Topic: Chronic Fatigue Syndrome, TSH Levels, & More

A Reader Writes:

I'm a 48 year old male, who's dealt w/chronic fatigue syndrome fatigue and brain problems over the past 10 years. A few years back my CFS doc put me on Armour thyroid, as my basal temps were consistently low, however, after several months on this med it had no positive impact on my energy level or brain fogginess/unsteadiness. The other thing I've experienced in the past few years is loss of weight. I am 6'1" tall, used to weigh about 190 lbs. and now weigh just 150 lbs. I do not have any life threatening conditions, only the unrelenting fatigue, and brain stuff, I still have basal temps that are in the low 97 degree range and my average daytime temp is around the high 97 degree range at this point. My research has found that my problem is maybe more adrenal than it is thyroid, based on the weight loss, photophobia, low temps etc...so I've been taking some glandulars (which I get from Dr James Wilson's website), B vitamins, in addition to the magnesium, vitamin E, carnitine, choline, melatonin, anti-candida diet, NADH, and I'm also doing homeopathy at the current time. Factor in the fact that I had 15 molars w/silver amalgams replaced w/composites 2 years ago...and you can see that I have a few issues piled on top of each other here. My question is, am I right here about my problem being more adrenal than thyroid, and is that why the Armour really did not have an impact, or is the situation w/the metals from my old fillings causing other problems w/my endocrine system that will take more time to overcome?? I think that my brain would probably improve if my adrenals/thyroid were working better. . .but I have not been able to find a doc in the Detroit area who really knows all aspects of this to help...in the meantime, I'm trying the glandulars to see if those will help, along w/the B vitamins. Any ideas on what else I might try?

David Derry Responds:

You have brought up a lot of problems and issues, so I will discuss as many as I can and leave some parts for other questions.

Chronic Fatigue and Low Thyroid

Chronic fatigue symptoms of low temperatures, fatigue and accompanying brain fog are classical signs and symptoms of hypothyroidism. (1-3) There are many psychological symptoms and personality difficulties which accompany brain dysfunction related to hypothyroidism many of which have been published in a classical 1958 publication. (3) One of the most prominent is loss of self-esteem and inability to cope properly. There is a tendency by both doctors and patients to blame the illness or your sour muscle and joints and brain fog separately as the cause of an inability to cope. But in general terms thyroid hormone's overall function on the body is help the individual to “cope” with their environment and stresses.

An important function of thyroid hormone is to bring the brain and body up to a state that it can cope easily with life’s normal stresses. The person with chronic fatigue can hardly cope with simple stresses of shopping or driving which normal people handle without thinking. When corrected with adequate thyroid all of these abnormal symptoms and signs disappear completely. (3) But it is more useful to understand that low thyroid is the reason you are not coping not your circumstances. If you are given enough thyroid your brain fog would disappear with 2-3 weeks and the rest of your symptoms would disappears over the next month or so. Gradually your coping ability would rise back to its normal level. Schon, Sutherland and Rawson (3) laid out low thyroid mental symptoms with plenty of direct patient quotes who were unequivocally low thyroid. The statements in this paper read like quotes from chronic fatigue or fibromyalgia patients of the last 20 years.

Treatment and TSH Monitoring Blood Level Interpretations

So the main medication you need to get better forever is thyroid hormone. At an adequate dose, the Armour thyroid you took would have cured you right then. Your dose was just not enough. There is a tendency because of the laboratory test monitoring started in 1975 to prevent the dose reaching these therapeutic levels. As the TSH test is not related to the signs and symptoms of low thyroid (4), treatment using this type of monitoring ends up treating the lab tests (to make them normal) and not the patient. This does not fit with the first principle of medical ethics established in Geneva in 1945 "Consider first the well-being of the patient". The doses a patient gets when monitored by the TSH is currently two thirds or less of the well established clinically effective doses established from 83 years of clinical experience before the TSH arrived. (5-6)

Nicoleff and LoPresti (7) discussed this problem in their conclusions:

"It may be that the critical events controlling thyroid hormone action in non-thyroidal illness (all illness not related to thyroid) are largely regulated at the cellular level and that we are naive to believe that we can make interpretations from circulating thyroid hormones values." (7)

So the human body can operate at all the different levels of thyroid hormone. But at the low levels function is poor. At the correct levels the patient copes well and does well. So the well being of the patient thus depends on the effective thyroid hormone level not the laboratory thyroid hormone level. So if a patient has chronic fatigue and cannot function we should use thyroid hormone to make these people return to normal. If patients are clinically low thyroid -- they do not die-- they just function at a progressively lower levels. In the extreme they would be comatose, but this rarely happens now. At the other end of the scale a person might have a well functioning thyroid and be putting out enough thyroid hormone to cope with all the stresses of their lives. This means this normal thyroid person can get on with their life without worrying about mentally and physically breaking down from the normal hustle and bustle of today's world. Of course in Graves's disease the thyroid is pumping out too much thyroid and this has to be treated differently.

Dosages of Thyroid Hormone

Repeatedly, studies on normal people with increasing doses of thyroid found humans have a wide range of tolerance for thyroid hormone (8-11). All body tissues, including the brain can adapt individually to the higher or lower levels of thyroid hormone. Each organ outside the brain has a complex built in system for extracting the amount of thyroid it needs from the blood to function well. Each organ can adapt to low levels and to high levels only taking what it needs. The brain is the only organ with a feedback mechanism (through the TSH) in which the brain can tell the thyroid to produce more or less of the thyroid hormone. Because all organs can adapt to many levels of thyroid hormone it suggests that for each person there is an individual level at which this person can cope and function at optimal levels. (5)

For example, in a sixteen part study of the effects of desiccated thyroid on healthy prisoners Danowski et al found they tolerated dosages of 9 grains of desiccated thyroid (540 mgs which equals about 540 micrograms thyroxine) without ill effects. (9-11). On studies on obesity and thyroid hormone where the dosages for three months were between three grains and 25 grains (1500 mg of desiccated thyroid equals about 1500 micrograms of Eltroxine) (12). they said: "As in previous studies, these dosages of desiccated thyroid were well tolerated by the subjects. Occasional nervousness, increased sweating, and decreased endurance were reported. Tachycardia and slight increase in the systolic blood pressure and decreases in the diastolic blood pressure appeared in all. Electrocardiogram changes were minimal. Body weight decreased by an average of 26 pounds during the 22 weeks of treatment." (7).

Usually with desiccated thyroid (Armour) the brain fog and accompanying personality difficulties will lift early in a treatment regime with adequate thyroid. By early I mean within a few weeks. Any dose of thyroid extract below 180 mg is unlikely to work at all for someone in your condition. Clinicians even in the 1960s used history taking, clinical examination along with laboratory tests and rarely found that a dose below 180 mg had any effect at all. (4)

The more difficult problem you have is that you have had your disability so long without treatment. The clinicians of the earlier part of the century recognized that the longer you were low thyroid the more difficult and slower the signs or symptoms were to disappear. If you had the chronic fatigue for less than say, 2-3 years, then all signs and symptoms would be completely gone within 6 weeks to 2 months of starting treatment with thyroid hormone. Having said that, there are exceptions related to frightening experiences in childhood below the age of 12, which I will discuss in another answer. If you happen to be one of them, then the treatment is still thyroid but used a little differently. (13)

Like many other patients you have tried a multiplicity of dietary and herbal regimes trying to support your body to regain your health again. None of these are more than partially effective to support a body that is low in thyroid. Thyroid hormone is the master gland that controls every body system. Hence other remedies such as vitamins can plug some of the holes in the dike but not all of them.

I hope that helps.

David

1. Crile,G. & Associates, Diagnosis and treatment of diseases of the thyroid gland. W.B. Saunders, Philadelphia, 1932.
2. Werner, A.A. Endocrinology, clinical application and treatment. Lea and Febiger, 1942.
3. Schon,M., Sutherland A.M., Rawson R.W.. Hormones and neuroses--The psychological effects of thyroid deficiency. In: Reiss M, editor. Psychoendocrinology. New York: Grune & Stration, 1958: 835-839.
4 Toft A.D.. Thyrotropin: Assay, Secretory Physiology, and Testing of Regulation. In: Werner and Ingbar's The Thyroid, edited by L. E. Braverman and R. D. Utiger, New York:J.B. Lippincott Company, 1991, p. 287-305. Page 294.
5. Williams,R.H. Bakke,J.L. The thyroid in Textbook of Endocrinology Eds Williams,R.H. 1962W.B. Saunders Company. Philadelphia. pages 252-3
6. Danowski,T.S., Moses,C.. Thyroid indices during replacement with desiccated thyroid and proloid. Metabolism 14:99-103, 1965.
7. Nicoleff, J.T., Lopresti, J.S. Nonthyroidal illness.in Werner and Ingbar's The Thyroid eds Braverman, LE, and Utiger R.D. J.P Lippincott Company 6th edition, Philadelphia 1991 page 365 and page 366.
8. Hoffenberg,R.. Aetiology of hyperthyroidism. II. Br.Med J 3:508-510, 1974. (Introduction)
9. Danowski,.T.S. Lemay,N.R. Sunder,H.,Cohn,R.E. Moses,C.. Hydrocortisone and/or desiccated thyroid in physiologic dosage XVII. Major and minor thyroidal indices during therapy with large dosages of desiccated thyroid. Metabolism 14:950-954, 1965.
10.Danowski, T.S., Narduzzi,M.A., Cohn,R.,Lymaye,N.R., Grimes,B.J. Weir,T.F.. Hydrocortisone and/or Desiccated Thyroid in physiologic dosage. XIX, Desiccated thyroid in the therapy of obesity. Metabolism 16:102-110, 1967.
11. Sabeh, G. Bonessi,J.V., Sarver,M.E., Moses,C. and Danowski,T.S.. Hydrocortisone and/or desiccated thyroid. Metabolism 14:603-611, 1965.
12. Sawin,C.T. A comparison of thyroxine and desiccated thyroid in patients with primary hypothyroidism. Metabolism 27:1518-1525, 1978.
13. Derry, DM. Breast cancer and iodine. How to prevent and survive it Trafford Publishing Company, Victoria Canada, 2001. page 45