Dr. Dennis Remington

Many patients with CFS have clinical features suggestive of low thyroid function.  The most common symptoms associated with low thyroid activity are:

Constant tiredness

Low body temperature

Feeling cold at temperatures comfortable for others

Sluggish metabolism and weight gain


Dry hair and dry skin

Slowed down thought processes

Muscle and joint pains

Not everyone with some of the above features has a problem with their thyroid, and not everyone with low thyroid function (hypothyroidism) will exhibit all of the features. Someone may be hypothyroid and yet have a raised temperature due to a virus infection.  They may have diarrhea instead of constipation due to Candida, parasites, food allergies, or other bowel dysfunction.

Many people with all the clinical features of hypothyroidism have completely normal blood levels of thyroid hormone.  A body temperature measure is a reasonably reliable indicator of thyroid function.  If one randomly takes,over a few days,his/her temperature by mouth, and find that at no time it ever reaches 37 degree C, or 98.6 degree by mouth, low thyroid activity is most likely present.

The newer and more sophisticated tests of thyroid function will often identify hypothyroidism, but they are even normal in many cases.  There are several theoretical explanations for clinical hypothyroidism in the presence of normal lab tests including the following:

T3, one of the thyroid hormones, has 2 forms.  Regular T3 is very active, but reverse T3 is very inactive.  In response to reduced food intake (especially reduced carbohydrate intake) regular T3 drops dramatically and reverse T3 increases.  Blood tests which measure T3 show no change, and yet the person will develop a very slow metabolism and all of the other classical features of hypothyroidism.   This is an adaptive response which helps to conserve energy during starvation conditions.   There may be other factors as well as inadequate food intake responsible for low levels of active thyroid hormones.

Antibodies may form which attach to thyroid hormones rendering them inactive.  Blood tests will show normal levels of thyroid hormone, and yet can’t indicate their level of activity.

Various cells in your body may be resistant to the action of thyroid hormone.  To be effective, thyroid hormone has to cross the cell membrane into each cell, and then enter the nucleus of the cell where the hormone exerts its effect.   Anything which interferes with cell membrane transport systems may theoretically interfere with the ability of thyroid hormone to do its job properly.  A good parallel is maturity onset diabetes, in which plenty of insulin is present, but enough resistance to its action is present that much more than usual is needed to get the sugar into the cells.  In a similar way, some people seem to require considerably more thyroid hormone than usual in order to overcome symptoms of low thyroid.

Taking replacement doses of thyroid hormone often provides dramatic relief for those suffering from hypothyroid symptoms.  Thyroid hormone is inexpensive, safe, and easy to use.  There is a wide variation in the amount of hormone that produces optimal results.  By far the best indicator of optimal dose is clinical response.   Blood tests are of limited value.  There is a variety of natural and synthetic thyroid hormones available from which to choose.  The brand which we have found best tolerated in our patients (who have a high rate of allergic reactions to medications) is Armour thyroid, which is a natural hormone with no coloring agents.

Each person taking thyroid hormone should understand the symptoms associated with low thyroid activity, and those caused by excessive thyroid.  A good technique is to gradually increase the amount of thyroid taken until all the low thyroid symptoms are gone, or until symptoms of high thyroid activity appear.  The major symptoms of high thyroid include:

Feeling too hot

Pounding heart, fast heart rate, or palpitations


Shaking hands

Restlessness, irritability, anxiety

Trouble sleeping

The optimal dosage of Armour thyroid is usually between 1 grain (60 mg.) and 3 grains (180 mg.).  Some people need up to 6 grains to attain optimal results.   We usually prescribe the 1 grain (60 mg.) pills, and recommend starting by taking 1 pills at the same time once per day.  After two weeks, increase to 1½ pills if needed.  Increase one additional pill every two weeks until all the low thyroid symptoms are gone or until symptoms of high thyroid begin.  If high thyroid symptoms occur, stop the thyroid entirely for 3 days, then begin again at the previous dose that was well tolerated.  If two doses seem to be equally effective, use the lower dose.   When you have established an optimal dose, we can then give you an Armour thyroid pill of that strength. so you won’t have to count out several pills each day.

In some cases, heart pounding and other high thyroid symptoms may occur before all of the low thyroid symptoms are gone.  In that case, the best that can be done is to take the most comfortable dose and be content with less than perfect results.   If no significant improvement occurs after 2 to 3 months, it is usually not worth continuing.

Too much thyroid can be dangerous to an older person or to someone with

heart disease.  Excess thyroid speeds up the entire metabolism, causes muscle loss, and puts an extra burden on the heart.  We like to monitor very closely any doses above 3 grains.  One lady from California called requesting a repeat on her thyroid medication.  When we found that she was taking 6 grains a day, we quickly phoned her to make sure that she was okay at that dosage.  She had none of the features of high thyroid, and stated that she felt better than she had felt in her entire life.  She had been on the usual doses of thyroid on several previous occasions with very little help.  It was not until she took the high doses that she recovered from her hypothyroid symptoms.

Even when a person has all of the features of hypothyroidism, we don’t know how they will respond to thyroid replacement.  We therefore suggest a trial of therapy in these people.  We try the hormone replacement for a few months, and if we get a favorable response, continue the treatment.

Some people have expressed the concern that if they take thyroid, it will cause their own thyroid gland to stop working, and that they will have to keep taking thyroid hormone for the rest of their lives. Thyroid hormone does indeed suppress the production of thyroid by your own thyroid gland, but this function will return to the previous level within several weeks after stopping the hormone.  There is no particular danger during this period of time, and only minor symptoms, if any, are experienced.   If thyroid hormone does help you to feel better, you will usually need to keep taking it in order to continue to feel well.

We have seen cases in which symptoms of low thyroid disappeared without the need for supplementing thyroid, and cases in which people on thyroid hormone were able to decrease or stop the thyroid replacement.  We suspect that good nutrition along with mineral and vitamin supplements may reduce the thyroid resistance in some of these cases, and thus decrease the need for thyroid hormone.  Keep in mind that a dosage of thyroid that is optimal in early treatment may need to be decreased later as you become better nourished.

Sometimes unpleasant reactions occur to a particular brand of thyroid pills.  Other brands can be tried, and usually a variety can be found which will be tolerated.  Some patients seem to react to all forms of thyroid, and in fact, may be reacting to their own thyroid hormones.  Allergy treatment for thyroid hormone is often very helpful in these patients in controlling a wide variety of clinical problems.   We have now seen several cases of profound depression and fatigue respond dramatically to this approach.  Other doctors around the country using this technique also report very encouraging results.