Thyroid or Hypothalamic Dysfunction?
Written by Editor   
Friday, May 16, 2014 02:57 PM

Obese patients who continue to have "thyroid symptoms" even when their levels are normalized may have a hypothalamic dysfunction, researchers reported here.

In a single-center study of 50 patients referred for evaluation of thyroid symptoms, 68% had at least four symptoms that were characteristic of hypothalamic obesity disorder.  Those include fatigue, temperature dysregulation, weight change, changes in sleeping patterns, pain, and mood disorders, the researchers said.

"Patients who insist they have thyroid disease causing their weight problems are frequent," the researchers said. "Some try thyroid medications, yet they feel worse and don't lose weight. These patients would only benefit from therapy for their hypothalamic dysfunction."

Researchers assessed 50 patients who had been referred for the evaluation of thyroid symptoms. They diagnosed hypothalamic dysfunction as "likely" if symptoms from three different systems were present, and as "definite" if from four or more.

The majority of cases were women (76%) with an age range of 18 to 68. Most also had normal thyroid levels (72%).

The most common hypothalamic symptoms were:

  • Fatigue (76%)
  • Temperature dysregulation (68%)
  • Weight change (88%)
  • Changes in sleep (70%)
  • Pain (72%)
  • Mood disorders (80%)
  • Libido issues (38%)
  • Sympathetic or parasympathetic complaints (64%)

The researchers noted that an important physical finding is the presence of trigger points tenderness, which occurred in 68% of this population.

Overall, more than two-thirds of these patients (68%) were determined to have definite hypothalamic dysfunction, and 22% had likely hypothalamic dysfunction, the researchers reported.

Some clinicians diagnose these patients with malingering, borderline personality disorder, adrenal depletion, or uncharacterized disorders "when hypothalamic dysfunction would explain most," they wrote.  They concluded that hypothalamic obesity disorder is an easy diagnosis to make on clinical grounds and is the most common disease in patients who have normal thyroid tests but still report thyroid symptoms.