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The Metabolic Treatment
of Fibromyalgia
by Dr. John C. Lowe
Readers' Comments
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Do You
Have Signs
of Hypothyroidism or
Thyroid Hormone Resistance?
Dr. John C. Lowe
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On February 24, 2003, we posted to drlowe.com
a list of the most common symptoms of hypothyroidism and thyroid
hormone resistance. Since we posted the list, it's been one of the most visited
pages on drlowe.com.
The popularity of the symptom list
has prompted us to now provide a list of the most common
"signs" of hypothyroidism and thyroid hormone resistance.
Some readers may not be familiar with the distinction doctors make
between "symptoms" and "signs," so we’ll
briefly explain.
Both symptoms and signs are
abnormalities that suggest that a patient has a particular disorder,
or one of several possible disorders. But what we consider a symptom
differs from what we consider a sign.
A symptom is an abnormality the
patient is experiencing but that others can’t observe and
independently verify. For example, fatigue is a symptom. It's an
inner or subjective experience of the patient. Other people may have
the impression that the patient is lacking in energy, but they can’t
directly observe the fatigue and confirm that the patient is
experiencing it.
In contrast, a sign is an abnormality
the patient is experiencing and that others can observe and
independently confirm. Dry, scaly skin is a sign. The patient can
show it to her doctor, and the doctor is likely to remark,
"Yes, your skin is dry and scaly, isn’t it."
Beware, however: There's a good
chance your doctor won't know that dry, scaly skin and numerous
other signs are characteristic of hypothyroidism or thyroid hormone
resistance. You may have to teach him what the signs are. And you'll
most likely have to describe tests he can do to detect signs, such a
slow relaxation phase of the ankle reflex, and low voltage on the
QRS complex of your electrocardiogram.
The possible need to educate your
doctor about symptoms and signs is a disgraceful legacy of the
endocrinology specialty of the last 30 years. The specialty is
responsible for abbreviating most doctors’ knowledge of
hypothyroidism to three false beliefs: (1) the only form of thyroid
hormone any patient should take is T4 (thyroxine), (2) doctors
should adjust their patients’ dosage according to their TSH
levels, and (3) symptoms and signs are of no value in diagnosing or
treating hypothyroidism.[1]
But alas, you can correct the problem: You can enlighten your doctor
about symptoms and signs, and by doing so, lead him from the dark
age of medicine wrought by the endocrinology specialty.
Keep in mind that other disorders can
cause signs typical of hypothyroidism and thyroid hormone
resistance. Because of this, it’s important not to rush to
judgement and conclude that a thyroid disorder is the cause of your
signs. Your doctor should help you distinguish the cause of your
signs. For most patients, if no other disorder appears to be the
cause, it’s reasonable to do a trial of thyroid hormone therapy
anyway. Except for the rarest patient, a trial is justified, for
even if it doesn’t relieve the patient’s signs, it's harmless
when done with reasonable precaution. And, of course, the trial may
confirm the diagnosis by relieving the patient’s signs.
As I (JCL) wrote in The
Metabolic Treatment of Fibromyalgia,[1,p.837&839]
you should keep in mind that some signs may be extremely subtle.
They may be so subtle that your doctor and you are certain you had
them only in their absence after you reach an effective dose of
thyroid hormone. An example is the dull, listless appearance of some
patients’ eyes, replaced after therapy with a bright radiance.[2]
In the list below, we’ve used
researchers’ wording as much as possible, but we've reworded
terms for some signs to make them more understandable. We hope you
find the list helpful.
41
Most Commonly Reported Symptoms of Hypothyroidism*
|
| o
Dry skin |
o
Weight gain unexplainably |
| o
Thick, scaling skin |
o
Hoarseness |
| o
Coarse skin |
o
Low basal & activity level
temperature |
| o
Fineness of hair |
o
Protrusion of one or both eyeballs (exophthalmos) |
| o
Dry, coarse, brittle hair |
o
Slow speech |
| o
Sparse eyebrows, especially outer ends |
o
Slow pulse rate despite low physical fitness |
| o
Hair loss |
o
Slow thinking |
| o
Brittle nails |
o
Sluggish movement |
| o
Dry ridges down nails |
o
Slow relaxation phase of
the knee or ankle reflex
|
| o
Cold skin |
o
Listless, dull look to eyes |
| o
Swelling of face (edema) |
o
Wasting of tongue |
| o
Swelling around the eyes (edema) |
o
Nervousness |
| o
Swelling of eyelids (edema) |
o
Rapid heart rate with weak force of contraction |
| o
Nonpitting edema of ankles |
o
Slow heart rate despite low
aerobic fitness |
| o
Fluid accumulation in abdomen (ascites) |
o
Pounding heart beat |
| o
Thick tongue |
o
Cardiac enlargement on x-ray |
| o
Swelling of ankles |
o
Indistinct or faint heart tones |
| o
Paleness of skin |
o
Low QRS voltage on ECG |
| o
Paleness of lips |
o
Long-normal intervals on ECG |
o
Bluish or purplish coloration of the skin,
nail beds, lips, or mucous membranes
(cyanosis)
|
o
Fluid around heart (pericardial effusion) |
| o
Changes at the back of the eye
(at fundus oculi) |
* After
L.J. DeGroot, P.R. Larsen, S. Refetoff, and J.B. Stanbury, The
Thyroid and Its Diseases, 5th
edition. New York, John
Wiley & Sons, Inc. 1984, pp.577-578.
* R.L. DeGowin and E.L. DeGowin, Bedside
Diagnostic Examination, 3rd edition. New York,
MacMillan Publishing Co., Inc., 1976, p. 860.
* From J.C. Lowe: The Metabolic
Treatment of Fibromyalgia. McDowell Publishing Co., L.C.,
Boulder, 2000, p. 839.
References
[1] Lowe, J.C..: The Metabolic
Treatment of Fibromyalgia. McDowell Publishing Co., L.C.,
Boulder, 2000.
[2] Lowe, J.C., Reichman, A., & Yellin, J.: The
process of change with T3 therapy for euthyroid
fibromyalgia: a double-blind placebo-controlled crossover study. Clin. Bull. Myofascial Ther., 2(2/3):91-124, 1997.
Do You Have Symptoms of Hypothyroidism or Thyroid Hormone Resistance?
© Dr.
John C. Lowe, PLLC 2006
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