Editor's comment: People with fibromyalgia are frequently hypothyroid or thyroid hormone resistant, however, it is often missed because their TSH (thyroid stimulating hormone) test appears to be normal.
Although the following discussion of the thyroid and fibromyalgia between Dr. Joseph Mercola and Dr. John Lowe appears to be in video format, it is actually an audio presentation. If you would prefer to read a transcript of the discussion rather than listen to the audio, you can download the transcript here.
The Simple Fibromyalgia Treatment that’s Nearly Always Overlooked…
Dr. John Lowe is a skilled clinician, recognized as one of the leading experts on treating thyroid disease with natural medicine. In this interview, he discusses hypothyroidism and the lesser known thyroid hormone resistance, and how thyroid disease is connected to fibromyalgia.
Dr. Mercola's Comments:
Thyroid disease, or inadequate thyroid hormone regulation, is extremely common. According to estimates, anywhere from 10 to 40 percent of Americans have suboptimal thyroid function.
The Difference between Hypothyroidism and Thyroid Hormone Resistance
Hypothyroidism occurs when you produce insufficient amounts of thyroid hormone or when you have thyroid hormone resistance. As a result, your body cannot maintain normal metabolism, and your ability to convert tyrosine to dopamine, norepinephrine and epinephrine is impaired. This can cause a ripple effect of symptoms, including cognitive dysfunction.
A common give-away that you may be hypothyroid is feeling cold most of the time. This is because your body cannot generate enough ATP molecules to keep the core temperature of your body high enough.
Thyroid hormone resistance began being investigated in the 1950s, yet many endocrinologists still have never heard of it, or believe it’s a rare condition.
“The difference between hypothyroidism where there is a deficiency of thyroid hormone, and thyroid hormone resistance, is that the same amount of thyroid hormone—within the laboratories’ reference range—that would maintain normal metabolism in cells don’t do so adequately.
Those people [with thyroid hormone resistance] need a much higher dosage of hormones—a dosage that would cause most endocrinologists to scream, “You’re going to die of heart attack if you don’t get off that,” Dr. Lowe explains.
Why Lab Testing is NOT the Most Useful Tool for Diagnosing Thyroid Disease
Unfortunately, many if not most conventional doctors do nothing but look at lab test data when diagnosing thyroid disease, and typically ignore signs and symptoms revealed by the patient, such as dry skin or hair loss. Dr. Lowe and I often refer to these as extremist medical technocrats.
However, Dr. Lowe says he’s noticed a revival of sorts of the practice to listen to the patient; getting a list of the symptoms; looking at the patient and touching them.
This can be particularly valuable in the case of diseases like thyroid disease, which is littered with clinical symptoms.
The exclusive reliance on lab tests is actually NOT advisable in this case. In fact, Dr. Lowe discusses why these tests may at times be completely useless for diagnosis. For example, based on three decades worth of work in this area, and two rigorous studies, Dr. Lowe has concluded that the traditional testing used does not correlate with the far more powerful assessment of thyroid hormone in your body, which is your basal metabolic rate.
For more information about that, please listen to the interview, or read through the transcript.
A Forgotten Sign of Thyroid Disease
Dr. Lowe’s interest in the thyroid was ignited about 25 years ago. At the time he used myofascial trigger point therapy to treat pain, taught by Dr. Travell who used it on John Kennedy. Most patients responded favorable to this treatment, but some did not get the typical relief and he started wondering why.
“I went to Travell and Simon’s textbooks and found a huge section on perpetuating factors,” Dr. Lowe says.
“What can make a patient resistant to usually effective myofascial therapy? Among those were nutritional deficiencies. If patients don’t take enough B complex vitamins, various ones can cause neuromuscular hyper-excitability that has to be dealt with. I would give injections of B complex vitamins and would immediately get them on megadoses…
[R]ather than three treatments it might take eight or 10, but I was able to release them as ‘recovered’. But there were some patients for whom none of those usual tactics worked. They kept coming back. The reprieve from pain might be only six hours.”
He finally discovered information that linked myofascial pain and trigger points to hypometabolism, especially due to inadequate thyroid hormone regulation.
The standard tests used today to diagnose inadequate thyroid hormone regulation due to hypothyroidism are the free T3, free T4 and TSH. There’s also a test called TRH (thyroid releasing hormone) stimulation test. Using these tests, Dr. Lowe was able to determine that many of those patients could be diagnosed with central hypothyroidism.
“They didn’t have a thyroid gland problem per se where the thyroid gland wasn’t producing a thyroid hormone, but they had either a problem with the hypothalamus or with the pituitary,” he explains.
Some of the clinical symptoms presented by these patients were primarily pain, such as headaches and cervical- or back pain. One such patient became pain-free once she started taking thyroid hormone. That’s what got Dr. Lowe started on the path of treating thyroid disease.
Signs and Symptoms of Thyroid Disease
So, if the conventional lab tests are unreliable, what are the signs and symptoms to look for? As stated earlier, there are some 60 different symptoms (including many that correspond to symptoms of fibromyalgia) that are indicative of thyroid disease—although, remarkably, you won’t find these in the newer endocrinology books.
Dr. Lowe’s web site, www.DrLowe.com, contains a full list of all the signs and symptoms. Here are a few of the most common:
Fatigue—If you don’t have enough dopamine or have too few dopamine receptors due to inadequate thyroid hormone regulation, you end up with extreme fatigue, which is also a common complaint in fibromyalgia patients
Weight gain--Thyroid hormone controls gene transcription for lipolytic enzymes, which lower cholesterol and break down triglycerides and fatty tissues. If you have enough of these enzymes, they will reduce fat tissues in your body even if you do not diet and exercise
Dry skin, hair, eyes and other mucous membranes
Excess muscle tension and trigger points—For muscles to completely relax, filaments must lengthen and separate, which requires energy (ATP molecules). Low thyroid hormone reduces ATP
Delayed deep tendon reflexes (slow relaxation phase of the Achilles reflex)—Thyroid hormone controls gene transcription for calcium ATPase. When you hit the Achilles tendon and your foot goes down rapidly and then raises back slowly, it’s a sign of hypothyroidism or thyroid hormone resistance. This is due to lack of ATP molecules to provide the energy for the contractual filaments to separate and relax, hence you get a visibly slow relaxation phase of the Achilles reflex.
Here again is a classic thyroid indication that does not correlate with high TSH values. Unfortunately, this test (which used to be an established gold standard in thyroid testing) is no longer used because endocrinologists assume high TSH values must be present for hypothyroidism, which is not the case—but lab testing, like drugs, is big business, brining in billions of dollars.
Thyroid Disease and Fibromyalgia, and the Treatments that Work for Both
Interestingly, inadequate thyroid hormone regulation may be one of the primary underlying factors in many patients with fibromyalgia.
Dr. Lowe explains:
“I had prior training as a research psychologist and was able to pull forth that training and enlist physicians on the research team. It was a loose net research team until it eventually became a non-profit organization called the Fibromyalgia Research Foundation.
Seven or eight years ago, I gave a presentation at the Fibromyalgia Coalition International based in Kansas City… I got there late and heard none of the other presentations.
When I gave my presentation, people began saying, “Dr. Lowe, you’ve used the word “integrative metabolic therapies” for getting patients free from chronic fatigue and fibromyalgia. It just so happens, every single one of the -- at that point, considered alternative doctors -- have said exactly the same things.”
Through their personal, clinical experiences they had come to the same conclusions we had. If they used metabolic integrative therapies, nutritional deficiencies, anti-inflammatory diet, exercise, getting off medications that impede metabolism, and possibly treating cortisol deficiency, possibly balancing sex hormones, and treating the patients with effective thyroid hormone therapy... They got the patients well.
I said the same thing they had said, but my experience was based on rigorous scientific testing. Their experience was based on intuition and the wisdom that comes from listening to patients and working with them.”
This is yet another potent testimony to the truthfulness of the theory that health is based on a few fundamental principles, and although you will typically address specific aspects of a disease, the bulk of the therapy is the same for ALL diseases:
Eating a nutritious diet (a low-sugar, low-grain, mainly raw organic diet is optimally nutritious and anti-inflammatory)
Avoiding medications (virtually all medications create further imbalances, hence the side effects and deterioration of health)
Creating health really isn’t rocket science. It’s just “returning to basics,” and although it may not be easy, it’s rather simple.
Logic and Deductive Reasoning in Medicine—A Novel Idea
Dr. Lowe’s research team came to the conclusion that the thyroid was involved with fibromyalgia through the use of a method called “deductively formulated theory,” which he calls the “ultimate logic of problem solving.” Unfortunately, this method is virtually never used in medicine, and it’s a rare scientist who truly understands it.
Dr. Lowe explains it as follows:
“[Y]ou take competitive theories or hypotheses about what causes something, then use the methods of mathematical physicists to show which hypothesis tops them all out.
Well, there simply is no competitor to inadequate thyroid hormone regulation that accounts for about 43 of the 46 subjectively verified findings in fibromyalgia -- reduced brain blood flow, inhibitory alpha-2 adrenergic receptors, platelets that cause constriction of arterials and cold fingers... The list goes on.
If anybody looks at the method of deductively formulated theory and compare the inane serotonin deficiency hypothesis, which has been thoroughly refuted, there are no competitive theories.
… Hippocrates wrote about people with these symptoms and said, if these people will get a reasonable amount of physical activity, stop eating the trash the aristocrats eat and start eating vegetables and fruits, they’ll recover. Nothing has really changed there.
What we learned about fibromyalgia patients is that one set of symptoms: chronic aching and pain that lasts for three months or longer, and abnormal tenderness with associated symptoms (there are 12 of them), are all classic hypothyroid symptoms. It’s just another of what we call a clinical phenotype…
[M]ost [fibromyalgia] patients are either hypothyroid or thyroid hormone resistant.”
Thyroid Hormone—The Missing Ingredient in Fibromyalgia Treatment
Dr. Lowe’s extensive experience with treating patients with both thyroid disease and fibromyalgia has led him to come to some startling conclusions. One, that thyroid dysfunction is a component of fibromyalgia, and second, that the conventional thyroid test is typically useless in making a diagnosis.
Instead, he recommends simply treating fibromyalgia with thyroid hormone until the symptoms improve.
“We give patients monitoring forms. One of those forms is the 20 most common symptoms of thyroid hormone over-stimulation,” he explains.
… [P]atients record their basal body temperature and their basal pulse rate. The pulse rate in most of these patients is too low for their levels of cardiovascular conditioning. It’s under-regulation of the thyroid. Some of them are bradycardic (less than 50-60 beats per minute).
If weight is an issue, they measure their weight after getting out of bed before consuming any liquid or solid, along with temperature and pulse rate. We have a lot of symptom severity scales where they estimate the intensity of their symptoms. They fill out this form at least three times a week.
Then, it’s easy for us to chart the data on line graphs. We can see, as the dosage increases, are the data points moving in the right direction? Is the temperature rising properly? Is the pulse rate coming up so that it’s more appropriate to that person’s level of cardiovascular conditioning?”
A one-line summary of Dr. Lowe’s research would be that thyroid hormone is the missing ingredient in the treatment of fibromyalgia that is nearly universally overlooked.
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