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From the information gathered from the history, ROS, PE, we suspect the iodine administration is implicated with the hypoinsulinemia. We are also considering further testing for kryptopyrroluria. Kryptopyrroluria involves the overproduction of hydroxyhempyrolin, a protein in the heme biosynthetic pathway.7 Stress is one of the main triggers for this, but the cause can be genetic.7 Loss of function of the enzyme aminolevulinate synthase is linked with excessive production of pyrroles and, also, x-linked sideroblastic anemia.7 Some of the symptoms of pyrrole disorder include hypoglycemia, low alkaline phosphastase, fatigue, dizziness, and memory impairment. The patient has all these symptoms. The test for pyrrole disorder involves testing for kryptopyrroles via a urine test. Testing for this involves an at-home urine test; information for the patient to purchase this testing kit has been provided. The link between increased hydroxyhempyrolin production and thyroid dysfunction requires further investigation.
Sufficient thyroid production requires the following compounds: B6, selenium, zinc, vitamin C, B2, magnesium, iodine, among other compounds.9,11 If the patient does indeed have kryptopyrroluria, it would be sequestering his body of B6 and zinc.8 This would make him nutrient deficient in the co-factors necessary for thyroid hormone production. Future plans involve checking his body for current levels of vitamins and minerals. Depending on the patient's vitamin and mineral levels, we will recommend supplementation and/or IV vitamin and mineral therapy to make sure the patient is getting adequate nutrition.
Environmental toxicity is also a concern for exacerbating or causing thyroid dysfunction.10 In order to assess the patient's toxin load, a future plan will involve running an environmental toxicity panel. If there is a toxin burden, we will suggest a detoxification protocol which consists of sauna, detoxification nutritional support and, if necessary, heavy metal chelation. More research is needed to elucidate the effect of heavy metal chelation on circulating iodine levels. There exists a link between excess iron burden and kryptopyrroluria.13 This is due to iron's ability to displace zinc from its binding sites.13
We are limited because iodine testing in humans is unreliable at this time. The current literature mentions that Wolf-Chaikoff-induced hypothyroidism lasts roughly 3-4 weeks,3 and iodine-induced hyperthyroidism can last between 1-18 months.4 The standard for patients in iodine excess is to treat the symptomology. The patient's severity of symptoms will be assessed next visit. Beta-adrenergic antagonists, such as atenolol, will be considered if he is still experiencing the heart palpitations. A link between excess iodine consumption and low insulin status remains to be elucidated. The finding of hypoinsulinemia seems to be an incidental finding.
While an argument can be made regarding whether or not the RDA for iodine is sufficient for the average, healthy, adult human being, supplemental iodine administration should be used with caution as it can exacerbate pre-existing health conditions. Iodine dosing should be recommended under the guidance of a physician trained to rule out previously existing thyroid-related pathologies.
Testing for the etiology of thyroid pathologies is a complex process that involves ruling out food allergies, toxic exposures, nutritional deficiencies, as well as other pre-existing medical conditions, such as autoimmune diseases. This case report discusses a patient who is displaying symptoms of having thyroid dysfunction after iodine administration. Thorough investigation revealed he was affected by hypoinsulinemia. Treatment of a patient in this situation requires an endocrinologist as well as nutritional counseling for optimal thyroid functioning.
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Gregory Nacarelli is a fourth-year naturopathic medical student at Bastyr University California. Before attending Bastyr University, he was a research scientist at Merck & Co. He possesses a master's degree in molecular biology from Lehigh University and a bachelor's degree in biology from Cabrini University. His interests include genetics, nutrition, and botanical medicine.
Baljit Khamba, ND, MPH, is a clinic supervisor at Bastyr University Clinic and a core faculty member at Bastyr University, California. She treats a variety of conditions but has special interest in nutritional approaches to mental health, particularly anxiety, stress, depression, ADHD, memory, and cognition.
Dr. Khamba completed her honor's Bachelor of Science at York University, Toronto, Canada, specializing in psychology, as well as her Master in Public Health from Lakehead University. Her interest in mental health guided her graduate thesis on nutritional influences of mood disorders. She received her naturopathic doctoral degree from the Canadian College of Naturopathic Medicine (CCNM).
Upon graduating, Dr. Khamba worked in integrative psychiatric clinics and was actively involved with research projects at the University of Alberta reporting on adverse effects from natural health products used alongside psychiatric medication.
Dr. Khamba is a licensed naturopathic doctor in California and accepts patients at Bastyr University Clinic alongside student interns.