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Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease

Relationship Among These Conditions

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Updated April 14, 2014

September 1997 -- First, let's define the three diseases briefly and discuss how they're diagnosed.

While the constellation of symptoms can be similar, the primary complaint in Chronic Fatigue Syndrome (CFS) is the unrelenting fatigue. Even the smallest physical exertion can put the sufferer in bed for days. There is no official clinical test to make a firm diagnosis of CFS. Instead, doctors typically rule out other underlying illnesses before making a CFS diagnosis.

With Fibromyalgia (FMS), an arthritis-related condition, the primary complaint is the pain, a round-the-clock pain that rarely goes away. FMS can be diagnosed via a detailed 18-point "tender point" examination.

With Hashimoto's Autoimmune Thyroid disease ( HAIT), the thyroid fails to produce sufficient thyroid hormone to regulate metabolism. Symptoms of the resulting underactive thyroid usually include some complaint of fatigue or depression, but may include a host of other symptoms, including or muscular and joint pain, excessive weight gain, hair loss, dry and coarse, skin, menstrual irregularities, infertility and recurrent miscarriage, low blood pressure, high cholesterol and others. Diagnosis is most often by the sensitive thyroid stimulating hormone (TSH) test, but some doctors also use the thyrotropin releasing hormone (TRH) test or tests for thyroid antibodies.

Why is Diagnosis Difficult?

CFS, FMS and HAIT patients often visit their doctors complaining of a host of symptoms. (See sidebar.) Since symptoms are similar, there is a risk of misdiagnosis. Some doctors still fail to even acknowledge the existence of CFS and FMS.

And while medical tests can, in most cases, easily test for thyroid problems, many doctors still fail to diagnose the obvious signs of HAIT, or rely only on one test to diagnose the condition. Commonly, HAIT is also often misdiagnosed as depression, stress, or "female" hormonal problems such as premenstrual syndrome, post-partum depression or menopause symptoms, which are often labels applied to CFS and FMS sufferers as well.

Various Symptoms Seen in CFS, FMS & HAIT

Widespread pain
Fatigue
Feeling run down, sluggish
Muscle cramps and pains
Unexplained or excessive weight gain
Inability to lose weight
Gastrointestinal problems Irritable bowel syndrome
Poor sleeping
Headaches and migraines
Constipation
Exhaustion
Depression
Low exercise tolerance
Rashes
Concentration difficulties
Feeling cold Cold in extremities
Dry, coarse and/or itchy skin
Dry, coarse and/or thinning hair
Increased menstrual flow
More frequent periods
Infertility
Difficulty breastfeeding
Recurrent miscarriage
Swollen glands
Low grade fever
Slowed thinking, mental fog
Husky voice
Eczema, acne, rashes
Swelling and fluid retention
Carpal tunnel syndrome Numbness and tingling in extremities
Raynaud's Syndrome
Reduced sexual interest and ability
More frequent infections
Worsening of allergies and asthmatic reactions
Chemical sensitivities
Difficulty getting a full breath
More frequent yeast infections
Slow pulse
Puffiness around the eyes
Low blood pressure
Neck pain/neck aches

Who Gets CFS, FMS and HAIT?

The majority of diagnosed cases of CFS occur in women, most of whom are 25 to 45 years old. FMS strikes mostly women between the ages of 20 and 50. And HAIT is known to affect women seven times more often than men, often women in the same age range. Researchers speculate that the same autoimmune mechanisms may be at work, and hormonal relationships may explain the higher incidence in women.

Are CFS, FMS and HAIT All Autoimmune Diseases?

While HAIT is known to be an autoimmune illness, researchers are beginning to believe that there is a strong autoimmune component to CFS and FMS as well. Ultimately, the three diseases may, in fact, be found to be varying manifestations of the same underlying autoimmune problems. The autoimmune connection that underlies these three conditions is discussed at length in the book Living Well With Autoimmune Disease.

Research reported in the Journal of Clinical Investigation indicates that there is a clear autoimmune component in chronic fatigue syndrome, and that approximately 52% of chronic fatigue syndrome patients develop autoantibodies indicative of autoimmune reactions.

German researchers also suggested a relationship between CFS and autoimmune disease, including autoimmune thyroid antibodies. In the a 1994 article in the German medical journal Wien Med Wochenschr, ([link url=http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=7856214&form=6&db=m&Do pt=r]Chronic fatigue syndrome: immune dysfunction, role of pathogens and toxic agents and neurological and cardiac changes), a study of 375 patients with chronic fatigue syndrome showed an increased occurrence of autoantibodies in the CFS-patients...especially microsomal thyroid antibodies. According to the researchers, this suggests that "CFS is associated with or the beginning of manifest autoimmune disease."

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