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Higher prevalence of ‘low T3 syndrome’ in patients with chronic fatigue syndrome: A case-control study (2018) Ruiz-Núñez et al.

Discussion in 'BioMedical ME/CFS Research' started by Cheshire, Mar 1, 2018.

  1. Cheshire

    Cheshire Moderator Staff Member

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    Begoña Ruiz-Núñez, Rabab Tarasse, Emar Vogelaar, Janneke Dijck-Brouwer and Frits Muskiet

    https://www.frontiersin.org/articles/10.3389/fendo.2018.00097/abstract
     
  2. strategist

    strategist Senior Member (Voting Rights)

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    More evidence that this is a hypometabolic syndrome? Is this reliable work?
     
  3. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    Very interesting, but I'm dubious about the iodide suggestion. Low iodine is a cause of hypothyroidism in parts of the world where iodine is low in the soil that crops are grown in. But elsewhere in the world giving iodine to iodine-replete patients is likely to suppress thyroid activity, not give it a boost.
     
  4. MErmaid

    MErmaid Guest

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    My subtype is hypo for many different types of hormones. I doubt what I have resembles what Whitney has. I think what the evidence tells us it is that there are many subtypes, and thats why the current style of academic scientific research, one that collects massive amounts of data, is failing us.
     
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  5. Marky

    Marky Senior Member (Voting Rights)

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    What else can u do though? There`s not any obvious place to narrow down the research
     
  6. MErmaid

    MErmaid Guest

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    I don’t have answers ATM, but I feel this topic of discussion needs to be addressed, possibly after the MillionsMissing May 12 protests. I think that advocacy for May needs to be our top priority now.
     
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  7. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    You could start with the narrowest definition of ME, find out what rules seem to apply to that group, and then see if other groups are different. Hyde or Ramsay ME are the strictest definitions (Ramsay seems looser than Hyde). With MS, they use very narrow criteria to start with, for example, and in FMS studies they often use only women without co-morbid illnesses. Perhaps that's how we start, instead of the kitchen sink approach, and see what defines the 'classic' post-viral, acute onset ME patients with demonstrable CNS injury. Then look at, say, gradual onset, or autoimmune ME, or ME possibly caused by chemicals. See how they compare or not.

    Younger seems to think there are at least three broad subgroups (viral, autoimmune, metabolic), but until we see his study it's hard to see how he's reached this conclusion.
     
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  8. Eagles

    Eagles Senior Member (Voting Rights)

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  9. Barry

    Barry Senior Member (Voting Rights)

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    What might be the implications for someone whose ME began when they contracted a flu bug whilst recovering from a thyroid operation, but never then recovered their energy levels again. Been on thyroid treatment ever since.
     
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  10. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Byron Hyde noted more thyroid issues in his patients. I know MEA says they've not seen evidence of a link before (from their survey, I think?), but I wonder if many patients at the higher end of the 'normal' range (bear in mind some US docs treat when TSH > 3, whereas here we wait until it's >4.5) might unknowingly have issues with T3 production?

    My thinking, however, is that any thyroid issues will be like the HPA issues--i.e., secondary to mitochondrial or some other dysfunction. It's quite clear that few systems are entirely untouched in ME, since it seems to cause a cascade of problems.
     
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  11. Andy

    Andy Committee Member & Outreach

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    Opening section from the MEA's article.
     
  12. Trish

    Trish Moderator Staff Member

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    I don't know who wrote their press release, but I find this concerning:

    The full paper is available here:
    https://www.frontiersin.org/articles/10.3389/fendo.2018.00097/full


     
  13. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    I gather the Dutch are, like the UK, usually quite obsessed with the BPS model of ME. Although that seems to be (slowly) changing. I'm not sure why it's included in the MEA write-up, however.
     
  14. Amw66

    Amw66 Senior Member (Voting Rights)

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    Hutan, MEMarge, dangermouse and 3 others like this.
  15. Russell Fleming

    Russell Fleming Senior Member (Voting Rights)

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    The Press Release was written by Frontiers:

    It had an embargo until 10.00am this morning. The BBC were going to write about it and we had given them comment from Dr Shepherd, but then they changed their mind, so we went ahead with the Frontier's release in its entirety.
     
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  16. Trish

    Trish Moderator Staff Member

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    From the introduction:

    my bold.

    They used Fukuda criteria which has PEM as an optional symptom.

    This makes me uneasy about the conclusions - were they actually studying people with ME/CFS, or with idiopathic chronic fatigue, possibly caused by the sort of thyroid problems they found, or by depression.

    Can someone with more knowledge help here?
     
  17. Londinium

    Londinium Senior Member (Voting Rights)

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    Worth noting they used the 'CBO criteria' which is based on Fukuda 'with the exclusion criteria of Reeves' which does at least seem to rule out some kinds of psychiatric disorder. But (from my read at least) I think you're right in that PEM might not be mandatory. My impression is that the authors do not try and come down on a specific side on whether it it has an immunological/metabolic/neurological/psychiatric pathology.

    Still, it's an interesting study and I'm pleased the MEA is looking to fund any applicants who want to try and replicate it.
     
  18. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    Many doctors in the UK won't treat hypothyroidism until TSH is > 10 and Free T4 is below the reference range. It is institutionalised torture for many people.

    From this link (NICE Clinical Knowledge Summaries, which carry approximately zero weight): https://cks.nice.org.uk/hypothyroidism#!diagnosissub:1

    • Arrange investigations including:
      • Blood tests for thyroid stimulating hormone (TSH) and free thyroxine (FT4):
        • Diagnose overt hypothyroidism (OH) if TSH is greater than 10 mU/L and FT4 is below the reference range.
        • Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result to exclude transient causes of a raised TSH (such as intercurrent illness) and to confirm the diagnosis of SCH.
        • Suspect secondary hypothyroidism if the clinical features are suggestive and T4 is low without raised TSH. Be aware that in secondary hypothyroidism TSH may also be low, normal, or slightly elevated due to circulation of bio-inactive forms of TSH.
     
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  19. Esther12

    Esther12 Senior Member (Voting Rights)

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    Daily Mail coverage of this:

    http://www.dailymail.co.uk/health/article-5522831/Could-cause-chronic-fatigue-syndrome.html

    Some good:

    Some mixed to bad:

     
  20. Hutan

    Hutan Moderator Staff Member

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    Oddly, the paper itself doesn't mention depression as a symptom.
    From the abstract:
    And from the introduction:

    But there is some weird stuff in there, for example:
    . :banghead:
    (I think psychology researchers could use a few more of the psychological vulnerability factors of perfectionism and high moral standards...)

    It's not the first time we've seen European papers covering biomedical aspects of CFS that appear to have been written by two completely different people, at least one of whom is a BPS nutter.

    Possible faulty patient selection criteria notwithstanding, I think there may be some useful stuff in the paper although it's going to take me some time to go through it and understand it fully.

    My son and I both have low-normal T4 results with normal to low-normal TSH (and the T3 hasn't been measured) - so I think, at first pass, our results fit with what they found. But some of the differences in the medians for the results from patients and controls aren't super large.
     
    Last edited: Mar 21, 2018

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