anymore.

Now we are focusing on her thyroid.   For the most part, other practioners have kept her on synthroid or more recently Nature Throid but on both of these meds her TSH has been very low.  Paradoxically, she was particularly exhausted during this time of low TSH.  Her FT4 has generally been low or low normal and her FT3 has generally been high normal.

Thyroid antibodies : TPO Ab 6500 (yes, 6500) in 2007.  The most recent tests have this value at 231 in 10/2014 ad 639 in 4/2015.  Of note is that as she had begun to feel an increase in energy since coming to see me her antibodies have risen.  An odd, paradoxical quirk that concerns me.  TGB Ab have more or less been < 1, although the reading in 2007 had it at 107.

When she first came to me in 2014, she had hives that appear on her legs when she got under the covers at night.  For the most part my treatment in the first paragraph above has led to resolution, but they returned for no apparent reason two nights ago.  She also has had quarter sized eruptions on her legs and arms (mostly at night) that are firm non-pruritic nodules that resolve in 3-4 days.

History: Various diagnoses of DeQuervains thyroiditis, Hashimotos.  She had a period of intensely debilitating idiopathic arthralgias in 2009, around the time when her thyroid peroxidase antibodies were 6500..  All testing -except for a positive ANA reading- at Oregon Health Sciences University was negative.  She has INTENSE dysmenorrhea successfully managed first with Depo shots and now with an IUD.  She is reluctant to have the IUD removed because of the degree of pain she experienced during menstruation before it was inserted. Past history of exposure to EBV (high IgG titer).

Meds:Initially Nature Throid 130 mg.  After her energy dramatically improved and after observing her 10/14 TSH of  .030 I had her discontinue, weaning her slowly over 2 months.  She feels great off of the thyroid med, but her latest readings (TSH 4.08H, FT4 0.9L, FT3 4.7H, TPO Ab 639H) suggest that something is going on I am missing.

Imaging. Thyroid U/S on 4/15 found heterogenerous echogenicity, with findings consitent with chronic lymphocytic thryroiditis.  This is a condition that generally afflicts women postpartem, and then resolves.

I have not tested RT3.

I am interested in the thoughts of others out there.  What about Low Dose Naltrexone to lower the peroxidase Abs?

Daniel Smith, ND
Medford, OR



Virginia Oram, ND
Message 2 of 6 , May 6 6:13 PM
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Hi Dan!
Has she tried a gluten free diet to lower the antibodies?  I would consider placing her back on a low dose of thyroid.  I am using WP Thyroid now, which is very hypoallergenic, still by RLC Labs.  ! am thinking 1/2 grain for her.  You could try low dose naltrexone.  I would try Oxycell cream first from Apex, along with a gluten free diet.
Have you run an Adrenal Stress Index to see if her adrenals are back to normal?  Sounds like she is a lot better in that regard, but may still have some work to do, which can influence inflammation.
The antibodies can go up and down and are not always a reflection of a person doing better or worse according to Dr. Kharrazian.
My bias is blood type diet, and food allergy testing to improve immune function.
I hope you are doing well!
My Best,
Virginia A. Oram ND
Blair Centre for Natural Medicine



Heidi Peterson
Message 3 of 6 , May 6 6:15 PM
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I have a few comments.  I recently hosted a round table at community compounding on LDN.  The doctors reported mixed results with LDN and Hashi's.  But it is worth trying.  I had a patient with a TPO of 30,000.  She did diet, thyroid and heavy metal detox.   It finally came down after she did 1 year of hot yoga 4 week to under 100.   I think the thyroid is very sensitive to environmental toxins.   Lynn Patrick have a great talk on this a few years at Bastyr.  I found her lecture vary useful.  You may want to get it.

If she feels great with TSH under 10 then I do not think she needs thyroid. You could watch and do other therapies.

Heidi Peterson, ND
Portland, OR



Kristin Cox
Message 4 of 6 , May 6 7:35 PM
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I would suggest a gluten free diet.  I have seen that calm down paradoxical and changeable thyroid activity.  Also, learned a lesson with one patient who felt terrible but whose THS kept coming back low...  I was testing her in the morning too close to her thyroid dose.  Once she skipped the doses on test days, I got a more accurate reading of TSH.  I think your patient may still need a little bit of thyroid support and I would put her on a little USP thyroid.

Good luck.

Kristin Cox
Juneau, AK



James Mullane, ND
Message 5 of 6 , May 7 11:21 AM
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This would be my quick evaluation/ $.02. And I have no affiliation with any supplement company.

1) Moducare by Wakunga (can get through Emerson) to lower the antibodies. I used to use the Moducare by Thorne until it was unavailable for a time and switched my couple patients to the Wakunga. When the Thorne became available again tried to switch back to Thorne and both patients claimed to feel better on the Wakunga so kept on the Wakunga. Don't have accurate blood work to show a difference, just going by what patients say.

2) BCQ by Vital Nutrients or Aller-C by Pure Encaps to reduce the hives. Have treated 2 patients with similar presenting hives symptoms and got great results with those two products.

Hope that helps.

J


Jim Mullane
James Mullane, ND
Natural Family Medicine



laurarepola
Message 6 of 6 , May 7 7:43 PM
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I have a very similar case.  I will tell you where I am in my understanding and maybe somebody else can fill in the gaps.

Female 43 yo.  She has truncal fat, she is extremely anxious, and she has HTN.  She is gluten free for 5 years.
These are her most recent labs while taking Armour.  She reports that levo makes her swell and her T3 stays high on Levo too.  I cant remember if she has Hashi's but I can look back if you want.

TSH:        4.72 H  (0.4-4.5)
T4, free:   0.9       (0.8-1.8)
T3, free:   4.9   H  (2.3-4.2)

I'm trying to find a reason why her iodothyronine deiodinase enzyme is hyperactive.  This is the enzyme that converts T4 to T3.

We know that this enzyme has 3 types.  Type I comes from the liver and kidney.  Type II comes from brain, muscle, fat, and thyroid.  Type III inactivates T3.
Does she make more T3 because she has extra adipose?
Does she make more T3 because vasopressin and catecholamines affect the activity of deiodinase enzyme?
Does the complexity of the human body really matter in naturopathic medicine? kidding

Anyway, I will let you know what I find unless someone reading this has already been down this road.....

Laura Repola, ND
Butte, MT