Biography of a Doctor

Abstract

This is an autobiographical report of my own medical history of intracellular hypothyroidism, offered at the invitation of “Cureus” publishers and in the interest of furthering my colleagues’ knowledge of the syndrome from which I suffered for 40 years.
My intent herein is to assist others in the prevention or alleviation of this condition.
I offer this history without intent to compromise known and accepted methods of management and without intent to profit in any way from its publication.
I describe a 40 year history of steroidopenia and intracellular hypothyroidism (IH), which began at age 40.

The step-by-step evolution of the syndrome is laid out chronologically and the eventual cure is explained with reference to detail via my website.

A few supporting references are provided.

Introduction 

I had an extraordinarily stable, supportive and appreciative family, which provided me self-confidence and self-reliance, and rendered me extremely steady, stress resistant and subjectively tranquil.
However admittedly, I am subject to mild precognitive apprehension (fear?).

Professional history: a chronology of stress

1961: While studying at the University of the West Indies (“UWI”, https://www.uwi.edu/) in Jamaica, I married.

1964: I earned the MB, BS degree from London (England) University and following internship, worked for 18 months as the sole assistant MD at my father’s 164-bed rural, government hospital (pop. 6000), in Jamaica and was then “transferred” to a 65 bed rural hospital, with a population of 4,000, as solo “medical officer”.

July, 1966: I returned to the UWI to prepare for FRCS certification in general surgery, but subsequently elected to specialise in Urology and chose to study in Canada.

1968: Emigrating to Toronto with my wife and 6-month-old, adopted son in December, I did a six-month, family-practice “locum”, prior to beginning a 5-year urology residency in June of 1969.
Our second son was born in 1970 and our daughter, in 1972.
Resident’s pay was level with the poverty line of 1972: I supplemented my earnings with house-calls and the remaining income shortfall was covered by a bank loan.

1974: Newly certified FRCSC (in Urology), I returned to Montego Bay, Jamaica, as urologist for a population of 600,000.

1975: Professionally, all was well; but socioeconomic conditions were difficult and marital harmony was poor.

1976: Montego Bay was stressful, due to marital separation, socio-economic and political factors: I returned to Canada and began a Urology practice in Toronto, serving the inner city, in competition with 27 other urologists.

1979: I bought a “duplex” in downtown Toronto and renovated it myself.

1980: My legs lost all hair and I developed patellar tendinitis.

1981: The tendinitis continued, with the beginnings of patellar exostoses. I gained weight slowly and had severe constipation for the first time, with intermittent bouts of IBS: colonoscopy was negative.
I sold the “duplex” in a real estate boom, used the profit to purchase two smaller units, was caught in the subsequent real estate crash/interest rate crunch and eventually had to accept a net loss.

1982: Constant, severe hives began: complete laboratory testing was normal (HSCRP was not done).
The patellar exostoses became larger and more painful and the origins of the hamstrings at the ischial tuberosities developed tendinitis, sufficient to render a long motor vehicle journey intolerable.
Radiological investigation yielded a diagnosis of disseminated idiopathic skeletal hyperostosis (DISH) [1].

1983: My urology practice was moderately successful. I divorced from my first wife and remarried, producing a son in 1984 and another in 1986. Heberden’s nodes [2] and flexor tendon nodules [3] developed in both hands.
Hypercholesterolemia was discovered and treated with Baycol (subsequently Pravachol, then Crestor).

1994: Patellar and Ischial pain, plus hyperalgesia of subcutaneous bone (patellae, elbows, knuckles, etc.) continued.
My professional practice was busy, but I developed prostate cancer: I consulted with Dr. Patrick Walsh and had a radical prostatectomy [4] in Baltimore in December. Subsequently, I was unable to work for 3 months.

1995: My urology practice was adversely affected and the Ontario health insurance program refused to reimburse the costs of the prostatectomy.

1996: The cumulative costs of my divorce, a new family with two children, prostatectomy in Baltimore, practice loss following the surgery, Canada’s predatory fee-for-service system and its punitive income tax law resulted in bankruptcy.

1997: Ontario’s premier, Michael Harris, closed all three of my hospitals: I was “fired”, with no recourse.
I accepted a position as chief of Urology at the “North Western Armed Forces Hospital” in Tabuk, Saudi Arabia.

1998: My professional duties in Saudi Arabia were enjoyable and trouble-free, but social conditions were stressful. I did not feel “stressed” subjectively, but the constipation / IBS continued and fibromyalgia aches began.

2000: Returning from Saudi Arabia, I discontinued Urology and joined a family practice clinic.

2001: Weighing 193 pounds, I developed type -ll pre-diabetes, which responded to weight loss of 20 pounds.

2003: My novel, “XCRATH!”, written in Saudi Arabia, was printed via Amazon.com.

2004: The family practice went well (XCRATH! didn’t), but the IBS and fibromyalgia continued.

2006: Early in June, two new symptoms began:
(1) Anxiety and reduced perception of traffic flow during my daily highway commute and
(2) Cardiac dysrhythmia, due to multiple, benign extrasystoles.
At about the same time, I developed an interest in bioidentical hormones: I began to prescribe DHEA for my patients and to experiment by taking it myself [5].
Within a few days of starting on DHEA, both symptoms subsided: I was calm and “in control” on the highway and the dysrhythmia stopped.
After three weeks, there was an improvement in both the fibromyalgic pain and the tendinitis.
I elected to continue taking DHEA.

2008: The exostoses, palmar tendon nodules and Heberden’s nodes regressed slowly, but the IBS continued.

2013: I began a “BIHRT” study course with the American Academy of Anti-Aging Medicine (A4M) and self-diagnosed exceptionally severe Intracellular Hypothyroidism (IH):
My reverse T3 (rT3) was 34 Ng/DL and my T3/rT3 was < 7.0.  
Note (1): Nominally, “normal” rT3 is <25, but clinically, optimal rT3 is <14 [5]
Note (2): T3/rT3 should exceed 20 and optimally, should be more than 24.

For the IH, I experimented briefly with Desiccated Thyroid (DT): it made no subjective difference and caused an increase of my reverse T3 from 34 Ng/DL, to 54 Ng/DL.

2014: While playing doubles squash, the same three front teeth were broken by a squash racquet, resulting in a series of very expensive dental surgeries.

2015: I stopped playing squash due to rupture of the short head of the right biceps while playing. I again tried desiccated thyroid, this time with moderate success, in that my free T3 rose from 3.7, to 4.8.

2016: The A4M certified me in antiaging and metabolic medicine and granted me the “ABAARM” degree; but my IBS exacerbated. Colonoscopies showed multiple diverticula and mild colitis.

2017: IBS symptoms continued. I relocated to a rural area, began practising BIHRT as a specialty and treated my IH with Triiodothyronine (Cytomel) while continuing to take DHEA and progesterone.
In April I developed classical Polymyalgia Rheumatica.
Prednisone “cured” the polymyalgia instantly, but the IBS symptoms (6 stools daily, with urgency) worsened.
HSCRP was 134 (N = < 1.0), indicating very high IL-6 production and a CAT scan showed a diverticular abscess.
Antibiotic therapy, continued through October, was unsuccessful.
Sigmoidectomy was proposed, but delayed due to hospital bed shortage.

2018: Within a week following sigmoidectomy in February, my HS CRP normalized, the IBS symptoms disappeared, the hives went away and the fibromyalgia pain stopped (all this, after 39 years!).

2020: I had Covid in February/March, with classical “Covid toes” and in June a symmetrically identical, extremely itchy neurodermatitis began.
In July, I began to experience moderately severe shortness of breath, with tachycardia.

2021: The neurodermatitis and exertional dyspnea persisted.
I retired in July, at age 82.

2022: In February, my exertional dyspnea improved.
In June, complete cardiorespiratory evaluation, including spirometry, stress test with Persantine, echocardiography and CT of chest with contrast was entirely within normal limits.
By my 83rd birthday on 3 May, I was breathing normally.

Retrospective analysis

Although I was not consciously aware of stress between age 20 and age 75, I was subject to subconsciously perceived stress, resulting from the following list of stressors:

• Medical school, with marriage as a student at age 23,
• Managing a remote, 60 bed, Jamaican hospital (population 4,000, solo, with no local specialists,
• Moving to Canada for a 5-year residency in Urology with children and an unemployed wife,
• Two years in Montego Bay, Jamaica, as the only urologist for 600,000 people,
• Relocating, after marital separation, to a solo Urology practice in Toronto, under adverse conditions.
• Net real estate losses in 1982.
• Prostate cancer in 1994.
• Bankruptcy in 1996.
• Total loss of professional income due to hospital closures in 1997.
• Chief of Urology in Tabuk, Saudi Arabia, from 1997 to 2000.
• Fibromyalgia and diverticulitis, from 1998 to 2017.
• Sigmoid diverticular abscess, 2017.

Unrecognized chronic stress culminated in intracellular hypothyroidism (IH), by 1979.
The IH produced, over time, a cascade of conditions which culminated in diverticulitis and fibromyalgia.
IL-6, from the diverticulitis, caused polymyalgia rheumatica, successfully treated with prednisone.
The prednisone facilitated development of a diverticular abscess, which failed to heal with antibiotics.

Eventual cure
– NeuroHormone support (DHEA, progesterone) starting in 2006,
– Correction of Intracellular Hypothyroidism: minimal success with desiccated thyroid starting in 2014, moderate success with Triiodothyronine (Cytomel) in 2015 and complete control with slow-release, compounded triiodothyronine, since 2017.
– Sigmoidectomy in 2018, for a potentially lethal, pelvic abscess which was the end result of the “cascade”.

Covid 19 in 2020 resulted in minor “long Covid” symptoms *; but cardiorespiratory evaluation proved completely normal and my health is now excellent.

Summary:

Chronic stress caused Intracellular Hypothyroidism, which became overt in 1979, with leg-hair loss, tendinitis with slowly progressive DISH, constipation, diverticulosis and weight gain.
Stress from prostate cancer, urology practice “downturn”, bankruptcy, being “fired” by Ontario’s premier, (Michael Harris) and relocating to Saudi Arabia in 1997, caused subconscious PTSD.
The PTSD exacerbated the IH, which, combined with increased muscle inflammation due to chronically elevated IL-6, presented as fibromyalgia in 1998 [5-7].

By 2001 further weight gain, due to continuing Intracellular Hypothyroidism, resulted in early type II diabetes, which resolved with a reduced diet and weight loss.

In 2006 DHEA eliminated my anxiety, reduced the fibromyalgia slightly and corrected dysrhythmia.

Stress from “semi-retirement” in 2014 up-regulated the IH and with it, constipation/IBS/diverticulitis. Desiccated thyroid improved my “thyroid profile”, but not my symptoms.

Through 2016, chronic diverticulitis led to an early diverticular abscess, damaging the bowel mucosa, which maintained high IL-6 production to heal itself.

In 2017, Massive elevation of IL-6 from an infected diverticulum led to polymyalgia rheumatica (PMR).

Prednisone, prescribed for polymyalgia rheumatica, downregulated glucose management, reinstating my prediabetes, which in turn, facilitated exacerbation of a sigmoid abscess.

In 2018, Sigmoidectomy resulted in complete cure of the IBS, hives and fibromyalgia.
50 µg of slow-release, Compounded triiodothyronine eliminated the intracellular hypothyroidism completely; but occasionally, mild hyperthyroid symptoms ensued. I am now taking 40 µg.

Comments

• The Heberden’s nodes and flexor tendon nodules were incidental, caused by age-related DHEA deficiency. They had nothing to do with IL6, Intracellular Hypothyroidism or Diabetes.
• The prostate cancer may have been facilitated by DHEA deficiency.
• IL-6, a cytokine, heals damaged bowel but produces inflammation elsewhere, especially in muscles.
• Polymyalgia rheumatica (PMR) is produced by IL-6 [8]. I cannot categorically say the same for fibromyalgia, but I suspect that in my case, it was.
• IL-6 interestingly, is elevated by anxiety, which may have played a part in my fibromyalgia and PMR [9].
• Glucocorticoids (for example, prednisone) block IL-6 instantly and completely, eradicating muscle pain, at the cost of compromised glucose management and failure of the bowel to heal.
• “Intracellular Hypothyroidism” is a condition in which intracellular Triiodothyronine production is hobbled, by Deiodinase 1 blockade and Deiodinase 3 promotion. It can coexist with true hypothyroidism [9].  
• “Perceived stress” is subconsciously registered stress, which produces a stress response even though the individual is subjectively stress-free.
  “Subjective stress”, consciously noted and “felt”, can be described by the individual.
  “Objective stress” is stress as observed by others.
• Regardless of its origin, stress results in increased cortisol production: cortisol suppresses DHEA and actively eliminates intracellular production of T3 from T4 [10, 11].

Current status

2023: Since the surgery in February of 2018 I have been well, apart from the long-Covid symptoms, now gone.
Now aged 83 and retired since July 2021, I am very well.
Detailed cardiopulmonary investigation in 2022 was normal, perhaps due to taking DHEA, Progesterone and T3.
Heberden’s nodes and palmar, flexor tendon nodules responded to DHEA supplementation and resolved.
The DISH continues to subside and my spinal flexibility has improved with the aid of exercise and yoga.
My cognition is subjectively normal and my short-term memory is excellent.
I am not as strong as I was at age 60, but I exercise with 15 pound weights and do yoga, twice-weekly. I have no sarcopenia and my BMI is 26.1.
I walk the golf course in summertime and play pickle ball regularly, during winter, usually in two-hour sessions.
My skin quality is commensurate with age 65: I have few wrinkles.
My early cataracts have not progressed. My visual acuity and colour vision have improved, on compounded T3: I do not need eyeglasses.
My cholesterol profile has been normal since I started taking DHEA in 2006 (statins discontinued, 2015).
The Heberden’s nodes have not recurred.
The patellar exostoses are smaller by 50% and I can kneel without pain.
I continue on Triiodothyronine, 40 µg at 4 AM, DHEA, 50 mg at 8 AM,  Progesterone 100 mg at bedtime, with Melatonin, 10 mg and Magnesium Threonate.
I also take Omega 3, DHA, NAC 900mg, MTHF 1mg, Vitamin C 2 g, Vitamin D3 5,000 iu and a multivitamin.

Gervais A. Harry, MB, BS, LMCC, FRCSC, ABAARM [retired].
17^th April, 2023.

References

[1] New developments in our understanding of DISH (diffuse idiopathic skeletal hyperostosis), by
Sarzi-Puttini, Piercarlo; Atzeni, Fabiola,
Current Opinion in Rheumatology: May 2004 – Volume 16 – Issue 3 – p 287-292PMID: 15103260
https://pubmed.ncbi.nlm.nih.gov/15103260/
DOI: 10.1097/00002281-200405000-00021

[2] Generalized osteoarthritis and heberden’s nodes,
by J. H. Kellgren and R. Moore, Br Med J. 1952 Jan 26; 1(4751): 181-187,
PMCID: PMC2022370, PMID: 14896078
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2022370/
DOI: 10.1136/bmj.1.4751.181

[3] Diagnosis and treatment of swellings in the hand, by Saiidy Hasham and Frank D Burke,
Postgrad Med J. 2007 May; 83(979): 296-300. PMCID: PMC2600075 ,
PMID: 17488856
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600075/
DOI: 10.1136/pgmj.2005.043992

[4] Radical prostatectomy with preservation of sexual function: Anatomical and pathological considerations, by Dr Patrick C. Walsh, Herbert Lepor, Joseph C. Eggleston, First published: 1983,
Citations: 783. https://onlinelibrary.wiley.com/doi/abs/10.1002/pros.2990040506
https://doi.org/10.1002/pros.2990040506

[5] Is fibromyalgia associated with a unique cytokine profile? A systematic review and meta-analysis,
by Luke Furtado O’Mahony 1 , Arnav Srivastava 1 , Puja Mehta 2 , Coziana Ciurtin 3,
Rheumatology (Oxford), 2021 Jun 18;60(6):2602-2614, doi: 10.1093/rheumatology/keab146, PMID: 33576773, PMCID: PMC8213433,
https://pubmed.ncbi.nlm.nih.gov/33576773/
DOI: 10.1093/rheumatology/keab146

[6] IL-8 and IL-6 primarily mediate the inflammatory response in fibromyalgia patients,
by Danelia Mendieta, Dora Luz De la Cruz-Aguilera, Maria Isabel Barrera-Villalpando, Enrique Becerril-Villanueva, Rodrigo Arreola et al. J.Neuroimmunol, 2016 Jan 15;290:22-5, Epub 2015 Nov 26. PMID: 26711564 DOI: 10.1016/j.jneuroim.2015.11.011
https://pubmed.ncbi.nlm.nih.gov/26711564/
DOI: 10.1016/j.jneuroim.2015.11.011.

[7] Fibromyalgia and cytokines,
by Ignasi Rodriguez-Pintóab, NancyAgmon, Levinac Amital, and Howarda Yehuda Shoenfeld, in Immunology Letters, Volume 161, Issue 2, October 2014, Pages 200-203
https://www.sciencedirect.com/science/article/abs/pii/S0165247814000133
https://doi.org/10.1016/j.imlet.2014.01.009

[8] Correlation of interleukin-6 production and disease activity in polymyalgia rheumatica and giant cell arteritis,
by N E Roche 1 , J W Fulbright, A D Wagner, G G Hunder, J J Goronzy, C M Weyand, Arthritis Rheum, 1993 Sep, 36 (9): 1286-94. doi: 10.1002/art.1780360913. 1993 Sep;36(9):1286-94. PMID: 8216422,
https://scholar.google.ca/scholar?hl=en&as_sdt=0%2C5&as_vis=1&q=Correlation+of+interleukin-6+production+and+disease+activity+in+polymyalgia+rheumatica+and+giant+cell+arteritis&btnG=
DOI: 10.1002/art.1780360913

[9] Clinical anxiety, cortisol and interleukin-6: Evidence for specificity in emotion-biology relationships, by Aoife O’Donovan, Brian M.Hughes, George M.Slavich, Lydia Lynch, Marie-Therese Cronine, Cliona O’Farrelly, Kevin M.Malone, in Brain, Behavior, and Immunity, Volume 24, Issue 7, October 2010, Pages 1074-1077 https://doi.org/10.1016/j.bbi.2010.03.003
https://www.sciencedirect.com/science/article/abs/pii/S0889159110000565

[10] “T3 and Intracellular Hypothyroidism”, by G.A. Harry, https://cbhrt.ca/intracellular-hypothyroidism/

[11] “Stress causes Hypothyroidism”, by G. A. Harry, https://cbhrt.ca/2022/12/14/stress-causes-hypothyroidism/