Are All Chronic Fatigue/Fibromyalgia Patients Low Thyroid?

[Guest guest]

There is mounting evidence that hypothyroidism is present in the

majority of and possibly all chronic fatigue and fibromyalgia (CF/FM)

patients. The problem is that standard blood testing that consists of

TSH, T4 and T3 does not detect it. Thus, many CF/FM patients are

erroneously told over and over that their thyroid levels are fine.

TSH is secreted by the pituitary in the brain, telling the thyroid to

secrete T4, which is not the active thyroid hormone. T4 must then be

converted in the body to the active thyroid hormone T3. When T4 and

T3 levels drop, the TSH should increase indicating hypothyroidism.

This is the standard way to diagnose hypothyroidism. There are,

however, many things that result in hypothyroidism but are not

diagnosed using the standard TSH and T4 and T3 testing. This method

misses thyroid problems with CF/FM patients 90% of the time.

First of all, there is clearly pituitary dysfunction in these

diseases from a variety of causes, including viruses, bacteria,

stress, yeast, inflammation, toxins, pesticides, plastics and

mitochondria dysfunction. This results in low normal TSH levels along

with low normal T4 and T3 levels. Very few doctors understand the

significance of this and incorrectly state that the thyroid is fine.

In addition, most CF/FM patients do not adequately convert T4 to the

active T3, resulting in low levels of active thyroid hormone and

suffer from low thyroid despite having a normal TSH. Also, there is

another problem in that T4 cannot only be converted to T3, but it can

also be converted to reverse T3, which is inactive and blocks the

thyroid receptor. Very few practicing physicians consider this, but

it is a major problem. There is an evolutionary enzyme that increases

the T4 to reverse T3 in times of stress and illness. This worked well

for our ancestors because in times of famine it allowed those who had

this enzyme to survive. But in our modern society, reverse T3 works

against us causing fatigue, difficulty losing weight, brain fog,

muscle aches and all the other symptoms of hypothyroidism. Reverse T3

can be increased with chronic illnesses such as CF/FM, yo-yo dieting

(often responsible for the quick weight gain after losing weight),

stress, heavy metals and infections commonly present in CF/FM. Low

thyroid not only results in undesirable symptoms, but it also

increases the risk of heart disease and cancer. When more extensive

testing is done, these patients are so relieved to be shown on paper

that their thyroid is truly low and that they can expect to be

feeling better soon. There are only a few labs that can accurately

measure reverse T3. It is difficult for labs to do and many labs will

erroneously indicate normal or low levels of reverse T3. Some doctors

that have ordered reverse T3 on patients have found it not to be

useful because they are not getting accurate results or they don't

know how to interpret the results.

In addition, there is also a thyroid resistance syndrome found in

these patients, meaning that there may be thyroid in the blood but

there is no thyroid effect. This has been discounted in the past, but

more and more evidence is surfacing proving that this is indeed a

significant problem with these conditions.

The combination of factors present in CF/FM, including pituitary

dysfunction, high reverse T3, and thyroid resistance, results in

most, if not all, CF/FM patients having inadequate thyroid effect. T4

preparations such as Synthroid and Levoxyl rarely work and Armour

thyroid, a pig glandular product, is somewhat better, but definitely

not adequate for most patients.

The treating physician must know when to use a T4/T3 combination or

straight T3. T3 works the best for many of these patients, but

Cytomel, a very short acting T3 available at normal pharmacies, is

also a poor choice because the varying blood levels cause problems.

Compounded timed release T3 is usually the best treatment. However,

to achieve significant improvement, the treating physician must be

very knowledgeable about T3 and must realize that when on T3,

standard bloods blood test will lead one to dose incorrectly and not

obtain significant benefits. I have trained many doctors on how to

use thyroid with CF/FM patients and they all cannot believe how

effective it is when used properly. This includes doctors who

previously felt that they were thyroid experts and had been using

thyroid with CF/FM for a long time. Ultimately, it is the expertise

and dosing of the T3 or T4/T3 combinations and the makeup of the

medications that determines the patient outcome and success of

treatment.

Related references 1. Garrison RL, Breeding PC, A metabolic basis for

fibromyalgia and its related disorders: The possible role of

resistance to thyroid hormone. Med Hypotheses 2003-7-31 61(2) 182-9

The combination of factors present in CF/FM, including pituitary

dysfunction, high reverse T3, and thyroid resistance, results in

most, if not all, CF/FM patients having inadequate thyroid effect.

T4 preparations such as Synthroid and Levoxyl rarely work and Armour

thyroid, a pig glandular product, is somewhat better, but definitely

not adequate for most patients. The treating physician must know when

to use a T4/T3 combination or straight T3. T3 works the best for many

of these patients, but Cytomel, a very short acting T3 available at

normal pharmacies, is also a poor choice because the varying blood

levels cause problems. Compounded timed release T3 is usually the

best treatment. However, to achieve significant improvement, the

treating physician must be very knowledgeable about T3 and must

realize that when on T3, standard bloods blood test will lead one to

dose incorrectly and not obtain significant benefits. I have trained

many doctors on how to use thyroid with CF/FM patients and they all

cannot believe how effective it is when used properly. This includes

doctors who previously felt that they were thyroid experts and had

been using thyroid with CF/FM for a long time. Ultimately, it is the

expertise and dosing of the T3 or T4/T3 combinations and the makeup

of the medications that determines the patient outcome and success of

treatment.