Bibz Explains | Thyroid Disorder Case Study

Bibz Explains | Thyroid Disorder Case Study

Hi guys! Today I thought I would try something a little bit new on my blog. I think I should just put it out there, that I’m a really big fan of this Malaysian Youtuber - Allyna Wong. I honestly think she’s really quirky and does REALLY fun vlogs!

PS. I definitely hope you don’t mind me using this as a kind of ‘case’, because I thought this would just be a bit more of a fun project for me to do.

Just a bit of background from me first, in case you think a lot of what I say is mumbo jumbo. I’m a third year medical student - I’m just doing this in a bit of my free time because I think it’s really fun to blog about things here and there. Of course, feel free to leave in the comments points that you perhaps disagree with, or things that I might have gotten wrong. I’ll definitely respond and update the post accordingly!

Case

Pretty long video, but basically, the main gist of how it starts would be at 0:50, where she mentions that she’s going for a blood test.

So what she mentions that would be her main presenting complaint would be a neck lump. So, just a bit of medical terminology here - if it IS in fact caused by the thyroid gland, it would be called a goitre, and this can be BOTH hyper and hypothyroidism. Other causes could be enlarged lymph nodes, a cyst (which would be like a sac of water) or a cancerous growth. BUT, common things being common, your enlarged lymph nodes (suggesting some kind of infection), hyper/hypothyroidism or cysts would be more common for someone of her age, especially (and assuming she doesn’t have any congenital problems)

Source: ThyroidPharmacist.com

Source: ThyroidPharmacist.com

IMPORTANT: You have different types of neck lumps for thyroid. It could be single, multiple or even a big diffuse lump (which would make you consider different things). She seems to be pointing to a solitary node, my best guess would be that it is maybe Hashimoto’s Thyroiditis - which can cause both hyper and hypo, depending on when you are seeing the patient - her symptoms will later will suggest why I perhaps think this way. I’ll be talking about Hashimoto’s Thyroiditis as a whole - risk factors, management and cause at the end to kind of summarise this whole case (with advice for what to do)!

Next, she says that she is going for a blood test - which I assume would be to check 3 things. TSH (Thyroid stimulating hormone), T3 and T4. In hyper/hypothyroidism - you check the T3/T4 levels and if that is high, then hyper. If low, then hypo. You can then use TSH to establish whether there truly is something wrong with the thyroid or not (I won’t go too deep into this, because otherwise it’ll be pretty long).

Iodine Rich Foods

She then talks about how a lack of iron is the cause for her enlarged thyroid. Whilst I believe there is some relationship between iron and thyroid, my personal understanding is that it is more so usually because of an excess or a lack of iodine would be the cause of thyroid disorders. Iodine rich foods would be your spinach, figs, quinoa, kidney beans and oats (which she definitely eats a lot of!).

So, at around 8:10 it gets to the part where she is talking about her symptoms. She doesn’t feel cold normally (I assume not hot as well, because this question is important for hyperthyroidism), she feels tired (pretty typical for hypothyroidism normally), is gaining weight (very typical for hypo as well).

So, a bit of a basic explanation of the relationship between metabolism and thyroid hormone. Thyroid hormone is basically the powerhouse of your body! If you have a lot of it, your heart beats faster (you can feel it sometimes), your intestines process food faster, etc. —> so you will lose weight. It works the opposite way for hypothyroidism.

So. We move on, to around 27:20 and she talks about her diagnosis. She says that the lab results are back, and she has HYPOTHYROIDISM, and that they are going to a surgeon to take a biopsy.

She mentions that the doctor warns her of a few symptoms of hypothyroidism - including depression and that’s pretty much a job well done from his perspective! I applaud that doctor for the safety netting, especially so because she agrees with his points.

What I’ll say at this point would be that I personally feel that at this point in time, the most likely diagnosis would be Hashimoto’s Thyroiditis, just listening to her vlog. Because of the hypothyroidism in the blood test, the symptoms and the nature of the neck lump. The biopsy makes sense - Hashimoto’s Thyroiditis is associated with an increased risk of Thyroid cancer, so doctors will just want to make sure it isn’t a cancerous growth.

She then does the operation, and from her later vlogs, she’s definitely feeling better now!

Source: EquityMates.com

Source: EquityMates.com

Hashimoto’s Thyroiditis in Simple Terms

Basically, Hasimoto’s Thyroiditis is an AUTOIMMUNE disease. This means that you basically have your cells attacking your own cells (because it thinks that let’s say in this case, the thyrorid is foreign). Think self-destructing. It is a disease that is more common in women, and there is usually a genetic risk to it (basically, tendency to run in the family).

Another risk would be the low iodine. There’s a little bit of debate as to whether excess or low iodine results in autoimmune thyroiditis, but I’ll just leave this study right here below if you’re interested. The study suggests that it is LOW iodine rather than high that causes such a condition.

https://www.bmj.com/content/352/bmj.i941/rr-2

As I mentioned before, it can be hyperthyroid in the intial phase (but rare to find it in this phase), but will progress to USUALLY become hypothyroid. So you get the hypothyroid symptoms (but you may be without symptoms).

If left untreated, the low levels of thyroid coma can cause a coma (myxedema coma) and other heart complications.

Usually, the treatment would be just to give levothyroxine —> which is basically to replace the reduced thyroid hormone. This makes sure your thyroid hormone levels are in the normal range. I find it quite strange personally that they proceeded for surgery straightaway without even trialing the drug first - because a lot will shrink in size just with levothyroxine, but perhaps a) I’m getting the diagnosis completely wrong or b) There’s some other complication that she might have missed out in the videos like difficulty breathing, something they found in the imaging (or if she was worried about the cosmetic aspect of the lump).

If you’re wondering whether surgery helps, this article talks a little bit about it!

https://www.journalofsurgicalresearch.com/article/S0022-4804(11)00063-1/abstract

Allyna did a partial thyroidectomy (basically not removing both). In the case of removing both, you would require lifelong levothyroxine - to replace thyroid hormone that your body can’t produce anymore - but in partial, you would need to be on this medication about 40% of the time (depending on your hormone levels). I don’t think she mentioned anything about medication, so I’m just going to assume that she didn’t require it. XD

For recommendations on diet after surgery, you want to do a few things. First, avoid things that cause flareups of this autoimmune condition (for MOST people, this is wheat, dairy and to a lesser extent soy). There are a lot of advocates for paleo and vegan diets - but in general, the research suggests that if you have a balanced diet, you should basically be good to go.

Sorry if I ramble on and on. XD Just thought that this would be something a bit interesting to talk about. I would really appreciate any feedback about how I should do these kind of posts going forward! Should I simplify? Should I elaborate? Do leave your thoughts in the comments section below, the feedback would be really appreciated!

DISCLAIMER: I’m just a medical student, this does not replace any advice given to you by your attending doctor. This is just me spending some of my personal time pretty much rambling about this case. Please go seek a medical professional if you have any symptoms or any questions you would like answering!

(Sorry if there are mistakes along the way, I did this just out on a whim at 2am in the morning).