THYROID DEFICIENCY: SOME PATIENTS WHO HAVE RESPONDED

One patient who illustrates well how so many manifestations of low thyroid function may sometimes appear in the same individual and go undiagnosed is a thirty-seven-year-old woman I saw six years ago. Her primary complaint then was extreme fatigue. She was having great difficulty caring for her three children, aged seven to twelve. She was also markedly depressed.

Actually, a first possible indication of thyroid deficiency had come when she was in the third grade and had to be sent home repeatedly from school with severe headaches. Another came when she started her menses at age eleven, flowed heavily, experienced severe cramps, and lost several days each month from school. Still another was her tendency to develop far more than the usual number of colds and upper respiratory infections. As a freshman in high school, she developed severe pneumonia complicated by empyema, a collection of pus between lung and rib cage. She had to be hospitalized for two months, was out of school for a year, and an ugly scar at the bottom of the ribs on her back offers testimony to prolonged drainage.

In college, an astute physician realized that she needed thyroid and her health improved on thyroid therapy, but soon another physician discontinued the medication seeing no paticular need for it. Her obstetrician put her back on thyroid during her first pregnancy, but later another physician stopped the medication.

I examined her thoroughly, did blood and other laboratory tests to exclude other possible factors, and had her take her basal temperature at home. I could hardly be surprised when it proved to be below normal.

Her response to thyroid therapy didn't come overnight, of course. But over a period of several weeks, she began to notice that she no longer felt fatigued immediately after arising in the morning and over the next several weeks she felt a progressive increase in vigor. Her depression began to lift, too. Over a period of several months, her menses became regular. The next winter she experienced only one cold instead of the usual repeated wintertime respiratory problems, and the winter after that she was free of any respiratory infection. On continued thyroid therapy, just enough to maintain her basal temperature in the normal range, she is today a thoroughly healthy and effective wife and mother.

A man in his midforties had fought the handicap of excessive fatigue all of his life—and well enough to have become professor and chairman of his department at a major university. For years he had needed a minimum of ten hours' sleep a night plus frequent rest periods during the day. He was slow in his actions and slow in conversation. His slowness—since he was a brilliant man—had been regarded by his colleagues as an indication only of a deliberate, meticulous personality.

He sought help when, during an administrative crisis at the university, he felt that he was on the verge of total exhaustion. Like many hypothyroid patients I have seen, he told me that he felt as if he had been "born tired." And he added: "I am just tired now of being tired and of having to fight so hard against it."

The basal temperature test did not leave the slightest doubt about his low thyroid function. He responded, as expected, to thyroid therapy. Within a few months, he was delighted not only with his increased vigor but also with finding that his thought processes were faster, he was getting more fun and excitement out of his work, and, needing less sleep, he had time for avocational activities.

More Patients

I have seen many "hopelessly lazy" children who weren't basically lazy at all and who, when their thyroid deficiency was detected and adequately treated, lost their laziness.

Headaches can have many causes. But repeatedly I have seen hypothyroid patients with headaches associated with easy fatigability; their headaches have been reduced greatly in frequency and severity and in some cases eliminated entirely once their hypothyroidism was corrected.

Many skin disorders in hypothyroid patients have yielded to thyroid therapy. One baby comes vividly to mind even after more than twenty years. He was seven months of age when I first saw him. He had bleeding eczema covering virtually his whole body. Since birth he had been kept in a straitjacket to keep him from scratching himself to death by hemorrhage. Two hospitalizations and repeated dermatological consultations had been to no avail. Five months of thyroid therapy cleared his skin.

Psoriasis is a serious, often disfiguring skin problem that still remains mysterious. Not all but at least some patients with the disease have responded to thyroid treatment. One, a retired dean of the University of Denver, had had psoriasis for fifty years; it cleared entirely on thyroid therapy.

I have seen many patients with acne—teen-agers and adults—who, when they also had hypothyroidism, experienced marked improvement and even complete clearing of the skin on thyroid treatment. And results in those with chronic boils have often been remarkable as thyroid treatment has built resistance to bacteria ever-present on the skin.

Chronic or recurrent infection of one kind or another has been "the story of my life" for many patients with thyroid deficiency. One man, seventy-nine years old when first seen, had had a left ear draining pus since childhood. For twenty years, he had suffered from a bone infection which oozed pus continuously from his left thigh. Three months after he was started on thyroid treatment, his leg infection cleared; after a year, his ear was clear.

I have seen many children who suffered from repeated colds followed by complications such as tonsillitis, sinusitis, ear and mastoid infections, who needed repeated antibiotic treatment and went right on getting new infections until their hypothyroidism was treated.

Menstrual disorders may stem from fibroids, ovarian cysts, cervical polyps and other organic causes, but in most cases no such physical abnormalities are found. But many women with menstrual problems have proved to be hypothyroid and among them, my records show, about 90 percent have experienced relief of painful menstruation following thyroid therapy, and cure rates have been equally high for those with irregular cycles and others with excessive bleeding.

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