They’ve just come from the immunologist, having presented with extensive vitiligo in dad and early stage vitiligo now in their primary school aged son.  The immunologist, without running a single blood test, told them, ‘Bad news, you both have autoimmune issues and watch this space because the vitiligo is just the first presentation, there will be more to come’.  Slightly unsatisfied with this dead-end conclusion and non-existent management plan, the family then presents at a long established naturopathic clinic to see Anna Sangster, a fabulously sleuth-like detective, who takes her patients’ health very seriously and has the knowledge and skills that make her one of the best at what she does. I can say that because I’ve been mentoring Anna for a long time & she is one of the clueiest practitioners I know.

For example, she knows about the substantial research demonstrating the overlap between thyroid autoimmunity and vitiligo and, in addition to comprehensive case taking, decides some blood tests may provide valuable insight that would help to understand the degree of self-attack from their immune systems, identify if there are in fact already concurrent autoimmune targets and perhaps even provide a clue as to underpinning drivers. Well, look what she found!

Anna forwarded each family member’s results to me for our last mentoring session and I don’t recall ever seeing such a striking cluster pattern.  All 3 have significantly elevated anti-nuclear antibodies (ANA), mum at the highest level detectable, all 3 have significantly raised TPO and thyroglobulin antibodies and signs of actual thyroid impairment as a result.  The little boy in particular is making such a small amount of T4 that only approx 5% of boys his age produce such low levels.  And both the dad and the boy, the ones with vitiligo, show some unusual red blood cell characteristics.  What have we gained by finding this out?

Well firstly, it’s important to know that an autoimmune thyroiditis is not simply a theoretical risk in dad & son but a current reality. Maybe this goes some way to explaining why the boy is having so many concentration & learning issues at school? Secondly, it has been revelatory in that the the autoimmune markers are almost identical across all 3…but, wait a minute, mum doesn’t have the condition!

So is it just a case of 2 parents with ‘bad genes’ make a son with ‘worse’ ones?!  No doubt, genetic susceptibility is playing a part in here but what else could we be looking at? Could this be the impact of a family that has been equally environmentally exposed?  Well guess what? Dad’s a builder..and they live in houses while they renovate them to prepare them for re-sale…and the 1st obvious exposure dad could name was Arsenic treated pine, the cutting & breathing in of the subsequent sawdust, which has been established as a major Arsenic exposure for builders 🙁

Nothing is proven in this case as yet & the family have been referred for specialist heavy metal assessment but I think running the bloods, the bloods that are recommended in article after article on vitiligo, just may have been worth it…nice work Anna.

Want to learn more about the other autoimmune conditions that overlap with thyroid autoimmunity?  Want to learn more as well about how to read and interpret kids’ thyroid results so we can spot a problem that isn’t being flagged by your pathology company due to insensitive reference ranges, like we did in this case? 

Thyroid Assessment in Kids & Teenagers – Why, When & How gives you these tools and more. Subclinical thyroid impairment, is increasing in both children and adults. Many practitioners competent in adult thyroid identification & management are less familiar and confident with knowing when why and how to test in this population. Make sure you’re not missing thyroid imbalance in your paediatric patients…early detection makes treatment easy.