What have I done? I think to myself, laughing and shaking my head.
The patient was a 64 year old farmer, a tough old bird, whom I first saw months ago when he was admitted for atrial fibrillation with rapid ventricular response. He was also found to be thyrotoxic, with impressive levels of free T4 and T3, no doubt a key player in causing his a-fib.
But true to his farmer personality, he didn't think he was symptomatic. He didn't feel the irregular pulse or palpitations (not uncommon). He did proudly report an 80 lb (36 kg) weight loss. I blamed that on his thyroid. He disagreed; he claimed to have intentionally lost this via a strict diet and exercise (as he told me that, his dear old wife looked at me with a half-giggle and shook her head).
A thyroid uptake and bloodwork suggested Grave's disease. I nuked his thyroid with an ablative dose of radioactive 131-I. When I last saw him, his blood tests suggested he was starting to become hypothyroid, and so I initiated thyroid replacement therapy.
Fast forward to this week; I see him again after 4 months. The difference was visible from across the room. He had ballooned up. No other word for it, he was now fat. 25 kgs in 3 months. And he was euthyroid. He feels a ton better; his energy and sleep and general well-being are improved. And he sheepishly admitted, maybe I was right, he didn't lose all that weight himself; maybe it was the overactive thyroid.
He asked me what he could do to keep the weight down. I told him to do it like everyone else; diet and exercise.
But I ask myself in jest, what have I done? I've created a monster. Heh.