Hashimoto’s is the most common cause of hypothyroidism in the United States. An estimated 20 million people suffer from some form of thyroid disease.
Up to 60 per cent have no idea that they have a thyroid problem.Women are five to eight times more likely than men to have thyroid issues.
Fibromyalgia is a multi-symptom disorder that affects an estimated 5 million Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are also women.
This week, I was thinking about the number of patients that I have seen that have been diagnosed with both conditions.
I put the question to my Facebook support group and 74 people with Hashimoto’s responded.
Almost all of them confirmed that they had been diagnosed with both or had all of the symptoms of fibromyalgia.
This is hardly a scientific study, but it does give us some evidence that there is a lot of overlap between the 2 conditions.
As I said, several patients have come to me with a pre-existing diagnosis of fibromyalgia, or FMS, for which they have received little effective treatment or relief.
Many doctors treat these symptoms using drugs rather than uncovering the root cause of the patient’s issues.
Diagnosing fibromyalgia is admittedly difficult. For years it has involved assessing the presence in the patient of multiple symptoms that indicate the syndrome.
Currently, there are three main symptoms which must be present for a fibromyalgia diagnosis. They are:
1. Widespread pain
2. Sleep problems
The only existing blood test available is the FM/a, which tests for a lowered cytokine level suggestive of fibromyalgia, but the test is controversial and not yet considered definitive.
I do not mean to diminish or discount a diagnosis of fibromyalgia. What I am curious about is the link between FMS and Hashimoto’s.
Studies have come to indicate there is a component of thyroid dysfunction associated with FMS. A 2007 study by the Division of Rheumatology at the Department of Internal Medicine at the University of Pisa looked into a possible link between fibromyalgia and Hashimoto’s Hypothyroidism. It concluded that the presence of thyroid autoimmunity may predispose one to fibromyalgia.
This opens up the possibility that the opposite may be true: what if in some cases the various symptoms that point to a diagnosis of fibromyalgia are, in fact, just Hashimoto’s (which is often undiagnosed)?
In my own experience, I can tell you that a lot of fibromyalgia symptoms are present in my Hashimoto’s patients.
Is there a connection between the two?
In a review published in Thyroid Science by John C. Lowe and Jackie Yellin at the Fibromylgia Research Foundation, the authors wrote that, based on the available research, “inadequate thyroid hormone regulation is the most likely underlying mechanism of the symptoms and objective abnormalities of patients who meet the criteria for FMS.”
In the authors’ view, only hormone therapy has been seen to result in the mitigation of fibromyalgia symptoms. This, obviously, points to a connection between fibromyalgia and thyroid autoimmunity.
In fact, 2 neuroscientists at Stanford (Dr. Ian Carroll, MD and Dr. Jarred Younger PhD) are currently doing a clinical trial investigating T3 treatment for fibromyalgia.
So, at the very least, FMS and Hashimoto’s share a great number of symptoms. If you are diagnosed with FMS, it is highly advisable that you be tested for Hashimoto’s.
If you aren’t familiar with which tests to order for Hashimoto’s, check out my previous blog post for an in depth discussion on this.
Since there is so much overlap, I have decided to illustrate how virtually all the common symptoms of fibromyalgia can be caused by hypothyroidism (and, often, Hashimoto’s).
According to WebMD the most common symptoms of fibromyalgia are those in italics below. We will examine how hypothyroidism leads to each group of symptoms and why.
• Chronic muscle pain, muscle spasms, or tightness: Muscle-related symptoms are common with patients with hypothyroidism. The symptoms vary, but in a recent series of studies 79% of patients reported some kind of myopathy (muscle pain).
The exact reasons why are not known, theories include impaired glycogenolysis (the breakdown of glycogen to glucose – a reminder of why blood sugar balance is so important), reduced mitochondrial activity (mitochondria are the cell’s energy producers) and a decrease in production of ATP (Adeosine triphosphate), the actual fuel in the cell.
A recent study also showed increased lactate production during exercise with hypothyroid patients – this is also consistent with mitochondria problems.
• Tension or migraine headaches: Any of the causes above or below can lead to tension and headaches.
• Jaw and facial tenderness: Jaw and facial tenderness can also be caused by the same factors that lead to other muscle pain.
• Moderate or severe fatigue and decreased energy: Fatigue and decreased energy are some of the most common symptoms of hypothyroidism and Hashimoto’s.
There are many factors that lead to this including too little thyroid hormone production, the affect of too little thyroid hormone on the adrenals and blood sugar metabolism and the problems with ATP and mitochondria mentioned above.
• Insomnia or waking up feeling just as tired as when you went to sleep: Sleep issues are also incredibly common with hypothyroidism. Instability of thyroid hormone levels due to poorly managed autoimmunity, T3 building up and being released into the bloodstream, and the thyroid’s affect on the adrenals can all lead to insomnia.
With hypothyroidism, too little T4 can lead to a slower breakdown of cortisol. It then builds up in the body and this impacts the HPA axis (hypothalmus-pituitary-adrenal axis). See my past blog post for an in depth look at this.
• Stiffness upon waking or after staying in one position for too long: Hypothyroidism tends to cause a slower relaxation of tendons and some studies have shown high serum creatinine kinase levels. The levels are almost invariably in the MM isoenzyme that is the type of creatinine kinase found in skeletal muscles.
High levels of this enzyme are normally found in people who have been under extreme stress or who have just completed heavy exercise.
• Reduced tolerance for exercise and muscle pain after exercise: This certainly could be caused by what we just discussed. In addition, there are a host of issues that hypothyroidism can cause that relate to reduced tolerance for exercise. Check out my previous post on this.
• Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”): According to Dr. Datis Kharrazian, the role of the thyroid on the brain is profound. Thyroid function impacts brain inflammation, plasticity, neurotransmitter activity and general brain function.
Thyroid hormone impacts all neurotransmitter receptors in men and women.
All of them.
So hypothyroidism can impact serotonin, dopamine, acetylcholine and gaba levels.
These neurotransmitters have a huge influence on memory, concentration and mood. Especially acetylcholine. Hypothyroidism can lead to acetylcholine deficiency and inefficient nerve firing.
This can cause memory loss and poor concentration.
Brain fog is brain inflammation, plain and simple. It is really important not to ignore it, like many doctors do. The consequences can be really bad.
• Feeling anxious or depressed: As we just discussed, thyroid hormone impacts all neurotransmitter receptors. Gaba is an inhibitory neurotransmitter, it keeps you calm.
Hypothyroidism can impact gaba synthesis, release and reuptake. All of this can lead to increased anxiety.
Dopamine and serotonin are responsible for enabling us to experience joy and enjoy activities in our life and to get pleasure out of what we do. Hypothyroidism can also impact these neurotransmitters and can lead to deficiencies in both serotonin and dopamine.
• Increase in urinary urgency or frequency (irritable bladder): Acetylcholine deficiency can impact urinary urgency and frequency.
• Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome): Studies in human and dogs of hypothyroid patients have demonstrated a decrease in the electric and motor activity of the esophagus, stomach, small intestine and colon.
Digestive dysfunction is also incredibly common with hypothyroid patients. Leaky gut has been implicated in the formation and progression of various autoimmune diseases including Hashimoto’s.
Neuropathic symptoms including parasthesias (tingling or prickling sensation caused by issues with peripheral nerves) and painful dysthesias (an abnormal, uncomfortable sense of touch) are also common with hypothyroidism.
The most common type of neurological symptom in hypothyroid patients is carpal tunnel syndrome.
• Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold: Neuropathies involving the cranial nerves (those that control smell, hearing, vision) have all been reported. Hearing loss due to hypothyroidism is the most common and has been reported in 31%-85% of patients.
There are many theories on how hypothyroidism impacts nerves, but some studies have shown demyelination (the loss of the coating around nerve fibers), and axonal degeneration (degeneration of the nerve branches).
• Numbness or tingling in the face, arms, hands, legs, or feet: Certainly, this can be caused by what we just discussed.
• A feeling of swelling (without actual swelling) in the hands and feet: This could be neurological or it could simply be caused by the destructive inflammatory process that is at the root of Hashimoto’s.
As you can see, there is a plausible argument to be made that almost all of the symptoms of fibromyalgia could be rooted in hypothyroidism and Hashimoto’s.
Of course, this begs the question of what to do.
As with all things related to this disease, we are once again reminded that this is a multi-system disorder.
It’s much more than just a thyroid problem and it requires a multi-system approach if you want to manage it successfully.
This is exactly why I created my program: Healing Hashimoto’s: The 5 Elelments of Thyroid Health.
In it, I teach a step by step strategy for finding and healing your issues in all of these systems.
For more information, check out my program here.
http://www.thyroid.org/media-main/about-hypothyroidism/ : Statistics on thyroid disease
https://med.stanford.edu/clinicaltrials/trials/NCT00903877 : Clinical study using T3 to treat fibromyalgia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856434/?tool=pubmed : Paper on leaky gut
: A review of the evidence on the link between fibromyalgia and hypothyroidism
http://www.ncbi.nlm.nih.gov/pubmed/21085966 : Study linking fibromyalgia and autoimmune thyroid disease
Rodcolico C, Toscano A, Benvenga S, et al. Myopathy as the persistently isolated symptomaology of primary autoimmune thyroidism. Thyroid 1998;8:1033
Monzani F, Caraccio N, Siciliano G, et al. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J. Clinical Endocrinol Metab 1997;82:3315
Goti I. Serum creatinine phosphokinase isoenzymes in hypothyroidism, comvulsions, myocardial infarction and other diseases. Clin Chim Acta 1974;52:325
Kowalewski K, Kolodej A. Myoelectrical and mechanical activity of the stomach and intestine in hypothyroid dogs. Am J Dig Dis 1977;22;235
Bhatia PL, Gupta DP, Agrawal MK, et al. Audiological and vestibular function tests in hypothyroidism. Laryngoscope 1977;87:2082
Dyck PJ, Lambert ED. Polyneuropathy associated with hypothyroidism. J Neuropathl Exp Neurol 1970;29:631
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Isn’t My Brain Working? Dr. Datis Kharrazian, Elephant Press, 2013