Wellwood Christopher, Rardin Sean
is the owner and operator of private practices Natural Health Center in Medical Lake, Washington State; and North Idaho Pain Clinic, PLLC, in Post Falls, Idaho. is a consulting faculty member at National University of Health Sciences in Lombard, Illinois, and is in private practice at Riverwalk Family Practice in Naperville, Illinois.
Integr Med (Encinitas). 2014 Jun;13(3):41-7.
One of the many challenges for any physician is determining the correct course of treatment for patients with more than 1 area of complaint. Should the physician treat the symptoms or the underlying cause of a condition? If treating the cause, what and who determines the cause? Further complicating the issue, doctors must succeed in getting patients to follow the prescribed treatment, which has always been and will continue to be an issue in reaching therapeutic goals. In late 2009, a 49-year-old Caucasian woman visited the Natural Health Center of Medical Lake (NHCML) in Medical Lake, WA, complaining of multiple symptoms. One symptom was a goiter that had not been relieved with a prescription for 0.375 mg of Synthroid daily. Her comorbidities included mixed hyperlipidemia; multiple joint pains; alopecia; fatigue; bilateral, lower-extremity edema; and severe gastric disruption with bloating and acid reflux. After initial success from treatment, with a complete reduction of her presenting goiter and most of her other symptoms, the patient withdrew herself from her prescription medication and her nutritional supplementation. After 4 wk, the patient visited NHCML with indications of severe hypothyroidism, including a severely enlarged goiter of the right wing. After 6 wk of treatment with iodine and a glandular nutritional supplement (GTA Forte), her symptoms of severe hypothyroidism abated. Subsequent treatment for adrenal insufficiency, which was diagnosed at NHCML using salivary adrenal stress-index testing for cortisol rhythm and load, allowed complete resolution of her presenting complaints. This result persisted even at the 3-y follow-up to a greater degree than did the results from the use of thyroid nutritional supplementation and Synthroid, both alone and combined. The hypothalamus-pituitary-adrenal (HPA) axis may contribute to the existence of thyroid-type symptoms, particularly for those individuals with subclinical thyroid conditions. The treatment of the feedback mechanisms for the HPA axis may provide a valuable framework for treatment of mixed hyperlipidemia because normalizing or improving thyroid stimulating hormone (TSH) levels can reduce serum cholesterol levels.
对于任何医生来说,众多挑战之一是为有多个主诉部位的患者确定正确的治疗方案。医生应该治疗症状还是疾病的根本原因?如果治疗病因,是什么以及由谁来确定病因?使问题更加复杂的是,医生必须成功让患者遵循规定的治疗方案,而这一直是并将继续是实现治疗目标过程中的一个问题。2009年末,一名49岁的白人女性前往华盛顿州医疗湖的自然健康中心(NHCML)就诊,主诉有多种症状。其中一个症状是甲状腺肿,每天服用0.375毫克左旋甲状腺素的处方并未使其缓解。她的合并症包括混合性高脂血症、多处关节疼痛、脱发、疲劳、双侧下肢水肿以及严重的胃部不适伴腹胀和胃酸反流。在治疗初期取得成功,她出现的甲状腺肿和大部分其他症状完全减轻后,患者停止服用处方药和营养补充剂。4周后,患者因严重甲状腺功能减退的迹象再次就诊于NHCML,包括右翼甲状腺肿严重肿大。在用碘和一种腺体营养补充剂(GTA Forte)治疗6周后,她严重甲状腺功能减退的症状减轻。随后针对肾上腺功能不全进行的治疗(该病症在NHCML通过唾液肾上腺应激指数检测皮质醇节律和负荷得以诊断)使她目前的主诉完全得到解决。即使在3年的随访中,这一结果仍比单独或联合使用甲状腺营养补充剂和左旋甲状腺素的效果更为显著。下丘脑 - 垂体 - 肾上腺(HPA)轴可能导致甲状腺类型症状的出现,特别是对于那些患有亚临床甲状腺疾病的个体。对HPA轴反馈机制的治疗可能为混合性高脂血症的治疗提供一个有价值的框架,因为使促甲状腺激素(TSH)水平正常化或改善TSH水平可以降低血清胆固醇水平。