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A naturopathic physician talks to a patient about a weight-loss product.

ND Prescribes Weight-Loss Product That Causes Reaction

What happens when a patient takes more than the prescribed dose of a weight-loss product?

A 30-year-old woman with no prior clinical problems saw her ND and asked for her help in losing weight. The ND prescribed two capsules a day of a professional-line weight loss product that contained desiccated thyroid, kelp, calcium, zinc, and green tea extract. Counseling the patient that this process takes time, they agreed to a follow-up visit in three weeks, and the patient was given a supply of capsules to last four weeks.

Unbeknownst to the ND, the patient increased her dosage to eight capsules daily. She found a local specialty supplement store that carried this line of products and procured her own supply. She lost 11 pounds during the first six weeks. However, she developed headache, irregular menstruation, tachycardia and heat intolerance. As a result of these complaints, the patient went back to her ND, and the doctor advised further testing, which revealed:

  • Thyroid function tests showed TSH, T3 and T4 of thyrotropin of less than 0.07 mIU/L (normal range 0.3-5.0 mIU/L) free T4 of 1.9 ng/dL (24.45 pmol/L) (normal range, 0.7-1.6 ng/dL [9.01-20.59 pmol/L]), and free T3 of 720 pg/dL (11.08 pmol/L normal range, 170-370 pg/dL [2.62-5.70 pmol/L])
  • Serum thyroglobulin level was 10.9 ng/mL (normal range, <35 ng/mL)
  • 24-hour radioiodine uptake was 1.4% (normal range, 10%-40%)

The ND told the patient to discontinue taking the weight loss pills immediately, and the patient agreed. Fortunately, one week after the patient stopped taking the weight loss product, all signs of hyperthyroidism disappeared.


What Can We Learn?

There is a myriad of things that can go “wrong” at a variety of points when prescribing drugs, botanicals, vitamins, or dietary supplements including:

  • Selection and dosage
  • Writing the prescription
  • Filling of the prescription
  • Ensuring the quality of the botanical
  • Administering or ingesting of the medication or supplement
  • Compliance with the drug regimen
  • Interaction of the drug with other drugs, foods and diseases

Many of these variables are out of your direct control. However, you can improve the desired therapeutic effect for your patients by applying sound concepts and practices. A good resource is PDR for Herbal Medicines.

  • Perform a baseline assessment for an accurate diagnosis. This should include the patient’s health, social and family history, along with proper testing, examination, and evaluation. In this case, there was no indication a baseline assessment was performed during the initial visit. Also, it can be helpful to use an intake form stating, “The information contained in this document is correct.”
  • Determine the patient’s motivation, desire, and clinical assessment before embarking on a weight-loss treatment regimen. There could be an underlying reason, such as a thyroid problem, for the weight gain.
  • Be aware of potential interactions with herbal medicines. In this case, the ND should have been aware that patients with unrecognized factitious thyrotoxicosis can face diagnostic and therapeutic problems. Researchers have concluded that laboratory results in patients with factitious thyrotoxicosis.

The preceding cases represent composites of several cases, modified to illustrate risk management practices.

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