Other Underlying Mechanisms. Other metabolism-impairing factors may also induce and sustain symptoms that lead to a diagnosis of fibromyalgia. All that is necessary is that these other factors impede the metabolism of the tissues from which fibromyalgia symptoms and signs arise. Such factors include a diet that contributes to impaired carbohydrate metabolism, B complex vitamin deficiencies, the use of beta-blocking drugs, and physical deconditioning. One such factor may not be enough to induce fibromyalgia symptoms. However, combinations of the factors may be sufficient. The fibromyalgia symptoms of most patients who come under our care are caused by a combination of such factors combined with inadequate thyroid hormone regulation of their tissues.

Basic Requirement for Effective Treatment. The metabolism-impeding factors responsible for fibromyalgia must be controlled or eliminated before a patient can significantly improve. When fibromyalgia results from inadequate thyroid hormone regulation, the proper form of thyroid hormone is indispensable if the patient is to improve or recover. The use of T4 alone (such as Synthroid) is seldom effective. Most patients require treatment with desiccated thyroid (such as Armour Thyroid), a synthetic T4/T3 combination (with 4 parts T4 to one part T3, such as Thyrolar), or T3 alone. Treatment is seldom effective when the clinician adjusts the patient's dosage according to blood TSH levels. Treatment results are likely to be no better when the patient's dosage is adjusted according to the free T3 level. Most patients improve or recover only when their thyroid hormone dosage is adjusted according to the responses of their tissues to thyroid hormone.