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Dr. Lowe How to Prepare Patient-to-Patient Fibromyalgia Research Foundation
The Metabolic Treatment |
November 18, 1998 Have you, in your extensive work with the links between fibromyalgia and thyroid dysfunction, come across this before? Also, is there something in particular in my regular blood work that I should look for, besides the normal thyroid screen? My endocrinologist usually orders a total T3 and T3 uptake, T4(thyroxine), and TSH. I don't know if this is important, but I have been in remission without using medication for 10 months, but last time, the doctor said it looked like the levels were rising again. I really appreciate your time. I'm very confused and worry about spending so much money (no insurance) when there may be something else entirely wrong with me. Dr. Lowe: By "hyperthyroidism," I assume you mean that your endocrinologist found laboratory evidence of (1) an overly active thyroid gland (such as a high titer of thyroid-stimulating antibodies) and (2) elevated circulating thyroid hormone levels. If he or she diagnosed your hyperthyroidism according to such laboratory evidence, I doubt that you also simultaneously have fibromyalgia. I have never seen a patient with both documented hyperthyroidism and fibromyalgia. On both theoretical and practical grounds, I believe the two conditions are incompatible. A clinician may, however, wrongly believe that a patient who is "thyrotoxic" has fibromyalgia. The word "thyrotoxic" refers to tissue overstimulation by excess thyroid hormone. Hyperthyroid patients usually have thyrotoxic muscles. (So do hypothyroid patients who are overstimulated by taking too much thyroid hormone medication.) Weakness is the main symptom of thyrotoxic muscles, and some patients also have muscle pain. It is the patient with both muscle weakness and pain that the clinician may mistakenly diagnose as having fibromyalgia. Pain is the hallmark of fibromyalgia, and most patients also have chronic fatigue. A misdiagnosis is likely if the thyrotoxic patient describes her muscle weakness as fatigue rather than weakness. The clinician may mistakenly consider this evidence of fibromyalgia. The muscle weakness of the thyrotoxic patient, however, is easily distinguished from the general fatigue and low motor drive of the fibromyalgia patient. The fibromyalgia patient’s muscles are usually not weak in relation to her level of physical conditioning. Clinicians, including rheumatologists, must be careful to make this distinction or risk making a misdiagnosis of fibromyalgia. Other than this possibility, I don’t know how to
reconcile your description of having both hyperthyroidism and fibromyalgia at the same
time. Based upon my clinical and research experiences, I believe it is highly unlikely
that you have both conditions. References
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