Interesting article from a meeting of the American Association of Clinical Endocrinologists in Las Vegas. If this snippet piques your interest, follow the link to read the rest of the article.
'Thyroid' Issues May Really Be Hypothalamic
Published: May 15, 2014
By Kristina Fiore, Staff Writer, MedPage Today
LAS VEGAS -- Obese patients who continue to have "thyroid symptoms" even when their levels are normalized may have a hypothalamic dysfunction, researchers reported here.
In a single-center study of 50 patients referred for evaluation of thyroid symptoms, 68% had at least four symptoms that were characteristic of hypothalamic obesity disorder, Saad Sakkal, MD, and colleagues reported during a late-breaking poster session at the American Association of Clinical Endocrinologists meeting here.
Those include fatigue, temperature dysregulation, weight change, changes in sleeping patterns, pain, and mood disorders, the researchers said.
Sakkal explained that every endocrinologist sees patients who have been referred for "thyroid symptoms" with normal or low thyroid-stimulating hormone (TSH) levels.
But some overweight patients continue to have these thyroid symptoms even when they've had sufficient hormone replacement.
"Patients who insist they have thyroid disease causing their weight problems are frequent," the researchers said. "Some try thyroid medications, yet they feel worse and don't lose weight. These patients would only benefit from therapy for their hypothalamic dysfunction."...
"Sakkal explained that every endocrinologist sees patients who have been referred for "thyroid symptoms" with normal or low thyroid-stimulating hormone (TSH) levels."
Low TSH would be hyper. Think that is a typo?
I wish Dr. Lowe was still with us, it would be interesting to see his response.
"The researchers noted that an important physical finding is the presence of trigger points tenderness, which occurred in 68% of this population." FM anyone? or ME as I think it is called in the UK. PR
Low TSH would normally be associated with hyper, indeed. But with a poorly functioning hypothalamus, therefore possibly not enough TRH, and so either not as much TSH as there should be for the thyroid hormone levels, or inappropriate glycolsylation of the TSH, ... All bets are off.
In addition there are likely people who have been taking thyroid hormone so TSH may be normalised or low because of that.
Absolutely agreed about FM/ME, whatever we call it. Immediately made me think about why some seem to be helped by thyroid hormones and others not. Obvious answer could be whether or not their hypothalamus is also not functioning perfectly and, maybe, precisely what is wrong.
Some scientists now believe that fibromyalgia is triggered by a drop in core temperature. This could be caused by hypothyroidism or by hypothalamic dysfunction (and maybe other things). They believe fibromyalgia is a condition in itself but is caused by the above. If this is true, even if the thyroid or hypothalamic dysfunction is treated, the patient may not recover very quickly. I wonder if those that are diagnosed and treated quickly would recover better...
I find it interesting that treatments that work for some fibromyalgia patients are also the treatments suggested for hypothalamic dysfunction. Pressure point pain is also used to diagnose fibromyalgia. Investing that these guys noticed it in their groups.
It is also, in my view, of profound interest that TRH (which is produced in the hypothalamus) affects the glycosylation of TSH. Now what does that do?
Do the variously glycolsylated forms of TSH actually have functions such as (and this is pure speculation) affecting conversion or the proportion of T3 originally created? Or affect the transport of thyroid hormone(s) across cell walls and/or blood-brain barrier?
I would love to know the answers. What is definitely clear is that the greater thyroid system is not nearly as simple as we are led to believe by our doctors!
Yes, this is of interest - though the statement: 'Overall, more than two-thirds of these patients (68%) were determined to have definite hypothalamic dysfunction, and 22% had likely hypothalamic dysfunction, the researchers reported.' needs qualifying - how *did* they determine this? What tests were they using?
It's also a little confusing as the 'treatment' path seems to suggest the underlying problems weren't to do with the thyroid after all - all will be resolved with antidepressants, a healthy diet and exercise, etc - isn't that just what GPs and endos keep saying to those of us whose TSH is 'within range'? Or have I misunderstood?
I've just read it properly, I agree ann. I'm not depressed, don't have anxiety or compulsive behaviour, but the obesity and fibro, yes. So I retract my first comment saying 'fascinating'!
Whilst the treatments mentioned in the summary article are pretty disappointing, the simple acceptance that hypothalamic issues could be present is, I feel, a major step. (Did I write "pretty"? I think I meant "extremely".)
Maybe "they" would even go so far as to consider things like TRH?
I think the point they are trying to make is that, although the symptoms may be due to too little thyroid hormone, the cause of low thyroid in those cases was hypothalamic dysfunction. If the hypothalamic dysfunction can be successfully treated, the thyroid should start producing enough thyroid hormone. At least that's what I hope they're trying to say!
However, I suspect there are many patients who have both conditions. Perhaps if the hypothalamus was treated alongside the thyroid, treatment might be more successful. I do think it is a good thing that someone is acknowledging that all may not be well just because one has a normal TSH.
Of course, there are still many who have hypothyroidism with no hypothalamic dysfunction and are not being treated because TSH is tested on its own.
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