Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease

According to Dr. Kellman, "about 40% of the patients I see in my practice who have chronic fatigue actually have a condition called hypothyroidism--a thyroid gland that fails to meet all its bodily functions which include energy regulation. Nutrient tests have shown us that many chronic fatigue patients have numerous vitamin deficiencies, notably vitamin C and the B-complex vitamins."

How Do Doctors Diagnose HAIT?

As suggested by the research conducted by Dr. Lowe and Dr. Kellman, when HAIT-related hypothyroidism underlies chronic fatigue or fibromylagia, it may not be picked up by the standard thyroid hormone panel, which tests primarily the TSH, (thyroid stimulating hormone).

If HAIT symptoms are present, but TSH tests are normal, Drs. Kellman and Lowe often rely on the TRH -- thyrotropin releasing hormone -- stimulation test to assess possible hypothyroidism. According to Dr. Kellman, "the physician measures the patient's TSH level (a simple blood test), gives an injection of TRH, then draws blood 25 minutes later and remeasures the TSH. If the first TSH level is normal and the second TSH level is high--above ten--it tells us the patient's thyroid is underactive. A TSH reading of 15 is suspicious, while 20 strongly points to hypothyroidism."

Dr. Kellman states that, "of the patients I've seen with three or more typical symptoms of underactive thyroid but who have tested 'normal' in standard tests, 35-40% actually have underactive thyroids based on the TRH test."

Dr. Elizabeth Vliet, founder of the pioneering women's medical center Her Place, at All Saint's Hospital in Fort Worth, Texas, relies on a thyroid antibodies test to help pinpoint elusive thyroid problems. In her book, Screaming to be Heard: Hormonal Connections Women Suspect...and Doctors Ignore, Dr. Vliet says that she does not believe that TSH tests are the almightly indicator of a woman's thyroid health. Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote from her book:

"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."

What are the Treatments?

Dr. Lowe's treatments for FMS emphasize inclusion of the T3 thyroid hormone in treatment. Dr. Vliet's treatment for hypothyroid symptoms relies primarily on standard thyroid replacement, (which is typically a brand name or generic version of levothyroxine sodium). And Dr. Kellman, in addition to putting his chronic fatigue/hypothyroidism patients on Synthroid brand levothyroxine sodium, also details in his article a full range of supplements he's used with patients, including an animal-derived glandular called Thyrosine Complex, tyrosine, vitamins C and B complex, grape seed extract, magnesium, the Chinese herb astragalus.

In addition, clinical trials have shown that patients with fibromyalgia benefit from low-dose tricyclic antidepressants, and more doctors are now prescribing these for CFS patients as well. It's also becoming more common for doctors to prescribe other anti-depressants, including serotonin reuptake inhibitors, for patients with CFS, FMS and HAIT.