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An article written by a medical professional I read stated that everyone with Fibromyalgia has low thyroid function to some degree.  That’s a bold statement and yet I agree.  The question that remains is whether the problem is the thyroid or it’s related mechanisms, or something else affecting the thyroid or thyroid hormones.  Ultimately it may not matter, as treating with hormone replacement helps low thyroid function (LTF) regardless of the cause.

First, what does low thyroid mean?  Many think low thyroid means your blood work for thyroid appears abnormal.  When your doctor checks your thyroid function they usually look at three markers, TSH, T4, and T3.  There are other tests that can be done, reverse T3, anti-thyroid antibodies, as well as other types of tests that can be used to rule out other abnormalities if your doctor finds reason to believe something else is wrong.
There are serious medical conditions that can affect the different mechanisms and structures involved in the production of thyroid hormone.  These need to be ruled out by a qualified medical professional.  This information is NOT intended to be a substitute for such health care.  If, however, everything is ruled out and the blood work shows you have, or even if it doesn’t show you have low thyroid function, you may benefit from thyroid treatment.
TSH refers to Thyroid Stimulating Hormone, which is produced in your brain in the anterior pituitary.  TSH tells your thyroid to produce T4 which in turn breaks down into T3.  T3 is the active hormone used by the different systems of the body for metabolism regulation as well as many other functions.  (this is a simple version)
In most cases, Doctor’s including Endocrinologists prescribe T4 (Synthroid, Levothyroxine) for hypothyroidism.  The theory is that your body will break down the T4 into the needed T3 making you will feel better.  Many times, however, even though a patient’s blood work may look better, they continue to feel terrible.  Inevitably they are then prescribed even more T4, and the process continues.  More about this will be said in the section on reverse T3.
Symptoms of Low Thyroid
Depression
low body temperature (below 98.6)
no sex drive
Anxiety
insomnia
constipation
brittle nails
high cholesterol
cold hands / feet
fatigue
hair loss
restless legs
neuropathy
dry skin
weight gain
muscle / joint pains
fibromyalgia
mood swings (sometimes misdiagnosed as Bipolar)
lack of concentration and focus (sometimes misdiagnosed as ADHD)
That’s an incomplete list of symptoms one can experience with LTF.
What if you have hypothyroid symptoms but your blood work is normal?  Often times people will have hypothyroid symptoms yet their blood work remains normal.  In fact blood work for TSH levels only started to be used in the early 1970’s.  Before then doctors looked at clinical symptoms such as those above.  The main medication for treating LTF for years was Armour’s Thyroid, which is typically desiccated porcine thyroid which naturally contains both T4 and T3 in a ratio similar to what humans produce.  It has been around since the late 19th century actually.  If you went to a doctor in 1910 then, feeling lethargic, gassy, constipated, and depressed your doctor may have prescribed Armour’s thyroid.
Today no doctor would treat you unless your blood work, specifically your TSH, is abnormal.  Yet many people continue to have hypothyroid symptoms even though their blood work continues to fall in normal range.
What are other reasons for treating with Armour’s Thyroid?  If a patient who has been diagnosed with LTF continues to feel poorly despite being given a T4 preparation, most likely it’s because they don’t break down T4 properly or they tend to produce too much reverse T3 instead of the active T3.  Reverse T3 is something we all produce.  Most likely reverse T3 is an old evolutionary mechanism that we still carry that slowed our metabolism during times of hunger or injury until either food was found or we healed.  Once some people start producing reverse T3 they may have a problem turning the mechanism off.  Another theory that may explain the overproduction of reverse T3 is a lack of enzyme to break T4 down into healthy or active T3.  Reverse T3 as the name suggests doesn’t work like active T3, and if you have a tendency to producing too much of this, all the T4 in the world won’t make you feel better.
The reasons why someone may produce too much reverse T3 are irrelevant.  The only option to taking only T4 is adding T3 to it in a ratio of 4:1, 3:1, 2:1, or even 1:2 of T4:T3.  This can be given as regular prescriptions of Synthroid / Levothyroxine and Cytomel.  Another option is to have them compounded.  And lastly another option is Armour’s Thyroid, Natur-Throid, or a synthetic T4:T3 formula.  I personally take only T3 every day, and every other day add T4 because I don’t feel well taking T4 on a daily basis.
by Mark Michalica, LPC

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