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Dr. David Derry Answers Reader Questions
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Index of Q&As with Dr. David Derry



Topic: Urticaria (Hives) and Thyroid Problems



A Reader Writes:

Have you ever seen a patient suffering from acute urticaria (hives) and acute angioedema (swelling) that did not respond to treatment (by antihistamine and by steroid), lasted in excess of one year, and no physician was able to diagnose thyroid disease until ten years elapsed and a second bout occurred more intense than the first? Is this a common problem among those suffering from Hashimoto's disease?

David Derry Responds:

Dear Patient

Acute giant urticarial reactions (hives) with angioedema are not a common problem. However I have had in the practice about half a dozen all of whom responded completely to treatment with thyroid. After I had success with a couple of patients, I started to search the literature for any other physicians who had found this. Only in the early part of the last century could I find anyone discussing the topic of Giant urticaria. (1)

I remember two of these cases quite well. One was of a lady of 60 who developed the "giant hives" so badly that she was admitted to hospital. As I was the doctor on call that day and she did not have a family physician she ended up being my patient. I waited until she was discharged from hospital by the specialists and I could discuss this approach in my office. She was desperate and was willing to try anything. She was first started on 180 mg of desiccated thyroid for about 6 weeks and got a partial improvement in her symptoms. When I put her up to 250 mg all of the hives disappeared. They never returned over the following 8 years while she was on the thyroid.

The second was a man in his early 50s who had a some other symptoms as well. He was in good shape and played soccer every week. However at visits to friends houses he often would fall asleep. He also sometimes fell asleep while eating at the table.. At the same time he kept having huge swellings in different places. The most conspicuous were his lips. It did not occur in the same place every time. I witnessed these a couple of times and they were truly alarming swellings. He was sent to all types of specialists all of whom confirmed his diagnosis of acute giant urticaria with angioedema.

At one point he was seen by and Ear Nose and Throat specialist who did a Cat scan of his upper body and found a large swelling at the back of his throat near his tonsils and adenoids. The ENT specialist felt this was a cancer (lymphoma) and admitted him to hospital for a biopsy. However, when he got to surgery, there was nothing there. The hive at the back of his throat had disappeared. Finally I suggested we try some thyroid to which he agreed. Again this patient was desperate to solve his problem. He didn't think that his falling asleep and the swelling of his lips were related. He was started on 250 mg of desiccated thyroid and within about a week he started to improve. By the end of two months his hives completely stopped. His falling asleep problem also disappeared.

It is interesting that you were given prednisone and antihistamines which I also found do not work. Prednisone is far more dangerous and has far more side effects than thyroid medication. So it does not make sense not to try thyroid in adequate does for such an awful problem. It is not well know that thyroid is safer than aspirin by far. Both aspirin and desiccated thyroid were discovered in the 1800s. So during the first 70 years of their use in medicine hundreds of children died every year from overdoses of aspirin. This was only finally stopped when pharmacies started putting child-proof caps on the bottles. During that same time children also overdosed with thyroid. There are no reported deaths from any of the acute overdoses of thyroid hormone. Only 4% of the thyroid overdoses are even admitted to hospital. (2)

My overall conclusions from this is that giant urticaria with angioedema is a individual low thyroid problem, which is easily treated. As you can see if the patient is questioned carefully symptoms of low thyroid can be found as well. This is one of the problems with low thyroid conditions is each person can show the effects of low thyroid in their own personal manner.

One patient has mentioned that she did will with the giant hives with accupuncture. I think this could be quite helpful. But if the true nature of the problem is hypothyroidism then the other symptoms will likely not be fixed (like falling asleep at the dinner table) unless thyroid is also given. Also the Giant Urticaria indicates there is low thyroid condition and likely other symptoms and problems will start to come up if only accupuncture is used. Nevertheless that is an interesting and apparently effective approach for some people.

I should mention that people who have unexplained recurrent hives also respond to thyroid treatment. The two types of swellings likely are both related to low thyroid condition.

Hope that helps with your understanding one of many types of peculiar individual reactions to low thyroid.

David

1. Roussel.J.N. Chronic urticaria, thyroadrenal syndrome; how to determine direction of dysfunction, and what type of agents to employ in its treatment. South M J 22:668-672, 1929.

2. Cohen,J.H. 3rd, Ingbar,S.H. Braverman.L.E.. Thyrotoxicosis due to ingestion of excess thyroid hormone. Endocr.Rev. 10:113-124, 1989.



About Dr. Derry:

Dr. Derry is no longer in practice.

These answers are personal opinions. Please discuss any ideas you get with your physician.

Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.

My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”

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