The Fibromyalgia-Thyroid Connection. If your TSH thyroid test is normal, you better read this… – National Pain Report – By Donna Gregory Burch – April 4, 2017
Did you know that thyroid conditions are routinely misdiagnosed as fibromyalgia?
That’s because the TSH test, the test most commonly used by doctors to diagnose thyroid issues, is a poor indicator of overall thyroid health.
It takes a much more comprehensive approach to testing and clinical expertise to properly diagnose thyroid disorders.
I recently interviewed Dr. Brady about the connection between fibromyalgia and thyroid dysfunction and how to get properly evaluated and treated if you have a thyroid disorder.
Q: What is the connection between fibromyalgia and thyroid disorders?
They’re both big points of diagnostic confusion. Underperforming thyroid, even if it’s not overt hypothyroidism, is one of the top three masqueraders of fibromyalgia.
There are a lot of women who have symptoms that are really caused by underperforming thyroid that, when they go to a physician, they get erroneously diagnosed as having fibromyalgia, and unfortunately [are] often put on a fibromyalgia medication, which has no hope of helping them and a high degree chance of causing side effects and problems, and their underlying true condition is never getting addressed.
Q: What are the most common symptoms of thyroid dysfunction?
- Tired all the time,
- cold all the time,
- dry skin,
- dry hair,
- hair falling out more than normal,
- difficulty concentrating, and
- you can also start to develop muscle aches or myalgia.
- Even joint pain can be caused by hypothyroidism
Q: How common is it for thyroid disorders to be misdiagnosed as fibromyalgia?
It’s unbelievably common! There are lots of conditions that get erroneously labeled as fibromyalgia mainly because they are occurring in a woman, and there’s sort of a golden cluster of symptoms, like
- pain or achiness around the body,
- feeling tired or fatigued,
- anxiety and/or depression,
- poor sleep or insomnia,
- constipation and
- vague bowel problems [and]
- brain fog.
All of those things occur if you’re having thyroid [dysfunction].
It gets a little complicated, but in thyroid disorders, the vast majority of thyroid [hormone] that [is] produced is something called thyroxin or T4.
It gets converted to a more active hormone known as T3 or triiodothyronine.
You don’t have enough thyroid hormone, your biochemistry slows down, and you feel like you got hit by a train.
If you’re only looking at the front end of it [by just testing TSH], and you’re not looking at the whole picture,
Q: Most doctors are only testing TSH levels. Why is TSH not a good measure of thyroid function?
You have to go to a very low total production of T4 to stimulate an increase in TSH, and that’s what they’re looking for when they are doing a TSH test. They are looking for elevations of TSH to be indicative of a hypothyroid state.
When you’re using laboratory ranges … you have to be different statistically than 95 percent of the population to come up either high or low on most blood tests.
What that means for hypothyroidism is you’re only dealing with one end of the bell curve tail, so you have to be in the lowest 2.5 percent of the population to come up low on a TSH test, and facts are that many people feel the effects of underperforming thyroid long, long before they would meet that criteria.
If the thyroid is producing a reasonable amount of T4, the test never goes abnormal … but if you don’t convert the T4 you make to T3 adequately, your lab test may look fine, but from a functional standpoint you’re hypothyroid, or you at least [have an] underperforming, suboptimal thyroid, so you have to look at other tests.
You have to look at not only the T4 hormone, but the T3 hormone, and you have to look at both of those hormones in both their total state and their free state.
Q: What are the thyroid tests that patients should request?
When I’m doing a full thyroid assessment initially on a patient, I order a TSH. I order a total T4, a free T4, a total T3, a free T3, and then particularly if there’s any family history of Hashimoto’s, Grave’s or any kind of autoimmune thyroid condition, we order what are called TPO antibody and thyroglobulin antibody [tests].
Q: Your thyroid levels can come back normal, but you can still have dysfunction, correct?
Yes, because once again you’re looking at standard, normal ranges based on the 95th percentile. We want you to be at least in the mid part of the normal range.
There’s a difference between normal and optimal thyroid function.
If you think about it, these [laboratory ranges] are based on data from the population, so if the population en masse starts getting sick all in the same way, the labs’ normal ranges follow the sickness because they’re based on that population statistically, but just because something is common doesn’t mean it’s a normal state of affairs.
Q: I’ve read that the most popular thyroid medications, like Synthroid, are not always the most effective treatment. What’s your approach to treating thyroid issues?
Synthroid is synthetic T4. That can be very effective in patients whose core problem is they aren’t making enough T4 hormone. In those patients, generally, they show up on the orthodox testing. They usually have an elevated TSH and low T4, and they get put on Synthroid, and often they do fine.
But if you’re one of those many other folks who your problem is more in converting T4 to T3, we still have to intervene with some level of thyroid support. When we do that, we tend to use a form of replacement agents that have a combination of the right physiological ratio that your thyroid would put out of T4 and T3, and usually we’re using these in a bioidentical form or some sort of glandular form.
A popular alternative to the synthetic hormones is Armour Thyroid. Armour Thyroid is a porcine-based thyroid, so it’s from pig hormones. It’s a fully processed pharmaceutical that’s standardized.
A lot of the stuff that’s said about it is just patently untrue. It’s regulated like any other drug, and it has to meet targets of T4 and T3, so it’s very easy to use, and patients basically get a much more complete treatment.
They feel better. They get better results because they’re getting the same kind of hormones introduced from the outside that they would be producing internally in the right ratios of T4 to T3.
Q: What is your best advice for how to get properly evaluated for thyroid issues?
Find a doctor who’s trained in functional medicine or integrative medicine who really understands looking at thyroid in a very granular way.
If you’re a woman … in your 30s or 40s, and you’re starting to feel like “I’m tired all the time, I can’t think straight, I don’t have any energy, I don’t have any exercise tolerance, my muscles ache, I’m constipated, my hair’s getting thinner,
You need to find someone who can really evaluate your thyroid even if your family practitioner or endocrinologist says your thyroid is fine. It might be fine statistically in the laboratory, but it may not be where you need it to be to feel good.
Q: Where can people connect with you online?
I’d invite people to check out my website, DrDavidBrady.com. I have a lot of articles about thyroid [and fibromyalgia] on my website under the “media” tab.