! Results of an open trial of T3 therapy with 77 euthyroid female fibromyalgia patients. John C. Lowe, MA, DC: Clinical Bulletin of Myofascial Therapy, 2(1):20, 1996.

Abstract. Lowe and coworkers reported a 1990-1991 open trial by Lowe and Poo of 77 euthyroid female fibromyalgia syndrome (FS) patients treated with a regimen based on the use of T3. Data from that trial are quantified in this abstract.

Patients ranged in age from 21-to-49. Dosages of T3 that patients and clinicians considered effective ranged from 75 µg to 150 mcg (normal replacement doses range from 25-to-75 µg). Most patients required between 81.25 mcg and 100 µg. Patients, in addition to taking T3, were instructed to follow a treatment regimen that included lifestyle changes (see # 1 below).

Average pressure/pain thresholds of the 18 tender points were measured with algometry before and after treatment. Post-treatment increases in algometer scores were considered to signify improvement only if they equaled or exceeded 1 kg/cm². Also, patients were asked to rate recurrent experiences with FS symptoms after variable lengths of treatment. Of the 77 patients, 58 (75.32%) had post-treatment increases in algometer scores of 1 kg/cm² or more, and reported that they benefited from treatment to varying degrees. Nineteen patients (24.67%) had scores that increased less than 1 kg/cm² after treatment.

A t-test for paired samples was performed on the algometer scores of the 19 patients whose scores had increased less than 1 kg/cm² after treatment. The difference between pre- and post-treatment scores was significant (p=0.01). The difference between pre- and post-treatment scores of the remaining 58 patients was highly significant (p<0.0005). When all 77 sets of pre- and post-algometer scores were combined and tested, the difference was still highly significant (p<0.0005). The pressure/pain thresholds of the 18 tender point sites of the group of 77 patients, therefore, were significantly higher (improved) after T3 treatment.

The 19 patients who did not judge that T3 had improved their status were withdrawn from the hormone and no data were collected on recurrences of FS symptoms. The remaining 58 patients were asked to estimate any recurring FS symptoms as none, mild, moderate, or severe. Outcome: none, 23 patients (39.66% of the 58); mild, 21 (36.20% of 58); moderate, 11 (18.97% of 58); and severe, 3 (5.17% of 58).

The most important lessons of protocol gleaned from this trial are that the FS patient benefits most when:

The factors most common to patients who did not benefit from T3 were abstention from aerobic activities and lack of B complex vitamin supplementation.

Data from this and other open trials suggest that a treatment regimen based on T3 use may be effective with euthyroid FS patients.

! Improvement in euthyroid fibromyalgia patients treated with T3 (triiodothyronine). John C. Lowe, MA, DC, et al.: Journal of Myofascial Therapy, 1(2):16-29, 1994.

Abstract. Four patients with fibromyalgia syndrome (FMS) were treated on a case study basis with T3 (Cytomel) and a physical regimen. Weekly or biweekly monitoring continued for approximately one year. Three patients took supraphysiologic doses of T3 and another took a replacement dose. Each patient's mean algometer score (the mean of the quantified pressure/pain thresholds of her 18 tender point sites) improved significantly. Two patients' algometer scores reached and remained well within the normal range. One other patient's scores reached normal and then remained slightly subnormal although markedly higher than her baseline score. The other patient's scores approached normal. Each patient's symptoms significantly improved. Two patients had almost complete relief of symptoms, one retained mild symptoms, and another patient, after some symptom relief, began experiencing severe symptoms including widespread pain. Our uncontrolled observations suggest that supraphysiologic doses of T3 override an underlying neuromuscular molecular abnormality in some FMS patients.

! T3-induced recovery from fibromyalgia by a hypothyroid patient resistant to T4 and desiccated thyroid. John C. Lowe, MA, DC: . Journal Myofascial Therapy, 1(4):26-31, 1995.

Abstract. The main purpose of this case report is to illustrate a clinical observation common to me: that fibromyalgia syndrome (FMS) patients with central hypothyroidism who fail to benefit from T4 or desiccated thyroid completely recover when they switch to T3. A similar observation was reported by numerous researchers in the 1950s, after the discovery and synthesis of T3. Changing status in the patient was evaluated in three ways: a psychiatrist used a depression inventory, a physical therapist performed functional musculoskeletal assessments, and I performed algometer tender point exams and monitored symptoms. I hope the description of the management of this case, in which the patient fully recovered from FMS symptoms, provides a protocol that other clinicians will use with FMS patients similar to the one who is the subject of this report.