January 22, 2004

Question: I've been on 60 mg of Armour Thyroid for six weeks. The only change I’ve noticed is that my skin isn’t as dry. I feel "buzzy" earlier in the day, and since December 31, I’ve had a headache. On the 6th of January, I had lab work done. My TSH level was very high at 6.59. At this point I’d like to know if my headaches could be because of my high TSH level?

Dr. Lowe: I know of no means by which your high TSH level could cause your headaches. It's possible that they’re caused by the excess muscle tension that undertreated hypothyroidism often causes—in your case, tension of neck and upper back muscles. Your high TSH level, of course, certainly suggests that your hypothyroidism is undertreated. Obviously, 60 mg of Armour isn’t enough for you.

Some people are confused when I explain that many hypothyroid patients have excess muscle tension. To them, it seems that the low energy level of hypothyroid patients would leave them with too little energy to maintain excess muscle tension. It’s a paradox, but it is the low muscle energy in hypothyroid patients that causes the excess tension.

Consider the stiffening of the body after death called rigor mortis. The body stiffens because the depletion of energy in all body muscles causes them to shorten. The body stays stiff until muscle proteins begin deteriorating, and then the body becomes lax. The paradox is that muscles need energy to relax. When muscle energy is low enough, muscles can’t completely relax and they maintain an excess degree of tension.

Trigger points in muscles are like small, localized areas of rigor mortis. When hypothyroidism decreases energy metabolism, trigger points often form in many muscles and refer pain. The small caliber muscles of the neck and upper back are highly susceptible to forming trigger points that refer to the neck and head. The trigger points are usually resistant to even skilled trigger point therapy, and so the patient has chronic pain.

It's most likely, then, that it's not your high TSH that's causing your headaches. It's more likely to be excess muscle tension, trigger points, or both. If one or both are the cause, only effective thyroid hormone therapy will enable you to completely stop them. But effective thyroid hormone therapy probably won’t be enough. Most likely, you’ll also need effective trigger point therapy to thoroughly relax your muscles and desensitize your trigger points.

I suggest you read over our section on myofascial pain at drlowe.com, and then seek a referral from the National Association of Myofascial Trigger Point Therapists. Their website is: www.MyofascialTherapy.org. You can contact them by email at info@myofascialtherapy.org, or by phone at (800) 845-3454.