A case study of a 37-year-old female presented with pre-syncope, fatigue, daily headaches, migraines, dizziness, visual disturbance, brain fog, chest pressure, sharp pain around the chest and insomnia. Symptoms began 2-3 weeks after a sinus infection and the use of Zithromax and Prednisone. She reports a medical history of cat scratch fever, EBV, chronic fatigue syndrome for 2 years after EBV and insomnia. Suspected POTS and Hashimoto's non-thyroiditis in this case study.
Examination and Diagnosis
The patient presented with a confirmed diagnosis of POTS from her cardiologist via tilt table testing. Lab work revealed antibodies to the thyroid without abnormal TSH levels, this is known as Hashimoto’s non-thyroiditis. Orthostatic vital examination revealed a heart rate increase of 65bpm – 105bpm upon standing, which was maintained above 100bpm for over 1 minute. The patient reported feeling lightheaded with tunnel vision upon standing. Physical examination revealed visual fatigue, convergence insufficiency of right eye, decreased gains of vertical tracking, soft palate fatigues bilaterally, color and temperature changes in hands and feet, and decreased sensation of the left V2 trigeminal nerve distribution.
Patient was placed on immune regulatory and thyroid support supplements along with a gluten free diet. She began treatment in the office with two 1hr visits once a week for five weeks. Treatment included PEMF therapy, orthostatic retraining, neuromodulation, eye movement therapies, and near infrared light therapy.
At the re-examination the patient reported improvement in headaches/migraines, fatigue, tingling on the left side of her body, light sensitivity, and sleep. She reports feeling about 80% better overall. She was originally having 6-7 bad days a week. She reports zero significant flare up days since the second week of treatment.
Re-examination revealed that her heart rate increased from 65-89bpm upon standing and was immediately returned to normal 75bpm. The patient denied lightheadedness and tunnel vision upon standing. There was also improvement in convergence, vertical eye movements, sensory to the face, and palatal fatigue.
After the re-examination, she was advised to continue with a gluten free diet and was given neurological exercises to continue at home. A follow-up visit was scheduled two months later to assess continued progress.
Functional neurological care has been shown to be effective in the treatment of postural orthostatic tachycardia syndrome (POTS). Every patient requires an individualized approach and targeted treatment to achieve optimal results. Please visit our Dysautonomia Program webpage for more information.