When Spencer Nadolsky was a medical student, his mentor was sick for a while and Spencer needed to do some research. While surfing the Internet, he stumbled upon a website that featured medical mysteries. The site required you to solve a medical mystery that was similar to what the author had experienced. Since the mysteries were equally challenging, he decided to take on the challenge and, like a true doctor detective, ended up solving some of the mysteries on the site, while also finding out that the author is not a real doctor.
Doctor Detective is an investigative reporter who travels the world to uncover the truth about the medical industry and help people who are wrongly denied care, and other health information.
Doctor Detective is a new health blog written by a board-certified OBGYN, who is also a practicing investigator. Dr. Nadolsky is a physician who is passionate about helping people achieve their health goals. He is a Financial Crime Investigator with the Board of Governors for the New York State Office of Medicaid Inspector General.
Dr. Detective digs further into the reasons of yellowing skin in this month’s case study, revealing that autoimmune hypothyroidism is not limited to middle-aged women.
Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.
Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.
We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet — not to mention their own physicians — can’t seem to cure. Spencer Nadolsky is one of them.
Dr. Nadolsky is an osteopathic physician with a background in exercise physiology and nutrition. He was an academic All-American wrestler in college and is now an enthusiastic exerciser and smart physician who does what he teaches to patients by treating avoidable illnesses with lifestyle changes first (instead of prescription drugs).
Dr. Nadolsky transforms from a happy, athletic doctor to a rigorous, no-holds-barred forensic physiologist when clients have nowhere else to turn. He takes out his microscope and examines blood, saliva, urine, lifestyle – anything it takes to solve the medical puzzle.
We leapt at the opportunity to collaborate with Dr. Nadolsky on a regular case study segment. You’ll learn how a skilled practitioner thinks by following along with these interesting examples. You’ll also learn how to take better care of yourself.
In today’s instance, we encounter a guy who isn’t too fond of his yellowness.
Do you recall Steve, the customer who was self-conscious about his yellow skin? We determined that he had had too much pumpkin and sent him on his way.
Well… Steve has returned. With a similar problem.
Symptoms and indications of the client
Steve was the last person I saw a year ago. He’d restored his healthy complexion and removed the yellow tint to his skin by following my previous suggestion to cut down on pumpkin. However, his complexion had begun to turn yellow once again.
It couldn’t be because he was eating pumpkin, which is even more puzzling. He’d gone from one can of pumpkin each week to no pumpkin at all since he was worried about the situation.
You may remember that I thought of Steve as a hypochondriac. As a result, I received the impression that he was exaggerating the issue.
But, upon closer inspection, I discovered that he was correct. His complexion had a bright golden color.
He was avoiding pumpkin, carrots, and pretty much all orange foods, so it couldn’t be too much beta-carotene.
Furthermore, his lifestyle remained much the same as it had been when I last saw him, with the exception that he was now enrolled in medical school. And if he was fatigued a little more than usual – which he was – he attributed it to the additional hours he’d been studying at night.
|Symptoms / Signs||My views on the subject – possible problems|
|Skin discoloration||Last time, we ruled out liver involvement. We discovered he was obsessed with pumpkins. We didn’t examine his thyroid, which might have had a role.|
|Tiredness||Sleep deprivation is almost certainly the case. It may be a thyroid issue.|
I didn’t want to conduct any additional liver tests at this time. I was convinced it wasn’t his liver that was the issue.
Truth be told, I was still suspicious that he was consuming carotenoids without recognizing it!
However, I needed to inspect him and ask him a few questions.
Except for the fact that he was somewhat slimmer, his physical appearance hadn’t altered much in the previous year.
What about dry skin, coarse hair, diarrhea, a sluggish heartbeat, and a chilly feeling? All of these signs and symptoms point to a thyroid issue. However, none of these were reported by Steve.
Steve’s deep tendon reflexes seemed to be delayed, which was the only thing that looked odd. This may be a symptom of hypothyroidism, but I’m not certain. Hypothyroidism is more common in middle-aged and older women, so given Steve’s age and gender, it seemed improbable. When I touched his thyroid, I didn’t detect any fullness or goiter.
So, even though it was a long chance, I informed Steve that we’d check for hypothyroidism.
A thyroid stimulating hormone, or TSH, must be checked to do this. I sometimes request a free T4 (thyroxine) and perhaps a free T3 (triiodothyronine) test. Hormones T4 and T3 aid in the regulation of human development and metabolism.
This panel isn’t exhaustive, but it will usually alert you to a problem. Most physicians will just prescribe the TSH test. I decided to get a TSH and a free T4 like a determined detective.
Read All About the Thyroid and 7 Thyroid Issues Your Doc Likely Missed to understand more about the thyroid and how it functions.
The exams and evaluations
Panel of blood chemistry
Steve’s lab results are as follows:
|Marker||Result||Reference Range in the Laboratory||Thoughts|
|TSH||5.5 micrograms per milliliter||0.45 – 5||Slightly elevated. Hypothyroidism or subclinical hypothyroidism may be the cause.|
|Free T4||2.0 ng/dL||0.9-2.4||On the higher end of the scale. He has a little subclinical hypothyroidism as a result of this and his TSH.|
If Steve had full-blown hypothyroidism, his testing would show a higher TSH as well as a lower free T4 level. Instead, he had a normal T4 and a higher TSH. This implies he had what’s known as subclinical hypothyroidism.
Steve’s pituitary gland (as shown by TSH) was attempting to entice his thyroid gland to produce more hormone (indicated by the T4 number). But his thyroid was deafeningly deafeningly deafeningly de As a result, the pituitary gland had to scream louder and louder.
His thyroid was reacting for the time being. But if anything were to get in the way of that – say an autoimmune disruption – then Steve would be plunged into full-blown hypothyroidism. He was running on an almost empty tank, with little in reserve, to use another metaphor.
What does any of this have to do with Steve’s primary symptom, which is his skin becoming yellow?
A slow thyroid, like eating a lot of orange foods, may contribute to carotenoid build-up. Overall, the metabolism slows down, making the conversion of beta-carotene to Vitamin A more challenging.
Steve’s fading skin was finally explained. However, it raised a more fundamental question: how did a 25-year-old man get himself with subclinical hypothyroidism in the first place?
Steve’s position would not have been uncommon a few years ago. Iodine insufficiency was the most frequent cause of hypothyroidism back then (since iodine is used to make thyroid hormone and it is often lacking in our soil). Idodine insufficiency is still a major health issue in various areas of the globe today.
In North America, however, iodized salt was introduced in the 1920s, which almost eradicated the issue. Hashimoto’s thyroiditis, an autoimmune thyroid disease, is now the most prevalent cause of hypothyroidism in the United States. However, Hashimoto’s disease is much more prevalent in middle-aged women than in young males.
It was now a distant possibility that goitrogens or flouride in Steve’s diet were interfering with his thyroid hormone synthesis. However, a brief review of his meal plan revealed that he was not consuming several of the suspect items.
As a result, we had to test for Hashimoto’s disease in the end. We were on the lookout for antibodies that might be causing his thyroid to fail.
The findings of the second round of testing
Panel of blood chemistry
Steve’s lab results are as follows:
|Marker||Result||Reference Range in the Laboratory||Thoughts|
|Antibody against thyroid peroxidase (TPOAb)||120 IU/mL||<35||Thyroiditis with autoimmune symptoms. Although not very high, this is a clear positive test.|
|Antibody against thyroglobulin (TgAb)||10 IU/mL||<20||Normal|
This is Steve’s third visit.
Steve’s hypothyroidism had an autoimmune component, according to his test findings.
His ears pricked up when he heard the term “autoimmune.” He suddenly recalled something similar from his grandma. His mild hypothyroidism was beginning to make sense at this point. Autoimmune diseases are often passed down via families.
There were a few therapy choices available to us. We might put him on thyroid replacement medicine right away, or we could wait a few days to see whether his problem was temporary, while making some dietary adjustments that may assist.
Steve wanted to start with dietary modifications.
First, I advised him to stay away from gluten. Why? Because celiac disease and autoimmune thyroiditis have a close connection.
Steve didn’t eat much bread or spaghetti, so this wasn’t a huge issue for him.
I then recommended that he take probiotics and vitamin D supplements. I also advised him to consume a couple Brazil nuts each day to supplement his selenium intake. In those with autoimmune thyroiditis, selenium has been found to reduce TPO antibodies.
Steve’s pink complexion did not return after six months of eating gluten-free and taking probiotics and vitamin D. He was also more tired than he had ever been.
His TSH level had risen to 7 mIU/mL, according to another examination.
It had come to that time to begin thyroid replacement medication.
The treatment plan
Thyroid replacement is generally required for autoimmune thyroiditis, although this is not always the case.
Fix #1: Try to avoid triggers as much as possible and supplement as needed.
A healthy gut may help with autoimmune thyroiditis. Because celiac disease may be an underlying component in the condition, this involves eliminating gluten. It’s important to note that I’m not advocating that everyone avoid gluten. It’s just necessary to be aware of the link.
TPO antibodies that damage the thyroid gland may be reduced by selenium intake from Brazil nuts. While there is no evidence that eating a few nuts a day would alter the course of the illness, it would be foolish not to give it a go.
TPO antibodies that damage the thyroid gland may be reduced by eating Brazil nuts, which are rich in selenium.
Fix #2: If required, replace the thyroid.
Steve’s autoimmune condition, however, did not respond to diet and supplements alone. As a result, we decided to assist his thyroid gland by administering thyroid hormone from outside sources. There are a few choices, but we went with synthetic thyroxine (T4).
Low-dose naltrexone is the third fix.
Low-dose naltrexone is a novel treatment for autoimmune diseases that has been shown to benefit. However, the data on this isn’t conclusive, and I’d want to see additional study before recommending it to patients.
The end result
Steve returned for a check-up two months after starting thyroid replacement. His vitality had increased, and his skin had become less yellow. TSH had dropped to 1.8 mIU/mL, which was a significant improvement.
Conclusions and suggestions
The body’s capacity to convert beta carotene to vitamin A may be hampered by a slow thyroid. This may cause skin to become yellow. Hormone replacement treatment may be necessary if diet and supplements do not assist.
What can we learn from Steve’s experience?
- Yellowing skin may be caused by a variety of factors, ranging from severe issues like jaundice to minor issues like eating too many orange veggies. However, it may also indicate a thyroid issue.
- Hypothyroidism manifests itself in a variety of ways. Contact your health care practitioner if this tale or symptoms seem similar to you, or if you’re worried about an autoimmune issue in general.
- Try to figure out what’s causing your hypothyroidism. Thyroid replacement treatment may be required if the condition is caused by an autoimmune disease.
There is a lot of mystery and intrigue in medicine in general, and medicine you practice can be even more exciting. It’s not unusual to hear a patient say ‘I don’t know what’s wrong with me’, or ‘I’m not feeling well’, or ‘I’m afraid I may have cancer’. We can help.. Read more about spencer nadolsky steadymd and let us know what you think.
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