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These criteria say that the patient’s symptoms must have been present for more than 3 months, there must be widespread pain distributed both above and below the waist, on both the left hand and the right hand side of the body, and that 11 out of 18 tender points must be present when pressure is applied to them. Tender points hurt when pressed but do not cause pain in any other part of the body, and their approximate locations are shown as little black dots on the drawing opposite.
Diagnostic labels are used by the medical establishment when the underlying cause for the collection of symptoms so described is not understood. For this reason the treatment of fibromyalgia is usually approached symptomatically, that is, on a symptom by symptom basis. |
Because the underlying cause is not treated, the patient almost invariably remains unwell and so the prognosis for fibromyalgia patients is usually regarded as being very poor. Furthermore, as the fibromyalgia ‘diagnosis’ becomes more fashionable, there is a growing risk that people who don’t meet the ACR criteria will be incorrectly labelled with fibromyalgia.
An Alternative View of Fibromyalgia
There are, however, a number of alternative views about fibromyalgia. We at Thyroid UK take the view that the set of signs and symptoms attracting the fibromyalgia label represents part of a spectrum of manifestations of a slow metabolism (or hypometabolic state) which in turn is caused, or aggravated, by one or more of the following factors:
- Under regulation of the metabolism by thyroid hormone.
- Unhealthy diet.
- Too little cortisol (adrenal insufficiency).
- Sex hormone imbalances.
- Nutritional deficiencies (lack of important vitamins needed for the metabolic processes).
- Exposure to chemical contaminants (which impede the metabolism).
- Poor physical fitness (which itself leads to a slow metabolism).
- Untreated physical problems (which may lead to poor sleep, so inhibiting the metabolism).
- Troublesome drugs (which impede the metabolism).
The spectrum of manifestations of a slow metabolism also includes chronic fatigue syndrome, M.E. and depression, depending on precisely what effect on any particular individual the slow metabolism has.
Whilst a lack of physical fitness will contribute to a slow metabolism, fitness improvement will not on its own make the patient better if other aggravating factors are still present. Similarly, whilst a thyroid hormone deficiency will contribute to a slow metabolism, simply administering thyroid hormone replacement therapy will not on its own bring about a recovery if the patient still suffers from, say, untreated adrenal insufficiency and tender points, and remains unfit. Only when all the above factors active in a particular individual have been identified and the appropriate adjustments made will the patient recover. Thereafter the patient will only stay well if all the changes made, lifestyle and otherwise, are maintained.
Comparison of the Symptoms of Fibromyalgia and Hypothyroidism
It is always fascinating to hear people labelled with fibromyalgia comparing symptoms with people diagnosed with hypothyroidism and discovering just how similar they are! One of the UK fibromyalgia support groups once circulated a questionnaire one of the questions of which concerned the symptoms that people with fibromyalgia complain of. Some 105 people responded and between them they reported 89 symptoms. Of these people, some 89 (84.8%) were women and 16 (15.2%) were men. Now, most of those who suffer from over/underactive thyroids are women. On further examination, 62 of those symptoms are also experienced by people who suffer from hypothyroidism. The main symptoms of fibromyalgia that hypothyroid patients also complain of are fatigue, sleep problems, headaches, pains in specific parts of the body, poor memory, depression, irritability, problems with concentration and mental processing, muscles spasms and cramps, feeling cold, etc. One of the main symptoms the fibromyalgia people suffer from but hypothyroid people don’t is widespread muscle pain, but as fibromyalgia and hypothyroidism are two different clinical manifestations of a slow metabolism then some differences in symptoms are only to be expected. The full list of reported fibromyalgia symptoms are listed in Table 3 which can be found at the end of this article.
It is not hard to conclude that one of the main differences between the two groups is that fibromyalgia sufferers are more likely to come back with ‘normal’ blood test results and therefore not offered thyroid hormone treatment.
Historical Perspective
As much interesting historical information can be found at www.thyroidresearch.com only a brief overview will be provided here. Before doctors learnt what the thyroid gland does, people suffering from what we now recognise as hypothyroidism developed mysterious symptoms and the more severely affected died. In 1877 a physician named William Ord noticed during postmortems that some patients had shrunken thyroid glands. Then in 1892 a brilliant doctor, Dr Murray, realised that the patients with a shrunken thyroid gland had suffered from particular symptoms such as fatigue and intolerance of cold before they died. This gave him the idea of treating patients presenting those particular symptoms with sheep’s thyroid gland extract. To his amazement these patients recovered and the treatment for hypothyroidism was thus discovered. Eventually pharmacists learned how to desiccate pig’s thyroid in such a way that all the hormones contained within were preserved intact and for many years after that this was the only available treatment for underactive thyroids.
However, as there was no laboratory test available for hypothyroidism doctors had to rely solely on the close observation of the patient’s signs and symptoms. There followed numerous attempts to devise a laboratory test, all which all had to be abandoned because they didn’t work. Eventually a technique for measuring the concentration of the various thyroid hormones in the blood stream was devised which, in spite of its limitations, was adopted for routine clinical use in the late 60’s. At the time many doctors were very unhappy about the new test but they had their expertise at diagnosis using clinical signs and symptoms to fall back on. The impact on their patients was thus minimised but only for as long as they remained in practice. As these experienced doctors retired they were gradually replaced by younger doctors who were increasingly reliant on the blood tests rather than the signs and symptoms for the diagnosis of hypothyroidism. Eventually these younger doctors came to place more reliance on the blood tests than on the patient’s signs and symptoms. It is interesting that that we now have a rise in ‘modern’ illnesses such as Chronic Fatigue Syndrome, Fibromyalgia and M.E.
In parallel with the search for a laboratory test, bio-chemists strived for years to reproduce the thyroid hormone molecule in the laboratory. After a tremendous struggle they eventually managed to produce a synthetic version of the T4 molecule which we know in the UK as Thyroxine (Synthroid in the USA) but no clinical trials were performed to check the efficacy of Thyroxine relative to desiccated pig’s thyroid extract. In spite of this, Thyroxine rapidly became the accepted treatment for hypothyroidism and by 1985 desiccated thyroid extract was almost completely unused. However, whilst some people do get better on Thyroxine, many don’t.
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