Thyroid Treatment and FM
Your Thyroid Gland and Fibromyalgia: Is your thyroid making your FM worse? By Dr Maggie Stratton, PhD. Co-Founder and Clinical Director of the Centre for Fibromyalgia (UK). Ltd
The Thyroid Gland.
There is a delicate, butterfly-shaped gland in your windpipe area at the front of your neck under your chin. It's called the thyroid, and it secretes a hormone called thyroxine into your system. Several of your important organ systems and body and brain chemicals (including serotonin, according to researcher Ridha Arem!) need the hormonal input of the thyroid to function well. In common with the adrenal gland, adequate thyroid activity is essential for optimum health.
Some researchers (e.g. Dr John Lowe, director of the FM Research Foundation of USA) believe that FM is caused by dysfunctions of the thyroid - although in UK this is NOT generally an accepted theory. However, it's clear to all of us who work closely with FM sufferers that thyroid problems appear to be certainly associated with FM. Possibly some of you who suffer FM also suffer what is called mild hypothyroidism (low activity of the thyroid gland - hypo meaning low, as opposed to hyper which means high).
What are the Symptoms of Mild Hypothryoidism, or "MH"?
The symptoms of mild hypothyroidism (MH) are alarmingly similar to FM and include fatigue, thinning hair, muscle (and joint) pain, poor nail health, dry skin, weight gain, depression, inability to withstand the cold, brain fog and many many more of the old familiar signs.
What of our own clients at CFM(UK), Ltd?
We have questionnaires to help you analyse your symptoms (courtesy of Arem, Shomon, Budd, and other authors). We have now evaluated a number of FM and CFS clients at our clinic (Centre for Fibromyalgia (UK), Ltd) and it is becoming clear to us that MH may be a factor we need to consider in helping them attain better health. We are now asking clients who appear to "fit the bill" (we do a thorough assessment on the basis of their medical history etc and put the facts together) to approach their GPs to have a simple blood test for "TSH" (thyroid stimulating hormone) and "Free T4".
Interpreting the Routine Clinical Test for Thyroid Activity
The results of this clinical test for thyroid activity are not always easy to interpret fully. For example, a person may well fall within the "normal" range, but what is "normal" for one may not be for another. Certainly, many patients with FM seem to fall into the "low normal" range and are struggling along without prescribed thyroxine because they are deemed "normal" - however low and however redolent their symptoms are of MH. Interpretation of test results requires a fair bit of medical know-how and depends also on factors such as age and general health variables. Sometimes, other more sophisticated tests can be ordered, and may help in a better diagnosis. However, it's certainly not worth going into the ins and outs of clinical tests for this article.
How Can we Help at CFM(UK), Ltd?
Very often I call on the wisdom of our medical advisors, and generally speaking the team members and I are getting to know the important figures and links, so that our team along with the help of our medical experts, are able to make reasonable interpretations of your test results and thus offer some valuable suggestions about how to go about improving thyroid levels where this is deemed appropriate. Very often members of our multi-disciplinary team can provide alternative tests to the routine clinical test that your GP might refer you for, and they may also help significantly by assisting you with natural thyroid supplements.
Many FM patients are told that their clinical test results are "normal", but it is important for us at the centre to have a copy of the actual figures involved in the test results. The case is more simple when a person is definitely hypothyroid according to the routine clinical tests. Then your GP will generally prescribe Thyroxine which is a synthesised or "man-made" drug , but one which is almost identical to the T4 hormone produced by the thyroid gland. This T4 is converted (or metabolised) mostly by the liver into the "active ingredient" called T3. The term active ingredient that I use here means that it is T3 that is the form of thyroid hormone responsible for helping a large number of organs in the body function properly.
When it all "looks" normal but isn't!
But the plot thickens! When is "normal" normal? For most humans and other mammals the conversion of T4 into T3 is a routine operation by a process called metabolism. However, occasionally patients have a metabolic problem in that they are unable to convert T4 into T3 and thus they are permanently short of the active ingredient - no matter how much synthesised thyroxine (T4) tablets they consume! . The result then is that even the prescribed thyroxine (which is T4, the less active ingredient) doesn't work, and they stay hypothyroid and their FM symptoms are correspondingly severe. If this is the case we at the centre have to think of alternative ways of helping someone raise their T3 levels, and we can help with this.
The first scenario of simple mild hypothyroidism (MH) then is that T4 production is low (albeit still in the "normal" range) and you have a reasonable chance of achieving improved health with prescribed thyroxine if your GP thinks this is appropriate. However, as many of our clients are finding, the course of recovery may be frustratingly slow and rocky. This type of MH (where test results indicate low normal thyroid activity) is amazingly common in older people, particularly WOMEN near, during, and after, the menopause. In the USA, top-selling author and MH sufferer, Mary J. Shomon believes that in total (men too) 13 million Americans are suffering from it. I believe that the same kind of proportionate figures apply to UK, taking the smaller population into account.
Nearer home, Martin Budd (best selling author AND member of our multi-disciplinary team) tells me that MH figures in UK are possibly the highest in Europe! Mr Budd certainly believes that MH is intimately involved in the development of conditions such as FM and Chronic Fatigue Syndrome. There could be many reasons for this and is a subject beyond the scope of this article. Suffice to say, we at the centre are not going to neglect the role of MH in our aim to plan for the best possible treatment of FM.
Many people have asked us "How did this happen? How did my thyroid stop functioning well?" There are many reasons and going into all those will make this article too long. But what is important to say is that the presumed causes for dysfunction of the thyroid are remarkably similar to the presumed causes of FM (e.g. surgical operations, viruses, trauma. etc.). That in itself is worth remembering. And we at CFM(UK),Ltd are willing to tackle some of the inherent problems of clinical test interpretation and will apply our skills to assist any FM sufferer with mild hypothyroidism in their aim (and ours) to attain significant improvements in their health. Again, we make no promises, but we will do our best to assist.
© Dr Margaret C. Stratton, BA (Hons), MSc, PhD, March, 2001
Clinical Director and Head of Research and Education, Centre for Fibromyalgia (UK), Ltd.
Rethinking the TSH Test: An Interview with David Derry, M.D., Ph.D. by Mary J. Shomon (copyright Mary Shomon, 2000-2001) http://thyroid.about.com, firstname.lastname@example.org
Mary Shomon: First, Dr. Derry, can you tell us a little bit about your interest in thyroid testing and treatment?
After about 3-4 years in practice I thought I would start to do my own research. I started with Vitamins. Amongst many other topics, I taught Vitamins at the University of Toronto and when Dr. Linus Pauling's book on Vitamin C and Cancer came out in 1970 I was asked by the Faculty of Medicine to present the essential material of the book to about 300 faculty members and students. Therefore, vitamins, their prophylactic and therapeutic use was a good place for me to start to investigate. So I investigated the use of vitamins for all manner of disease. Eventually after about 10 years I had fairly well exhausted every aspect of the therapeutic use of vitamins I could think of. By then I knew what you could do and couldn't do with vitamins.
Most of the patients were only too glad to help me with this and the ones who got better were very grateful. Since then I have slowly over the last 15-20 years developed an interest in thyroid problems. There are reasons for my interest in thyroid that are too long to tell. Gradually I obtained copies of all the relevant thyroid literature back to the 1883 Committee on Myxedema. I have a huge library on the thyroid literature consisting of about 5000 reprints and books. All of the old textbooks I copied and have them in my library for my use. All of this is computerized of course.
The consensus of thyroidologists decided in 1973 that the TSH (Thyroid Stimulating Hormone ) was the blood test they had been looking for all through the years. This was about two years after I started practice. Having been taught how to diagnose hypothyroid conditions clinically I was in a position to watch to see what the relation of the TSH was to the onset of hypothyroidism. What I found was many people would develop classic signs and symptoms of hypothyroidism but the TSH was ever so slow to become abnormal, rise and confirm the clinical diagnosis. Sometimes it never did. Finally I began treat patients with thyroid in the normal manner I was taught. I could not see why I had to wait for the TSH to rise for me to be able to treat them.
The main ingredient of thyroid hormone, which distinguishes it from other molecules of similar size (molecular size), was the element which made thyroid hormone namely iodine. So I did a thorough search of the literature on iodine. This review led me to try to use iodine and thyroid therapeutically. The TSH had caused all research on the therapeutic use of both of these substances to stop dead. My biochemical and pharmacological background has allowed me to search in areas of the literature that are impossible for a normal physician or even a specialist to explore.
If you remember it was a long time before the medical profession admitted that there were two new diseases to appear in the world that were not there before. Chronic fatigue and fibromyalgia were non-existent before 1980. This is seven years after the 1973 consensus meeting. So where did these two new diseases come from? The symptoms and signs of chronic fatigue and fibromyalgia were described in the literature in the 1930's as one way that low thyroid could be expressed. Treated early it was easily fixed with thyroid in adequate doses. But even then the clinicians had noticed that if a patient has low thyroid (chronic fatigue and fibromyalgia) for too long then it became more difficult to reverse all signs and symptoms regardless of what they were.
You indicated that you feel chronic fatigue and fibromyalgia are both hypothyroid conditions. There are some physicians who feel that these two conditions are manifestation of difficult to diagnose hypothyroidism, and yet other studies claim there is no relationship. Can you explain why you feel there is a connection among these conditions?
For many years the literature (before the TSH) supported the fact that if your symptoms responded to thyroid hormone you were low thyroid but especially if when you took the person off the thyroid and their symptoms returned. My own patients who develop chronic fatigue or fibromyalgia I treat them with thyroid and all --and I mean all-- of their symptoms disappear. IfI stop the thyroid or if they stop it for some reason all the symptoms start to slowly come back over the following months. You might ask do I do thyroid function tests? The answer is yes if for no other reason that I am curious to know what they look like in the face of the patient's obvious clinical diagnosis. The other patients who come to me from outside my practice respond roughly in proportion to how long they have had it. But I have had lots of pleasant surprises of people badly disabled by fibromyalgia or chronic fatigue for six years or more who slowly over 6 months to a year their symptoms completely disappear. It is of course a delight to see this happen.
What are the most common clinical hypothyroidism symptoms you've found most useful in making a diagnosis?
I gave a lecture on thyroid about three years ago and discussed this topic. The signs and symptoms list continues to grow as I learn more. Most people will have some form of fatigue but there is a group that are high output (read will-power) and low thyroid. These patients are not always thin. A good example I had was a 19-year old ballet dancer, while dancing for a national Ballet company, started to see a counselor for depression. She continued to dance with the company. There is no way a person that physicallyhealthy and that age with no previous history should be depressed except by low thyroid. But suspicions would be heightened when you know her mother and her sister have low thyroid conditions. Her TSH was raised above normal but the cure was the same regardless of whether the TSH was abnormal or not. She has been completely well since her low thyroid was corrected. All ballet dancers have enormous drive and self-control therefore they can ignore many symptoms and carry on. So people with strong will power can ignore many symptoms and signs for a long time.
To quote Dr. George Crile on hypothyroidism from his textbook in 1932 on The thyroid and its diseases. "In the advanced stage of the disease the patient may complain of almost any symptom which can result from a low metabolism. A summary of the literature discloses that symptoms referable to every organ in the body have been attributed to thyroid deficiency and have been relieved by the administration of thyroid extract." I now have a huge organized list of hypothyroid symptoms which I will not burden you with. Initially it was made for my lecture but I have been adding to it slowly since as I witness new signs and symptoms disappear with therapy.
People who have had terrible childhood experiences (sexual abuse, physical abuse, personal tragedies etc) for whatever reason have altered thyroid metabolism. They are more complex to treat. They are different from everyone else biochemically and pharmacologically. The blame for most of their residual difficulties is not with their brains and minds but with their chemistry. I believe also other areas of their biochemistry are not normal. I don't think this has been generally recognized yet.
What type of thyroid hormone replacement therapy do you favor? Levothyroxine, levothyroxine plus T3, or natural thyroid hormone replacement, and why?
I use any of the above. In Canada we have only Eltroxine (levothyroxine) or desiccated thyroid (Parke-Davis). T3 is available through specialty pharmacies but is not as readily available as in the US. If I don't get the response that I am looking for, I will often switch either way in order to try and make the patient better.
Mary Shomon: Are you practicing currently? How can patients arrange to see you? Do you do phone consults?
I have no intentions of retiring in the near future. Since I gave my two lectures three years ago on Breast cancer and Thyroid I have had close to 2000 new patients. Fortunately for me I have been able to help most of them so I don't have to go on seeing them. A fair number of patients come quite far. I have a bunch of patients who come from Alberta and one of these is a young lady from Calgary who flies to Victoria for each of her appointments. All who want to come can do so by booking through the office, at 250 478-8388. I would be too flooded to answer much over the phone. Also I am sure I couldn't diagnose and or treat anyone without meeting with them I need to follow people for several months after seeing them - but not often after that - as the thyroid works so slowly that you have to give it time.
At present I am writing a book on breast cancer. Hopefully it will be finished by year-end or before. After the breast cancer book I will write one on this topic.
David M. Derry M.D., Ph.D.
305 Goldstream Avenue
Victoria B.C. V9B 2W4
Comment from Dr Alex Allinson - Medical Director UK Fibromyalgia
"The above article by Dr Derry is factually correct in many respects, but draws inconclusive conclusions from anecdotal evidence. Whilst there is undoubted debate over the biochemical definition of thyroid disorders, to explain FM and CFS as purely a manifestation of hypothyroidism is to ignore the wealth of scientific evidence pointing towards other hypotheses. A small proportion of those with the symptoms of FM may have thyroid problems, but the definition of FM is based on a range of symptoms in biochemically normal people. Unrestricted use of thyroid hormones carries potential problems, and I know of no UK Doctors who would prescribe thyroxine to someone with normal blood test results."