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Fibromyalgia

 

Lower Resting Metabolic Rate and Basal Body Temperature of Fibromyalgia Patients Compared to Matched Healthy Controls
John C. Lowe, Gina Honeyman-Lowe, Jackie Yellin

Thyroid Science 1(8):1-18, 2006
Introduction. All symptoms and most objectively verified abnormalities of fibromyalgia are common among patients with hypothyroidism or partial peripheral thyroid hormone resistance. In treatment trials, thyroid hormone therapy has reduced or eliminated fibromyalgia symptoms, and a long-term follow-up study showed that improvement with thyroid hormone therapy lasted 1 to 5 years. In a previous study by the authors, solicited female fibromyalgia patients had significantly lower resting metabolic rates and basal body temperatures than matched healthy controls. In this study, the resting metabolic rates and body temperatures of fibromyalgia patients previously evaluated at a specialty metabolic clinic were compared with healthy controls to whom they were matched.

Methods. Fifteen female fibromyalgia patients and 15 healthy females served as study subjects. Patients were clinical cases selected to match controls by sex, age, weight, and activity level. Resting metabolic rate (RMR) was measured by indirect calorimetry (MedGem®), basal body temperature with digital thermometers, and body composition by bioelectrical impedance. The mean (average) measured resting metabolic rate (mRMR) was compared to percentages of the mean predicted RMR (pRMR) by two methods: fat-free weight and sex, age, height, and weight. Measurements were taken during the follicular phase of subjects’ menstrual cycles. Patients’ mean basal body temperature was significantly lower than that of controls. Patients’ serum free T3 level was significantly lower than that of controls

Conclusions. The patient group had a lower mean mRMR and lower mRMR as percentages of pRMRs. Patients also had a significantly lower mean basal body temperature. Neither calorie restriction nor low fat-free weight accounted for patients’ lower RMRs. As in the previous study, fibromyalgia patients’ normal fat-free weight argues against low physical activity with poor physical fitness as the mechanism of their low RMRs. Free T4, free T3, and TSH levels did not correlate with fibromyalgia measures or RMRs in either patient or control group. The lack of correlation does not rule out inadequate thyroid hormone regulation as the mechanism of the low RMRs because studies have not shown that these laboratory values reliably predict RMR values.

 


 

Female Fibromyalgia Patients: Lower Resting Metabolic Rates Than Matched Healthy Controls
John C. Lowe, Gina Honeyman-Lowe, Jackie Yellin
Med Sci Monit, 2006; 12(7): CR282-289

Background: Many features of fibromyalgia and hypothyroidism are virtually the same, and thyroid hormone treatment trials have reduced or eliminated fibromyalgia symptoms. These findings led the authors to test the hypothesis that fibromyalgia patients are hypometabolic compared to matched controls.
Material/Methods: Resting metabolic rate (RMR) was measured by indirect calorimetry and body composition by bioelectrical impedance for 15 fibromyalgia patients and 15 healthy matched controls. Measured resting metabolic rate (mRMR) was compared to percentages of predicted RMR (pRMR) by fat-free weight (FFW) and by sex, age, height, and weight (HB).
Results: Patients had a lower mRMR  and lower percentages of pRMRs. Whereas FFW, age, weight, and body mass index (BMI) best accounted for variability in controls’ RMRs, age and fat weight (FW) did for patients. In the patient group, TSH level accounted for 28% of the variance in pain distribution, and free T3 (FT3) accounted for 30% of the variance in pressure-pain threshold.
Conclusions Patients had lower mRMR and percentages of pRMRs. The lower RMRs were not due to calorie restriction or low FFW. Patients’ normal FFW argues against low physical activity as the mechanism. TSH, FT4, and FT3 levels did not correlate with RMRs in either group. This does not rule out inadequate thyroid hormone regulation because studies show these laboratory values do not reliably predict RMR.

Pub Med Abstract:
http://www.ncbi.nlm.nih.gov/pubmed/16810133?dopt=Abstract

Full text in PDF format:
Female fibromyalgia patients: Lower resting metabolic rates than matched healthy controls


 

Effectiveness and safety of T3 (triiodothyronine) therapy for euthyroid fibromyalgia: a double-blind placebo-controlled response-driven crossover study.
John C. Lowe, MA, DC, Richard L. Garrison, MD, Alan J. Reichman, MD, Jackie Yellin, BA, Mervianna Thompson, RN, MSN, APN, Daniel Kaufman, MD: Clinical Bulletin of Myofascial Therapy, 2(2/3):31-58, 1997.

Background. Clinical features of fibromyalgia syndrome (FMS) resemble those of hypothyroidism although some patients have normal thyroid function tests results. The hypothyroid-like FMS features of these patients may result from partial cellular resistance to thyroid hormone. We treated euthyroid FMS patients with T3 to see if they would respond as do patients with peripheral thyroid hormone resistance syndrome: significant therapeutic effects with supraphysiologic dosages, without target tissue responses typical of thyrotoxicosis.

Methods. Seven patients were alternately treated with T3 and placebo over an 8-month period.
Phase crossover was response-driven, based on changes in measures of mean tender point sensitivity by algometry, mean symptom intensity by visual analog scales, and mean pain distribution by the percentage method and the ACR criteria. Testing for adverse responses to supraphysiologic dosages of T3 was performed for heart, bone, muscle, and liver.

Results. Significant therapeutic effects were shown in T3 phases compared to placebo phases on all measures of FMS status. Effective T3 dosages were supraphysiologic, and ranged from 93.75-to-150 µg. Available patients had maintained improvement at 2-month follow-up. Tests showed no clinically significant cardiac, osseous, muscle, or hepatic adverse effects.

Conclusions. In this study, supraphysiologic dosages of T3 were safe and significantly effective in the treatment of euthyroid FMS. Though these dosages produced thyroid function test results indicative of hyperthyroidism, our patients had no clinically significant adverse target tissue effects. Results suggest that euthyroid FMS is a clinical phenotype of partial peripheral resistance to thyroid hormone. We recommend that further studies be done to answer the questions: Are euthyroid FMS patients partially resistant to thyroid hormone? And if so, what are the molecular mechanisms of the resistance? Further testing is also necessary to establish the long-term safety of T3 therapy.

 

! The process of change during T3 treatment for euthyroid fibromyalgia: a double-blind placebo-controlled crossover study.
John C. Lowe, MA, DC, Alan J. Reichman, MD, Jackie Yellin, BA: Clinical Bulletin of Myofascial Therapy, 2(2/3):91-124, 1997.

Methods. Comparative effects of placebos and T3 were tested on four euthyroid fibromyalgia patients over a period of nine months. Each patient completed alternately two T3 phases and two placebo phases, the sequence depending on the medication with which each was randomly assigned to begin. The ABAB single subject crossover design enabled each patient to serve as her own control. Phase crossover was response-driven, based on changes in measures of mean tender point sensitivity by algometry, pain distribution by the percentage method, and mean symptom intensity by visual analog scales. Changes were evaluated by visual inspection of graphs and single subject statistical analyses. Traditional group comparison statistics were performed for changes on the Fibromyalgia Impact Questionnaire, the Zung's Depression Scale, and pain distribution according to the ACR criteria.

Results. Quantitative analysis of trends of repeated measures across phases showed significant improvement in fibromyalgia status in T3 phases compared to baseline and placebo phases. Testing throughout the 9-month study and at 4-month follow-up showed no clinically significant adverse target tissue effects. No patient met the diagnostic criteria for fibromyalgia by the end of the study.

Conclusion. Repeated administration and withdrawal of T3 corresponded to significant improvement and deterioration in fibromyalgia measures during this study. It is highly probable, then, that improvement in fibromyalgia status of our four patients was functionally related to their use of supraphysiologic dosages of T3 (effective range: 118.75-to-162.50 µg). These dosages were shown to be safe at 4-month follow-up. Further testing is necessary to establish long-term safety.

http://www.drlowe.com./articles/blinded.htm

! Triiodothyronine (T3) treatment of euthyroid fibromyalgia: a small-n replication of a double-blind placebo-controlled crossover study.
John C. Lowe, MA, DC, DC, Richard L. Garrison, MD, Alan Reichman, MD, and Jackie Yellin, BA: Clinical Bulletin of Myofascial Therapy, 2(4):71-88, 1997.

Background. In a previous study, T3 was found to be highly effective compared to placebos in the treatment of euthyroid fibromyalgia. In this replication study, the comparative effects of placebos and T3 were tested with 4 euthyroid fibromyalgia patients. A randomized double-blind placebo-controlled crossover design was used.

Methods. Patients completed alternately two T3 phases and two placebo phases. The sequence for each patient depended on the medication with which she was randomly assigned to begin. Crossover from one phase to another was response-driven, based on changes in 3 measures of fibromyalgia status: mean tender point sensitivity by algometry, mean symptom intensity by visual analog scales, and pain distribution by the percentage method. Measurements taken repeatedly during each phase were used to determine when a patient's scores warranted a crossover. Patients also completed the Fibromyalgia Impact Questionnaire and Zung's Self-Rating Depression Scale at the end of each phase.

Results. Paired-samples t-tests showed a highly significant difference between scores in placebo and T3 phases. Serial ECGs throughout the 8-month study, and urine and serum calcium, phosphorus, creatinine, serum alkaline phosphatase, and bone densitometry at 6-month follow-up revealed no adverse effects from T3.

Conclusion. The highly significant difference between fibromyalgia measures in placebo and T3 phases, despite the small N, indicates a powerful therapeutic effect of supraphysiologic dosages of T3. Despite low TSH and free and total T4 levels, and high free T3 levels, there was no evidence of thyrotoxicosis. Long-term safety of T3 use by euthyroid fibromyalgia patients has not yet been established.

http://www.drlowe.com./articles/blinded.htm


 

Relief of Fibromyalgia Symptoms Following Discontinuation of Dietary Excitotoxins
Annals of Pharmacotherapy: Vol. 35, No. 6, pp. 702-706.
Jerry D Smith, Chris M Terpening, Siegfried Of Schmidt, and John G Gums

This study sees four women patients diagnosed with fibromyalgia syndrome for 2 to 17 years. All had had little success with various treatments. All had complete, or nearly complete, resolution of their symptoms within months after eliminating monosodium glutamate (MSG) or MSG plus aspartame from their diet.  All have had recurrence of symptoms whenever MSG is ingested.

Excitotoxins are molecules, such as MSG and aspartate, that act as excitatory neurotransmitters, and can lead to neurotoxicity when used in excess. The researchers proposed that these four patients may represent a subset of fibromyalgia syndrome that is induced or exacerbated by excitotoxins or, alternatively, may comprise an excitotoxin syndrome that is similar to fibromyalgia.

The researchers concluded that, “the elimination of MSG and other excitotoxins from the diets of patients with fibromyalgia offers a benign treatment option that has the potential for dramatic results in a subset of patients.” They felt that there may also be many more yet unknown, or widely unrecognised, excitotoxins that could also cause fibromyalgia syndrome and they stated that they could not unequivocally confirm that MSG caused fibromyalgia.

http://www.theannals.com/content/35/6/702.abstract