Misdiagnoses can happen for several reasons, including inadequate clinical assessment, lack of patient and clinician knowledge, and communication or cognitive misconceptions. It is common for patients to present with stress-related symptoms, leading clinicians to attribute these symptoms only to stress and anxiety. While stress can cause physical symptoms, it is important to investigate all possible causes of a patient’s symptoms. We will discuss some of the diagnoses that are commonly missed and attributed to stress, including thyroid disorders, Lyme disease, multiple sclerosis (MS), celiac disease, endometriosis, and histamine intolerance.
Thyroid Disorders
- The thyroid gland is a small, butterfly-shaped gland located in the neck. It produces hormones that regulate the body’s metabolism, heart rate, and body temperature. When the thyroid gland is not functioning correctly, it can cause a range of symptoms such as fatigue, weight gain, and depression. Unfortunately, these symptoms are often attributed to stress or aging, leading to the misdiagnosis of thyroid disorders.
- There are two types of thyroid disorders: hypothyroidism and hyperthyroidism. Hypothyroidism occurs when the thyroid gland does not produce enough hormones, leading to a slowing of the body’s metabolic rate. Symptoms of hypothyroidism can include fatigue, weight gain, depression, and constipation. On the other hand, hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone, leading to an increase in the body’s metabolic rate. Symptoms of hyperthyroidism can include weight loss, anxiety, heart palpitations, and diarrhea.
- Thyroid disorders can be diagnosed through a blood test that measures the levels of thyroid hormones in the body. Treatment for thyroid disorders typically involves hormone replacement therapy, which can alleviate symptoms and improve quality of life.
Lyme Disease
- Lyme disease is a bacterial infection that is transmitted by ticks. If caught early, it can be easily treated with antibiotics. However, if left untreated, it can cause serious health problems such as joint pain, heart palpitations, and cognitive issues. The symptoms of Lyme disease can be similar to those of other conditions such as fibromyalgia or chronic fatigue syndrome, leading to misdiagnosis.
- The early symptoms of Lyme disease can include a rash, fever, and flu-like symptoms. However, not all patients with Lyme disease develop a rash, and some patients may not even remember being bitten by a tick. Later symptoms of Lyme disease can include joint pain, heart palpitations, and cognitive issues such as memory loss and difficulty concentrating.
- Lyme disease can be diagnosed through a blood test that looks for antibodies to the bacteria that cause the disease. For chronic cases, detecting the spirochete bacteria (and/or co-infections) is far more difficult, since it hijack’s the immune cells. Lyme disease typically involves antibiotics, and early diagnosis and treatment are critical for preventing long-term complications.
Multiple Sclerosis
- MS is a neurological condition that affects the central nervous system. Symptoms can include numbness or tingling in the limbs, muscle weakness, and difficulty with coordination. Because these symptoms can also be caused by stress, anxiety, or depression, MS is often overlooked as a possible diagnosis. While MRI testing and spinal taps may help to diagnose this, a clinician need to be suspicious of it in the first place. If it is not on a physician’s radar screen, months or years could go by before a patient gets treatment.
- MS is a chronic condition that can cause permanent damage to the nerves in the brain and spinal cord. While there is no cure for MS, there are medications and therapies that can help manage symptoms and slow the progression of the disease.
Celiac Disease
- Celiac disease is an autoimmune disorder that affects the digestive system. It is triggered by gluten, a protein found in wheat, barley, and rye. Symptoms can include abdominal pain, diarrhea, and weight loss. However, because these symptoms can be caused by stress or other digestive disorders, celiac disease is frequently missed.
- Celiac disease can be diagnosed through a blood test that measures the levels of antibodies to gluten in the body. Confirmation of the diagnosis typically requires a biopsy of the small intestine. Treatment for celiac disease involves a strict gluten-free diet.
Endometriosis
- Endometriosis is a painful condition in which tissue similar to the lining of the uterus will grow outside of the uterus. This tissue does not belong there. The symptoms will include pelvic pain, heavy periods, or painful intercourse. Since these symptoms can be worsened by stress or menstrual cramps, it is often misdiagnosed or not diagnosed at all. The pain is legitimately there and intolerable. To be fair, there is no blood test available to easily identify it.
- Endometriosis requires ruling out other problems by ultrasound such as fibroids, or bladder problems, or pelvic congestion. It is not usually seen on ultrasound or Ct scan, and it requires an astute practitioner to listen to the patient’s symptoms and have a high suspicion of this clinically. It can be seen and treated under laparoscopy.
Histamine Intolerance
- Histamine problems can run the gamut from simple environmental allergies to a full-blown mast cell activation syndrome (MCAS). Since histamine is primarily released by mast and immune cells, and these cells are distributed all over the body, it stands reasonable that the symptoms involve many aspects of the body’s function. It can be quite complicated if someone sees each individual symptoms as one problem. It takes the ability to step back and see the puzzle pieces to fit a puzzle.
- Histamine is tricky to diagnose, since we have to capture it “on the run”. Obvious skin prick and blood work can rule this is for simple case. The more involved cases may involve POTS, EDS, and require cardiac evaluations to rule out other causes or work on the severity of the symptoms.
If you are experiencing unusual and ongoing symptoms that are hard to describe, you may need a super-sleuth in functional medicine who looks at the root cause and takes symptoms in context to solve a puzzle. It is just not ok to receive a diagnosis of stress without an appropriate investigation.
