1. Hormones and Pain Healing in the Balance

2. Symptoms of Low Thyroid Activity o Muscle Aches o Fatigue o Cold Intolerance o Constipation o Dry Skin and Hair o Depression o Difficulty Losing Weight

3. Reasons Blood Tests May Not Show Hypothyroidism o TSH may be normal with low thyroid activity: o If reason for low thyroid activity is in the hypothalamus, not the thyroid o If problem is peripheral conversion of T4 to T3 Selenium deficiency Soy and some xenobiotics o If there is peripheral competition for the receptor, such as in PCB and other environmental chemical exposure

4. Temperature Testing for the Thyroid o Morning Basal Temperatures below 97.6 may indicate low thyroid activity o Measurement should be made in the first part of the menstrual cycle in menstruating women

5. Signs of Excessive Thyroid Activity o Palpitations, rapid pulse o Insomnia o Irritability o Anxiety o Tremor o Diarrhea

6. Hypothalamic Pituitary Adrenal Axis o Set Point is determined by stressors in early life o Studies are contradictory but ACTH response to stress is exaggerated in fibromyalgia, while adrenal response to ACTH is blunted

7. Symptoms of Adrenal Insufficiency o Fatigue o Hypoglycemia o sugar craving o shakiness relieved by eating o Low blood pressure, esp. dizziness with standing o Recurrent infections

8. Treating the Adrenals o Nutritional – pantethine, magnesium o Glandular extracts o Cortef o Safest may be herbal: o Siberian ginseng o Licorice if blood pressure is low – but monitor BP, potassium

9. Growth Hormone o Secreted in Stage 3 + 4 Sleep o Depleted in Fibromyalgia o Symptoms of growth hormone deficiency: o reduced exercise capacity o poor general health o muscle weakness o cold intolerance

10. Elevators of Growth Hormone o Exercise o 10 minutes above lactate threshold intensity o Adequate hydration o Deep Sleep o Low GI diet o L-glutamine 2 grams, GABA 5 grams

11. Sex Hormones o Sex steroids will be modulated by stress and HPA axis o Low Androgens associated with Fibromyalgia: o DHEA-S – optimal is 120-180 for women, 300-500 for men o Testosterone – consider treating in the lower 20% of the normal range

12. Menopause o For some women, pain increases at menopause, and HRT may decrease this effect o Consider HRT if symptoms worsen in premenstrual period, if there has been TL or hysterectomy