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Swelling
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November
12, 2002
Question: I attended your seminar
in the Seattle-area a couple of months ago. At the seminar, you mentioned
a word doctors once used to describe puffiness in hypothyroid patients.
You said that in the past, doctors used the puffiness to diagnose
hypothyroidism and that many fibromyalgia patients also have the
puffiness.
Will you let me know how to spell the word so that I can find
information on it? I’m interested because of something that’s happened
to me since I started using thyroid hormone after your seminar. Before I
started thyroid hormone, I had puffy, swollen places below my knees. These
have now disappeared—which is just wonderful! Any help you can give me
will be very much appreciated.
Dr. Lowe:
In the early part of the 20th century, doctors believed that
all hypothyroid patients had the tissue puffiness, and they used the
puffiness as a diagnostic sign of hypothyroidism. The term doctors used
back then is the same one we now today: "myxedema."
In the 1930s, researchers showed that only
a small percentage of hypothyroid patients have the puffiness. Similarly,
only a small percentage of fibromyalgia have myxedema. Some of the
fibromyalgia patients are hypothyroid, and others are partially resistant
to thyroid hormone. In either case, when the patients reach effective
doses of thyroid hormone, the swelling disappears, usually with a week or
two.
The puffiness is caused by too little thyroid hormone suppression of
connective tissue cells called "fibroblasts." When thyroid
hormone fails to suppress the cells normally, they release too many
water-binding molecules into the ground substance of the skin and other
connective tissues. These water-binding molecules are a complex of protein
and sugar. Researchers used to call them "mucopolysaccharides,"
but most of us now call them "glycosaminoglycans." The excess
number of the molecules holds too much water in the connective tissues.
The excess water expands the tissues, causing them to feel and appear
puffy. This is the basis of carpal tunnel syndrome
in hypothyroidism; the ligament that surrounds the wrist swells and
compresses the median nerve. Compression of the nerve induces the carpal
tunnel symptoms. Subtle myedematous swelling most likely accounts for the
"subjective" swelling that many fibromyaglia researchers report
that patients complain of.
That the puffiness beneath your knees (a common site for the swelling)
has disappeared is indeed a positive sign. This makes it likely that too
little regulation by thyroid hormone is the cause of your other
"fibromyalgia" symptoms and signs. With the disappearance of the
swelling, it’s now reasonable for you to expect other positive changes
to soon occur from your use of thyroid hormone.
May 22, 2001
Question:
For many years now my hands, face, feet, and I think
maybe overall body (because of the way I feel) swell. My hands swell so
badly that the knuckles are white, and wearing a wedding ring is impossible
because of the serious indentation left when I swell. It comes and goes
throughout the day, but in the morning when I awake, I’m miserable. My
face becomes 'bloated' sometimes, and under my eyes are deep, dark circles,
as if I were sleep deprived. My physician tested my thyroid but said
the results were normal. I read your statement that someone may have a
thyroid problem even though her thyroid tests are normal. What do you think
is my problem?
Dr. Lowe:
In the early part of the 20th century, tissue swelling (called "myxedema")
was the main sign doctors used to decide that a patient was hypothyroid.
Of course, too little thyroid hormone regulation isn't the only cause
tissue swelling. It is important to learn the underlying cause of the
swelling and to treat it properly.
Unfortunately, I don't have enough
information on you to give an opinion about the cause of your swelling.
However, many people who have normal thyroid test results also have too
little thyroid hormone regulation of cells in their connective tissues
called "fibroblasts." A result of the inadequate regulation of
these cells is the perception of tissue swelling or actual swelling. In
some people, connective tissue swelling leads to regional problems. For
example, the tendons and ligaments in the wrist may swell, compress the
median nerve, and cause the symptoms known as "carpal
tunnel syndrome."
With actual swelling, the patient’s skin
usually looks puffy. But the swelling is "non-pitting." This
means that pushing a finger into the swollen skin and quickly removing it
doesn't leave a pit (indentation) in the skin. You wrote that your wedding
ring leaves an indentation around your finger. This may mean that your
swelling involves fluid retention unrelated to thyroid hormone regulation
of your fibroblasts.
That your thyroid test results are
"normal," however, does not mean that you have adequate
thyroid hormone regulation of your tissues. Many people who have so-called
"normal" blood levels of TSH and thyroid hormone nonetheless
have less-than-normal tissue responses to thyroid hormone. The result is
that the people have symptoms and signs similar to those of the
hypothyroid patient. Tissue swelling can be one of the sign.
Your best bet is to find an alternative
doctor who uses patients' symptoms and signs in his assessment of whether
they have enough thyroid hormone regulation of their tissues. If you have
other symptoms and signs that suggest inadequate thyroid hormone
regulation, the doctor may give you a trial of thyroid hormone therapy to
see if this reduces or relieves your swelling—even though the results of
your thyroid hormone tests are "normal."
Continued at
top of right column . . .
