Endocrine Soup – Managing the Interplay of Multiple Endocrine Imbalances
A Case Study by Gemma Martin
Thyroid imbalances are one of the most commonly treated conditions in naturopathic practice. However, often the patient will present with evidence of more than one endocrine imbalance as can be seen in this patient. This case presented an interesting challenge due to the impact that medication was having on the patient’s symptoms, as well as reproductive and adrenal involvement. The management of this case continues to offer a great learning experience.
Initial Consultation
A 32- year-old female presented with fatigue, hair loss, cold intolerance, and constipation that had been persistent for 2 years, following the birth of her third child. The patient was diagnosed with Hashimoto’s thyroiditis at age 10 and had been medicated since age 30 with thyroxine 200 mg daily. She also reported menstrual flooding, clotting and pain including ovulation pain requiring two ibuprofen tablets every 3 hours. The patient experienced premenstrual tension (PMT) for 1 week prior to menstruation.
A case history revealed
- Energy levels rated 5/10;
- Poor sleep – waking 3-4 times nightly to tend to her three children and waking
tired in the morning;
- Nocturia twice nightly;
- Moderately high stress rated 6/10;
- Low ferritin of 32 μg/mL (20-250) treated with iron polymaltose 100mg daily,
which caused constipation;
- Use of docusate sodium 50 mg and sennosides 8 mg every second day to
manage constipation;
- Intense sugar cravings;
- Intolerance to eggs and dairy;
- Poor memory and concentration;
- Light-headedness upon standing;
- Diet was of medium quality, however included dairy and excess alcohol.
Initial Prescription
The initial prescription was aimed at supporting thyroid health by providing substrates for converting thyroxine to triiodothyronine, reducing antibody levels and supporting the stress response. Reducing menstrual cycle symptoms and regulating blood sugar was also a priority.
The prescription included:
- A powder containing inositol 2 g, chromium 75 μg (as chloride hexahydrate and
picolinate), selenium 75 μg (as selenomethionine), zinc 5 mg (as citrate) and
quercetin 250 mg and cofactors. Dose: 1 scoop twice daily;
- A herbal tablet to reduce menstrual blood loss containing Paeonia lactilora (peony) 640mg, Capsella bursa-pastoris (shepherd’s purse) 640 mg, Achillea
millefolium (yarrow) 320 mg and Thuja ocidentalis (thuja) 200 mg. Dose: 1 tablet
twice daily from day 14 of the menstrual cycle until the bleed begins, then
increased to 3 tablets twice daily until bleeding slows, to be ceased until day 14
of the next cycle;
- A herbal tablet to support progesterone levels and manage PMT containing Vitex
agnus-castus (chaste tree) 500 mg. Dose: 1 tablet daily;
- A magnesium citate powder containing 400 mg magnesium to reduce menstrual
cramping, support blood glucose levels and manage her stress response. Dose:
take 1 sachet daily;
- Replace current iron supplement with an iron and probiotic capsule containing
iron 4.2 mg (as ferrous fumarate) and Lactobacillus plantarum (299V) 1 x 1010 CFU and cofactors. Dose: one capsule every second day away from food, tea,
coffee and herbal medicine.
Dietary and lifestyle advice included:
- Include 3 Brazil nuts daily for their selenium content to support conversion of
thyroxine (T4) to triiodothyronine (T3);
- Include pumpkin seeds for mineral replenishment;
- Include dried apricots, beetroot and leafy greens to support dietary iron sources;
- Reduce wheat, dairy and alcohol to a minimum or cease completely;
- Use Epsom salts baths weekly, especially in the week leading up to
menstruation;
- Look for a pelvic physiotherapist;
- Apply a castor oil packs over the liver, uterus and thyroid gland for 30 minutes 2-
3 times weekly.
9 Week Follow-Up
The patient reported improved energy rated 7/10, along with reduced stress which was now rated 4/10. She had lost 8 kg and had started running 4-5 km five times weekly. The blood loss during her period had reduced as had the clotting, pain and ovulation pain. She was no longer using docusate sodium and sennosides – however her bowel movements were affected by the inclusion of magnesium citrate, which she was now taking once every three days. The patient had pathology performed in between appointments revealing the following:
The prescription was updated to include the following:
A herbal and nutritional tablet to increase antioxidant status containing Vitis vinifera (grape seed) 4.8 g, Zingiber officinale (ginger) 150 mg, Ananas comosus (bromelain) 100 mg, ascorbic acid 25 mg, and quercetin dihydrate 250 mg. Dose: take 2 tablets twice daily.
Continue all other supplements, diet and lifestyle advice.
13 Week Follow-Up
The patient reported a continued improvement in her energy which was now rated at 7-8/10 even though her stress levels had also increased to 9/10 with work, family and study commitments. The patient had a review with her general practitioner who reduced her thyroxine dose from 200 mg daily to 175 mg daily. Her menstrual symptoms continued to improve with fewer and smaller blood clots, no flooding, no noticeable PMT, and significantly less pain during her menses that did not require pharmaceutical intervention. She still experienced two hours of mid-cycle pain, but not enough to interfere with her run. The patient reported taking one hour to fall asleep, which she did in front of the television. Her diet still contained gluten and dairy. The patient was referred or a follow up blood work including thyroid panel, ferritin, coeliac serology and factor V Leidin mutation (as a potential contributor to her menstrual blood loss).
Her prescription was continued with the addition of the following:
- A herbal tablet to support the stress response and promote oestrogen
biotransformation containing Rhodiola rosea (rhodiola) 150 mg, and Schisandra
chinensis (schisandra) 660 mg. Dose: take 2 tablets with breakfast and one with
lunch.
- Switch dairy-based protein powder to a collagen protein;
- Avoid all gluten for the next month;
- Avoid screen time before bed – read a book instead.
Clinical Reflections
In the naturopathic clinical setting, rarely does a patient present with just one complaint. This case was a classic example of the interplay between various endocrine dysfunctions, which left the patient feeling unwell and overwhelmed. While treatment continues and follow-up pathology has not been completed, initial treatment offered considerable symptom relief while underlying drivers were also targeted. Ongoing co-management with medical professionals will ideally lead to further resolution of the patient’s symptoms and improvement of overall health and vitality.
