Running on empty

Dr Jenny Goodman solves the mystery of a patient's serious thyroid illness and breast and ovarian cysts

- Dr Jenny Goodman

Olivia, age 36, dragged herself slowly into the consulting room. “I’m running on empty,” she said. She slumped in her chair and described how hard it was to get out of bed in the mornings and get through the ordinary tasks of daily life, much less to motivate herself to do anything beyond them.

Olivia said she’d had to give up an interesting academic job that she loved. “My brain had turned to mush,” she said. “I can’t catch my own thoughts.” She had very little appetite and yet had put on a lot of weight, which she couldn’t shift, partly because she was too exhausted to exercise. She was cold, constipated and puffy—all the classic signs of low thyroid hormone.

In the preceding eight years, she’d had two cysts removed from a breast, a cyst removed from an ovary, and half her thyroid gland removed due to goiter. Goiter is a swelling of the thyroid gland due to deficiency of iodine.

A hundred years ago, this would have been instantly recognized by any doctor. It was called “Derbyshire neck” in the UK because Derbyshire is an inland region very far from the sea, and foods containing iodine grow only in or near the sea. In the days when our food was all exclusively locally grown, people in Derbyshire (and Switzerland, for the same reason) were prone to iodine deficiency and to the resultant swelling of the thyroid.

Olivia had had half her thyroid gland surgically removed without anybody inquiring about her diet or measuring her iodine levels. When I examined the remaining half, I found it was hard and swollen, and she admitted swallowing was painful.