Co-Cure: res: Thyroid Malignancy In ME/CFS Patients -discussion,etc

[Guest guest]

Fri, 30 May 2008 05:42:50 +0200

Jan van Roijen <j.van.roijen

res: Thyroid Malignancy In ME/CFS Patients -discussion,etc

 

 

 

 

Reference:

 

*Thyroid Malignancy Association with Cortical & Subcortical Brain SPECT

Changes In ME/CFS Patients* Help ME Circle, 30 May 2008.

 

See also: Tom Kindlon's: *Thyroid Malignancy Association with Cortical &

Subcortical Brain SPECT Changes In Patients Presenting with a Myalgic

Encephalomyelitis / Chronic Fatigue Syndrome* at:

_http://listserv.nodak.edu/cgi-bin/wa.exe?A2=3Dind0805d & L=3Dco-cure & T=3D0_

(http://listserv.nodak.edu/cgi-bin/wa.exe?A2=3Dind0805d & L=3Dco-cure & T=3D0 & =P=3D3\

602) & =P=3D3602

 

 

````````

 

For those readers who are too busy (physicians, researchers, etc.) or brain

fogged (patients) I have copied the discussion- and conclusion sections of:

 

*Thyroid Malignancy Association with Cortical & Subcortical Brain SPECT

Changes In Patients Presenting with a Myalgic Encephalomyelitis / Chronic

Fatigue

Syndrome* - by Hyde MD, Byron et al. - Alasbimn Journal 10 (38):october

2007.

 

 

~jvr

 

 

````````

 

Abstract

 

Thyroid malignancy in ME/CFS patients greatly exceeds the normal incidence

of thyroid malignancy in any known subgroup. The thyroid malignancy incidence

in the ME/CFS group may exceed 6,000 / 100,000.

 

As part of their investigation, Myalgic Encephalomyelitis / Chronic Fatigue

Syndrome

(ME/CFS) patients should be examined by thyroid ultrasound for evidence of

thyroid pathology and malignancy. Thyroid pathology may be missed in this

group of patients if investigation relies only upon serum testing for TSH, FT3,

FT4, microsomal and thyroglobulin antibodies, which are usually normal.

 

Thyroid uptake scans tend also to be normal and may also miss malignant

lesions. A newly recognized syndrome may exist in ME/CFS patients characterized

by:

 

(a) thyroid malignancy,

 

(b) persistent abnormal cortical and subcortical SPECT brain scans

(NeuroSPECT),

 

© failure of thyroidectomy surgery and hormone replacement to correct the

fatigue syndrome, and

 

(d) an unusual high incidence of cervical vertebrae osteoarthritic changes.

 

ME/CFS patients with treated non-malignant thyroid disease and abnormal

NeuroSPECT scans may also fail to improve despite adequate thyroid hormone

replacement. A brief summary of the differences between ME and CFS is

discussed.

 

 

``````````

 

 

Discussion

 

 

1.) Myalgic Encephalomyelitis and Chronic Fatigue Syndrome are frequently

dismissed as variants of psychosomatic or neurotic illnesses by a large number

of serious physicians. Yet I have found that patients with this group of

diseases are a treasure trove of diseases. Since the CDC first defined this

group of illnesses as Chronic Fatigue Syndrome in 1988, and through the further

definitions of CFS, all physicians attempting a new definition have insisted

that CFS is a syndrome and not a disease.

 

Unfortunately, even those defining the illness have tended to treat CFS as a

disease and speak of it as a disease, rather than investigating the entire

patient as to the causes of their fatigue syndrome.

 

There has been some movement to consider these syndromes as the same. They

are not.

 

ME is essentially an acute onset, post-viral illness with CNS, organ and

immune system implications or pathologies. ME has a clearly defined incubation

period of 4 to 6 days, and is well known to occur in epidemics.

 

CFS is essentially defined by a persisting fatigue state of six months or

more in a patient who rapidly exhausts both physical and cognitive abilities,

and who is slow to recover to decreased baseline ability. CFS can have either

an acute or gradual onset, has no known incubation period, and has no organ

associated pathology other than the immune system.

 

ME has the attributes of a disease process, whereas CFS is clearly a

syndrome.

 

 

 

2.) Each of the 6 patients fell ill abruptly after an acute infectious

disease. Their illness was such that they could no longer function at a normal

level after the onset of their acute illness. Each of the 6 patients had

significant CNS dysfunction by history, and significant evidence by NeuroSPECT

of

CNS involvement of both cortical and subcortical brain perfusion.

 

Under the above interpretations of ME and CFS, these 6 patients would fall

into the ME group of patients. I would like to state that all ME patients

might be confirmed by measurement using SPECT and PET brain scanners.

 

Unfortunately, due to the lack of availability of high-quality

brain-dedicated SPECT scans, and the even greater rarity of dedicated PET brain

scanners

and appropriate software, these tools may not be available to the majority of

physicians.

 

 

3.) Patient 5 also had evidence of parathyroid dysfunction.

 

 

4.) Patient 1 had post-surgical complications and went into parathyroid

failure. She lived in a very rural area 60 miles away from the nearest

secondary

hospital and 120 miles from a principal hospital. The parathyroid failure

was responsible for a minor myocardial infarct. Patient 5, also a rural

resident, went into a post-surgical parathyroid crisis that was easily

corrected at

a nearby secondary hospital. She has also had a persisting vocal cord

dysfunction. Patient 6 had a short-term vocal cord dysfunction and recovered.

 

 

5.) Patients 1 and 3 developed autoimmune blood cell injury that at the

moment is ongoing.

 

 

6.) At the time of writing, the 6 patients have a 1 to

3 year post-surgical history. None of the 6 patients have had any

improvement from their fatigue syndromes. In some of these patients, their

illness has

further deteriorated. There has been no brain perfusion improvement in the 4

patients who have had a post-surgical NeuroSPECT scan. Travel considerations

have prevented repeat SPECT scans in

2 patients. One has to consider that the primary fatigue syndrome in these

patients is not related to the thyroid pathologies, but to the persisting

brain dysfunctions as measured by the NeuroSPECT.

 

 

7.) There was an obvious immune dysfunction in those patients who could be

measured for immune function anomalies. Unfortunately, although testing of

immune function is generally available in North America, the accuracy of

individual laboratories and their protocol are not standard and may not be

comparable. Repeat, detailed accurate immune studies are not generally

available and

are very expensive, and were beyond the scope of this study.

 

 

8.) The cervical vertebrae pathology noted may be mere coincidence, but is

being followed up in other ME/CFS patients with thyroid pathology. However,

only 1 of the subjects, who played college football, had any significant

history of cervical vertebrae trauma. ME/CFS patients describe muscle weakness

as

a primary dysfunction. Neck pain is a common complaint in this group of

patients. It is possible that, due to cervical muscle weakness, the cervical

spine

is forced to support the weight of the head directly. Over a period of time

this may incur repeat low-grade trauma that results in cervical vertebrae and

disc pathology.

 

 

9.) Although only 2 of the 6 patients demonstrated pathological findings

consistent with Hashimoto's thyroiditis, one should also consider whether these

6 patients, each with persisting evidence of CNS encephalopathy, do not

constitute an early but persisting Hashimoto-like encephalopathy.

 

 

10.) All 6 patients with thyroid malignancy have subcortical NeuroSPECT

pathophysiology. I have yet to find an ME/CFS patient with thyroid malignancy

that does not have subcortical pathology. The primary injury and cause of

fatigue in ME/CFS patients is probably not in the thyroid, since patients with

treated malignant or non-malignant thyroid diseases general fail to recover.

 

 

 

Conclusions

 

 

1.) ME/CFS patients who demonstrate the following:

 

a. Abnormal SPECT scans involving cortex and subcortical perfusion defects,

 

b. Thyroid malignancy,

 

c. Whose fatigue syndrome does not recover after appropriate surgery and

thyroid hormone replacement, and

 

d. Have a tendency for cervical vertebrae pathology may constitute a chronic

subgroup of ME/CFS patients.

 

 

 

2.) ME/CFS patients should all be evaluated by thyroid ultrasound and,

where appropriate, needle biopsy to rule out thyroid malignancy and other

thyroid

pathology. The fact that ME/CFS patients may have normal serum chemistry for

TSH, FT3, FT4 and normal Microsomal and Thyroglobulin antibodies does not

eliminate thyroid disease.

 

 

3.) A chronic Hashimoto's Encephalopathy=96like syndrome may be concurrent

with ME/CFS patients who have thyroid malignancy or multinodular thyroid

disease or other thyroid pathology and chronic subcortical & cortical brain

SPECT

changes. Non-recovery after thyroid malignancy surgery and adequate thyroid

hormone replacement may be related to this chronic ME/CFS encephalopathy.

 

 

4.) ME/CFS patients without thyroid malignancy yet with treated thyroid

pathology, and who have not recovered from their fatigue syndrome, may also

have

a similar NeuroSPECT brain dysfunction.

 

 

~~~~~~~~~~~~~~~~~~~~~~~

Send an Email for free membership

~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:

>>> Help ME Circle <<<<

>>>> 30 May 2008 <<<<

Editorship : j.van.roijen

Outgoing mail scanned by AVG AV

~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:

 

 

 

 

~~~~~~~~

------------

Send posts to CO-CURE

Un at http://www.co-cure.org/unsub.htm

Too much mail? Try a digest version. See http://www.co-cure.org/digest.htm

------------

Co-Cure's purpose is to provide information from across the spectrum of

opinion concerning medical, research and political aspects of ME/CFS and/or

FMS. We take no position on the validity of any specific scientific or

political opinion expressed in Co-Cure posts, and we urge readers to

research the various opinions available before assuming any one

interpretation is definitive. The Co-Cure website <www.co-cure.org> has a

link to our complete archive of posts as well as articles of central

importance to the issues of our community.

------------

 

(http://www.papercut.biz/emailStripper.htm)