Patient：Madam Lim, Age48
Date：19 May 2022, First Consultation
Main Issue：Seeking remedy for the issue of Hypothyroidism.
The patient is well manner, greeting me with a smiling face.
Madam Lim: “Hi Dr Liau, I did a blood test last week, the marker showed it was an issue of Hypothyroidism. This week on Tuesday, I went for an endocrine test for Thyroid hormone. Let me show you the result.”
The report shows TSH level is lower than the normal range (Central Hypothyroidism).
T3=4.07 pmol/L (2.63-5.7) [NORMAL]
T4=12.8 pmol/L (9-19) [NORMAL]
TSH=0.17 mIU/L (0.35-4.94) [LOW]
From our first sight, we observe there are swollen lymph nodes in the neck. From the biology checking, there are two lymph nodes in the neck, one of it having a size of 2CM++.
【Symptoms】
I ask: “Usually what are the symptoms you encountered thus far?”
Madam Lim: “I feel palpitation. My arm and my palm have numbness. Occasionally head ache (back of left ear) and heavy head. Feel fatigue and sometimes see things blurred. My neck feels uncomfortable too.” Further inquiry, we confirm that the patient has no trembling hand and no weight loss for recent months.
Base on the description of the symptoms, we decided to perform acupuncture and oral prescription for the patient. Due to the fine tune treatment, we acknowledged the patient that the treatment might take a longer time perhaps few months.
Medical History：Family history of lymphadenopathy (mom, sister)
Tongue Diagnosis: Red with yellow coating on the surface of the tongue. Below the tongue we see tiny blood clots.
Therapy: Acupuncture.
26-5-2022 Second visit Consultation：
The patient has gone to Sunway Medical Hospital for a biology checking. The report showed that the Thyroid Lymphadenopathy, the swollen lymph nodes in the neck is a benign type with a size of 22 x 23mm.
She mentioned that she encountered irregular menstruation with small amount volume of blood.
After the treatment given last week, the palpitation has slightly calm down. Heavy head has mitigated.Both the arm and the palm still feel numbness. Occasionally, she feels acid reflux, so she had little amount for her dinner.
The bowel movement is smooth daily.
Tongue diagnosis: Red with yellow white coating on the surface of the tongue.
Therapy：Acupuncture
2-6-2022, 9-6-2022, 16-6-2022, 24-6-2022 June visits Consultation：
Good appetite and perfect sleep. lmp=10-13/5/2022
The palpitation has alleviated gradually. Occasionally, both the arm and the palm are numbness (mitigated). Left wrist tingling sensation (sometimes appear). Heavy head (improved). She feels the memory getting worse. Left head temple acupuncture point is pain and sometime feels dizziness. For past few years, she has taking detoxification pills 2-3times per week to improve the bowel movement. Temporarily, she stopped the pills because she has taken the Chinese herbs since the visit for treatment. Now she goes for the bowel movement once every two days.
Tongue diagnosis：Red with the yellow white coating turn to white coating on the surface of the tongue.
Theray：Acupuncture
7-7-2022, 21-7-2022 July visits Consultation：
Recently, the palpitation has resumes (during sleeping hours). She feels hardly sleep after wake up in the midnight of 2-3am. Both the arm and the palm are numbness (stopped). Left wrist tingling sensation (sometimes appear). As observed, the swollen lymph nodes on the neck have become softening and lower down a bit.
Good appetite, sleep well. The knee joints sometimes feel pain. The menstruation has not come since last period in May. Sometime, she feels heaty inside the body.
Tongue diagnosis：Red with less white coating on the surface of the tongue. Below the tongue we see tiny blood clots.
Therapy：Acupuncture
4-8-2022, 18-8-2022 August visits Consultation：
For past one week, the palpitation is becoming serious, especially during the sleeping hours. She finds slightly hard to fall asleep. After awaken in the midnight, she finds hard to sleep again. In the morning, she feels the “qi” rising up and blocked at the chest causing uncomfortable feeling. Day time, she sometimes encountered palpitation. She told that she has the black coffee for the breakfast and teatime. We advised her to stop taking coffee at the moment as to reduce the problem of palpitation.
Appetite has improved and she feels hungry easily. She drinks plenty of water even though she has not having thirsty urge. The bowel movement is regular at once per day.
Tongue Diagnosis：Right side of the tongue is red, overall the surface is covered by white coating. Below the tongue we see tiny blood clots.
Therapy：Acupuncture
1-9-2022 September visits Consultation：
Madam Lim went for an endocrine test again after three months to do a follow up.
23/8/2022 endocrine test：
T3 = Not tested
T4 =11.2 pmol/L (9-25)
TSH= 0.958 mIU/L (0.4-4.7)
ECG heart check: Tested and brings normal results.
The result turned great as the TSH fall into normal range now.
TSH= 0.958 mIU/L (0.4-4.7)
Madam Lim feel relieved as it is such a weight off her mind. Suddenly, her palpitation issue during sleeping hours has eliminated. We encourage her to continue the treatment as to confirm the condition of Hypothyroidism really gone off.
The palpitation has alleviated. She is having good appetite and sleep well too. She encountered no digestive issue such as bloated stomach, acid reflux and less farting. Urination is normal. She started to take the detoxification pill to help improve the bowel movement, so she is able to have it once every day compare to 3 months back.
Tongue Diagnosis：The tip of the tongue is red. The surface of the tongue becomes yellow white coating with some uneven distribution on top the surface of the tongue. Below the tongue we see tiny blood clots.
Diagnosis：
On the first visit 19/5/2022, Madam Lim come for the fine tune for Hypothyroidism. As per informed, she has family genetic heredity Thyroid Lymphadenopathy (Mother and elder sister).
There are two lymph nodes in the right side of the neck, one of it after checked confirmed is a benign type with a size of 22 x 23mm.
From the conversation, she told that she feels the effect of palpitation. Her arm and the palm have numbness sensation. Occasionally head ache (back of left ear) and heavy head. She feels fatigue and sometimes sees things blurred. Her neck feels uncomfortable too. Further inquiry, we confirm that the patient has no trembling hand and no weight loss for recent months.
After the endocrine test, it shows the TSH level is lower than the normal range (Central Hypothyroidism).
She has good lifestyle with good appetite and good sound sleep. The bowel movement is not smooth for many years, she intakes the detoxification pills every 2-3 days to improve the bowel movement, about once in a two days.After a close follow up treatment for a continuous 6 weeks, by consuming the oral prescription and acupuncture, the problem of palpitation as well as the numbness of arms and palms has mitigated.
For the continuous 2 months treatment, the patient found that the lymph nodes have become softening and sizes getting smaller.Her bowel movement also improved.
However, in the month of July, the palpitation resume, this time the intensity of quick heart beat is not so serious compare to first visit. She encountered that she wakes up in the midnight 2-3am and hardly to get back to sleep.
Starting early month of August, she finds the palpitation getting worse. She still hardly get back to sleep after wakes up in the midnight. Sometimes, the palpitation happened in the day time. We advised the patient to stop taking black coffee in the morning and teatime. Due to the good appetite, she feels hungry faster. She sweats heavily. In the morning, she feels the “qi” rising up and blocked at the chest causing uncomfortable feeling. The problem might related to the stress. We ask patient to relax the mind and body to improve the situation of her problem. The delays of the menstruation since May, we consider maybe she is at the age of 48 and maybe that was part of the menopause symptom.
Due to worries in mind, she went for an endocrine test again.
The result turned great as the TSH fall into normal range now.
TSH= 0.958 mIU/L (0.4-4.7)
Madam Lim feel relieved as it is such a weight off her mind. Suddenly, her palpitation issue during sleeping hours has eliminated. We encourage her to continue the treatment as to confirm the condition of Hypothyroidism really gone off.
From the study of the case, we learnt that when our mind is simple, many issue resolved. Madam Lim getting to know her TSH marker fall into normal range and since ever her palpitation problem has been resolved and digestive system issue resolved. Mostly the phycology factor takes into considered in this vast improvement. We highly recommend everyone to maintain a calmful mind, in additional goes for regular exercise to promote dopamine hormone to create happiness.
Tips to pay attention in our daily life：
- Ensure to have a regular lifestyle habits. For instance, we cultivate a regular meal habits, sleep early in the night which is before 11pm.
- We should decline to touch electronic gadgets such as mobile phone and pc.
- Do not take cold food or drink which are stored in the fridge directly.
- Avoid drinking caffeine drinks such as coffee or tea.
- Regular exercise to promote the release of dopamine hormone in order for the process of message transfusion of happiness in the nerve system via the brain, to motivate pleasurable reward too.
- Train ourselves to have a regular bowel movement habit.
- Maintain a great relationship with family and friends.
What should a Hypothyroidism patient eat?
1. High protein food
Protein is essential for cell repair. Hypothyroidism patients are encouraged to take eggs, cheese, meat, fish, seafood, bean and bean curd food. They help improve the recovery of hypothyroidism.
2. Iodine-rich food
If the patients have an iodine deficiency, they may eat more iodine-rich foods like seaweed, fish, dairy, and eggs. During cooking, they may consider adding iodized table salt or sauce to the meal, just take note that we do not add iodized table salt while boiling as it will be vaporized. We encourage hypothyroidism patient to take less salty food to avoid the problem of edema.
3. Iron-rich food
For patients who are anaemia, they may eat more iron-rich foods like internal organ of animals, spinach, kelp etc. Sometimes, do take some folic acid as the supplement.
4. Warm and heated food
Hypothyroidism patients mostly are in “Yang” deficiency body type, they bother by the cold wind and like warm, easily feel fatigue. They are likely to eat food that warm up the body for instance: ginger, cinnamon etc.
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