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Fibromyalgia and Low Thyroid Function Over 20 million Americans suffer from thyroid dysfunction. And over 500,000 new cases of thyroid disease occur each year. However, as staggering as those numbers appear, millions more go undiagnosed. It’s estimated that more than 10 million women have a low-grade thyroid dysfunction, which isn’t treated. And almost another 8 million people with low thyroid go undiagnosed. Like my patient Allison, many individuals with low or hypothyroid simply fall through the cracks. Allison K. I really felt terrible most of the time. I had no energy at all. I’d gained 40 pounds over the last year even though I ate very little and tried to follow my Weight Watcher’s program. I kept cutting my calorie intake and even started skipping meals in an attempt to lose weight. The less I ate the worse I felt. I had numerous sinus infections, which I had never had before. My hair was falling out, I had tingling pain in my hands and feet and always felt cold even in the summer. I had this constant ringing in my ears. I was depressed or anxious a good deal of the time. Every doctor I consulted said that my blood tests were normal and it must be my fibromyalgia that was causing me to feel so bad. I knew something was wrong with me, but I couldn’t find anyone who could help me. One doctor said I had all the symptoms of low thyroid. But, the endocrinologist she referred me to, said all my tests were normal. How could my thyroid be normal when I have all the symptoms of hypothyroid? Allison’s story is a typical one. I routinely have new fibromyalgia and CFS patient’s who present with all the symptoms of hypothyroid including fatigue, headaches, dry skin, swelling, weight gain, cold hands and feet, poor memory, hair loss, hoarseness, nervousness, depression, dry skin, constipation, joint and muscle pain, and burning or tingling sensations in the hands or feet. The symptoms associated with hypothyroid are after all very similar to those of fibromyalgia and CFS. And in fact, up to 63% of patient’s with fibromyalgia and CFS have been shown to have hypothyroid. I estimate that as many as 40% of my FMS and CFS patients are suffering from low or hypothyroid function. Your Thyroid Gland The thyroid gland is shaped like a butterfly and is located in the lower front part of your neck (just above the breastbone). The thyroid gland is responsible for secreting thyroid hormones. A hormone is a chemical substance formed in the body and carried in the bloodstream to affect another part of the body. Thyroid hormones travel through the bloodstream and help cells convert oxygen and calories to energy. Thyroid hormones control a person’s metabolism. Metabolism is defined as the sum of all physical and chemical changes that take place within the body; it’s all the energy and material transformation that occur within living cells. Every cell in the body depends on having enough thyroid hormone. If your thyroid gland becomes dysfunctional, every cell in the body suffers. This is why thyroid disorders can cause so many problems. When your thyroid gland produces too much thyroid hormone, this is known as hyperthyroid. When your thyroid doesn’t produce enough thyroid hormone, it's called hypothyroid. As you can see below, hypothyroid can cause many of the symptoms of FMS/CFS. Symptoms Associated with Hypothyroid • fatigue (the most profound symptom) • headache • dry skin • swelling • weight gain • cold hands and feet • poor memory • hair loss • hoarseness • nervousness • depression • joint and muscle pain • burning or tingling sensations in the hands and/or feet (hypothyroid neuropathy) • yellowing of skin from a build up of carotene (conversion of carotene to vitamin A is slowed by hypothyroidism) • carpal tunnel syndrome • problems with balance and equilibrium (unsteadiness or lack of coordination) • constipation (from slowed metabolism) • edema around the ankles, below the eyes, and elsewhere • observation of delayed Achilles tendon reflex test • hypertension (high blood pressure) • angina (chest pain) • atherosclerosis (hardening of the arteries) • hypercholesterolemia (high cholesterol) • menstrual irregularities • infertility • PMS • fibrocystic breast disease • polycystic ovary syndrome • reactive hypoglycemia • psoariasis • urticaria • allergic rhinitis Understanding Thyroid Hormones, T3, T4 AND TSH The hypothalamus stimulates the pituitary gland to produce thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce and release the hormone, thyroxine (T4). T4 hormone is then converted into the more active, triiodothyronine (T3). T3 hormone is essential for life and four times more active than T4. You can live without T4 but not without T3. A thyroid gland that functions normally produces T4 and T3. Twenty percent of the T3 circulating in the body comes directly from the thyroid gland, and the remaining 80 percent comes from conversion of T4. This conversion of T4 to T3 takes place in the cells. (T4 can also be converted into reverse T3, which is physiologically inactive.) The enzyme 5-deiodinase converts T4 into T3 and reverse T3. The 5-deiodinase enzyme, can be inhibited by prolonged stress, steroids (stress hormones or cortisol), poor nutrition, acute and chronic illnesses. If T4 doesn’t convert into active T3, symptoms of low thyroid start to show up. This can happen in spite of a normal TSH blood test reading. Chronic Stress Leads to Low Thyroid The symptoms of low thyroid tend to come on or become worse after a major stressful event. Childbirth, divorce, death of a loved one, job or family stress, chronic illness, surgery, trauma, excessive dieting, and other stressful events can all lead to hypothyroidism. Under significant physical, mental, or emotional stress the body slows down the metabolism by decreasing the amount of raw material (T4) that is converted to the active thyroid hormone (T3). This is done to conserve energy. However, when the stress is over, the metabolism is supposed to speed up and return to normal. This process can become derailed by a buildup of reverse T3 (rT3) hormone. Reverse T3 can build to such high levels that it begins to start using up the enzyme that converts T4 to T3. The more stress the more likely rT3 can block T4 from converting into T3. Blood Test may be Inaccurate Blood tests for thyroid function measure the amount of TSH, T4, and T3 in the bloodstream. But thyroid hormones don’t operate within the bloodstream; the action takes place in the cells themselves. What good is a blood test that only shows what is racing around the bloodstream one second out of one minute, out of one hour, out of a one day? Blood tests are measuring how much thyroid hormone is swimming around in the blood stream, but not what is in the cell. Blood tests are an educated guess based on the bell curve theory. Sixty percent of patients will have thyroid levels between the usual testing parameters, twenty percent will be above and twenty percent will fall below these parameters. Traditional medical professionals know that thyroid blood tests are less than perfect. The Journal of Clinical Psychiatry has reported that “Laboratory blood tests for thyroid may be inaccurate for many who get tested for hypothyroid disorder.” Compounding the problem of using standard blood tests to diagnose hypothyroid is the inability of doctors to agree on the laboratory parameters. According to the American Association of Clinical Endocrinologists (AACE) guidelines, doctors have typically been basing their diagnoses on the "normal" range for the TSH test. The typical normal TSH levels at most laboratories, has fallen between the 0.5 to 5.0 range. Those with a TSH below .5 are considered to have too much thyroid hormone (hyperthyroid). Those whose test results are above 5 are considered to have too little thyroid (hypothyroid). However, it’s not uncommon to find doctors including endocrinologists (thyroid specialist) who withhold the diagnoses and treatment of hypothyroid until a patient's TSH tests considerably above 10. While some doctors believe that anyone who has a TSH above 2 and complains of hypothyroid symptoms (depression, fatigue, brain fog, etc.) should be placed on thyroid hormone. While doctors often debate which parameters or numbers are correct, millions of low thyroid patients are not properly diagnosed and treated. Patients often relate that they, and sometimes their doctors, suspected a thyroid problem only to have their blood work return normal. Most physicians, in this case, won’t recommend thyroid replacement therapy. Doctors are typically reluctant to prescribe thyroid replacement therapy, without a definitive test that reveals true hypothyroid. They’re afraid that doing so would jeopardize the health of the patient. And true, excess thyroid can cause several unwanted health problems including elevated heart rate, rapid pulse and accelerated bone loss. However, millions suffer with symptoms far worse then these when prescription therapy is withheld. Certainly the dangers of thyroid replacement therapy should be a concern. But if you weight the pro’s and con’s of administering thyroid replacement therapy to a patient with normal blood tests, yet all the symptoms of hypothyroid, fatigue, anxiety, depression, achy diffuse pain, weight gain, etc., its’ easy to see that withholding therapy should be considered malpractice. This is especially true in light of the fact that most of my fibromyalgia and CFS patients are taking numerous drugs to cover-up the symptoms of hypothyroid; Provigil or Aderall to increase energy, antibiotics for chronic sinus infections, a laxative for constipation, NSAIDs for pain, SSRI medication for depression, and perhaps a benzodiazepine like Ativan or Xanax for anxiety. All of these drugs may in turn cause side effects that may cause further symptoms (poor sleep, fatigue, depression, etc.). It’s not uncommon for my patient’s to be able to drastically reduce or eventually wean off these very medications once their thyroid disorder is corrected. New Developments To complicate matters, the parameters for determining who has a thyroid disorder and who doesn’t has recently been changed. The new guidelines narrow the range for acceptable thyroid function; the AACE is now encouraging doctors to consider thyroid treatment for patients who test the target TSH level of 0.3 to 3.04, a far narrower range. The AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder but have gone untreated until now. At a press conference in 2004, Hossein Gharib, MD, FACE, and president of AACE, said: "This means that there are more people with minor thyroid abnormalities than previously perceived." I still routinely get test results that use the old numbers and unfortunately many doctors continue to misdiagnose their patient’s based on these outdated lab parameters. The AACE estimates that the new guidelines actually double the number of people who have abnormal thyroid function, bringing the total to as many as 27 million, up from 13 million thought to have the condition under the old guidelines. Euthyroid Syndrome Euthyroid is a medical term for patients who have normal thyroid blood tests but have all the symptoms associated with hypothyroidism: fatigue, low metabolism, headache, etc. Many doctors don’t know about (or they choose to ignore) well documented studies that show that low body temperature is indicative of euthyroid hypothyroidism. Body Temperature, Metabolism, and Thyroid Hormones Self-test for Low Thyroid Dr. Broda Barnes was the first to show that a low basal body temperature was associated with low thyroid. His first study was published in 1942 and appeared in JAMA. This study tracked 1,000 college students and showed that monitoring body temperature for thyroid function was a valid if not superior approach to other thyroid tests. The test for low thyroid function, according to Dr. Barnes’s protocol, starts first thing in the morning. While still in bed, shake down and place the thermometer (preferably mercury; digital thermometers are not as accurate) under your arm and leave it there for 10 minutes. Record your temperature in a daily log. Women who are still having menstrual cycles should take their temperature after the third day of their period. Menopausal women can take their temperature on any day. A reading below the normal 97.8° strongly suggests hypothyroid. A reading above 98.2° may indicate hyperthyroidism (overactive thyroid). Treatment for Hypothyroid, The Barnes Method Dr. Barnes recommends patients take a desiccated glandular (derived from pigs) prescription medication known as Armour Thyroid, which was used before synthetic medications such as Synthroid were introduced. Armour Thyroid and other prescription thyroid glandulars (including Westhroid), contain both T4 and T3. Synthroid and other synthetic thyroid medications contain T4 only. Since some individuals have a difficult time converting inactive T4 to active T3, these medications may not work at the cellular level. Individuals may take T4 medications for years and never notice much improvement. Their blood tests look good, but mean time they’re falling apart; gaining weight, having more aches and pains, battling one sinus infection after another, and becoming more and more fatigued, depressed and withdrawn. Low Thyroid and Depression Several studies demonstrate that a combination of T4, T3 or T3 therapy alone may provide welcomed relief from a number of symptoms commonly associated with depression. Studies show that T3 therapy is more effective in reducing the symptoms associated with depression than SSRI antidepressants. Over All Well Being A study by the New England Journal of Medicine showed that patients who received a combination of T4 and T3 were mentally sharper, less depressed, and feeling better overall than a control group who received T4 only. The addition of T3 often helps with many symptoms of hypothyroidism that may not disappear with supplemental T4 only. It has improved or eliminated depression, brain fog, feeling cold, constipation, chronic fatigue, headaches, insomnia, muscle and joint pain, and chronic sinus infections. Weight Loss For some people it has helped them finally lose weight. Fibromyalgia One study showed that all the symptoms associated with FMS could be eliminated while the patient was taking high-doses (120 mcg.) of T3.6 Over the Counter Glandular Thyroid Supplements Since I no longer employ medical doctors in my practice I have to rely on natural supplements instead of prescription medications. I used to refer my patient’s back to their medical doctor in an attempt to get them on prescription Armour thyroid medication. I prefer my patients take Armour thyroid. However, most doctors are so reluctant to treat patient’s with normal thyroid blood tests or to use Armour thyroid medication, that I’ve been forced to use over the counter thyroid glandular replacement therapy. Fortunately I’ve found a reliable manufacturer of high quality thyroid glandular and I’m getting great results with my hypothyroid patient’s. Thyroid bovine glandular supplements have been used since the beginning of thyroid treatment. Dr. Barnes used Armour Thyroid, (available by prescription). However, over-the-counter thyroid glandular supplementations are also available. The over the counter thyroid glandulars come from pig glands just as the prescription drug Armour thyroid. However, unlike Armour Thyroid, over the counter thyroid glandulars contain no T4, only T3. By removing the T4 manufacturers can then legally sell the glandular extract with out a prescription. Since these raw thyroid tissue concentrates contain the active thyroid hormone T3, they can be used as a first line of treatment for low to moderate hypothyroid dysfunction. I’ve been using thyroid glandular supplements for almost 2 years. My patient’s report they feel better on these supplements. They often notice improved energy, better moods, increased mental clarity, and weight loss on these thyroid glandular replacement supplements. If you have fibromyalgia I encourage you to check for low body temperature it could a sign you're suffering from undiagnosed hypothyroid. About Dr. Murphree Dr. Murphree is a board certified nutritional specialist and chiropractic physician who has been in private practice since 1990. He is the founder and past clinic director for a large integrated medical practice located on the campus of Brookwood Hospital in Birmingham Alabama. The clinic was staffed with medical doctors, chiropractors, acupuncturists, nutritionists, and massage therapists. The clinic combined prescription and natural medicines for acute and chronic illnesses. He is the author of 5 books for patients and doctors, including "Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome," ""Heart Disease What Your Doctor Won't Tell You’” and "Treating and Beating Anxiety and Depression with Orthomolecular Medicine." In 2002 Dr. Murphree sold his medical practice and now maintains a busy solo practice specializing in fibromyalgia, chronic fatigue syndrome, heart disease, mood disorders, and other chronic illnesses. He can be reached toll free 1-888-884-9577 or at 205-879-2383 His website is at www.treatingandbeating.com for more information about Dr. Muphree and fibromyalgia treatingandbeating.com
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