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The lower TSH and the higher fT4, the more fatigue was reported by patients with FSS

Discussion in 'Hormones' started by pattismith, Jul 22, 2018.

  1. pattismith

    pattismith Senior Member

    Thyroid Functioning and Fatigue in Women With Functional Somatic Syndromes – Role of Early Life Adversity
    Objective: Fatigue is a core feature of functional somatic syndromes (FSS). Fatigue is also prominent in patients with thyroid diseases, which is unsurprising given the role of the hypothalamic-pituitary-thyroid (HPT) axis in regulating physiological energy demands. Research in healthy women has shown that early life adversity is linked with alterations in the HPT axis. In view of the substantial prevalence of early life adversity in patients with FSS, our aim was to investigate whether HPT functioning is related to (a) fatigue, and (b) early life adversity in these patients.

    Methods: N = 33 female patients with FSS and n = 30 age-matched controls were recruited. Fasting morning blood samples were taken to determine thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), and thyroxine (fT4). General, physical, and mental fatigue were measured via the multidimensional fatigue inventory (MFI). Early life adversity was measured using the childhood trauma questionnaire (CTQ).

    Results: Patients with FSS did not differ from controls in any thyroid parameters (all p > 0.672). However, the lower the patients’ TSH and the higher their fT4, the greater was their general (β = -0.32, p = 0.064; β = 0.35, p = 0.038) and physical (β = -0.47, p = 0.007; β = 0.32, p = 0.077) fatigue. In addition, emotional neglect (β = -0.32, p = 0.057), physical neglect (β = -0.60, p = 0.001), physical abuse (β = -0.47, p = 0.015), and sexual abuse (β = -0.40, p = 0.026) were linked with lower TSH.

    Conclusion: The lower TSH and the higher fT4, the more fatigue was reported by patients with FSS. In addition, lower TSH was linked with more early life adversity.
    Larger, prospective studies are warranted to determine whether HPT functioning may be a mediating pathway between early life adversity and fatigue in FSS.


    A total of n = 33 patients with FSS were recruited from the general population, from local primary and secondary care services, and via self-help groups.
    Inclusion criteria were age 18 years or above, fluency in the German language, and fulfillment of research diagnostic criteria for chronic fatigue syndrome, fibromyalgia syndrome, or irritable bowel syndrome.
    Chronic fatigue syndrome was diagnosed according to the Centers for Disease Control and Prevention (CDC) criteria (Fukuda et al., 1994), fibromyalgia syndrome was diagnosed according to the American College of Rheumatology (ACR) 2010 criteria (Wolfe et al., 2010), and irritable bowel syndrome was diagnosed according to the Rome III criteria (Longstreth et al., 2006).
    Last edited: Jul 23, 2018
    Shoshana likes this.
  2. Wally

    Wally Senior Member

    @pattismith - Your post seems to be missing the link that you have quoted from. Can you edit your post to include this reference information?
  3. adambeyoncelowe


    They make some big assumptions. Perhaps the so-called FSS patients really just have thyroid problems? Treat the thyroid and their FSPC may vanish!
    Runner5 likes this.
  4. pattismith

    pattismith Senior Member

    Yes maybe. The problem is that current medical consensus does not acknowledge any other thyroid problem than the ones with out of range thyroid values (values = T4, fT4, fT3, T3, TSH). As you can read in the abstract, FSS thyroid values are not different than healthy control's ones , so there is no chance that any doctor would treat them for a thyroid problem...(only american functional doctors may do so).

    So any study that shows a correlation between thyroid parameters and fatigue and other symptoms are welcome.

    FSS actually mean CFS, FIBRO and IBS.

    This study is interesting to compare to the one that found 16% of CFS patients to have a Low T3 syndrome.

    This study is also consistent with another one published this year:

    It shows that DIO2 expression is lower in recurrent Depressive Disorder patients. (DIO2 converts T4 to T3 in peripheral tissues, so it leads to lower T3 and higher T4.)
    adambeyoncelowe and Shoshana like this.

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