Scientific studies, logical analyses, and years of related clinical experience have
led me to several conclusions about the cause of fibromyalgia syndrome and its
proper treatment.

Most Common Cause of Fibromyalgia

The main cause of fibromyalgia has been determined. As I recently announced
in France, in most cases, fibromyalgia is caused by inadequate thyroid hormone
regulation of cell function. The inadequate regulation results from thyroid
hormone deficiency and/or partial cellular resistance to thyroid hormone.
Rigorous logical analyses of the available scientific evidence make it clear that
this is the most plausible explanation of the cause of fibromyalgia. In The
Metabolic Treatment of Fibromyalgia, I demonstrated that other proposed
explanations of the cause of fibromyalgia (such as the serotonin deficiency
hypothesis) are false. (See Dr. Lowe’s recent summary of evidence supporting
inadequate thyroid hormone regulation as the major underlying factor in
fibromyalgia.)

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.

Nutritional Supplements

For most patients, nutritional supplements are also essential. The nutrients
synergistically interact with thyroid hormone to cause a sustained increase in
metabolism. As thyroid hormone accelerates metabolism, the body s
requirement for nutrients especially B complex vitamins increases. Not taking
nutritional supplements may result in nutritional deficiencies and an abnormality
of heart muscle (cardiomyopathy). Taking nutritional supplements can avert
such adverse effects and can aid thyroid hormone in normalizing metabolism.

Exercise to Tolerance

For all patients, exercise to tolerance is essential. Exercise enables patients to
capitalize on the increased metabolic capacity provided by the combination of
thyroid hormone and nutritional supplements. Resistance exercises contribute to
the increase in metabolism by increasing muscle mass. Muscle has a higher
metabolic rate than fat, so increasing muscle mass by resistance exercises
increases the metabolic rate. Aerobic exercise also contributes to the increased
the metabolic rate.

Physical Treatment

For most patients, some physical treatment is necessary during metabolic
rehabilitation. For most patients, the most important forms of physical
treatment are trigger point therapy and spinal manipulation. Physical treatment
is essential for some patients’ pain scores to continue to decline. With effective
physical treatment, most patients eventually no longer meet the pain criteria for
fibromyalgia.