Hey Doc, When Are You Going to Write Up My Case?

I hear this question virtually every time I see Alan, an extremely healthy, energetic man in his forties who could easily pass for someone in his twenties. He comes to the office once a year for a check-up (he’s always just fine), but since we cross paths at our health club I’m reminded about his “case” fairly often.

I haven’t explained to him that when doctors do write up cases, most prefer those in which they themselves play a starring role for having made a great diagnosis or initiated a treatment that rescued someone from the fiery jaws of near-death.

In The Devil’s Dictionary, American writer Ambrose Bierce defines “positive” as being “mistaken at the top of one’s voice.” With Alan’s case, I got the opportunity to be both positive (in Bierce’s sense of the word) and, when it came time to celebrate Alan “getting well,” took my place at the sidelines to watch the parade go by.

Several months ago Alan arrived to report his thyroid gland was both painful and enlarging. I could feel the enlargement and ordered some thyroid tests, which showed that his gland was producing too much hormone (called hyperthyroidism). The diagnosis was pretty straightforward: acute thyroiditis, a sudden inflammation of the thyroid, cause unknown. Sometimes, and for reasons unknown, a person’s immune system starts producing antibodies against the thyroid. Other times there are no antibodies, just inflammation.

Since Alan was feeling fine, I told him there wasn’t much to be done, that he could use aspirin to relieve any pain, but he preferred not to do that.

Nothing really happened over the following few weeks until his thyroid tests began to change. Now he was drifting into thyroid underactivity (hypothyroidism), Alan’s loss of thyroid function unsurprising to me as it’s a fairly common consequence of thyroiditis. At this point he was feeling a little tired, so I wrote him a prescription for Armour thyroid to replace his lagging hormone.

Alan balked immediately, asking “Do you mean I might have to take a pill for the rest of my life?” I admitted this was a possibility, and suggested we wait a couple of weeks and see what direction his tests were going. He definitely preferred this.

Two weeks later his numbers were worse, his thyroid pumping out even less hormone. If he was feeling any fatigue, he didn’t let on. I handed him another thyroid prescription, to replace the discarded first one.

“No. I think I’ll try Mari instead.”

Alan chooses Mari Stecker, our traditional Chinese medicine (TCM) specialist
“Alan, you can work with Mari all you want. You’re significantly hypothyroid. Your gland is pooped out from the inflammation. Take the thyroid, it will make both of us feel better.”

Of course, “me, feeling better,” was not Alan’s priority, so it was thanks-but-no-thanks to my prescription. With much difficulty, I refrained from sulking about this.

Alan preferred to try TCM, and since I had no explanation for why his thyroid should suddenly start acting up he scheduled a visit with our Mari Stecker, who does have considerable experience with thyroid disorders.

In Chinese philosophical and medical theory, yin and yang are the essential components of the material universe. Everything that exists is essentially yin or yang, but most commonly a combination of the two:

• The yin principle is dark, moist, passive, and female.

• Yang is fiery, active, outward-expanding, and male.

Regardless your gender, good health is a balance of the two, poor health an imbalance. Treatment is usually a combination of acupuncture and Chinese herbs that seeks to restore healthful balance.

Alan himself is a very yang person: boundless energy, extroverted, thin, and always moving. In Chinese medicine, overactive thyroid is a sign of excess yang (or, conversely, a deficiency of yin). Something–perhaps stress at work–had thrown off his usual healthy yin-yang balance, first with too much yang, more than usual even for energetic Alan, and then too little. Mari would set out to correct this.

A week or two later, Alan’s thyroid tests worsened. And there I was, hovering around the door of Mari’s treatment room waving my thyroid prescription. Mari, who’s unflappable, asked me to please just be patient. Things would turn around.

And they did.

Within eight weeks, by following his herbal regimen and acupuncture treatments, Alan’s tests were normal, his thyroid back to its usual size, and he was feeling fine.

As I watched the parade go by without me in it, Mari opined, “Did you expect anything else?”

And now I have written up Alan’s case.

Be well,

David Edelberg, MD