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MEA Website: Frontiers Press Release: Chronic fatigue syndrome possibly explained by lower levels of key thyroid hormones

Discussion in 'BioMedical ME/CFS News' started by Eagles, Mar 20, 2018.

  1. Eagles

    Eagles Established Member (Voting Rights)

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  2. 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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  3. 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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  4. Andy

    Andy Committee Member

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    Opening section from the MEA's article.
     
  5. 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


     
  6. 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.
     
  7. Amw66

    Amw66 Senior Member (Voting Rights)

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  8. Russell Fleming

    Russell Fleming Established 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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  9. 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?
     
  10. 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.
     
  11. 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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  12. 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:

     
  13. 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
  14. Trish

    Trish Moderator Staff Member

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    Thanks, @Hutan, I agree it is an odd mix of interesting biomedical findings and psychobabble.
    I hope they do replicate it, but this time using a diagnostic criterion that insists on PEM.
     
  15. Hutan

    Hutan Moderator Staff Member

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    This paper gives some relevant background:
    Central hypothyroidism
    Vishal Gupta and Marilyn Lee
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169862/

    Central hypothyroidism is defined as hypothyroidism due to insufficient stimulation by thyroid stimulating hormone (TSH) of an otherwise normal thyroid gland. ... Fatigue and peripheral edema are the most specific clinical features. Diagnosis is established by the presence of normal to low-normal TSH on the background of low-normal thyroid hormones, confirmed by the thyrotropin releasing hormone stimulation test. Therapy includes use of levothyroxine titrated to improvement in symptomology and keeping free T4 in the upper limit of normal reference range.
     
  16. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Treating TSH only when it exceeds 10 seems ridiculous!
     
  17. Amw66

    Amw66 Senior Member (Voting Rights)

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    "Euthyroid sick "
    Suggestions of receptor resistance . This is not new ground -it's been suggested for at least a decade, but as highlighted above, thyroid is poorly understood/ treated in UK
    Studies are also ongoing for glucocorticoid receptor resistance (Dr Bansal I think is involved in this)
    The concern is by focussing on one aspect, do you make things worse elsewhere- it's the interconnectivity of this condition that is so infuriating.

    There seems to be a lot of threads of 1980s and 1990s research which is being looked at again-if I had a scientific brain I would look at it, list it and see what bits are being missed - " sticky blood" etc- it seems that the wheel is being reinvented when the brakes could simply be removed....
     
  18. Kalliope

    Kalliope Senior Member (Voting Rights)

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  19. Kalliope

    Kalliope Senior Member (Voting Rights)

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  20. Frogger

    Frogger Senior Member (Voting Rights)

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