“What does that mean?” asks Mary, a 23 year old female with long standing history of intravenous drug and alcohol abuse. “How did this happen?” she asks. Mary was just informed she has hyperthyroidism (an overactive thyroid disease). Every day here at Whole Health people are diagnosed with conditions they don’t fully understand.
When incorporating integrative medicine with addiction medicine, we are able to discover many conditions upon physical examination and routine blood work that can exhibit an extensive array of signs and symptoms if left untreated. Such disorders include thyroid dysfunction, vitamin deficiencies, sexually transmitted infections (STIs), anemia, and many more. The symptoms from these underlying medical issues can, and often do, contribute to our patients relapsing on their drugs of choice as they struggle to feel “normal” in the face of always feeling terrible!
As one specific example, many studies have shown opiate use can cause changes in thyroid-binding globulin (TBG: a circulating protein produced in the liver). High TBG levels can cause elevated TSH which is indicative of hypothyroidism (underactive thyroid), liver disease, and can be seen in pregnancy. On the other hand, low TBG levels can lead to elevated Free T4 and Free T3 which is indicative of hyperthyroidism.
In Mary’s situation, routine labs were checked within 1 month of her last use that showed mildly elevated Free T4 and a low thyroid stimulating hormone (TSH). At this point we recommend re-checking thyroid function in one month for follow up and re-assess. Upon doing so, we have found that Mary’s Free T4 continued to be elevated and TSH was low. An ultrasound of Mary’s thyroid was performed in our office which showed multiple thyroid nodule. Mary was then sent for a thyroid uptake scan to further clarify her clinical state and to evaluate for the likelihood of thyroid cancer. Luckily for Mary, her thyroid scan was not concerning.
After thorough evaluation and discussion with Mary, it was discovered that her biological mother also had hyperthyroidism, specifically Graves’ disease, which tends to run in families and is more common in women than men. Mary had been experiencing symptoms for a while but was never aware that her symptoms could be from something other than withdrawal symptoms.
Mary realized her recent weight loss, racing heart, palpitations, nervousness, difficulty sleeping, frequent bowel movements, and no period for the past 6 months were all contributing to her new diagnosis of hyperthyroidism. In retrospect, she realized that she had felt so poorly for so long, and wondered if she started and continued using drugs because she felt so terrible. Now Mary can be treated appropriately and her symptoms should resolve accordingly, hopefully contributing to her ability to stay clean and sober.
Also, when people use drugs and/or alcohol, many times they do so in a binge fashion. It is very common in this time period for a person to eat unhealthily, if they eat at all. With this poor nutrition comes vitamin deficiencies such as B1 (Thiamine), B12, folic acid, iron and these can lead to anemias (a low amount of red blood cells in the body). It is also common for an individual to be dehydrated due to lack of fluid intake or while experiencing withdrawal symptoms such as diarrhea, vomiting, sweating. With this comes electrolyte changes; decreased or increased sodium levels and decreased potassium levels. Consequently these electrolyte changes can cause muscle weakness, muscle spasms and cramps, confusion, lethargy, and even seizures.
The aforementioned are just a few examples of how general medical problems intertwine with our patients’ addiction issues. At Whole Health we focus on “Integrative medicine”, or the combination of physical medical diagnosis and treatment alongside effective psychiatric care. This combination of body and mind medicine offers our patients, whether living in our community or staying at a local treatment center, a true holistic approach to healing and gives them every chance to succeed!
Deanna Weilbacher, PA-C