Fibromyalgia: The elusive hypometabolic disease

Patients and physicians must understand that fibromyalgia is ultimately a hypometabolic condition dependent on diminished thyroid hormone levels or a resistance to the hormone that is present.

by Dr. Cristina Romero-Bosch — 

This controversial condition was first recognized by the American Medical Association as recently as 1987. It is defined by the presence of disperse body pain and tenderness with often debilitating fatigue and depression. Fibromyalgia is currently a condition that is ineffectively treated and, at times, even ignored. Despite being present in approximately five percent of the general population, many patients still find proper diagnosis and treatment elusive.

The diffuse pain of fibromyalgia is identified as a series of painful points on the body called trigger points. A doctor, such as a rheumatologist, makes the diagnosis of fibromyalgia based on the presence of 11 of 18 specific trigger points that elicit pain when pressed. The diagnosis also includes six months or more of persistent, related signs and symptoms. The most prevalent associated symptom is extreme fatigue. Fibromyalgia is often found in conjunction with a diagnosis of chronic fatigue.

Fibromyalgia may also result in sleep disturbance, weight gain, skin complaints, irritable bowel syndrome and cognitive dysfunction, to name a few. Cognitive dysfunction is evident by anxiety, depression and a common brain fog referred to as “fibro fog.” Symptoms are extremely varied in intensity but often render the patient handicapped by interfering with normal daily activities.

Doctors commonly have difficulty in agreeing on a diagnosis for fibromyalgia due to a lack of significant supportive laboratory evidence. Because of fibromyalgia’s nonspecific presentation, it is often considered a diagnosis of exclusion — or a diagnosis made when no other disease is found.

Fibromyalgia’s multi-system presentation makes it necessary to identify the underlying cause to effectively treat this complicated disease. At the core of fibromyalgia lies undiagnosed hypothyroidism, poorly treated hypothyroidism or resistance to the thyroid hormone present in the body.

Thyroid hormone resistance means the body’s cells cannot use available thyroid hormone effectively, even though adequate levels are present. It is similar to type 2 diabetes, or insulin resistance, where insulin is present in adequate amounts but is unable to do its job effectively, resulting in elevated blood sugar. When a doctor accurately assesses the patient’s metabolic and endocrine function, which is almost invariably low with fibromyalgia, a course of effective treatment becomes possible.

Hypometabolism can only be determined through analysis of blood thyroid hormone levels, measuring basal metabolic rates, assessing nutritional status and by detailed clinical examinations of medical history, signs and symptoms. This type of thorough examination is often bypassed, due to an inappropriate emphasis on blood test measurements of TSH (thyroid stimulating hormone). It is this common practice of relying on a TSH reading alone to evaluate thyroid function that has resulted in many patients inaccurately being dismissed by their physician as having normal thyroid function.

Many fibromyalgia patients are already being treated for hypothyroidism with thyroid hormone medication in the form of inactive T4, most commonly Synthroid® or synthetic levothyroxine. A patient who is already being treated for hypothyroidism, should not be satisfied with the use of a thyroid product containing only T4. Often hypothyroid or fibromyalgia patients will not recover if their thyroid hormone treatment includes the use of a T4-only product. Most patients find greater success on a product containing the active form of thyroid hormone, T3.

When undergoing proper metabolic evaluation and treatment, the patient must use a holistic metabolism-raising approach that includes thyroid hormone replacement, diet modification, nutritional education, exercise, mental and emotional support, soft tissue manipulation and, when medically appropriate, avoidance of metabolism-lowering medications such as pain medications and antidepressants. It is by coupling physician-recommended hormonal support with a holistic approach that the patient achieves full body recovery.

Fibromyalgia, although presently considered an incurable condition, has the potential to be effectively controlled. Focusing treatment on the underlying cause of the hypometabolism, rather than attempting to dissect the condition into seemingly unrelated symptoms with ineffective drug therapy, will help ensure successful and permanent results. Patients and physicians must understand that fibromyalgia is ultimately a hypometabolic condition dependent on diminished thyroid hormone levels or a resistance to the hormone that is present.

Fibromyalgia patients must remain hopeful and understand that the condition can be treated effectively if the hypometabolic state is properly addressed.

Cristina Romero-Bosch, N.M.D., completed a residency in integrative medicine with Yale University and University of Bridgeport. She practices at Iluminar in north Scottsdale, Ariz., where hypometabolic conditions are treated through endocrine and lifestyle assessments. drbosch@iluminartherapy.com, www.iluminartherapy.com or 480-338-8070.

Reprinted from AzNetNews, Volume 27, Number 5, October/November 2008.