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Fibromyalgia: What Is
It?
[Q&As are placed in reverse chronological
order. In other words,
the latest Q&As come first. Earlier ones are further down the
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October 12, 2010
Question: Are
fibromyalgia and hypothyroidism really linked? I think that they are. I have
fibromyalgia and I also have weight gain, although I eat very little and
have body swelling and many other symptoms of hypothyroidism. Conventional
thyroid lab tests come back as normal, but I know in my gut I have a real
thyroid problem. How can I get a more sophisticated, discerning thyroid
testing done? I am in the UK? Thank you very much for your time.
Dr. Lowe: Most patients’ fibromyalgia is
definitely related to too little thyroid hormone regulation! For those
patients, what we call “fibromyalgia” is largely a set of symptoms that
develops from too little thyroid hormone regulation. The two essential
symptoms are chronic widespread pain and abnormal tenderness. However, the
so-called “associated fibromyalgia symptoms”[1,2] are
each classic hypothyroid symptoms.
Some patients’ inadequate thyroid hormone regulation occurs because of they
have thyroid hormone deficiencies; for others, it occurs because of they
have partial cellular resistance to thyroid hormone. In either case, the
predominant symptoms can be widespread pain and tenderness. However, many
fibromyalgia patients’ symptoms are worsened by lifestyle factors such as
nutritional deficiencies and a pro-inflammatory diet, and various
prescription drugs.
The “more sophisticated, discerning” tests you ask about are for the most
part not laboratory tests, although for some patients, various lab tests can
be helpful. But the conventional laboratory thyroid function tests (TSH,
free T3, and free T4) are largely useless unless one or more of the levels
is way out of range.
The important points are these: In-range TSH, free T3, and free T4 levels
simply cannot logically rule out that a patient needs thyroid hormone
therapy. And when a patient is undergoing thyroid hormone therapy, these
test levels are not accurate gauges of the effectiveness of the therapy.
You said your thyroid lab tests were within range. Because of that, were I
you, I wouldn’t waste time undergoing more of the conventional tests.
Instead, I would look for a clinician who’ll listen to me, look at me,
physically examine me, and do physiological (such as your Achilles reflex
speed and the voltage of your ECG/EKG) and limited, meaningful lab tests.
You’ve apparently tried to get an accurate diagnosis from physicians who
lack skills at what’s called “pathognomy” (pa thog’ no mē). This term
means the study and knowledge of the symptoms and all other characteristics
of a disease. The term comes from the Greek for “skilled in judging
disease.”
When you find a competent physician, he or she will practice pathognomy.
Years ago, I invented the term “extremist medical technocrat” during an
interview with Mary Shomon. What I meant by this term is that most
conventional physicians don’t practice pathognomy; instead, they practice a
extreme medical technocracy. That is, they focus solely on lab test results,
stair into their computers screens rather than you without giving you so
much as a glance or permitting you to express yourself. In my view, for a
physician to fail to embrace and practice pathognomy is to forsake his or
her patients, such as you.
Laboratory thyroid function tests tell us nothing whatever about whether a
person’s tissue metabolism is sufficient regulated for the person to be
healthy. They tell us nothing whatever about a patient's
thyroid-hormone-related general metabolic status. Thyroid patient advocates
at Thyroid UK are a caring resource for people such as you in the UK. I
encourage you to contact them. Their organization’s contact information is
at their website:
http://www.thyroiduk.org.uk/tuk/index.html
You can learn a great deal about the relation of fibromyalgia to thyroid
hormone by reading some of the hundreds of webpages at www.drlowe.com. But I
especially encourage you to read a
review paper Jackie Yellin and I wrote a
couple of years ago for Thyroid
Science.[3] It the paper, we summarized the evidence that
inadequate thyroid hormone regulation is the main underlying factor of most
patients' fibromyalgia. It’s likely that seeing the evidence will turn your
suspicion that fibromyalgia and thyroid hormone are linked into an steadfast
belief.
I hope this reply is helpful to you, and I wish you the best for soon
recovering your health.
References
1. Wolfe, F., Smythe, H.A., Yunus, M.B. et al.: The
American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis
Rheumatol., 33:160-172, 1990.
2. Wolfe, F.: Diagnosis of fibromyalgia. J.
Musculoskeletal. Med., 7:54, 1990.
3. Lowe, J.C. and Yellin, J.:
Inadequate thyroid hormone regulation as
the main mechanism of fibromyalgia: a review of the evidence.
Thyroid Science, 3(6):R1-14, 2008.
Continued at
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September
23, 2002
Question: My endocrinologist
said that he doesn't really think that I have fibromyalgia. His reason is
that I my fibromyalgia symptoms started suddenly after I injured my neck by
turning it too quickly. Have you had any patients whose fibromyalgia
symptoms started suddenly after an injury?
Dr. Lowe:
According to some studies, about 30% of patients' fibromyalgia symptoms are
"post-traumatic." This means that their symptoms began either at
once or shortly after a trauma. Obviously, a sudden onset of
fibromyalgia symptoms is fairly common.
In The Metabolic Treatment
of Fibromyalgia, I gave the a plausible explanation for the sudden
onset of fibromyalgia symptoms following a trauma. When I carefully
scrutinized many patients' medical histories, I came to a tentative
conclusion: The typical patient with post-traumatic fibromyalgia symptoms
has a history of marginally adequate metabolism. The marginally adequate
metabolism is suggested by experiences the patient commonly reports after
some contemplation—intermittent hypothyroid-like symptoms, especially
after or during physical and emotional stresses.
As a part of stress—either physically or emotionally induced—the
adrenal glands release more "cortisol." Cortisol is a hormone that
helps the body adapt to cellular needs that abruptly change during stress.
The blood cortisol consequently rises. The increased cortisol transiently
suppresses the thyroid system. Increased cortisol reaching cells of the
pituitary gland suppresses TSH secretion. As a result, the reduced TSH
reaching the thyroid gland decreases the glands' release of thyroid hormones
into the blood. The increased cortisol reaching other cells inhibits their
conversion of T4 to T3. The result is a body-wide slowing of thyroid
hormone-driven metabolism.
In most people, the slowed metabolism might not generate fibromyalgia
(hypothyroid) symptoms. But some patients’ metabolism was only marginally
adequate to start with. Slowing their metabolism even more can induce
symptoms typical of hypothyroidism, which doctors diagnose as fibromyalgia.
Most clinicians today fail to recognize these symptoms as those of
hypothyroidism. This is especially true of most endocrinologists, who over
the past 30 years have all but lost the ability to recognized hypothyroid
symptoms for what they actually are. Hence, the patient may end up with a
diagnosis of post-traumatic fibromyalgia. The correct diagnosis, however,
would be hypo-metabolism secondary to post-traumatic hypothyroidism.
It's important to note that if the patient's cortisol level stays high,
her thyroid system usually "escapes" the inhibiting effect of the
cortisol. The escape usually occurs within a few weeks. But the injured
patient, especially if her injury was severe, is likely to be relatively
inactive physically for a few weeks. She may even be inactive for a few
months. Her low physical activity during this time is likely to reduce
her body's muscle mass. The reduction in mass will lower her metabolism even
further. Keep in mind: Other factors held constant, our metabolic rate is
proportional to our muscle mass. Even a small loss of muscle mass in a
patient with marginally adequate metabolism may reduce her metabolic rate
enough to produce chronic symptoms of abnormally slow metabolism.
In my experience, many fibromyalgia patients come to realize they've long
had symptoms of slow metabolism only after learning what the symptoms are.
Their realization often occurs after they've recovered a noticeable degree
of metabolic health. Experiencing good metabolic health teaches them to
distinguish good from poor metabolic health.
Is this mechanism of post-traumatic fibromyalgia established
scientifically? No, it's not. But it's reasonable based on the available
scientific evidence, and it’s presently our only plausible explanation.
Certainly it deserves investigation. You, of course, are the best person to
decide whether the mechanism applies in your case. Regardless, understanding
the mechanism can help one to see how some patients’ fibromyalgia symptoms
might start after an injury. Perhaps you can share this causative conjecture
with your endocrinologist. Perhaps he’ll then appreciate the fact that
some patient’s fibromyalgia symptoms are post traumatic and do develop
suddenly.
November 5, 2000
Question:
My doctor and I are hoping that you will soon solve the problem of
fibromyalgia. How much longer do you think it will take?
Dr. Lowe:
The time has passed. We’ve already solved the problem of fibromyalgia. In
addition, we have a treatment, "metabolic rehabilitation", that
relieves some 75% to 85% of patients from their fibromyalgia symptoms—fully
and permanently. I explain the solution and the treatment succinctly on
various pages of drlowe.com, and I explain in depth in The Metabolic
Treatment of Fibromyalgia. In a single statement, fibromyalgia is the
symptoms and signs of too little thyroid hormone regulation of tissues, due
either to hypothyroidism or thyroid hormone resistance, complicated in most
cases by a health-impairing diet, nutritional deficiencies, and physical
deconditioning.
But it isn’t enough that we’ve solved the
scientific problem of fibromyalgia. We must now solve a daunting
psychosocial problem—how to educate other fibromyalgia researchers and
practicing doctors about the fact that we’ve solved the problem. This
educational undertaking is proving far more difficult than solving the
scientific problem. The main difficulty is the unscientific code of conduct
that predominates in conventional medicine. In compliance with this code,
most conventional medical researchers and doctors dogmatically cling to
false beliefs they’ve accepted without question while bowing before the
throne of medical authority. This unscientific code of conduct is often
whitewashed as the "conservative nature of doctors." It is,
however, a major obstacle to the relief of human suffering from disease.
Tragically, as we toil at this educational task, patients with the set of
symptoms we label "fibromyalgia" will continue to suffer on a
worldwide scale.
© 2011 Dr. John C.
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