The fibromyalgia-thyroid connection | If your TSH thyroid test is normal, you better read this…

This article, “The Fibromyalgia-Thyroid Connection,” was originally published on NationalPainReport.com. It is being republished here with permission from the editor. This article contains affiliate links.

Updated 4/7/20

Thyroid conditions are commonly misdiagnosed as fibromyalgia. You can have underlying thyroid dysfunction even with a normal TSH test! Find out how to be properly evaluated for thyroid disorders and their connection to fibromyalgia here! | Fed Up with Fatigue

Did you know that thyroid conditions are routinely misdiagnosed as fibromyalgia? Before we were labeled with fibromyalgia, I’m sure most of our doctors ran a TSH test to check our thyroid function since hypothyroidism is one of the many conditions that are supposed to be ruled out before diagnosing fibromyalgia.

The fibromyalgia-thyroid connection | If your TSH test is normal, you should read this...
Dr. David Brady, author of “The Fibro Fix”

But did you know that you can have a normal TSH test result and still have a thyroid disorder? It happens frequently, according to fibromyalgia specialist Dr. David Brady, author of “The Fibro Fix.”

Worst still, some people have been mistakenly misdiagnosed with fibromyalgia when they may actually have a treatable thyroid condition.

That’s because the TSH test, the test most commonly used by doctors to diagnose thyroid issues, is a poor indicator of overall thyroid health. It takes a much more comprehensive approach to testing and clinical expertise to properly diagnose thyroid disorders.

I recently interviewed Dr. Brady about the connection between fibromyalgia and thyroid dysfunction and how to get properly evaluated and treated if you have a thyroid disorder. I hope you enjoy our interview!

Fed Up with Fatigue: What is the connection between fibromyalgia and thyroid disorders?

Dr. David Brady: They are both mainly occurring … in women who are middle age or approaching middle age, although they certainly can occur in women who are younger and males as well, but they’re both predominantly female disorders.

They’re both big points of diagnostic confusion. Underperforming thyroid, even if it’s not overt hypothyroidism, is one of the top three masqueraders of fibromyalgia. There are a lot of women who have symptoms that are really caused by underperforming thyroid that, when they go to a physician, they get erroneously diagnosed as having fibromyalgia, and unfortunately [are] often put on a fibromyalgia medication, which has no hope of helping them and a high degree chance of causing side effects and problems, and their underlying true condition is never getting addressed.

That being said, it’s not uncommon at all that I find patients, mainly women once again, that do truly have a central pain processing disorder and would meet the criteria for having fibromyalgia that also concomitantly have underperforming thyroid, so they go hand-in-hand a lot, but there’s not necessarily a causal relationship between the two.

What are the most common symptoms of thyroid dysfunction?

Tired all the time, cold all the time, constipation, dry skin, dry hair, hair falling out more than normal, difficulty concentrating, and you can also start to develop muscle aches or myalgia. Even joint pain can be caused by hypothyroidism.

When hypothyroidism gets severe enough, you can get something called mixed edema where you start getting very swollen and puffy looking, but that rarely happens.

How common is it for thyroid disorders to be misdiagnosed as fibromyalgia?

It’s unbelievably common! There are lots of conditions that get erroneously labeled as fibromyalgia mainly because they are occurring in a woman, and there’s sort of a golden cluster of symptoms, like pain or achiness around the body, feeling tired or fatigued, anxiety and/or depression, poor sleep or insomnia, constipation and vague bowel problems [and] brain fog. All of those things occur if you’re having thyroid [dysfunction].

Unfortunately when you look at how thyroid disorders are assessed within very conventional orthodox medicine models, you have to be significantly hypothyroid to pop onto the radar if they’re only doing a TSH test or maybe a TSH and total T4 test. You have to have a type of underperforming thyroid where it’s actually the thyroid not producing enough hormone to begin with.

[But] many thyroid conditions occur outside of the thyroid. By that I mean the thyroid may be putting out a reasonable amount of hormone to satisfy the lab test, but then [the body is] not doing the right things with the hormone.

It gets a little complicated, but in thyroid disorders, the vast majority of thyroid [hormone] that [is] produced is something called thyroxin or T4. It gets converted to a more active hormone known as T3 or triiodothyronine.

There are many things that are going on in our environment right now that are causing a sabotaging effect on thyroid hormone conversion … and if anything gets in the way along the process, the ultimate end scenario is the same: You don’t have enough thyroid hormone, your biochemistry slows down, and you feel like you got hit by a train.

If you’re only looking at the front end of it [by just testing TSH], and you’re not looking at the whole picture, it’s very easy to miss it. The way they look at thyroid disorders in the conventional medical paradigm right now, I equate it to picking up the book, “War and Peace,” reading the first couple of chapters, and then trying to write a book report.

You’re just not getting the full picture, and that’s what goes on if you don’t take a much more granular, detailed look at thyroid physiology using more lab testing and data points than they normally do. Most doctors are only testing TSH levels.

The fibromyalgia-thyroid connection | Fed Up with Fatigue

Why is TSH not a good measure of thyroid function?

You have to go to a very low total production of T4 to stimulate an increase in TSH, and that’s what they’re looking for when they are doing a TSH test. They are looking for elevations of TSH to be indicative of a hypothyroid state.

When you’re using laboratory ranges … you have to be different statistically than 95 percent of the population to come up either high or low on most blood tests. What that means for hypothyroidism is you’re only dealing with one end of the bell curve tail, so you have to be in the lowest 2.5 percent of the population to come up low on a TSH test, and the facts are that many people feel the effects of underperforming thyroid long, long before they would meet that criteria.

If the thyroid is producing a reasonable amount of T4, the test never goes abnormal … but if you don’t convert the T4 you make to T3 adequately, your lab test may look fine, but from a functional standpoint you’re hypothyroid, or you at least [have an] underperforming, suboptimal thyroid, so you have to look at other tests. You have to look at not only the T4 hormone, but the T3 hormone, and you have to look at both of those hormones in both their total state and their free state.

It’s something that really needs to be assessed, and when you’re not going to that level of assessment, it’s easy to grasp at straws of other things. One of the first things a doctor is going to grasp at is “Oh, this must be another one of those fibromyalgia cases.”

What are the thyroid tests that patients should request?

When I’m doing a full thyroid assessment initially on a patient, I order a TSH. I order a total T4, a free T4, a total T3, a free T3, and then particularly if there’s any family history of Hashimoto’s, Grave’s or any kind of autoimmune thyroid condition, we order what are called TPO antibody and thyroglobulin antibody [tests].

Tests to request from your physician to rule out thyroid dysfunction as the cause of your fibromyalgia symptoms | Fed Up with Fatigue

Your thyroid levels can come back normal, but you can still have dysfunction, correct?

Yes, because once again you’re looking at standard, normal ranges based on the 95th percentile. We want you to be at least in the mid part of the normal range.

There’s a difference between normal and optimal thyroid function, right?

Exactly. I don’t even look at it as normal. The lab ranges are looking at is it common, not is it normal.

If you think about it, these [laboratory ranges] are based on data from the population, so if the population en masse starts getting sick all in the same way, the labs’ normal ranges follow the sickness because they’re based on that population statistically, but just because something is common doesn’t mean it’s a normal state of affairs.

I’ve read that the most popular thyroid medications, like Synthroid, are not always the most effective treatment. What’s your approach to treating thyroid issues?

Synthroid is synthetic T4. That can be very effective in patients whose core problem is they aren’t making enough T4 hormone. In those patients, generally, they show up on the orthodox testing. They usually have an elevated TSH and low T4, and they get put on Synthroid, and often they do fine.

But if you’re one of those many other folks who your problem is more in converting T4 to T3, [then] you won’t convert the synthetic T4 any better than you convert your own.

You end up taking Synthroid, and you don’t feel better, so they increase the dose. You still don’t feel better, so they increase the dose [again]. They get to the maximum dose they’re comfortable giving you, and you still don’t feel better, and they just leave you there, and you are the way you are.

When we test more comprehensively, if we find out the problem is mostly or at least partially due to [poor] conversion of T4 to T3, the first thing we’re doing is looking at why might you be having a problem with conversion, why might those enzymes be downregulated.

We’re making sure that if you’re excessively stressed that you’re dealing with your stress levels to bring your cortisol down. If there’s any kind of toxins at play, whether it’s heavy metals or any other kind of toxic exposure, we try to deal with that.

We make sure your nutrition is good, particularly some of the trace minerals that are involved as enzyme catalysts in those pathways, like selenium and zinc.

But often we still have to intervene with some level of thyroid support. When we do that, we tend to use a form of replacement agents that have a combination of the right physiological ratio that your thyroid would put out of T4 and T3, and usually we’re using these in a bioidentical form or some sort of glandular form.

A popular alternative to the synthetic hormones is Armour Thyroid. Armour Thyroid is a porcine-based thyroid, so it’s from pig hormones. It’s a fully processed pharmaceutical that’s standardized.

A lot of the stuff that’s said about it is just patently untrue. It’s regulated like any other drug, and it has to meet targets of T4 and T3, so it’s very easy to use, and patients basically get a much more complete treatment. They feel better. They get better results because they’re getting the same kind of hormones introduced from the outside that they would be producing internally in the right ratios of T4 to T3.

There’s another analogous product to Armour Thyroid called Nature-Throid. I tend to use Nature-Throid a lot because it’s the same as Armour Thyroid from a hormone standpoint, [but] it’s cleaner. There’s no corn starch. It doesn’t have some of the binders.

The fibromyalgia-thyroid connection | Could your fibromyalgia symptoms actually be caused by a malfunctioning thyroid gland? | Fed Up with Fatigue

What is your best advice for how to get properly evaluated for thyroid issues?

Find a doctor who’s trained in functional medicine or integrative medicine who really understands looking at thyroid in a very granular way – particularly if you have a lot of those symptoms we talked about, particularly if you’re a woman and particularly if there’s a history in your family of thyroid conditions.

If you’re a woman … in your 30s or 40s, and you’re starting to feel like “I’m tired all the time, I can’t think straight, I don’t have any energy, I don’t have any exercise tolerance, my muscles ache, I’m constipated, my hair’s getting thinner,” and then ask yourself was your mom on Synthroid, was your aunt on thyroid medicine, is your older sister on thyroid [medication].

If you start answering yes to [those questions], you need to find someone who can really evaluate your thyroid even if your family practitioner or endocrinologist says your thyroid is fine. It might be fine statistically in the laboratory, but it may not be where you need it to be to feel good.

Where can people connect with you online?

I’d invite people to check out my website, DrDavidBrady.com. I have a lot of articles about thyroid [and fibromyalgia] on my website under the “media” tab.

Also, last June I did a weeklong in-depth dive into fibromyalgia called the Fibro Fix Summit. The Fibro Fix Summit is still available [via] digital access …or to order it on a flash drive.

Recommended resources

Book by Dr. David Brady: “The Fibro Fix”

Book by Izabella Wentz, PharmD: Hashimoto’s Protocol |A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back

Book by Dr. Amy Myers: The Thyroid Connection | Why You Feel Tired, Brain-Fogged, and Overweight and How to Get Your Life Back

Video by Dr. Martin Rutherford: Functional Medicine Back to Basics Thyroid

Video by Dr. Martin Rutherford: Fibromyalgia and Hashimoto’s Thyroiditis

Article by Stop the Thyroid Madness: How to find a good thyroid doctor

Article by Stop the Thyroid Madness: Fibromyalgia … it’s not what you think

Article by Hypothyroid Mom: 10 Root Causes of Fibromyalgia (#3 is Thyroid)

Now it’s your turn … How many of your physicians actually ordered a full thyroid test panel vs. just testing TSH or TSH/T4? Share in the comments below!

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  1. Kathryn Kellison says

    The TSH test range was taken from a pool of 90 nurses who were not screened for thyroid disease. They simply lopped off the outliers and put everyone else in the normal range. A survey of patients done by Mary Shomon shows that most of us feel our best with our TSH between 1.0 and 2.0, our frees in the top 1/4 of the normal range.

  2. I have fibro and my thyroid enlargement was found while performing an MRI for something else. Unfortunately, I do have both fibro and hypothyroidism. If I might respectfully offer a correction, the correct term for the puffiness is myxedema. This is a great article!

  3. Franchesca says

    I have been tested a few times multiple doctors all only doing the T4 test. I have all the symptoms the feeling fatigue and brain fog, my hair is thinning at a alarming rate now, pain all the time like Laura above I have to explain to my kids and husband that huge and simple playful touches of grabs hurt, I 1st gained 120lbs, exercise hurts and I used to be very active, some nights insomia. Prior to my mom passing suddenly 3 yrs ago at 59 she was being diagnosed with fibromyalgia. I am truly tired of being sick and tired and with having a career in IT I have noticed the challenge for me to retain new things and make difficult to do my job if I can drag myself out of bed to go.This is effecting my whole lively hood. Any help of guidance would be greatly appreciated.

  4. Bryony Brookfield says

    I had to stamp my feet and demand full thyroid function tests from my GP who treated me like a hyperchondriac time waster….my TPO results came back three times higher than the ‘normal’ but because my other results were within ‘normal’ range my GP is still refusing to deal with it. I have all the classic symptoms weight gain, extreme tiredness, insomnia, thinning hair and eyebrows dry skin, constant aches and pains and exercise is becoming very difficult and my mother has Hashimotos but yet my GP still won’t deal with it! I am trying to get a referal to an endocrinologist and if i cant i will go private …..why oh why are GP’s not better educated on this?!

    • Jennifer Armstead says

      I am having the same problem. I had to demand a full panel of tests after years of arguing with various doctors of different specialties. It’s always the same thing. I go in with complaints of extreme fatigue, hair loss, weight gain, brain fog, etc and I get told the same thing: “you’re getting older, this happens, you have a family history of thyroid cancer and disorders so let’s check your thyroid”. Then they check it and a few days later I get a call from some random nurse saying all my labs are normal. I’m tired of having to scream at them that even though my labs are “normal” or even “optimal” that I am still having symptoms. I just basically threw a fit and got my GP to refer me to an endocrinologist but was essentially told it won’t do any good because the endocrinology people these days only deal with diabetes patients.

  5. Since 1995 I haven’t found a doctor in the uk that would listen nevery mind carry out these tests. I’ve not seen an endocrinologist or anybody who has a slight inkling of this condition..I am sure they are there if you have the money to pay for them but not for the masses..I’ve now been diagnosed with fibromyalgia and the same thing applies. Doctors don’t want to know..just left on the shelf to get on with it and manage..

  6. I wish there were more doctors who understand this! I have had a CNP recently who had me on 8 grains of Nature-Throid and I was still dealing with every single symptom I have with no thyroid replacement! My problem is not T3 or T4, it is the uptake of the thyroid. I had an iodine CT scan (I think that’s what it’s called) and there is barely anything being utilized (if that’s the right word). Like 3 little bitty dots in the whole process. I am dragging, exhausted, hurting, losing hair, spoon nails the doctors say they haven’t seen outside of textbooks, gaining weight, every Hashi symptom without the antibodies. I am desperate!

  7. Oh, and one more thing… saw Rheumatologist last week, and noticed, after I left her office, that my diagnosis is now fibromyalgia.

  8. Where can I get to Dr. Brady? I can’t seem to find a doctor to help me. Some have been down right mean! My ANA is 1280, so there is no doubt that I have something autoimmune. Been through a lot of labs for about three years, but “the numbers” don’t show any specific disease.
    My father and brother both suffer from Graves, so two endocrinologists say they need to continue to monitor me. Thyroid scan of a nodule also shows nothing.
    I feel like I am dying. I also keep pushing myself because I don’t feel like I have any other options. The fatigue is unbearable. I take Plaquenil that was prescribed by a Rheumatologist, and I think it has helped some symptoms, like joint issues, but I really need answers and a plan.

  9. I am Miserable! Since Jan 2017 I have gained 105lbs. I have fatigue that is debilitating, muscle weakness and it hurts for my kids to hug me. I have tried two different doctors and explained that I was concerned that it was my thyroid, it took the doctors 10years to correctly diagnose my grandmother, and that I wanted to get it under control. They each ran the TSH test and it came back at he high end of the normal range, so they didn’t want to run any other tests. They told me to just cut calories and exercise more. I am only eating 1000 calories a day and it hurts too much to exercise as much and hard as they want me too; especially with all the extra weight now. The other symptoms I have are; very swollen legs and feet, very dry skin and it looks thin, memory loss is at an all time high, and I can’t take the cold anymore. I’m just ready for someone to listen and help.

    • Donna Gregory/FedUpwithFatigue.com says

      Hi Laura, I would encourage you not to give up and to try to find a thyroid-friendly doctor. As you’ve learned, most doctors won’t test anything other than TSH, and that’s not a true measure of thyroid function. This post may help you find a doctor in your area who can help you: https://thyroidnation.com/thyroid-friendly-doctors/

    • Dear Laura. Very sorry to hear your plight, I have been in the very same position myself. Seeing as you can’t find a doc to do all the necessary tests, have you thought about privately doing the required tests yourself. There are many private blood testing compaines these days, where you can order a home test kit. You take the blood sample yourself (via fingerprick), & return the sample via post for the lab anaysis. Within a couple of days you have the full results.

      I’m afraid I can’t recommend any companies myself since I’m in the UK, but I know you have the equivalent in the U.S. Just an idea, it’s how I finally got to the bottom of what was happening with me after many years of frustration. If you decide this route, what you need to do is make sure the testing includes Total T4, fT4, fT3, & ideally TPO/Tg antibodies. There are some great thyroid patient advocacy groups online, that will happily be able to look over your results, & let you know whether there might actually be a problem. And if there is, being armed with full blood test results & knowledge – you can then go back to a sympathetic doctor & hopefully get some proper assistance. Hope that helps. Good luck & best wishes, Mike.

  10. Tamara Barlette says

    I’ve been tested multiple times over the past eight years, even once being referred to mental health for depression because the doctor told me they have similar symptoms. I have recently started to see an integrative and functional nutritionist who had me request all the thyroid tests you recommend from my primary doctor, but when he ran them he only ran a few. My TSH came back “normal” (1.8) and therefore he didn’t run anything else other than the T3 uptake which was low (23). I don’t really know what this means other than that my nutritionist was frustrated because he didn’t run the most “important ones.” I have a follow-up appointment with her tomorrow and hope to learn more. Thank you for the great article, that made this much more clear to me.

    • Donna Gregory/FedUpwithFatigue.com says

      Hey Tamara, I understand your frustration. I have been in the same predicament. For some reason, doctors don’t want to run those extra tests. I’m guessing it has something to do w/ the insurance companies. You might want to consider seeking out a thyroid-friendly doctor. Here’s a list that might help you find someone near you: https://thyroidpharmacist.com/doc-list/ (You have to enter your email for the list, but Dr. Wentz’s thyroid info is top notch, and you can always unsubscribe if you don’t find her info useful. She just recently hosted an online thyroid series that was excellent.)

  11. Yvette says

    Thank you for sharing this article. After reading several recently published books on this same topic, I asked my primary to order the more in depth thyroid testing. She said there was nothing to justify it since my TSH is well within normal range. I was diagnosed with fibromyalgia about 7 years ago and despite all the meds, PT, and eating a very restrictive diet, my symptoms continue to get more frequent and intense. I am retired, live in a rural location where health care is limited, and am living on a fixed income so going to a functional medicine Dr isn’t a realistic option. Would appreciate any advice you could share as I am definitely fed up and so tired of being sick and tired all the time. Thank you! Love your blog-always look forward to your posts!

  12. That was an interesting read, I have naturally had thyroid problems ruled out. There is a little bit of my brain that 18 months later reads this and has a small spark of “Could I really be fixed” but another part of me thinks back to all of those months being a pin cushion (I’ve a bit of a needle phobia) and quietly tells myself that I am not managing too badly and I should just keep my chin up and keep going forwards.

  13. This is so timely for me. I have been debating on whether or not to see a functional doctor I found who specializes in endocrinology for my thyroid. Or continuing with the naturopath I have been seeing who can order LDN for me. This kind of seals it for me as I actually have been diagnosed as hypothyroid, but feel no better on the med. thanks again for a great fibro article!

  14. Such a useful post. Thyroid diagnosis and treatment is pretty poor in the UK so it’s incredibly important to raise more awareness and educate ourself. Thanks for sharing. x

  15. Super interesting read. Thanks for the research, reliable info and making it easy to understand. Too useful to not reshare on all my social channels for sure!

  16. My doctor tries to to more in depth Thyroid testing however the B.C. Government medical plan steps in when the TSH is viewed as normal and rejects the rest of the testing request. My doctor just says his hand are tied nothing more he can do. Is there a way to order the tests you suggest without first ordering the stand TSH/T4?

    • Donna Gregory/FedUpwithFatigue.com says

      In the U.S., there are labs that allow you to pay out of pocket for some medical tests. Maybe there’s something similar in Canada?

      • I live in the U.S.. How do I get a full thyroid panel done without a physician’s order? How much does it cost out-of-pocket?

        • Donna Gregory/FedUpwithFatigue.com says

          I’m not sure if it’s possible to get one w/o a doctor’s order. This site provides a list of thyroid-friendly doctors – you have to sign up for her newsletter, but her information on thyroid health is fantastic, and you can always unsubscribe after you download the physician list: https://thyroidpharmacist.com/doc-list/

        • Mannai says

          Ulta lab tests. You pick the labs you want. Print the slip and take it to the lab. They will post the results to your account when they are ready, usually within a couple of days.


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