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Dr Lowe Q&A – Hyperthyroidism and Fibromyalgia

November 18, 1998

Question: I have a perplexing situation. I have been diagnosed as hyperthyroid and have been seeing an endocrinologist for a year and a half now. I also have been diagnosed as having fibromyalgia by two relatively prominent rheumatologists out of the Emory Clinic. My doctors share my lab work information, so they are aware of each other and my diagnoses. The thing is, I have yet to discover anyone else who has this combination of illnesses. I’ve been tested for everything (seems like), so the fibromyalgia seems a correct diagnosis, with my symptoms and all.

Have you, in your extensive work with the links between fibromyalgia and thyroid dysfunction, come across this before? Also, is there something in particular in my regular blood work that I should look for, besides the normal thyroid screen? My endocrinologist usually orders a total T3 and T3 uptake, T4(thyroxine), and TSH. I don’t know if this is important, but I have been in remission without using medication for 10 months, but last time, the doctor said it looked like the levels were rising again. I really appreciate your time. I’m very confused and worry about spending so much money (no insurance) when there may be something else entirely wrong with me.

Dr. Lowe: By “hyperthyroidism,” I assume you mean that your endocrinologist found laboratory evidence of (1) an overly active thyroid gland (such as a high titer of thyroid-stimulating antibodies) and (2) elevated circulating thyroid hormone levels. If he or she diagnosed your hyperthyroidism according to such laboratory evidence, I doubt that you also simultaneously have fibromyalgia. I have never seen a patient with both documented hyperthyroidism and fibromyalgia. On both theoretical and practical grounds, I believe the two conditions are incompatible.

A clinician may, however, wrongly believe that a patient who is “thyrotoxic” has fibromyalgia. The word “thyrotoxic” refers to tissue overstimulation by excess thyroid hormone. Hyperthyroid patients usually have thyrotoxic muscles. (So do hypothyroid patients who are overstimulated by taking too much thyroid hormone medication.) Weakness is the main symptom of thyrotoxic muscles, and some patients also have muscle pain. It is the patient with both muscle weakness and pain that the clinician may mistakenly diagnose as having fibromyalgia. Pain is the hallmark of fibromyalgia, and most patients also have chronic fatigue. A misdiagnosis is likely if the thyrotoxic patient describes her muscle weakness as fatigue rather than weakness. The clinician may mistakenly consider this evidence of fibromyalgia. The muscle weakness of the thyrotoxic patient, however, is easily distinguished from the general fatigue and low motor drive of the fibromyalgia patient. The fibromyalgia patient s muscles are usually not weak in relation to her level of physical conditioning. Clinicians, including rheumatologists, must be careful to make this distinction or risk making a misdiagnosis of fibromyalgia.

Other than this possibility, I don t know how to reconcile your description of having both hyperthyroidism and fibromyalgia at the same time. Based upon my clinical and research experiences, I believe it is highly unlikely that you have both conditions.

Follow-up: The individual who submitted this question later sent her medical records to me at my request. Lab test results of her thyroid function did indeed indicate hyperthyroidism. However, the records from her rheumatologist did not show the results of a proper fibromyalgia evaluation. So, we do not know whether she meet the diagnostic criteria for fibromyalgia. According to her medical records, she did have chronic muscle pain, and the records suggested that she had multiple trigger points. The records also showed that she was using oral contraceptives. It is possible, although we can’t be certain, that the progestins (synthetic progesterone-like chemicals) in the contraceptive synthetic were causing a chronic muscle energy deficiency. The deficiency could have kept her trigger points actively referring pain. I found oral contraceptives to be a cause of chronic myofascial pain syndromes (with highly active, pain-referring trigger points) in some of my young woman patients. I published two papers on oral contraceptives and trigger point pain.[1][2] I discussed the subject at greater length in the sex hormone chapter of my book The Metabolic Treatment of Fibromyalgia.[3]

References:

1. Lowe, J. C.: Oral contraceptives and myofascial pain. Dig. Chi. Con., 34:100-101, 1991.

2. Lowe, J. C.: Myofascial pain and “The Pill.” J. Nat. Assoc. Trigger Point Myother., 5.1:5, 1992.

3. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Co., 2000.

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