‘Thyroid’ Issues May Really Be Hypothalamic

‘Thyroid’ Issues May Really Be Hypothalamic

Though this article addresses only obese patients, it seems the same could be true of patients of any weight.

Obese patients who continue to have “thyroid symptoms” even when their levels are normalized may have a hypothalamic dysfunction, researchers reported here.

In a single-center study of 50 patients referred for evaluation of thyroid symptoms, 68% had at least four symptoms that were characteristic of hypothalamic obesity disorder.

Those include fatigue, temperature dysregulation, weight change, changes in sleeping patterns, pain, and mood disorders.

some overweight patients continue to have these thyroid symptoms even when they’ve had sufficient hormone replacement.

Sakkal and colleagues hypothesized that their symptoms may relate to hypothalamic dysfunction instead.

So Sakkal and colleagues assessed 50 patients who had been referred for the evaluation of thyroid symptoms. They diagnosed hypothalamic dysfunction as “likely” if symptoms from three different systems were present, and as “definite” if from four or more.

The most common hypothalamic symptoms were:

  • Fatigue (76%)
  • Temperature dysregulation (68%)
  • Weight change (88%)
  • Changes in sleep (70%)
  • Pain (72%)
  • Mood disorders (80%)
  • Libido issues (38%)
  • Sympathetic or parasympathetic complaints (64%)

These symptoms seem identical to those of Fibromyalgia.

The researchers noted that an important physical finding is the presence of trigger points tenderness, which occurred in 68% of this population.

…which would also imply Fibromyalgia.

Overall, more than two-thirds of these patients (68%) were determined to have definite hypothalamic dysfunction, and 22% had likely hypothalamic dysfunction, the researchers reported.

Some clinicians diagnose these patients with malingering, borderline personality disorder, adrenal depletion, or uncharacterized disorders “when hypothalamic dysfunction would explain most,” they wrote.

Drug treatment involved:

  • fluoxetine/spironolactone followed by
  • topiramate/phentermine — and then
  • buspirone for anxiety,
  • trazodone for sleep problems or fibromyalgia,
  • fluoxetine or bupropion for OCD,
  • testosterone in hypogonadism, and
  • bromocriptine for those with hyperprolactinemia.

They found that over 12 weeks, the mean weight loss for patients diagnosed with the condition was 13 pounds.

“Since the majority of clinical obesity is hypothalamic in nature, many other symptoms need to be addressed as well to treat the etiology as well as the weight problem itself,”

“Treatment for anxiety, depression, compulsive behavior, sleep disorders, and fibromyalgia — all of which often cause the behavioral pattern leading to obesity — by weight-neutral medications is intuitive, but rarely reported.”

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