Burnout is a very real condition that can affect anyone, and it is particularly common amongst carers, health workers and parents. It can be described as an imbalance between the high demands placed on the individual and their capacity to cope, which understandably diminishes over time.

In this case, excessive physical and mental workload, combined with inadequate access to downtime, social support, and restorative practices, resulted in a feeling of burn-out, along with a concurrent diagnosis of Hashimoto’s thyroiditis, which may or may not have preceded the burn-out.

Initial consultation

A 38-year old female presented to the clinic with a feeling of overwhelm and burnout that manifested as a migraine with kaleidoscope vision, six weeks prior to her initial consultation. The patient was the mother of 2 small children, the youngest of which was 5 months old. Due to COVID-19 restrictions, she had also been physically distanced and isolated from her support network for the year prior.

A visit to her general practitioner (GP) to discuss the migraine revealed:

• TSH 6.9 mIU/L (reference range 0.3-3.5)
• Free T4 10 pmol/L (reference range 9.0-19.0)
• Free T3 3.8 pmol/L (reference range 2.6-6.0)
• Peroxidase antibodies 539 IU/mL (reference range <6)
• Thyroglobulin antibodies 458 IU/mL (reference range <4)
• Ferritin 51 μg/L (reference range 30-250)
• Active B12 60 pmol/L (reference range >35)

Due to these results, she was prescribed thyroxine 50 mg/d, which she commenced immediately.

Additionally, her case history revealed:

• Energy rated 6/10 (improved from 2/10 with the addition of thyroxine)
• Low current stress levels (rated 3/10) with the return to her social support network
• Bowel movements once every 2nd day, which were difficult to pass
• Waking multiple times per night to tend to children, with difficulty falling back to sleep after waking
• Poor memory
• Cold extremities
• Neck and shoulder tension
• Breast-feeding 5-month-old infant
• A nutritious whole-foods, omnivorous, gluten and dairy-free diet
• Inadequate water intake (1 L/d, cold from the fridge) and 2 shots of coffee daily

The patient was already taking self-prescribed nutritional and herbal supplements including:

• Withania (Ashwaganda somnifera) 5g/d
• Zinc picolinate providing 25 mg/d elemental zinc
• Vitamin D 5000 IU twice daily
• Methylated B12 1000 μg/d
• Vitamin B3 80 mg/d
• Potassium iodide providing 288 mcg/d elemental iodine (taken inconsistently)
• Selenomethionine providing 68 μg/d elemental selenium
• Magnesium hydroxide providing 260 mg/d elemental magnesium

Initial prescription

The initial prescription was aimed at providing additional energy through adrenal support, in addition to reducing inflammation and antibody levels, while optimising her current supplement regime. Her prescription included:

• A herbal tablet for adrenal support containing 3.0 g Rhodiola (Rhodiola rosea) and 660 mg Schisandra (Schisandra chinensis). Dosage: 2 tablets at breakfast and 1 at lunch;
• An anti-inflammatory herbal tablet containing 40 mg  Grape seed (Vitis Vinifera) extract, 7.5 mg  Ginger (Zingiber officinale), 100 mg  bromelains, 25 mg  ascorbic acid, and 250 mg  quercetin dehydrate. Dosage: 3 tablets twice daily;
• The dose of selenium was increased to 200 μg/d, withania and magnesium were taken at night for improved sleep quality and she was instructed to continue taking all other supplements until finished.
• Review vitamin D3, iodine and zinc levels with her GP

She was also asked to make the following nutritional and lifestyle changes:

• Consume iron-rich foods such as slow-cooked kangaroo (1 x weekly), apricots, almonds, parsley. and spinach
• Add 1 teaspoon of psyllium husks and 1 tablespoon linseeds to breakfast
• Add ¼ teaspoon each of powdered cinnamon and ginger to breakfast for improved circulation and digestion
• Consume 3 brazil nuts per day
• Reduce caffeine intake to 1 shot of coffee per day
• Increase fluid intake - consume room temperature water and/or herbal teas to achieve 2 L fluids per day
• Gentle exercise only - restorative yoga, walking and stretching
• Increase morning and afternoon sun exposure - torso in the sun for 20 minutes per day

2-week follow up

The patient reported that she was feeling much better as her energy had improved to 7-8/10 and her stool regularity had returned to daily, without straining. She had been unable to see her GP to review her nutritional status due to COVID-19 restrictions.

Her herbal and nutritional prescription was continued; however, as her zinc, iodine and vitamin B3 supplements had run out, they were replaced with:

• A herbal and nutritional tablet for thyroid support containing 400 mg  Rehmannia (Rhemannia glutinosa), 500 mg  tyrosine, 50 mg  nicotinamide, 15.1 mg  zinc, 120 mcg  iodine, 50 μg  selenium, and cofactors. Dosage: 1 tablet, twice daily.
• Continue taking additional selenium at the original dose of 68 μg/d.

The patient was encouraged to book a telehealth appointment with her GP to review thyroid hormone and antibody levels and to assess her nutritional status.

7-week follow up

The patient reported a further improvement in energy levels to 8-9/10 and had noticed restoration of her memory. She was experiencing improved sleep, with less waking (children were waking less frequently) and falling back to sleep easily.

Her follow up blood work revealed:

• TSH 4.1 mIU/L (reference range 0.3-3.5)
• Free T4 14 pmol/L (reference range 9.0-19.0)
• Free T3 4.0 pmol/L (reference range 2.6-6.0)
• Peroxidase antibodies 346 IU/mL (reference range <6)
• Thyroglobulin antibodies 277 IU/mL (reference range <4)
• Ferritin 59 μg/L (reference range 30-250)
• Active B12 120 pmol/L (reference range >35)
• Vitamin D3 92 nmol/L (reference range >49)
• Serum zinc 10 μmol/L (reference range 10-25)
• Urinary iodine 67 μ/L (50-99 mild iodine deficiency)

Her prescription was continued with the following changes:

• Reduce vitamin B12 spray to 1 dose twice weekly
• Reduce vitamin D supplement to 1 capsule twice weekly
• Add zinc citrate providing 30 mg zinc to be taken twice daily

19-week follow up

The patient’s TSH, T4 and T3 levels had returned to ‘in range’ and her antibodies continued to fall (results not provided).  Her GP had ceased thyroxine supplementation 4 weeks prior to this appointment and the patient reported continued good energy, rated 9/10. She was happy with her progress and wished to reduce her supplement intake to rely predominately on whole foods and nutrition.

Her ongoing prescription included:

• A herbal tablet for thyroid support to be taken once daily
• A herbal tablet for adrenal support to be taken 1 at breakfast and 1 at lunch
• Continue with previous dietary recommendations with a special focus on foods rich in iron, zinc and selenium
• Review nutritional status at next GP appointment

On the road to recovery:

Whether thyroid disease preceded burnout or vice-versa is unknown in this case. What is known, however, is that although both body and mind are phenomenal in their ability to adapt, their capacity is also limited. When a system is overloaded, adaptive mechanisms begin to fail and illness creeps in at the weak points. Fortunately for this patient, she had a sound diet, a history of good health, and a thorough GP to support her on her health journey. With the additional support of herbal and nutritional medicine, she could return to her previous level of good health and enjoy parenting her children.