When muscle and joint aches and pains accompany hypothyroidism, are they a separate problem -- fibromyalgia -- or is fibromyalgia a symptom of the thyroid problem itself? Fibromyalgia is a condition typically characterized by musculoskeletal pain and fatigue. The pain can be severe and affecting a number of muscles, tendons, ligaments and soft tissues. If you are hypothyroid, and start to develop muscle or joint achiness, you may be concerned that you've developed fibromyalgia, or even in some cases even rheumatoid arthritis. Many thyroid patients with so-called "normal" TSH levels on thyroid hormone replacement find that over time, they begin to develop more and more joint and muscle pains and arthritis-like symptoms. Your doctor may even diagnosis you as having fibromyalgia "in addition to" hypothyroidism or test to see if you have rheumatoid arthritis. What you need to know is that what is happening may actually be a symptom of undertreated hypothyroidism. Innovative practitioners are theorizing that fibromyalgia and chronic fatigue are in many cases just a package of symptoms of an underlying underactive thyroid problem. In the course of writing my book, Living Well With Hypothyroidism, I had the opportunity to interview and get to know Dr. John C. Lowe, who is Director of Research for the Fibromyalgia Research Foundation. Dr. Lowe is one of the nation's innovators in the diagnosis and treatment of hypothyroidism. It might seem surprising that an expert on fibromyalgia is also an expert on hypothyroidism treatment. But Dr. Lowe's long-term care of fibromylagia patients, coupled by his indefatigable search for the keys to resolving their chronic health problems, have given him tremendous insights into metabolic illness and how to resolve it. Dr. Lowe discusses his theories in great depth in his own book, The Metabolic Treatment of Fibromyalgia . I was so impressed with his ideas, attitude and commitment to patients that he is one of the two featured doctors profiled in my book. He is dedicated to making people well, and that comes through very clearly in the way he deals with everyone. Dr. Lowe's years of practice have led him to conclude that fibromyalgia is, for many people, a symptom of an underlying thyroid problem, not necessarily a disease unto itself. He feels that the typical patient's fibromyalgia is actually evidence of too little thyroid hormone regulation of certain tissues. According to Dr. Lowe: "In some patients, the inadequate tissue regulation by thyroid hormone results from cellular resistance to thyroid hormone. In others, the inadequate regulation results from a thyroid hormone deficiency. So, when I refer to fibromyalgia, I'm referring to a certain set of symptoms and signs of too little thyroid hormone regulation of tissues." Dr. Lowe has had success broadening the scope of thyroid diagnosis to include a narrow definition of the "normal range," and looking at T3 deficiencies and TRH testing -- not just TSH tests -- for more thorough evaluation of hypothyroidism. If you're in the TSH "normal range," Dr. Lowe still believes that you could be suffering from hypothyroidism -- and all its related symptoms, including fibromyalgic aches and pains. How can you be hypothyroid, yet in the "normal range," and declared euthyroid by conventional doctors? According to Dr. Lowe: "There are four false propositions of the current endocrinology model. These are: (1) The only cause of thyroid deficiency symptoms is hypothyroidism. (2) Only individuals with thyroid function test results indicating primary hypothyroidism should be permitted to use thyroid hormone. (3) Hypothyroid patients should only be permitted to use T4 (i.e., levothyroxine drugs such as Synthroid, Levoxyl, etc.). (4) Patients' dosages should be limited to "replacement dosages" -- amounts that keep the TSH within the normal range." For Dr. Lowe, because conventional medical practitioners accept these unproven propositions as mandates for clinical practice, many patients develop continuing symptoms of inadequate thyroid hormone regulation. These symptoms --despite their using replacement dosages of T4--are now defined as new diseases, such as fibromyalgia and chronic fatigue syndrome, instead of as symptoms of the failure to adequately treat the existing problem -- hypothyroidism. When patients are already diagnosed as hypothyroid, he is not surprised when they start to manifest fibromyalgia-like symptoms, such as various muscular aches and pains and difficulty sleeping. When someone has been hypothyroid, Dr. Lowe believes that over time: "Hypometabolism imposes a lifestyle that can further complicate the hypothyroidism. For example, the hypothyroid patient may not be able to engage in enough physical activity to maintain normal muscle mass. Metabolic status is critically dependent on muscle mass; the lower an individual's muscle mass, the lower her metabolic rate." Dr. Lowe believes that many patients who develop fibromyalgia symptoms after a trauma were already hypometabolic before the trauma occurred. Says Dr. Lowe: "After learning what the various symptoms and signs of hypothyroidism are, many of these fibromyalgia patients say things such as, 'You know, come to think of it, I remember having those symptoms off-and-on since I was in my early teens.' A short period of physical inactivity after the trauma appears to decrease their muscle mass and further lower their metabolic rate. It is after the short time passes, which would permit a significant loss of muscle mass, that many people develop post-traumatic fibromyalgia. In many cases, the patients' metabolic insufficiency was probably worsened by their typical American diet and their not taking nutritional supplements. To shorten a potentially long story, factors such as hypothyroidism (even borderline), nutritional insufficiencies, and inadequate physical activity become intertwined and interactive in impeding the person's metabolism. By the time I've seen some patients, the probable interactions of factors that have contributed to their disabled condition have become almost impossible to comprehend. The best I've been able to do with such patients is start working with the multiple factors that may be currently sustaining their fibromyalgia, making recommendations and working collaboratively with them. Usually, I've asked patients to try and muster a few months faith; it may take that long before they feel better subjectively and before our objective measures show that fibromyalgia status is improving." Most conventional health practitioners do not approach the issue of hypothyroidism and fibromyalgia in the way that Dr. Lowe does. According to Dr. Lowe, for most patients, it is best to work with holistic M.D.s or D.O.s. In particular, Dr. Lowe believes that the physicians best qualified by philosophy and education to work with fibromyalgia patients are naturopaths. Says Dr. Lowe: "When I say naturopaths, I'm referring to those who graduated from accredited naturopathic medical schools and are eligible to be licensed in states that license naturopathic physicians. They use both natural and conventional medicine. Also, in general, they are far more willing to spend the time needed with patients to do a good job. They are also in general willing to do the clinical detective work that conventional medicine has for all practical purposes abandoned. If you live in a state where naturopathic physicians are licensed, I would encourage you to find a good naturopath." Hypothyroid patients following Dr. Lowe's treatment protocol have reported a high degree of success. Dr. Lowe typically starts hypothyroid patients with desiccated thyroid (i.e., Armour Thyroid). The reason he uses desiccated thyroid is the higher T3 content than in synthetic T4/T3 preparations. According to Dr. Lowe: "I have found that many hypothyroid patients also have cellular resistance to thyroid hormone. Most of these patients don't benefit much from T4 alone, but some of them do from desiccated thyroid, presumably because of the relatively high T3 content. Some we have to switch to synthetic T3 because they don't benefit from desiccated thyroid. We've stopped altogether giving patients T4 alone."