doctor with patient

A Case Study in Autoimmune Disease – Part 1 – Evaluation

January 20, 2021

In June 2020, Molly, a pleasant 35-year-old woman, presented to me for an evaluation of a hypothyroid condition. Molly’s symptoms included fatigue, lack of focus, unstable mood, digestion issues, and skin and hair problems. On top of these symptoms, she had a nagging hip injury that prevented her from exercising, her main form of stress relief. She loved life and spending time with her family and husband but had pulled back from social activities and confided in me that her libido had also significantly suffered as a result of her health challenges. She wanted to get healthy enough to have a baby and be the best wife she could be for her loving husband.

When Molly was 20 years old and in her second year of college, her life started to spin out of control. She had great difficulty managing the stress of her heavy workload and as a result, turned to binge eating and excessive exercise. She began to develop social anxiety and felt depleted and exhausted all the time. Molly also noticed significant short- term memory issues and would walk into rooms and forget why she was there. Molly admitted that she just didn’t feel as mentally sharp as she used to.

Her primary care physician ordered blood work and found an elevated thyroid stimulating hormone and prescribed Armour Thyroid. She responded decently at first, but her symptoms continued to fluctuate especially around menstruation. During her case review with me, her husband indicated he thought she might be suffering from seasonal affective disorder, or SAD, because her symptoms would worsen during the shortest days of the year. She admitted to needing naps to function and that she had terrible bloating after meals. After further questioning around her bowel movements, she admitted to chronic constipation and that it could fluctuate “all over the place and it’s really confusing what’s causing what!”

Exam findings:

I performed a comprehensive neurologic and metabolic exam and observed some important findings: 1. Fungal nail growth 2. Decreased vibration sensation from her shoulder to large thumbs 3. Poor capillary refill in thumbs 4. Poor parietal pointing 5. Down going optokinetic testing poor 6. L side soft palate failed to raise normally 7. Chronic trigger points in her glut max, glut medius and overtightened psoas 8. Restricted L hip mobility in flexion


Fungal nail growths indicate a few things metabolically. One is that she was clearly not getting enough blood flow into her feet and that the origin of the fungal growth was most likely the gut. The poor capillary refill and abnormal vibration sensation further confirmed that inflammation was decreasing her body’s natural ability to send blood flow. Low iron levels were discovered later which can contribute to poor circulation as well.

Parietal pointing is a test to determine how well the body knows where it is in space. She had a poor ability to place her index finger over a dot of ink I had placed on her arm while her eyes were closed. Your parietal lobe is highly correlated to body image disorders and one of our treatment goals was to avoid a flare up of her previous food deprivation condition. I’ll explain how we supported this when we cover her treatment plan.

Her optokinetic ability was a test of her tracking a tape with different colored squares. As her eyes vertically tracked the tape downward, it was difficult for her to keep her eyes moving in a fluid manner. This, plus a drop in her L side soft palate was an indication her vagus nerve was not firing optimally. The vagus nerve is critical to your parasympathetic nervous system, aka “rest and digest” (versus the sympathetic “fight or flight”).

Remember, one of the tenets of functional medicine is – fix the gut first – but in reality, it’s fix the gut & brain first! More on rehabilitation to this system later. Lastly, Molly had chronic musculoskeletal concerns which were creating big problems in her ability to cope with stress – since she could not run, she could not keep her inflammation in check!

Check out A Case Study in Autoimmune Disease – Part 2 – Testing to learn about the diagnostic testing that is conducted to further evaluate autoimmune disease.

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