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Fibromyalgia, Hypothyroidism, Thyroid Hormone Resistance

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The Metabolic Treatment
of Fibromyalgia
by Dr. John C. Lowe
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Other Published Papers

! Lowe, J.C. and Yellin, J.G.: Inadequate Thyroid Hormone Regulation as the Main Mechanism of Fibromyalgia: A Review of the Evidence. Thyroid Science, 3(6):R1-14, 2008.

! Lowe, J.C., et al.: Lower resting metabolic rate and basal body
temperature of fibromyalgia patients compared to matched healthy controls.
Thyroid Science. 1:CLS1-24, 2006.

ABSTRACT. Introduction: All symptoms and most objectively verified abnormalities of fibromyalgia are common among patients with hypothyroidism or partial peripheral thyroid hormone resistance. In treatment trials, thyroid hormone therapy has reduced or eliminated fibromyalgia symptoms, and a long-term follow-up study showed that improvement with thyroid hormone therapy lasted 1-to-5 years. In a previous study by the authors, solicited female fibromyalgia patients had significantly lower resting metabolic rates and basal body temperatures than matched healthy controls. In this study, the resting metabolic rates and body temperatures of fibromyalgia patients previously evaluated at a specialty metabolic clinic were compared with healthy controls to whom they were matched.

Methods: Fifteen female fibromyalgia patients and 15 healthy females served as study subjects. Patients were clinical cases selected to match controls by sex, age, weight, and activity level. Resting metabolic rate (RMR) was measured by indirect calorimetry (MedGem®), basal body temperature with digital thermometers, and body composition by bioelectrical impedance. The mean measured resting metabolic rate (mRMR) was compared to percentages of the mean predicted RMR (pRMR) by two methods: fat-free weight (Sterling-Passmore equation: SP) and sex, age, height, and weight (Harris-Benedict and Mifflin-St. Joer equations: HB and MSt.J). Measurements were taken during the follicular phase of subjects’ menstrual cycles.

Results: Patients had a lower mean mRMR (939.70 ± 216.04 kcal/d vs 1293.40 ± 166.34 kcal/d, p = 0.00001) and lower mRMRs as percentages of pRMRs (SP: -26.91 ± 13.36% vs -6.826 ± 12.55%, p < 0.0001. HB: -32.45 ± 13.48% vs -9.13 ± 9.51%, p = 0.0001; MSt.J: -27.96 ± 14.53% vs -5.089 ± 11.30%, p = 0.0002). Age and fat-free weight accounted for 62% of variability in controls’ mRMRs. Fat-free weight, water as a percentage of body weight, and fibromyalgia symptom intensity accounted for 83% of the variability of patients’ mRMRs. Patients’ mean basal body temperature was significantly lower than that of controls (96.38 ± 0.98 F vs 97.54 ± 0.59 F, p = 0.001). Patients’ serum free T3 level was significantly lower than that of controls (3.18 ± 0.559 vs 3.75 ± 0.717 pg/mL, p = 0.023).

Conclusions: The patient group had a lower mean mRMR and lower mRMR as percentages of pRMRs. Patients also had a significantly lower mean basal body temperature. Neither calorie restriction nor low fat-free weight accounted for patients’ lower RMRs. As in the previous study, fibromyalgia patients’ normal fat-free weight argues against low physical activity with poor physical fitness as the mechanism of their low RMRs. Free T4, free T3, and TSH levels did not correlate with fibromyalgia measures or RMRs in either patient or control group. The lack of correlation does not rule out inadequate thyroid hormone regulation as the mechanism of the low RMRs because studies have not shown that these laboratory values reliably predict RMR values.

! John Lowe, Jackie Yellin, et al.: Female fibromyalgia patients: Lower resting metabolic rates than matched healthy controls. Medical Science Monitor. 12(7):CR282-289, 2006.

Background: Many features of fibromyalgia and hypothyroidism are virtually the same, and thyroid hormone treatment trials have reduced or eliminated fibromyalgia symptoms. These findings led the authors to test the hypothesis that fibromyalgia patients are hypometabolic compared to matched controls.

Material/Methods: Resting metabolic rate (RMR) was measured by indirect calorimetry and body composition by bioelectrical impedance for 15 fibromyalgia patients and 15 healthy matched controls. Measured resting metabolic rate (mRMR) was compared to percentages of predicted RMR (pRMR) by fat-free weight (FFW) (Sterling-Passmore: SP) and by sex, age, height, and weight (Harris-Benedict: HB).

Results: Patients had a lower mRMR (4,306.31+/-1077.66 kJ vs 5,411.59+/-695.95 kJ, p=0.0028) and lower percentages of pRMRs (SP: -28.42+/-15.82% vs -6.83+/-12.55%, p3 (FT3) accounted for 30% of the variance in pressure-pain threshold.

Conclusions: Patients had lower mRMR and percentages of pRMRs. The lower RMRs were not due to calorie restriction or low FFW. Patients' normal FFW argues against low physical activity as the mechanism. TSH,FT4, and FT3 levels did not correlate with RMRs in either group. This does not rule out inadequate thyroid hormone regulation because studies show these laboratory values do not reliably predict RMR.

http://www.medscimonit.com/abstracted.php?level=4&id_issue=40182

When you reach the page at Medical Science Monitor, scroll down to the second paper under "Clinical Research".

! Ultrasound treatment for trigger points: differences in technique for myofascial pain syndrome and fibromyalgia patients. Dr. John C. Lowe et al.: Lyon Méditerranée Médcal: Médecine du Sud-Est. (Avril-Mai-Juin) No.2:12-15, 1999.

(French and English abstracts below)

Abstract (French): Les auteurs rapportent leur expérience sur le traitement par ultra-sons au cours des syndromes myofasciaux (MPS) et des fibromyalgies (FMS). Les points-gachette des MPS sont traités par ultra-sons en continu, dont les paramètres (intensité: 1-1,5 w/cm², vitesse de déplacement: 1,2--2,5 cm/s, durée: 4 à 5 mn) sont modulés en fonction des réactions du patient. Les ultra-sons doivent être utilisés sur un muscle en discrète élongation et une application de chaleur humide doit être effectuée en fin de séance. Le traitement des FMS comporte un aménagement des paramètres avec une intensité beaucoup plus faible, une vitesse de déplacement plus rapide et une durée plus longue (4 à 10 mn), mais les ultra-sons ne représentent qu'une partie de la prise en charge de cette affection.

Abstract (English): The authors report their experience with the ultrasound treatment of trigger points (TPs) in myofascial syndromes (MPS) and fibromyalgia (FMS). The trigger points of myofascial pain syndrome are treated by continuous ultrasound (intensity: 1-1.5 w/cm², movement speed: 1.2 - 2.5 /cm, time: 4 to 5 minutes), modulated according to the patient’s reactions. The muscle being treated should be in a moderate degree of stretch, and moist heat should be applied after the ultrasound treatment. The treatment of TPs in most FMS patients requires a lower ultrasound intensity, possibly quicker movement of the ultrasound transducer over the skin, and a longer application of the ultrasound (4 to 10 minutes). Again, the treatment should be modulated according to the patient’s reactions. Ultrasound, however, represents only a part of the treatment that is appropriate for TPs in FMS.

(For a reprint of this paper by Dr. John C. Lowe and Dr. Gina Honeyman-Lowe, please contact the publisher: Editions Galliena: Tél: 01-53--36-01-80. Fax: 01-53-36-01-64.
E-mail: galliena@club-internet.fr )

! Fibromyalgia and thyroid disease. Dr. John C. Lowe. Presented and discussed in Grenoble, France, May 6 (conference of the French Fibromyalgia Association of Région Rhône-Alpes) and in Toulon, France on May 11 (at the Centre Hospitalier Intercommunal), 2000. Published: Lowe, J. C. et al.: Thyroid disease and fibromyalgia syndrome. Lyon Méditerranée Médical: Médecine du Sud-Est., 36(1):15-17, 2000.
Full Text of Article: http://www.drlowe.com/france.htm