OCD or Graves’? A case of missed hyperthyroidism and the Functional Approach to Graves’ Disease.  

Thyroid Health

Admitted to the hospital to the psychiatric team in her mid-40s with weight loss, palpitations, anxiety and Obsessive-Compulsive disorder; Anna was given anti-depressants and discharged.  

One whole year later, Anna was eventually diagnosed with Graves’ Disease. It was at that point appropriate treatment was offered. 

In the meantime, Anna took to eating sweets and icing sugar to try to maintain weight and reduced her workload to try to cope with her lack of mental focus.  

While Hypothyroidism (an under-performing thyroid gland) is a common condition and one which most doctors are familiar with, autoimmune hyperthyroidism (or Graves’ Disease) is relatively rare and often misdiagnosed as stress.  

Given the serious nature of over-active thyroid disease in terms of its impact on both physical and mental health, treatment is essential. However, treatment options are not ideal – long-term medication to block the thyroid hormone production (which can often result in hypothyroidism and which can have severe side effects) is offered first line.  

In the long term, many patients are left with only the choice of major surgery to remove the thyroid gland or radioactive iodine to destroy the thyroid tissue.  

Anna was unhappy with the options she was offered and came to the Functional Nexus to ask whether a Functional Medicine approach could provide an alternative way to control her autoimmune Thyroid disease.  

Amazingly, a few months of dietary change and support for immune function with Low-Dose Naltrexone helped Anna feel the best she had in years.  

In addition, her thyroid antibody levels fell into the normal range, and she avoided any surgical interventions. Anna no longer eats icing sugar, and her mental clarity and focus have been restored.  

So whether you have an under- or over-active thyroid gland or thyroid antibodies that have not yet disturbed hormone levels, we have safe and effective ways to reduce antibody levels, normalise thyroid output, and help you regain your health.  

To learn more about our nuanced approach and investigation of the ‘root causes’ associated with complex thyroid problems, GO HERE to reach out to our experienced patient care team for more advice, or read our article on the topic of the Functional approach to thyroid disease.

References:

  1. Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am. 1997 Mar;26(1):189-218. doi:10.1016/s0889-8529(05)70240-1. PMID: 9074859. https://pubmed.ncbi.nlm.nih.gov/9074859/
  2. Wekking EM, Appelhof BC, Fliers E, Schene AH, Huyser J, Tijssen JG, Wiersinga WM. Cognitive functioning and well-being in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol. 2005 Dec;153(6):747-53. doi: 10.1530/eje.1.02025. PMID: 16322379. https://pubmed.ncbi.nlm.nih.gov/16322379/
  3. Wiersinga WM. T4+T3 Combination Therapy: An Unsolved Problem of Increasing Magnitude and Complexity. Endocrinol Metab (Seoul). 2021 Oct;36(5):938-951. doi: 10.3803/EnM.2021.501. Epub 2021 Sep 30. PMID: 34587734; PMCID: PMC8566135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8566135/
  4. Liothyronine prescribing in England: costs versus need. Heald, Adrian et al. The Lancet, Volume 402, Issue 10417, 2074 – 2075 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01792-0/fulltext
  5. Yi W, Kim BH, Kim M, Kim J, Im M, Ryang S, Kim EH, Jeon YK, Kim SS, Kim IJ Heart Failure and Stroke Risks in Users of Liothyronine With or Without Levothyroxine Compared with Levothyroxine Alone: A Propensity Score-Matched Analysis. Thyroid. 2022 Jul;32(7):764-771. doi: 10.1089/thy.2021.0634. Epub 2022 Jun 7. PMID: 35570696. https://pubmed.ncbi.nlm.nih.gov/35570696/
  6. Are There Long-Term Adverse Effects of T3 Therapy for Hypothyroidism? We All Want to Know! Natalia Genere and Trisha Cubb Clinical Thyroidology® 2022 34:8, 332-335 https://www.liebertpub.com/doi/full/10.1089/ct.2022%3B34.332-335
  7. Medscape UK EXPERT INTERVIEW: Why Aren't Doctors Prescribing T3 (Liothyronine)? Siobhan Harris | Disclosures | 16 January 2019 https://www.medscape.co.uk/viewarticle/why-aren-t-doctors-prescribing-t3- liothyronine-2019a10000gh
  8. Jiang H, Powers HJ, Rossetto GS. A systematic review of iodine deficiency among women in the UK. Public Health Nutr. 2019 Apr;22(6):1138-1147. doi:  10.1017/S1368980018003506. Epub 2018 Dec 31. PMID: 30596360; PMCID: PMC10260541. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260541/
  9. Patil AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian J Endocrinol Metab. 2014 May;18(3):307-9. doi: 10.4103/2230-8210.131155. PMID: 24944923; PMCID: PMC4056127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056127/
  10. Frishberg Y, Feinstein S, Rinat C, Drukker A. Hypothyroidism in primary hyperoxaluria type 1. J Pediatr. 2000 Feb;136(2):255-7. doi: 10.1016/s0022- 3476(00)70112-0. PMID: 10657836. https://pubmed.ncbi.nlm.nih.gov/10657836/
  11. How Oxalates Affect Thyroid Health Medically reviewed and written by Izabella Wentz, PharmD, FASCP DR. IZABELLA WENTZ / FEBRUARY 17, 2021 https://thyroidpharmacist.com/articles/oxalates-affect-thyroid-health/
  12. Kobayashi R, Hasegawa M, Kawaguchi C, Ishikawa N, Tomiwa K, Shima M, Nogami K. Thyroid function in patients with selenium deficiency exhibits high free T4 to T3 ratio. Clin Pediatr Endocrinol. 2021;30(1):19-26. doi: 10.1297/cpe.30.19. Epub 2021 Jan 5. PMID: 33446948; PMCID: PMC7783124. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7783124/#:~:text=Of%20the%20three%20deiodinases%20(DIO1,of%20T4%20to%20T3%20conversion.
  13. Pamphlett R, Doble PA, Bishop DP. Mercury in the human thyroid gland: Potential implications for thyroid cancer, autoimmune thyroiditis, and hypothyroidism. PloS One. 2021 Feb 9;16(2):e0246748. doi: 10.1371/journal.pone.0246748. PMID: 33561145; PMCID: PMC7872292. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872292/
  14. Walter KN, Corwin EJ, Ulbrecht J, Demers LM, Bennett JM, Whetzel CA, Klein LC. Elevated thyroid stimulating hormone is associated with elevated cortisol in healthy young men and women. Thyroid Res. 2012 Oct 30;5(1):13. doi: 10.1186/1756-6614- 5-13. PMID: 23111240; PMCID: PMC3520819. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/
  15. Sinha SR, Prakash P, Keshari JR, Kumari R, Prakash V. Assessment of Serum Cortisol Levels in Hypothyroidism Patients: A Cross-Sectional Study. Cureus. 2023 ec 8;15(12):e50199. doi: 10.7759/cureus.50199. PMID: 38192949; PMCID: PMC10772313. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10772313/
  16. Bianco AC, Kim BS. Pathophysiological relevance of deiodinase polymorphism. Curr Opin Endocrinol Diabetes Obes. 2018 Oct;25(5):341-346. doi: 10.1097/MED.0000000000000428. PMID: 30063552; PMCID: PMC6571023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571023/
  17. Krishnamurthy HK, Reddy S, Jayaraman V, Krishna K, Song Q, Rajasekaran KE, Wang T, Bei K, Rajasekaran JJ. Effect of Micronutrients on Thyroid Parameters. J Thyroid Res. 2021 Sep 28;2021:1865483. doi: 10.1155/2021/1865483. PMID: 35140907; PMCID: PMC8820928. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820928/
  18. Piticchio T, Frasca F, Malandrino P, Trimboli P, Carrubba N, Tumminia A, Vinciguerra F, Frittitta L. Effect of gluten-free diet on autoimmune thyroiditis progression in patients with no symptoms or histology of celiac disease: a meta- analysis. Front Endocrinol (Lausanne). 2023 Jul 24;14:1200372. doi: 10.3389/fendo.2023.1200372. PMID: 37554764; PMCID: PMC10405818. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405818/
  19. Food Sensitivities and Hashimoto’s Medically reviewed and written by Izabella Wentz, PharmD, FASCP DR. IZABELLA WENTZ / JUNE 9, 2023 https://thyroidpharmacist.com/articles/food-sensitivities-and-hashimotos/
  20. Green KA, Werner MD, Franasiak JM, Juneau CR, Hong KH, Scott RT Jr. Investigating the optimal preconception TSH range for patients undergoing IVF when controlling for embryo quality. J Assist Reprod Genet. 2015 Oct;32(10):1469-76. doi: 10.1007/s10815-015-0549-4. Epub 2015 Aug 18. PMID: 26280527; PMCID: PMC4615921. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615921/
  21. Ahluwalia R, Baldeweg SE, Boelaert K, Chatterjee K, Dayan C, Okosieme O, Priestley J, Taylor P, Vaidya B, Zammitt N, Pearce SH. Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement. Clin Endocrinol (Oxf). 2023 Aug;99(2):206-216. doi: 10.1111/cen.14935. Epub 2023 Jun 5. PMID: 37272400. https://pubmed.ncbi.nlm.nih.gov/37272400/

Stay in touch

Join Dr Sarah's newsletter for insights and health advice in your inbox.

This field is for validation purposes and should be left unchanged.