Hypothyroidism
The thyroid gland is a sort of butterfly shaped gland with each ‘wing’ sitting on either side of the windpipe, just above the central meeting point of the collar bone. When this gland does not make enough thyroid hormone the illness is called hypothyroidism. It is more common in women and the elderly.
Symptoms of hypothyroidism include sensitivity to cold, fatigue, weakness, joint or muscle pain, sadness/depression, memory loss, dry, pale skin, thin, brittle fingernails and/or hair loss, weight gain or difficulty losing weight even with dietary restriction, constipation, and abnormal menstrual cycles.
Everybody is different however, and a patient does not have to have all of these symptoms to be diagnosed with hypothyroidism, and one patient may have one or more symptoms predominate, while another person will have different symptoms predominate.
It can be clearly seen that there is some overlap with MS symptoms, and some sources indicate that MS and hypothyroidism are fairly common comorbidities. This BartsMS post cites a study into thyroid issues and MS, and the professor who contributes to this website notes that he routinely screens on an annual basis if any of his MS patients suffer from fatigue. He states: “Hypothyroidism is a treatable cause of fatigue and shouldn't be missed." http://multiple-sclerosis-research.blogspot.com/2013/04/autoimmune-thyroid-disease-in-ms.html
If someone with MS has hypothyroidism, then diagnosing that condition and optimising thyroid hormones could potentially greatly improve their health outcomes and quality of life.
As with MS, the primary symptoms of hypothyroidism are the loss of energy that produces unusual fatigue, and disruption of thermoregulation. People with an underactive thyroid can suffer exercise intolerance and tend to always feel the cold, but can also be intolerant of heat, feeling most comfortable in a narrow temperature range.
Diagnosis of Hypothyroidism
The presentation of hypothyroid symptoms can be vague. A patient doesn’t always have to have a particular symptom to be diagnosed, and many of the symptoms listed above can be present in a range of other diseases, including MS.
For this reason, clinical diagnosis can be difficult, and blood tests are considered definitive.
The main blood test for hypothyroidism is the thyroid-stimulating hormone (TSH) test. It measures the levels of the thyroid hormone (thyroxine or T4) in the blood. If it is abnormally high, then it means the gland is being asked to make more T4 because there isn’t sufficient T4 in the blood.
This Australian Family Physician page provides comprehensive information on hypothyroidism, and diagnostic practice in Australia http://www.racgp.org.au/afp/2012/august/hypothyroidism/
Patient advocacy around diagnosis
Patient advocates sometimes claim that thyroid test ranges are not sensitive enough, and that a full panel of thyroid blood tests should be done, including TSH, free T4, free T3 and reverse T3.
Others note that where thyroid tests are normal, but symptoms persistently point to hypothyroidism, temperature testing can clarify things. This site describes how to test for basal body temperature which may indicate hypothyroidism in the absence of abnormal test results http://www.holistic-hypothyroidism-solutions.com/basal-body-temperature.html
Some sites recommend a mercury thermometer for measuring basal body temperature but these have been withdrawn from sale in Australia. A digital basal body temperature thermometer measures much smaller increments and can be used instead of a regular digital thermometer.
The possible role of reverse T3 (RT3)
Wilsons temperature syndrome is a somewhat controversial theory that holds that people can have symptoms of Hypothyroidism with low body temperature even with thyroid blood tests within the normal range. Developed by Dr Denis Wilson MD in 1988, he found that treating patients with T3 medication only, normalised their body temperatures and often resolved their symptoms even after the medication was stopped. The theory seems to be based on the idea that high reverse T3 blocks the action of T3. It seems that when reverse T3 is lowered, or T3 is elevated relative to reverse T3, symptoms resolve.
Those who would like to explore this possibility can read more here http://www.wilsonssyndrome.com/
This site goes into considerable detail on the effects of reverse T3 and explains the reverse T3 ratio http://www.holistic-hypothyroidism-solutions.com/reverse-t3.html
This site explains how to calculate your reverse T3 ratio http://the-natural-thyroid-diet.com/reverse-t3-ratio/
This site comprehensively discusses the detrimental effect of chronic low body temperature on our health http://davidjernigan.blogspot.com.au/2010/01/chronic-fatigue-syndrome-and-low-body.html
Research has shown that thyroid disease can be a frequent comorbidity with MS. As noted above, one respected professor of neurology has indicated that he tests annually for this comorbidity in people with MS fatigue. Anyone who feels that they may have the symptoms of Hypothyroidism as a contributor to overlapping MS symptoms, particularly chronically low body temperature, sensitivity to cold and/or heat, fatigue, weakness, joint or muscle pain, sadness/depression, and memory loss, may wish to discuss the issue with their doctor and/or neurologist. It may be wise to ask for a full thyroid panel including TSH, T4, T3 and in particular RT3. Given the significant disability that many with MS face, and in particular the severely debilitating nature of symptoms of fatigue and pain, then where thyroid tests are normal but the patient feels that after personal research that their symptoms and basal body temperature still points to likely thyroid involvement, patients may calculate their own RT3 ratio if their doctor is unable to do so. If the results are not within acceptable limits they may then discuss their results with a doctor who is familiar with the theory that reverse T3 may cause symptoms of hypothyroidism in the presence of otherwise normal thyroid tests.
Coeliac Disease and gluten sensitivity
The thyroid gland is a sort of butterfly shaped gland with each ‘wing’ sitting on either side of the windpipe, just above the central meeting point of the collar bone. When this gland does not make enough thyroid hormone the illness is called hypothyroidism. It is more common in women and the elderly.
Symptoms of hypothyroidism include sensitivity to cold, fatigue, weakness, joint or muscle pain, sadness/depression, memory loss, dry, pale skin, thin, brittle fingernails and/or hair loss, weight gain or difficulty losing weight even with dietary restriction, constipation, and abnormal menstrual cycles.
Everybody is different however, and a patient does not have to have all of these symptoms to be diagnosed with hypothyroidism, and one patient may have one or more symptoms predominate, while another person will have different symptoms predominate.
It can be clearly seen that there is some overlap with MS symptoms, and some sources indicate that MS and hypothyroidism are fairly common comorbidities. This BartsMS post cites a study into thyroid issues and MS, and the professor who contributes to this website notes that he routinely screens on an annual basis if any of his MS patients suffer from fatigue. He states: “Hypothyroidism is a treatable cause of fatigue and shouldn't be missed." http://multiple-sclerosis-research.blogspot.com/2013/04/autoimmune-thyroid-disease-in-ms.html
If someone with MS has hypothyroidism, then diagnosing that condition and optimising thyroid hormones could potentially greatly improve their health outcomes and quality of life.
As with MS, the primary symptoms of hypothyroidism are the loss of energy that produces unusual fatigue, and disruption of thermoregulation. People with an underactive thyroid can suffer exercise intolerance and tend to always feel the cold, but can also be intolerant of heat, feeling most comfortable in a narrow temperature range.
Diagnosis of Hypothyroidism
The presentation of hypothyroid symptoms can be vague. A patient doesn’t always have to have a particular symptom to be diagnosed, and many of the symptoms listed above can be present in a range of other diseases, including MS.
For this reason, clinical diagnosis can be difficult, and blood tests are considered definitive.
The main blood test for hypothyroidism is the thyroid-stimulating hormone (TSH) test. It measures the levels of the thyroid hormone (thyroxine or T4) in the blood. If it is abnormally high, then it means the gland is being asked to make more T4 because there isn’t sufficient T4 in the blood.
This Australian Family Physician page provides comprehensive information on hypothyroidism, and diagnostic practice in Australia http://www.racgp.org.au/afp/2012/august/hypothyroidism/
Patient advocacy around diagnosis
Patient advocates sometimes claim that thyroid test ranges are not sensitive enough, and that a full panel of thyroid blood tests should be done, including TSH, free T4, free T3 and reverse T3.
Others note that where thyroid tests are normal, but symptoms persistently point to hypothyroidism, temperature testing can clarify things. This site describes how to test for basal body temperature which may indicate hypothyroidism in the absence of abnormal test results http://www.holistic-hypothyroidism-solutions.com/basal-body-temperature.html
Some sites recommend a mercury thermometer for measuring basal body temperature but these have been withdrawn from sale in Australia. A digital basal body temperature thermometer measures much smaller increments and can be used instead of a regular digital thermometer.
The possible role of reverse T3 (RT3)
Wilsons temperature syndrome is a somewhat controversial theory that holds that people can have symptoms of Hypothyroidism with low body temperature even with thyroid blood tests within the normal range. Developed by Dr Denis Wilson MD in 1988, he found that treating patients with T3 medication only, normalised their body temperatures and often resolved their symptoms even after the medication was stopped. The theory seems to be based on the idea that high reverse T3 blocks the action of T3. It seems that when reverse T3 is lowered, or T3 is elevated relative to reverse T3, symptoms resolve.
Those who would like to explore this possibility can read more here http://www.wilsonssyndrome.com/
This site goes into considerable detail on the effects of reverse T3 and explains the reverse T3 ratio http://www.holistic-hypothyroidism-solutions.com/reverse-t3.html
This site explains how to calculate your reverse T3 ratio http://the-natural-thyroid-diet.com/reverse-t3-ratio/
This site comprehensively discusses the detrimental effect of chronic low body temperature on our health http://davidjernigan.blogspot.com.au/2010/01/chronic-fatigue-syndrome-and-low-body.html
Research has shown that thyroid disease can be a frequent comorbidity with MS. As noted above, one respected professor of neurology has indicated that he tests annually for this comorbidity in people with MS fatigue. Anyone who feels that they may have the symptoms of Hypothyroidism as a contributor to overlapping MS symptoms, particularly chronically low body temperature, sensitivity to cold and/or heat, fatigue, weakness, joint or muscle pain, sadness/depression, and memory loss, may wish to discuss the issue with their doctor and/or neurologist. It may be wise to ask for a full thyroid panel including TSH, T4, T3 and in particular RT3. Given the significant disability that many with MS face, and in particular the severely debilitating nature of symptoms of fatigue and pain, then where thyroid tests are normal but the patient feels that after personal research that their symptoms and basal body temperature still points to likely thyroid involvement, patients may calculate their own RT3 ratio if their doctor is unable to do so. If the results are not within acceptable limits they may then discuss their results with a doctor who is familiar with the theory that reverse T3 may cause symptoms of hypothyroidism in the presence of otherwise normal thyroid tests.
Coeliac Disease and gluten sensitivity