Thyroid Megathread

[frozenborderline]

I'm going to use this thread to try and compile all of the theory about thyroid that i've seen that may be pertinent to CFS.

 

[frozenborderline]

http://www.chronicfatiguediagnosis.com/2018/02/08/737/

A theory of CFS and thyroid transporter hormones, by a doctor who is on this forum
@Iritu1021

 

[frozenborderline]

https://www.lesswrong.com/posts/9yK...ness-core-argument-evidence-probabilities-and

This is an argument about why CFS and related illnesses could be due to underdiagnosed thyroid issues that don't show up in blood tests. It goes through the history of thyroid diagnoses and how doctors stop diagnosing based on pulse and temp. It makes an argument that the blood tests could be unreliable and that thyroid resistance needs to be taken into account. It connects the switch from diagnosing based on pulse and temp to the time frame in which CFS first emerged in the US.

 

[frozenborderline]

http://raypeat.com/articles/articles/thyroid.shtml

Ray peat is a physiologist whose work is basically all about metabolism, structure and energy.

here's the table of contents of this:

R T I C L E

Thyroid: Therapies, Confusion, and Fraud
I. Respiratory-metabolic defect

II. 50 years of commercially motivated fraud

III. Tests and the "free hormone hypothesis"

IV. Events in the tissues

V. Therapies

VI. Diagnosis

 

[frozenborderline]

https://power-surge.co/2013/10/05/hypothyroidism-the-many-myths-by-kenneth-blanchard-m-d/

Kenneth Blanchard was an endocrinologist that used an idiosyncratic method of very low dose thyroid hormones to treat various issues.

 

[frozenborderline]

https://www.frontiersin.org/articles/10.3389/fendo.2018.00097/full

Recent research that shows people with CFS may have a "low T3 syndrome", which doesn't show up as abnormal in a standard TSH blood test. Should be explored further

 

[lafarfelue]

Will you add summaries or excerpts under the links too, so it's more accessible to people with bad fatigue and cognitive issues?

 

[frozenborderline]

Will you add summaries or excerpts under the links too, so it's more accessible to people with bad fatigue and cognitive issues?

I just edited the posts to be a little better

 

[percyval577]

An article from 2007, about changes in serum levels and maybe directly on thyroidal actions (deiodinase) by manganese.

According to the question of #8 one might boldly guess manganese (of course not part of #8) might be
A) the same root-cause under different circumstances with two different diseases (cf ~2.1.in #10), or
B) the same cause with only different effects in order to one systemic goal and then disease (cf -2.2.in #10). However:​

effects of manganese on thyroid hormone homostasis

3a:
"We posit that manganese may affect thyroid hormone homeostasis and neurodevelopmental processes as a result of both direct dysregulation at the level of the thyroid gland and thyroid hormones, or indirectly via alterations in dopaminergic control of the thyroid gland and its hormones. Dopamine is a known modulator of both TSH and TSH subunit secretion. ...

Abstract
"Dopamine is also a known inhibitory modulator of thyroid stimulating hormone (TSH) secretion.The involvement of dopamine and dopaminergic receptors in neurodevelopment, as well as TSH modulation, led us to hypothesize that excessive manganese exposure may lead to adverse neurodevelopmental outcomes due to the disruption of thyroid homeostasis via the loss of dopaminergic control of TSH regulation of thyroid hormones. This disruption may alter thyroid hormone levels, resulting in some of the deficits associated with gestational exposure to manganese."

3a
"An additional effect of manganese on thyroid hormones homeostasis may be mediated through their metabolizing enzymes. Current data suggests that manganese can affect thyroid hormones directly by regulating the deiodinase enzymes. ...

To examine the effect of manganese on the regulation of thyroid hormone, rats were treated with a manganese-rich diet (10 mg/kg/day as manganese sulfate [MnSO4]) for a period of five weeks (Buthieau and Autissier, 1983). High accumulation of manganese in the pituitary gland resulted in a significant decrease in serum T4, T3, and in TSH concentrations. No change in thyroidal T4 and T3 concentrations were observed. Given that binding of TSH to thyroid plasma membranes is strongly inhibited by neutral salts at relatively low concentrations, manganese probably contributes to a decrease in the binding of TSH to the thyroidal plasma membrane. The decrease in binding would then result in higher circulating TSH levels which, through negative feedback, would inhibit release of TSH from the pituitary gland. It is expected that the decrease in T4 levels would be followed by an enhanced pituitary TSH secretion. In agreement with other studies this study suggests that the role of manganese in thyroid hormone regulation and metabolism is not directly mediated by thyroid hormone synthesis."

(+) salt (eg Mn) -> (-)TSH at thyroid plasma membrane ->
(+) TSH in serum -> inhibition of TSH release from pituitary gland ->
(-) TSH in serum

But no change of T4/3 in the thyroid gland​

Conclusion
"Many questions still remain concerning the relationship between manganese and thyroid hormones. Although not conclusive, experimental findings point to the ability of manganese to interfere with deiodinase activity thus affecting circulating thyroid hormone concentrations. The role of manganese uptake by the thyroid gland is still unclear and the potential mechanisms by which it may directly affect thyroid hormone homeostasis or function remain to be elucidated; however, dose-dependent goitrogenic effects of manganese have been illustrated. It is also noteworthy, that effects of manganese on optimal brain dopamine concentrations, which in turn, affect thyroid hormone homeostasis, may alter the regulatory function of thyroid hormone, both in developing and mature animals. Similarly, manganese may affect a plethora of other neurotransmitters, in turn, causing dysregulation of thyroid hormone homeostasis."

referring to #3/10, analogous to insulin. Effects of Mn on the thyroidal system:

type 1 (altering of the gland) -- possibly deiodinase: D1 (responsible for 20% of complete T3)
type x (altering of the blood levels) -- yes (1983), practical importance? as Mn may be only part of some salt.
type 2 (altering of the target cells) -- possibly deiodinase: D1 (liver,kidney), D2 (brain,other), D3 (inactivation)
type 3 (altering indirectly) -- via dopamine which inhibits TSH secretion

There is an action of Mn via upregulating gene expression of inducible nitric oxide synthase.
The amounts of nitric oxide are shown to reuptakeinhibit dopamine (with some chaos?...)

This dopamine is as well a possible common between the diseases cf (3/4)#10.
The non-thyroid action would be directly some altering of the feeling and further interdependencies with other nerves.​

 

[frozenborderline]

https://www.lesswrong.com/posts/9yK...ness-core-argument-evidence-probabilities-and

This is an argument about why CFS and related illnesses could be due to underdiagnosed thyroid issues that don't show up in blood tests. It goes through the history of thyroid diagnoses and how doctors stop diagnosing based on pulse and temp. It makes an argument that the blood tests could be unreliable and that thyroid resistance needs to be taken into account. It connects the switch from diagnosing based on pulse and temp to the time frame in which CFS first emerged in the US.

CORE ARGUMENT


(1.1) Hypothyroidism is a disease with very variable symptoms, which can present in many different ways.

It is an endocrine hormone disease, which causes the metabolism to run slow. A sort of general systems failure. Which parts fail first seems random.

It is extraordinarily difficult to diagnose by clinical symptoms.


(1.2) Chronic Fatigue Syndrome and Fibromyalgia look very like possible presentations of Hypothyroidism


(1.3) The most commonly used blood test (TSH) for Hypothyroidism is negative in CFS/FMS


=>


EITHER


(2.1) CFS/FMS/Hypothyroidism are extremely similar diseases which are nevertheless differently caused.


OR


(2.2) The blood test is failing to detect many cases of Hypothyroidism.


It seems that one is either forced to accept (2.1), or to believe that blood hormone levels can be normal in the presence of Hypothyroidism.


There is precedent for this:


Diabetes, another endocrine disorder (this time the hormone is insulin), comes in two forms:


type I : the hormone producing gland is damaged, the blood hormone levels go wrong. (Classical Diabetes)

type II: the blood hormone levels are normal, but for some reason the hormone does not act. (Insulin Resistance)


I therefore hypothesize:


(3) That there is at least one mechanism interfering with the action of the thyroid hormones on the cells.

and


(4) The same, or similar mechanisms can interfere with the actions of other hormones.

A priori, I'd give these hypotheses a starting chance of 1%. They do not seem unreasonable. In fact they are obvious.

The strongest evidence against them is that they are so very obvious, and yet not believed by those whose job it is to decide.

 

[bertiedog]

To be honest I don't see that it is correct to just concentrate on the thyroid. The adrenals have to be strong in order for the thyroid to function as it should and in the past studies have shown a degree of low normal levels of cortisol in patients with CFS (as they called it then though I hate that term).

At the moment I am in an adrenal crash caused through the effects of high dose vitamin C recommended to me by a certain well known ME doctor and my temperature has plummeted and I feel cold and have all the symptoms of hypothyroidism/ME back but I hadn't changed my usual thyroid medication that I have been taking for over 15 years and normally keeps me fairly well. My adrenals have caused this after weeks of a gut bug/migraines and intolerance to so much citric acid.

However back to the topic of this thread, one has to be very careful in trying to push thyroid meds up when the adrenals are weak, you just end up with more undesirable side effects that can feel horrible. It has to be done slowly and gradually which can be very frustrating but one has to work with the weak adrenals too.

I agree that so many of the symptoms of ME/CFS are the same as hypothyroidism and for me they definitely go together.

Pam

 

[Judee]

One website I've read said when our temperatures plummet then our adrenals pump out a bunch of adrenaline trying to get them back up. Not sure if this is correct but since I've read that, I've been wondering if that is what causes the crash. Do we burn out because of the overdose of adrenaline?

 

[frozenborderline]

To be honest I don't see that it is correct to just concentrate on the thyroid. The adrenals have to be strong in order for the thyroid to function as it should and in the past studies have shown a degree of low normal levels of cortisol in patients with CFS (as they called it then though I hate that term).

At the moment I am in an adrenal crash caused through the effects of high dose vitamin C recommended to me by a certain well known ME doctor and my temperature has plummeted and I feel cold and have all the symptoms of hypothyroidism/ME back but I hadn't changed my usual thyroid medication that I have been taking for over 15 years and normally keeps me fairly well. My adrenals have caused this after weeks of a gut bug/migraines and intolerance to so much citric acid.

However back to the topic of this thread, one has to be very careful in trying to push thyroid meds up when the adrenals are weak, you just end up with more undesirable side effects that can feel horrible. It has to be done slowly and gradually which can be very frustrating but one has to work with the weak adrenals too.

I agree that so many of the symptoms of ME/CFS are the same as hypothyroidism and for me they definitely go together.

Pam

Of course the hpa axis is important but it is downstream of the thyroid. I've had some experience with trying to correct the adrenals directly, via adrenal support supplements, and it just seemed like they increased stress hormones and only helped temporarily, it was like taking corticosteroids

 

[bertiedog]

Do we burn out because of the overdose of adrenaline?

Thankfully I have lost the crash feeling today because I added half a tablet of Fludrocortisone to my normal dose of 6mg Prednisolone plus I took 2 Metavive for the thyroid and my temperature has gone up to 36.2 and I didn't feel cold at all. As soon as the weather warms up my temperature should move up to around 36.5.

I don't need to take Fludro very often but its effect is like a miracle drug for me when my electrolytes have been messed up. Many forget that the adrenals don't only supply glucocorticoids but also balance electrolytes and we need both to work at least reasonably well in order for the thyroid to do its job.

Pam

 

[Judee]

I think you're right. It's all about balance but sometimes figuring how to make everything balance feels like a juggling act.

 

[Learner1]

My illness may include thyroid, but it encompasses so much more, like my immune system, mitochondria, nervous system, etc.

Tweaking the endocrine system to function well is helpful in recovery, but one must look at what's throwing it off in the first place.

 

[frozenborderline]

My illness may include thyroid, but it encompasses so much more, like my immune system, mitochondria, nervous system, etc.

Tweaking the endocrine system to function well is helpful in recovery, but one must look at what's throwing it off in the first place.

I agree this may be reductive, and I am also interested in theories like Naviaux's that focus on a more complex etiology (purinergic signalling).

But thyroid is upstream of a lot of things, and I am curious about the theories (that I admit are a little kooky) that focus on thyroid issues as the root of a lot of disorders. The piece by John Lawrence aspden?? that I posted is particularly interesting, because he posted it on a rationalist forum that's certainly populated by skeptics, and he presents the arguments with a lot of logical formulas , etc.

I by no means know what the cause of CFS is. Some of the stuff about thyroid issues being not diagnosable by blood test, the role of T1AM, and thyroid hormone resistance would all help explain some ME/CFS symptoms though.

I meant to explain more of that in this thread, but it was kind of an ambitious undertaking and I'm not feeling that great rn.

 

[frozenborderline]

I agree this may be reductive, and I am also interested in theories like Naviaux's that focus on a more complex etiology (purinergic signalling).

But thyroid is upstream of a lot of things, and I am curious about the theories (that I admit are a little kooky) that focus on thyroid issues as the root of a lot of disorders. The piece by John Lawrence aspden?? that I posted is particularly interesting, because he posted it on a rationalist forum that's certainly populated by skeptics, and he presents the arguments with a lot of logical formulas , etc.

I by no means know what the cause of CFS is. Some of the stuff about thyroid issues being not diagnosable by blood test, the role of T1AM, and thyroid hormone resistance would all help explain some ME/CFS symptoms though.

I meant to explain more of that in this thread, but it was kind of an ambitious undertaking and I'm not feeling that great rn.

for example, even if someone doesn't respond to standard thyroid treatment, it might not be an indicator that they don't have thyroid issues. the t1am theory in particular discusses complex thyroid resistance

 

[Misfit Toy]

As a person who was diagnosed with CFS when I was 18, it all started with EBV and hyperthyroidism.

I can tell you that since having my thyroid removed in 2016, I have it severely. I was always able to work and keep at it until the thyroid was removed.

With my thyroid levels in normal range, I feel like a different person. Mentally, physically, etc. I have developed some sort of POTS.

I know, like Pam says, it's adrenals. My adrenals are tanked. I can barely function. I was just on medrol and had to get off of it as it was making me insane. I see an endocrinologist tomorrow. It is amazing how much hormones can affect someone. I would have never ever guessed that I would ever be this sick.

I am sicker than any other person who has had their thyroid removed, but I am also sick with many other things. The thyroid and the adrenals are essential when it comes to ME or CFS. Absolutely essential in staying afloat.

 

[Learner1]

Thyroid is incredibly important, as are all hormones. I agree with @Misfit Toy that imbalanced hormones can make one incredibly sick.

But they are not the cause of ME/CFS, which is a multiorgan system disease frequently triggered by genetics and infectious agents.

In many of us, it has autoimmune features like POTS, MCAS, etc. And microbiome disruption, T cell clonal expansion, mitochondrial dysfunction, nutrient deficiencies, hypercoagulation, etc.

All of the above may disrupt thyroid function and hormone distribution and vice versa. But, it is highly unlikely that the thyroid is the root of this disease.