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Is it Fibromyalgia or Thyroid?

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April 2, 2015

A Functional Medicine Approach

Many people suffering from either of these conditions may see a close overlap of symptoms, or may have been diagnosed with one and are curious if they have the other. In a 2012 article in Rheumatology International, scientists asked the question: “Does thyroid autoimmunity represent a predisposition for the development of fibromyalgia (FM)?

According to the researchers, “Based on our data, we speculate that maybe there is more than a hypothesis regarding the cause-effect relation between thyroid autoimmunity and the presence of FM, thus suggesting a hypothetical role of thyroid autoimmunity in FM pathogenesis.”

Fibromyalgia is a poorly understood pain syndrome with no known cause. Additional symptoms include fatigue, headaches, numbness, altered sleep, gastrointestinal disturbances and chemical sensitivity. The latter described symptoms tend to overlap with hypothyroidism, especially auto-immune Hashimoto’s hypothyroidism. Since upwards of 90% of hypothyroidism has an autoimmune component, it is worth asking some questions: If I have Fibromyalgia is it possible it is a result of hypothyroidism or “functional hypothyroidism”?

Or, if I have Hypothyroidism, is this connected to my symptoms of “fibromyalgia”. From a functional medicine perspective the answer is an emphatic “yes”! Two fundamental premises of functional medicine are: (1) chronic diseases are the result of chronic dysfunctions, and (2) dysfunction can result from a broad range of intertwined metabolic, inflammatory, microbial, nutritional, psychological and environmental influences. Most of these issues are not adequately treated by standard medical pharmacology. I believe this is because pharmacology treats all patients the same within a given diagnosis.

Functional medicine practitioners believe there is an underlying cause to every conditions and by addressing each person as an individual, specific therapies can be incorporated for rapid recovery. Fibromyalgia is commonly used as a wastebasket diagnosis for any patient that presents with chronic, widespread pain. Unfortunately, the current paradigm of healthcare limits testing in these patients resulting in a failure to identify readily treatable problems that cause widespread pain!

Similarly, Hashimoto’s hypothyroidism is rarely diagnosed when an elevated TSH is present because most general practitioners won’t alter the standard treatment of thyroid hormone replacement even if either of the two antibodies comes back positive on blood work! The bottom line is that functional medicine allows a practitioner to investigate the underlying cause, or ask the simple question, “why”?

So why does this overlap exist between fibromyalgia and thyroid and how can we address both by looking at the cause? To understand the connection we need to look at common correlations between the conditions. Fibromyalgia has a high prevalence of migraine like headaches, which may suggest impairment of mitochondrial function. Likewise, hypothyroidism patients suffer from similar headaches.

Another very common connection between both conditions is leaky gut. Leaky gut is an underlying finding in all autoimmune conditions. This alteration in normal nutrient trafficking within the body significantly increases inflammation due to the over activation of our immune system. There are many causes of such, and are commonly found in both FM and Hashimoto’s.

Bacterial overgrowth of the small intestine (SIBO) has become one of the most researched causes of FM and Hashimoto’s. According to a 2008 journal article in Rheumatology, the pain intensity of patients with FM correlated with the degree of small intestinal bacterial overgrowth (SIBO) resulting from altered intestinal permeability.
The overall conclusion was that the intestinal permeability in FM and, unexpectedly, complex regional pain syndrome are increased and the severity of intestinal permeability related to the severity of symptoms. Intestinal permeability can arise from more than just small intestinal bacterial overgrowth. Low vitamin D affects the tight junctions which hold intestinal cells together and therefore controls the level of permeability.

Interestingly, vitamin D deficiency is more common with patients who have chronic pain and anyone suffering from an autoimmune disease! Vitamin D deficiency is commonly misdiagnosed as FM and that increased severity of hypovitaminosis D correlates to depression and anxiety. What about Thyroid and vitamin D? According to a 2011 article in cellular immunology, “the prevalence of vitamin D deficiency was significantly higher in patients with auto immune thyroid disease compared with healthy individuals (72% versus 30.6%) as well as in patients with Hashimoto’s thyroiditis compared to patients with non-AITDs (79% versus 52%; P<0.05).” Vitamin D deficiency also correlated to the presence of antithyroid antibodies and abnormal thyroid function tests. It seems this particular vitamin is not just about bone health anymore! Whether it is detoxification, intestinal permeability, low vitamin D, bacterial overgrowth or another cause, functional medicine’s purpose is to ask “why does someone have these symptoms? It is not enough to name it, blame it and tame it pharmaceutically!

In these two conditions there is an overwhelming amount of overlap and proper testing should be performed to demonstrate the presence of one, or both conditions. Working with an experienced functional medicine practitioner can set a course of action that incorporates dietary, lifestyle and supplemental changes to help you achieve your goals in health. There is hope and it starts with the knowledge that an alternative exists!

For more information on functional medicine, please visit the Institute for Functional Medicine’s website at www.functionalmedicine.org.

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