We’ve all seen patients who present with a wide variety of symptoms, and chief among them are often fatigue, brain fog, lack of restful sleep, and aches and pains throughout the body—all proven resistant to ordinary treatment. In the absence of other clear disease signs and symptoms, the mind begins to turn towards generalized conditions, such as fibromyalgia.


Foundational Fibromyalgia Treatment

Fibromyalgia often proves difficult to resolve fully. The first lifestyle changes I recommend include getting the patient on board with as much healthy exercise as they can tolerate and improving sleep quality with good sleep hygiene. Targeted chiropractic adjustments, ESWT (extracorporeal shockwave therapy) and deep-tissue massage may prove helpful in alleviating the immobility and soreness of specific problem areas.

But what can we do beyond these basic health-improving measures? In many patients, we should next look to the thyroid.


Fibromyalgia, the Thyroid and Mitochondria

Thyroid dysfunction is strongly correlated with fibromyalgia and shares many of the same symptoms. The incidence of both primary and secondary hypothyroidism is elevated among people with fibromyalgia. While the causes of fibromyalgia are complex, it certainly involves dysfunction of the HPTA axis (hypothalamic-pituitary-thyroid axis), whether due to trauma, stress or environmental toxicity.

Fibromyalgia also involves mitochondrial metabolism issues, which in turn can lead to difficulties in proper cellular utilization of thyroid hormones. Both systems interact with each other in a complex fashion that requires addressing both simultaneously to resolve dysfunction.


Supplement Support for the HPTA Axis

Considering the thyroid’s role in fibromyalgia, how should we approach treating such patients? Our first priority is to get the HPTA axis under control; when under stress or after trauma, abnormal cortisol and thyroid hormones can occur, causing a significant strain on perceived stress and energy levels.

I use a supplement formulated to support a healthy stress response when taken for some time that includes these time-honored herbal extracts:

  • Ashwagandha root
  • Eleuthero root
  • Rhodiola root
  • Chinese skullcap root

These extracts go along with L-theanine, which can help regulate stressed mood more immediately.

Although getting the HPTA axis under control can take some time, this is crucial to setting the groundwork for a better-functioning patient! We may not be able to abolish the stresses in our patients’ lives, and we certainly cannot change the traumas they may have been through that are so common in those with fibromyalgia. Still, we can make their bodies much more resilient in dealing with these stresses.


Impact of Chronic Inflammation on Thyroid and Mitochondrial Function

One of the primary physiological stresses the body can face is chronic inflammation, which is unfortunately common in our modern world. Any source of chronic inflammation will make it much harder for the body to properly rest, heal or express healthy cellular metabolism.

Thyroid and mitochondrial function are particularly vulnerable to chronic inflammation, so it is crucial to help patients who are already deficient in both to deal with the source of inflammation.


How to Support Patients with Inflammation or Thyroid Dysfunction

First, it’s important to identify any potential sources of inflammation in the patient’s life—whether it’s a food they cannot tolerate, a chemical common in their workplace or an environmental toxin, such as mold in their house. Once such external sources are dealt with, we can turn to nutraceuticals to help the body better regulate its inflammatory response.


Inflammation Regulation Support

Turmeric works wonderfully to help regulate inflammation, starting with its role in regulating the gut microbiota—a crucial aspect of a proper immune response. Turmeric supplements should provide a wide spectrum of bio-effective curcuminoids and other natural, medicinal turmeric components in a well-tested dosage.


Muscle and Soft Tissue Inflammation Support

Of course, inflammation in the muscles and soft tissues is particularly concerning for fibromyalgia patients. Inflammation in these areas can be moderated by supplementing with broad-spectrum proteolytic enzymes.

These exogenous enzymes help break down unneeded proteins while the cells try to metabolize and grow, particularly post-exercise. These enzymes have also been shown to help maintain a healthy level of pro-inflammatory cytokines, which can help keep a patient who is already in pain and reluctant to stress their muscles or joints more on track with healthy movement and exercise.


Thyroid Support Supplements

Finally, we should pay attention to supporting the thyroid directly. It is essential to remove stresses from the thyroid and help cells become more reactive to it, but the body will still not work perfectly if the thyroid cannot provide proper hormone levels.

Iodine and L-tyrosine are essential nutrients for the thyroid, providing it with the base materials it needs to manufacture thyroid hormone. In addition, zinc, selenium and vitamin A allow the thyroid to convert T4 into its active T3 form. I prefer using supplements that combine these key components for easy patient compliance.

An all-purpose multivitamin for the thyroid should also ideally contain the Ayurvedic botanical compound guggulipid, which helps to enhance thyroid health and function. In addition, N-acetyl cysteine provides antioxidant activity, which removes yet another stressor to this sensitive organ.


The Bottom Line

Every doctor loves treating patients they can quickly diagnose and cure. Stubborn and complex conditions, like fibromyalgia, thyroid disorders, chronic pain and fatigue, stand in contrast to this quick satisfaction. However, it can be just as rewarding to go through the process of discovering the numerous complex ways each patient responds to stress, trauma and toxicity. Unraveling the intricacies of the many systems involved leads to a slower but just as worthwhile healing process and improvements to a patient’s quality of life.

In dealing with the many aches, pains and associated symptoms these patients present to us, it is crucial to keep an eye on the larger picture. Some patients may have thyroid dysfunction without fibromyalgia or vice versa, but the two conditions are deeply intertwined, and many patients will benefit greatly from an approach that incorporates understanding how these conditions act and interact.




Educated in both the Netherlands and the United States, Adrian den Boer, ND, DC, IFMCP is a board-certified and licensed naturopathic and chiropractic physician. In addition, Dr. den Boer is fully certified as a functional medicine doctor. Dr. den Boer has treated over 10,000 patients successfully by utilizing multiple resources to manage patient care. Most recently, he joined the Lifestyle Matrix Resource Center as the Clinical Expert serving the MSK Solutions Pain Recovery Program.