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Back in the ICU, Glick followed the patient closely. Hours passed, then days, and although his blood pressure was better, it was still too low. Why? Glick sent test tube after test tube to the lab, looking for signs of infection, inflammation, autoimmune disorders – anything she could think of. After the man’s near-death experience, Glick knew many of his lab results would be abnormal. His liver was damaged, his kidneys, his heart. His job was to identify which abnormalities resulted from its rapid deterioration and which were the cause.
Aberrant results poured in, but only one surprised the resident. The human thyroid was not making its essential hormone. The thyroid is like the carburetor of an old internal combustion engine. It tells the body when to speed up and when to slow down. Right now, the human body needed to be completely invigorated, but without this hormone, it couldn’t do it. Before giving the man any replacement hormones, Savarimuthu reminded Glick that they need to recheck his cortisol level. They had checked him out when he arrived, and he was elevated – as expected, given the physiological stress he was under. But giving thyroid hormone to someone who is deficient in cortisol is like starting a car with no engine oil. You could ruin the whole machine. Glick therefore sent in a second cortisol level test. This time the level was undetectable. She checked again: undetectable.
The steroid test
Another test revealed the cause: His adrenal glands, where cortisol is made, were not working at all, as was his thyroid gland. She started the man on steroids – an artificial form of cortisol – with thyroid hormones, and consulted the endocrine team. She then went through Westerly’s files, where she saw, buried deep in her file, that she had been given steroids there. Because he had no deficiency when he arrived and they had not mentioned the steroids in their notes, Glick had not administered them at Yale New Haven. She has now turned to the medical literature to understand what could have caused these devastating twin hormonal deficiencies.
It didn’t take long to determine that he must have had autoimmune polyglandular syndrome type 2. In this rare disorder, the immune system suddenly and mistakenly begins to attack parts of the patient’s body – in this case, the thyroid gland and the adrenal glands. Why this happens is not well understood. A few hours after receiving the two replacement hormones, the young man was doing well enough to start gradually reducing the drugs that keep his blood pressure down. A few days later, he was well enough to leave the intensive care unit. Ten days later, he was able to return home.
Once the patient understood what he had and started to feel the benefits of the treatment, he realized that he was sick long before the mint fell badly. He will have to take these hormones for the rest of his life, but he is feeling better than he has been in years. No one can know exactly when their glands were destroyed; that was probably a long time ago. “I’m not a guy who goes to the doctor,” he admitted. He thought he was only getting older: “You know what they say, after 30 years, it’s the descent. ” But not anymore. Not for him, anyway.
Lisa Sanders, MD, is a contributing writer for the magazine. His latest book is “Diagnosis: Solving the Most Baffling Medical Mysteries”. If you have a resolved case to share with Dr. Sanders, email him at [email protected].
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