Saturday, June 18, 2011

The Untold Story of your Thyroid, FM and CFS/ME

Why is it important to understand how these conditions can relate to those of us with fibromyalgia (FM) and/or chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? The answer is, research is consistently pointing to an association of hypometabolism, hypothyroidism, Hashimoto's, and thyroid resistance, particularly in fibromyalgia, but also ME/CFS. This research has been ongoing for at least a decade now, and it is important that we pay attention to what the results are showing. The participants in these studies are representative of us and what we go through every day.

Following are some brief overviews and resources for learning more.

HYPOTHYROIDISM ©

The thyroid gland is a butterfly-shaped organ located in the front of the neck, just over the windpipe. It produces iodine-containing hormones, such as thyroxin. Thyroxin regulates the rate at which body cells use energy and produce heat. When these hormones are low, a person is said to have hypothyroidism.

There are several types of hypothyroidism, (discussed here) but the symptoms are generally the same; physical and mental sluggishness, fatigue, dry skin, weight gain, hair loss, cold sensitivity, muscle cramps, constipation, irritability, and in more serious cases, enlargement of the tongue and/or thickening of the skin.
End excerpt (Cooper & Miller, pg 93-94).

According the the National Institute of Health at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001393
The most common cause of hypothyroidism is inflammation of the thyroid gland, which damages the gland's cells. Autoimmune or Hashimoto's thyroiditis (insert, discussed later). Some women develop hypothyroidism after pregnancy (often referred to as "postpartum thyroiditis").

Other common causes of hypothyroidism include:
•Congenital (birth) defects
•Radiation treatments to the neck to treat different cancers, which may also damage the thyroid gland
•Radioactive iodine used to treat an overactive thyroid (hyperthyroidism)
•Surgical removal of part or all of the thyroid gland, done to treat other thyroid problems
•Viral thyroiditis, which may cause hyperthyroidism and is often followed by temporary or permanent hypothyroidism

Certain drugs can cause hypothyroidism, including:
•Amiodarone
•Drugs used for hyperthyroidism (overactive thyroid), such as propylthiouracil (PTU) and methimazole
•Lithium
•Radiation to the brain
•Sheehan syndrome, a condition that may occur in a woman who bleeds severely during pregnancy or childbirth and causes destruction of the pituitary gland

Risk factors include:
•Age over 50 years
•Being female

More recent research, http://www.ncbi.nlm.nih.gov/pubmed/21085966 suggests that Hashimoto's may be a risk factor for fibromyalgia. I am in hopes that the NIH, will be able update their information as the science evolves.

A great book with a holistic approach on hypothyroidism or Hashimoto’s is Living Well With Hypothyroidism: What your Doctor Doesn’t Tell You that you need to Know by Mary Solomon.

You can find information and patient comments on physicians around the country at her website;

website. www.thyroid-info.com

Dr. Jacob Teitelbaum is one of her physician consultants and author of From Fatigued to Fantastic. He has energy systems that include high vitamin B Complex and other treatments. Find out about him and what he has to say at:

http://www.endfatigue.com/

LAB Values have changed
This is probably one of the best kept secrets of all time, yet a factor that can have a great impact on your quality of life if you have undiagnosed thyroid problems.

The old antiquated thyroid assessment scale of 0.5 to 5.0 for the thyroid stimulating hormone -- TSH was changed by specialists in the field in 2003. All labs and physicians should be assessing the thyroid by:

TSH of 0.3 to 3.0

This means in a normal individual (remember in FM and CFS/ME the HPA Axis is out of kilter) a TSH of <0.3 would indicate hyperthyroidism and a TSH of >3.0 would indicate hypothyroidism. At any rate, either requires further investigation, thyroid scans to actually check the function and ultra sounds to see if there could be a tumor that needs to be removed are indicated, but frequently missed with disastrous results for anyone with thyroid disease, but particularly the FM and ME/CFS patient.

The wretchedness of this story is that it STILL is not recognized in most labs, and doctors are either unaware of the changed parameters or chose to ignore them.

Read “The Tragic and Invisible Epidemic of Thyroid Disease” at Vitality 10
http://www.endfatigue.com/health_articles_t-z/Thyroid-tragic_and_invisible_epidemic_of_thryroid_disease.html

HYPOMETABOLISM–Thyroid Resistance ©

Hypometabolism is not the same as hypothyroidism. In this case the thyroid is working appropriately, but the body isn’t utilizing the thyroid hormones. Like reactive hypoglycemia, thyroid hormone levels are normal but they are resisted in the peripheral tissue; this is thyroid resistance. As suggested in chapter 1 of our book, some FM and CFID (ME/CFS) patients have hypometabolism.

The role of thyroid resistance in the fibromyalgia patient is being investigated, and thyroid autoimmunity has been associated with FM severity (Bazzichi, et al. 2007). It may also contribute to the development of myofascial trigger points (Starlanyl and Copeland, 2001).

Thyroid resistance has also been considered as a metabolic factor in chronic fatigue syndrome, as well as fibromyalgia. (Garrison and Breeding, 2003)

End of excerpt (Cooper and Miller, pg 94-95.)

Dr. John C. Lowe is a fibromyalgia, thyroid, and metabolism researcher. As Director of Research for the Fibromyalgia Research Foundation, he has spearheaded the scientific study of two related topics: the metabolic causes of fibromyalgia, and the relief of fibromyalgia symptoms through the treatment approach he developed and named "metabolic rehabilitation." Read more at:

http://www.drlowe.com/jcl/biojcl.htm

IMHO, I am not sure that treating hypometabolism will END fibromyalgia, or CFS/ME. Though having my own Hashimoto's treated with thyroid hormone has helped with the life altering fatigue, it has not helped my pain, insomnia, migraines, and other centrally mediated co-morbid conditions or the peripheral pain generators from myofascial trigger points. However, I do believe hypothyroidism has a more than casual connection to fibromyalgia. And, it is possible that some diagnosed with chronic fatigue syndrome, may not have a viral connection, but a metabolic one if they have undiagnosed thyroid disease. As in my case, one cannot rely solely on a TSH. The proper tests must be done for a proper diagnosis.

Knowing if you have hypothyroidism or hypometabolism, and treating it will certainly help control this co-existing condition. As we talk about in the book, this is extremely important and gives one a sense of empowerment over fibromyalgia and chronic fatigue syndrome.

You can read about Dr. John Lowe’s theory on hypometabolism in an article written by Mary Shomon at:

http://www.thyroid-info.com/articles/drlowefms.htm

HASHIMOTO'S THYROIDITIS—Autoimmune Thyroiditis ©

Hashimoto’s thyroiditis is a condition known to coexist—although not exclusively—in a certain subgroup of CFID patients. It is a type of autoimmune thyroid disease, meaning the body’s immune system attacks and destroys the thyroid gland. Its characteristics are inflammation of the thyroid gland, fatigue, depression, cold sensitivity, weight gain, muscle weakness, thickening of the skin, constipation, dry or brittle hair, muscle cramps, increased menstrual flow, and goiter. Some patients may not have any symptoms.
End excerpt (Cooper and Miller, pg 95).

As we now know, Hashimoto's has been significantly linked to fibromyalgia, http://www.ncbi.nlm.nih.gov/pubmed/21085966 in the latest Bazzichi, et al study (Nov 2010). This is not the first study and should be receiving the recognition it deserves by those who treat fibromyalgia.

Kristin Thorson, is a patient, advocate and editor of Fibromyalgia Network. http://www.facebook.com/#!/FibroNetwork She also runs the nonprofit organization, http;//afsafund.org which funds important FM research and the board has several well known physicians.

As do all of her articles, the January 2011 edition of Network News article, “Thyroid Malfunction Dragging you Down?: Symptoms, Tests and Treatments" caught my eye.

I suggest you take her article and the studies cited her, and a copy of my blog with you to your doctor if you are having unusual symptoms consistent with those mentioned here. Preface your remarks with, you probably already know this, but I found it quite interesting, and thought I would like to share it with you so we can get to the bottom of my symptoms. Get that TSH, free T4, free T3, TPO and TG. Take them actual journal articles and articles supported by research. If they are not interested, find a new doctor.

“As I walk this path, I understand the privilege of intersections, these interruptions enrich my life.” --Celeste


PS
You can find my letter of gratitude to the authors in my blog, Thyroid Autoimmunity and Fibromyalgia, Letter to the author, (Laura Bazzichi, lead author of studies).

http://fmcfstriggerpoints.blogspot.com/2011/01/thyroid-autoimmunity-and-fibromyalgia.html
I hope you will read it. It is important to recognize people for their unending dedication to helping others.

Resources other than those previously linked:

Bazzichi L, Rossi A, Zirafa C, Monzani F, Tognini S, Dardano A, Santini F, Tonacchera M, De Servi M, Giacomelli C, De Feo F, Doveri M, Massimetti G, Bombardieri S. “Thyroid autoimmunity may represent a predisposition for the development of fibromyalgia?” Rheumatology International, Nov 18, 2010., by Division of Rheumatology, Department of Internal Medicine, University of Pisa, Pisa, Italy.

L. Bazzichi, A. Rossi, T. Giuliano, F. De Feo, C. Giacomelli, A. Consensi, A. Ciapparelli, G. Consoli, L. Dell’osso, and S. Bombardieri, “Association between thyroid autoimmunity and fibromyalgic disease severity,” Clinical Rheumatology 26, no. 12 (2007): 2115–20.

Cooper C and Miller J. Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection. Healing Arts Press: Vermont, 2010.

R. L. Garrison and P. C. Breeding, “A metabolic basis for fibromyalgia and its related disorders: the possible role of resistance to thyroid hormone,” Medical Hypotheses 61, no. 2 (2003): 182–89.

Network News. (2011, January) “Thyroid Malfunction Dragging you Down?: Symptoms, Tests and Treatments.”

Mary Shomon. Living Well with Hypothyroidism: What Your Doctor Doesn't Tell You... That You Need to Know (Collins; 1st edition, March 2000)

Devin. J. Starlanyl and Mary. E. Copeland, Fibromyalgia & Chronic Myofascial Pain Syndrome: A Survival Manual (Oakland, Calif.: New Harbinger Publications, Inc., 2001), 44.

1 comment:

Claudia said...

Im sure natural bovine thyroid is good for you too. Don't take my word for it, use it and see for your self.

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