Hypothyroidism - A Common Hormonal Problem in CFS

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My New Book - "The Underactive Thyroid"

See my My Book - The Underactive Thyroid - Do it yourself because your doctor won't
This has all the theory and also the practice of treating your underactive thyroid YOURSELF.


It is now quite clear there is a distinct hormonal disturbance in CFS sufferers, with a general suppression of the hypothalamic - pituitary - adrenal axis ["HPA" axis]. It is the pituitary gland which is the "conductor of the endocrine orchestra". If the pituitary is malfunctioning then this has knock on effects for the thyroid gland, adrenal gland, sex hormones, possibly the pineal gland (which produces melatonin for normal sleep), as well as hormones for growth and urine production.

In practice I invariably measure thyroid hormones (TSH, T4 and T3 - see Thyroid profile: free T3, free T4 and TSH), and take a detailed medical history, complete with the all important clinical signs and symptoms that are present in hypothyroidism (underactive thyroid). Then, given a suspicion of hypothyroidism, I will trial thyroid glandulars. In addition, I will often prescribe melatonin and check adrenal function (and use adrenal glandulars, or DHEA, or pregnenolone, where indicated) and very occasionally I will use sex hormones - mainly testosterone in men. Testosterone can also be boosted naturally by herbs - please see Great Green Wall - 10 Top Herbs That Boost Testosterone Levels. Many CFS sufferers are substantially improved by correcting thyroid hormones. Please see also these pages:

Underactive thyroid gland

The problem in CFS is caused by low levels of thyroid hormones in the blood. This can be underactive for four reasons (much more detail in My Book - The Underactive Thyroid - Do it yourself because your doctor won't) --

  • Primary hypothyroidism - when the thyroid is malfunctioning
  • T3 hypothyroidism (conversion problem) - when the thyroid cannot convert inactive T4 to the active T3
  • Secondary hypothyroidism - the pituitary is under-active due to deficiency or poisoning
  • Thyroid hormone receptor resistance - The circulating thyroid hormones are blocked or inhibited by
    • reverse T3
    • prescription drugs such as beta blockers
    • toxins from the fermenting gut
    • exogenous toxins
    • genetic link

The symptoms of these four problems are the same. Regarding blood test results, we have -

  • In primary hypothyroidism, the blood tests show high levels of thyroid stimulating hormone and low levels of T4 and T3.
  • In T3 hyothyroidism - conversion problem, TSH and T4 may be normal, but T3 is low.
  • In secondary hypothyroidism - pituitary failure, the blood tests show low levels of TSH, T4 and T3.
  • In thyroid hormone receptor resistance, the blood tests may show high reverse T3.

"Normal Ranges"

See also Thyroid - the correct prescribing of thyroid hormones

There is another problem too, which is that the so-called "normal range" of T4 is probably set too low. I know this because many patients with low normal T4 often improve substantially when they are started on thyroid supplements to bring levels up to the top end of the normal range. Indeed Dr Skinner (sadly now deceased), who was a consultant virologist at Birmingham, has shown how many patients with CFS have low normal levels of thyroxine (T4) and do well when their levels are increased to average levels. The laboratory I use has a normal range of 12-22 pmol/l and I am finding many levels coming back at 12-15. In these patients there is an indication for trying T4, especially if symptoms suggest this.

Symptoms and signs of an underactive thyroid

Again, much more detail in My Book - The Underactive Thyroid - Do it yourself because your doctor won't

  • Anybody with CFS could fit a diagnosis of hypothyroidism.
  • Symptoms: lethargy, sensitivity to cold, heat intolerance, mood swings and depression, poor memory and concentration, joint pains and morning stiffness, headaches, vertigo and deafness, pre-menstrual tension, voice changes, loss of libido and susceptibility to viral infections.
  • Signs: weight gain, fluid retention, puffy face, puffy eyes, hair loss (classically the outer third of the eyebrows), cold extremeties and dry skin, rashes, eczema and boils, enlargement of the tongue, hoarse voice, hypoglycaemia, constipation, menstrual problems, skin problems and tendency to infections, slow pulse or bradycardia, goitre, infertility, digestive problems, slowed Achilles tendon reflex, carpal tunnel syndrome. Further useful information is the basal body temperature - see Conducting the CFS orchestra How to put yourself in charge Remember that low body temperature can also be caused by poor mitochondrial function - see CFS - The Central Cause: Mitochondrial Failure

Treatment of an underactive thyroid

In deciding whether to treat, one must consider both the symptoms and the blood tests. Many doctors just treat the blood levels. The issue here is that one's personal normal range of thyroid hormones is not the same as the population normal range. Some people feel much better running high normal rather than low normal levels of T4 and T3.

I now treat hypothyroidism with thyroid glandulars and any associated adrenal problems with adrenal glandulars, DHEA, pregnenlone and other adaptogen herbs. Please see Conducting the CFS orchestra How to put yourself in charge and My Book - The Underactive Thyroid - Do it yourself because your doctor won't

Treatment with thyroid hormones is nearly always for life.

The Pulse Test

For some people, their pulse rate at rest parallels the activity of their thyroid gland. This can be particularly helpful to a brittle minority whose levels of thyroid hormone fluctuate widely with just minor adjustments to the daily oral dose. A normal pulse lies between 65 and 75 beats per minutes at rest. See also Conducting the CFS orchestra How to put yourself in charge

Related Test

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