Perimenopause has always been associated with classic vasomotor symptoms, mood swings, insomnia, cardiovascular health, etc.

But little has been talked about when it comes to hashimoto thyroiditis and autoimmune thyroiditis. The case I am about to share is an important story.

A 50 year-old woman, whom I shall name her Darlene here, recently underwent thyroidectomy due to papillary thyroid carcinoma, sought help at my office. Thyroid hormone is critical for energy and metabolism, so after the surgery, her energy plummeted quickly. Her doctor prescribed levothyroxine (T4), which raised her energy on some days but not on most. She was denied cytomel (T3) because the surgery seemed to have impacted the parathyroid gland as shown on her parathyroid hormone and calcium levels in the blood, which put her at greater risk of osteoporosis.

Like most stay-at-home moms, Darlene’s days are preoccupied with errands, chores, cooking large meals for her teenage kids, driving them to school, and after-school activities. She pushes through her day even though she is sleep-deprived and suffers from joint aches and stiffness. She tries to exercise every day but it’d only make her more tired.

Darlene noticed that since the thyroidectomy, she had become more depressed, weepy, weak, fog-minded, and snappy. She turned to food for energy but mostly for comfort. Over time, stress eating had become a vicious cycle. All her life, she’s struggled with maintaining a healthy weight and was even more so after the surgery. After the surgery, she even tried thyroid-friendly diets free of soy and allowing minute amounts of cruciferous vegetables, but to no avail with reducing weight and bloating. Her BMI hovered around 30 (normal 18.5-24.9).

At night, she is tired but wired, unable to fall asleep. She also experienced frequent night sweats. She had had an IUD since 5 yrs ago due to PMDD (intense form of PMS), and because of the IUD, she couldn’t tell if she was going through perimenopause.

Let’s pause here for a moment. We know that ailments don’t rise out of thin air, particularly when it pertains to the thyroid. What could have been the triggers of Darlene’s thyroid cancer (or any cancer)? Back in the days when I was a medical student, there was a very popular book called When The Body Says No. In that book Dr. Gabor Mate, MD shares his patients’ stories of negative health outcomes as a result of not just poor lifestyle and diet, but even more so of long-standing stress, trauma, abuse, self-neglect, and significant negative life events.

I asked Darlene what significant events took place in her life in the last 5 years. Darlene gave me a confirmatory look as if she herself already knew that stress played a huge part in the rise of her cancer.

It turned out that in the last couple of years her mother battled against and eventually passed away from same cancer. “Ok, there may be genetic predisposition here” I noted to myself. Given that she wasn’t working, Darlene took up the responsibility of being the primary caretaker for her mom while also looking after her elderly father and mother-in-law, all the meantime still holding down her own family. Undeniably, emotional stress, grief, and physical overburden were part of the big picture.

“I had pain and stiffness in my throat before I fell ill, and I was always cold and sluggish even years before my mom got sick.” Her endocrinologist suspected that Darlene had undiagnosed Hashimoto’s for years that may have been the precedent to papillary thyroid carcinoma. It’s important to note here that in a meta-analysis in 2017, researchers have concluded that Hashimoto’s thyroiditis does predisposes patients to papillary thyroid carcinoma(1).

Based on the information thus far, I was quite confident that the combination of perimenopause, stress, and genetics increased the risk of cancer. I formulated a treatment protocol centering around the peripheral conversion of T4 to T3, which requires selenium and zinc; as well inositol, Rhodiola, magnolia, Schisandra to balance out insulin and cortisol, which at a high level would hinder the deiodinase enzymes; and lastly, glandular concentrates that could potentially elevate T3 level until Cytomel was prescribed.

But I would be amiss if I didn’t ask about her gut health as the gut is truly the gateway to health. Upon further inquiry, Darlene revealed that she experienced diarrhea from white bread, oatmeal, and even probiotics. Given that she had always struggled with weight, I’d imagine that she had some form of disordered eating, and in combination with a concussion she had in her 20s, I suspected that she had small intestine bacterial overgrowth. If that was the case for years before she developed thyroid problems, the bacteria overgrowth could be another contributing factor to Hashimoto’s thyroiditis and ultimately, cancer. Therefore, I also added antimicrobial herbs such as oregano, thyme, garlic, and clove to her treatment protocol.

She returned to my office 2 months later feeling like her old self. “I am back to the person that my husband married”. We continued the protocol and made sure at the same time she was taking vitamin D and calcium. Soon after that, she followed up with her endocrinologist and was cleared of cancer, and was later prescribed Cytomel.

The last time I saw her I removed some of her supplements to prevent interaction with her thyroid medications. She continues to do well today.

This case stood out to me because it’s not uncommon that a woman’s perimenopause coincides with life events that require her to push through physical and mental challenges. I hope this story not only honors women in the caretaking role but also reminds them to care of themselves especially when times are tough.

(1) X. Lai et al. (2017). A meta-analysis of Hashimoto thyroiditis and papillary thyroid carcinoma risk. Oncotarget, 8(37), 62414–62424.


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