Curious case N51: Of a young woman whose intestine treatment resulted in solving joint and thyroid gland issues

I promised to tell about curious cases and I will try to do so in the simplest way so that both doctors and non-professionals interested in medicine understand what I am talking about. Perhaps, somebody will see themselves in this story... So, the case in point is about several conditions. All of them are still considered idiopathic diseases, i.e. with unknown cause. It all started when I was examining a patient diagnosed with a serious medical issue. Yet, the story is not about him, it is about his wife whom he convinced to do a preventive check-up at our clinic upon my recommendation.

According to the husband, the wife rarely underwent regular check-ups at hospitals as she was disappointed in doctors. She suffered from fatigue, intestinal discomfort and joint pain. Besides, she had extra weight, which she could not lose through physical exercise and diet. Sometimes she could gain 3-4 kg in 3 days while following a strict diet recommended by a professional nutritionist. Prior to her visit to Biokurs clinic, she consulted several rheumatologists, a rehabilitation centre, several psychologists and even a psychiatrist. Each of the doctors was trying to recommend effective treatment and even made her do general tests and rheumatoid sampling. Nevertheless, the patient did not get better and sadly lost her faith in doctors.

We planned to run a maximum number of tests but she insisted that we start with minimum tests and later use her blood stored at our lab to run additional ones. We, of course, started with the general tests. The results were all within norm but for relative lymphocytosis (higher lymphocyte count in blood), decreased level of hemoglobin (90 units) and iron (by 5 units). During the next stage we took rheumatoid samples (ASLO, CRP, RF), urine samples and ran anti-CCP test (rheumatoid arthritis specific test) as well as ANA screen for anti-nuclear antibodies (a test run for many autoimmune diseases). All the results were within norm!

As the patient had low iron and hemoglobin levels, we assigned fibrogastroscopy and colonoscopy. There were no issues with the patient's stomach, Helicobacter pylori (gastroduodenitis-causing bacteria) test was negative, but the intestine tests revealed she had idiopathic enterocolitis (intestinal inflammation with no apparent cause). The patient had consulted several gastroenterologists but all the doctors prescribed identical treatment – take Salofalk (anti-inflammatory medication) over a prolonged time to decrease intestinal inflammation. The patient started taking the medication combined with iron-containing preparations, which relieved the discomfort. However, when we ran her total blood count again there was no improvement of said characteristics.

The patient agreed to undergo comprehensive ultrasound examination at our medical center. As a result, we found a few deviations from norm: increased blood flow in the thyroid gland, which is indirect sign of autoimmune thyroiditis (thyroid inflammation); ultrasonic signs of fibrocystic breast disease and adenomyosis (cervical endometriosis) and a large uterine polyp (which most probably stimulated higher blood loss during menstruation). The patient was referred to inpatient care to have the uterine polyp removed. The procedure was successfully completed by our colleagues from gynecology department. We ran repeat tests three weeks after the surgery – hemoglobin and iron levels were stabilized. Iron levels were even higher than normal, which was quite unexpected! In addition, we ran thyroid hormone tests. The results pointed to thyroid hypofunction and confirmed the previous diagnosis – autoimmune thyroiditis. TSH index (thyroid-stimulating hormone) was 5; anti-TPO antibodies (thyroid peroxidase) was 825. The patient was prescribed thyroxine preparation to improve her thyroid functions. Her condition improved significantly but she was still suffering from joint and back pain!

After she started taking thyroid hormones, we ran a repeat test for thyroid hormones – TSH index dropped to 1.5 points (norm), while anti-TPO index remained at 820. The patient's medical history has record of idiopathic autoimmune uveitis – eye inflammation, for which symptomatic treatment with a large dose of steroid hormone had been prescribed by eye doctors 1.5 years before the patient consulted our clinic. The council of physicians decided to use biochip of arthritis to exclude potential infections, which could cause reactive arthritis and enterocolitis. Results showed that the patient had high concentrations of igM against 4 types of yersinia. Yersinia enterocolitica gets into small and large bowel and can lead to their inflammation. Via an autoimmune mechanism, it can also affect other organs such as joints, eyes, liver, spleen, thyroid gland and sometimes even the reproductive system, namely mammary glands and uterus with annexes. Yersinia, which is an "iron loving" bacteria, can also stimulate iron accumulation in our bodies, which may result in liver hemosiderosis.

The patient was prescribed several courses of anti-bacterial therapy to eliminate the cause of inflammatory changes. After 2 months from the start of anti-bacterial therapy, joint pain disappeared, intestinal work got better and thyroid hormones levels were normal, namely TSH index was 0.3 and anti-TPO index was 35 units (a variant of the norm). As a result, the patient stopped taking L-thyroxine and Salofalk. Iron dropped to 18 units again, which is considered variant of the norm! During control ultrasound, the doctor noticed decreased blood flow in thyroid gland and decreased signs of mastopathy. The patient's condition has been stable for several years and after a year from the treatment our heroine got pregnant and gave birth to a healthy girl!

P.S. This case is interesting for several narrow-field specialists at once. Understanding the cause of a disease can help physicians run more careful diagnostics and, besides symptomatic (at times life-long) treatment, prescribe medication that eliminates the main cause of misbalance. Furthermore, the described medical case shows that autoimmune thyroiditis, idiopathic enterocolitis, idiopathic autoimmune uveitis, development of polyps in endometriosis, mastopathy, reactive idiopathic arthritis, and hemosiderosis of liver can be сaused by a simple bacteria, which can get into our bodies with low-quality food and water!

Yours sincerely, Taras Zhyravetskyy, Chief Doctor of the Biokurs Private Clinic