T Nation

Think Tank- Case History #1

Hey guys, can I play too?

TC,
This is a very interesting case indeed. There are a couple of points that I think might need to be clarified. First, does she know for sure if her entire thyroid was removed, or just a lobe?

I find it hard to believe that she has not had more hypothyroid problems (thinking classic myxedema-like symptoms)if her entire gland was removed and she has not been taking any meds. She should try the Armour thyroid med and she if she has a better reaction. Basal temp measurements could be recorded pre/post to assess some degree of metabolic response. The thyroid hormones have such an influence on just about every major system, that without them, weight loss will be the least of her worries.

Regarding the 75 pound weight loss that occurred after taking the insulin shots, I would like to know 1) how much weight did she gain during the pregnancy 2)when did she start the insulin 3) how much of this weight did she lose within the first few months following the pregnancy?

The only reason that I could think of off the top of my head as to why the insulin helped, was that it was countering the anti-insulin action of the cortisol, as elevated cortisol in diabetics makes them worse.

If she has any copies of blood work that have been done on her and would be willing to some how provide the results, I think that would be useful.

I would concur with Dave Barr and John Berardi that blood-work is necessary. A CBC, Comp. metabolic panel, T3/T4 (free) and TSH, OGTT with both glucose and insulin evaluated,HbA1c, hormone profile including DHEA/Testosterone along with the female hormones, LH/FSH, cortisol, possible 24 hour urine cortisol and a suppression test.

These tests would give a pretty comprehensive look into her metabolism/physiology and would help to rule out the PCOS and Cushings that Cy was referring to in his post.

While all this testing is important for providing appropriate diagnostic work-up, I think JB is on the right track with his diet and exercise rec., as regardless of what the tests tell us, following his guidelines will help pretty much every condition. Obviously the more info we have the more we could individualize the diet and supplement program to acheive a better outcome.

I look forward to following this case.

Take care,
Ryan

Dr. Skeptix

Glad to have you on-board here at T-nation.

Based on your initial post I am pretty sure that you are well versed in oncology.
I am curious as to whether or not it is common to remove the entire gland? I’m guessing it would obviously depend on the degree to which the cancer is infiltrating the gland. If the entire gland was removed, would she not have to take thyroid hormone constantly to avoid a hypothyroid crisis? The fact that TC indicated that the thyroid gland was removed and that she is no longer taking any hormone, struck me as odd.

I thought Cy’s PCOS r/o was good as well, although the pregnancy did decrease the likelihood. Maybe she had been trying for a while, there are a lot of missing pieces to the puzzle.

Your last statement “Am I close?” makes it sound like the case has been closed. I was under the impression that it was an ongoing case that we were trying to help.

I look forward to your insight.

Take care,
Ryan