Exhausting the reasons for chronic fatigue

James Le Fanu

The symptoms of an underactive thyroid can be so subtle and come on so gradually that they can be easily overlooked. “I woke up tired, dragged my body to work and fell asleep before the children when reading their bedtime story,” recalls a Scottish family doctor, attributing her chronic exhaustion to combining full-time work with being mother to three boisterous boys.

This went on for several months until, when attending a medical conference, a former colleague remarked that she did not look her usual self and tactfully suggested she should have her thyroid function tested. It took just a couple of weeks of a daily dose of levothyroxine for her former energy levels to be wondrously restored.

Yet for almost a third of patients their symptoms persist and repeated tests remain abnormal despite incremental increases in dosage. Here, two possibilities need to be considered. First, several foods and medicines may interfere with the absorption of the levothyroxine in the intestine – the main culprits being coffee, kelp, soya, iron and calcium supplements, the acid suppressant proton pump inhibitors and cholestyramine. This can be readily circumvented by taking the levothyroxine with water on an empty stomach before breakfast.

Next, several of the typical symptoms – fatigue, sensitivity to cold, sluggish bowels, poor concentration – are not unusual in those in their eighties and beyond, being part of “normal” ageing. They may, however, be misattributed to being due to an underactive thyroid because the standard diagnostic test, an elevated TSH (thyroid stimulating hormone), tends to rise with age. Hence the recent recommendation that an abnormal test in the elderly should be interpreted with caution.

Benefits of statistics

role of statistical data in charting the progress of an infectious epidemic. While the cumulative (and by definition exponential) increase in the number of confirmed cases and fatalities is obviously disconcerting, the global perspective provided by the Worldometer website reveals the distinctive pattern of a rise and fall – starting in China in January before peaking in mid-february. The same picture a month later is apparent in South Korea.

Europe is a further month behind, with a plateauing of new cases over the past week, while the United States is still very much on the upward curve. There are many imponderables, of course – why has Italy been so badly hit and why has Japan escaped relatively unscathed? But this still offers a most useful insight into current uncertainties.

Meanwhile, several readers noting the claim that the virus is heatsensitive have inquired whether regular steam inhalations might be a simple preventive measure. Probably not, though for those with upper respiratory symptoms a 15-minute session with a towel over the head is a most effective decongestant.

A further frequent query relates to the widely prescribed blood pressure-lowering ACE inhibitors (such as ramipril), implicated in

Breathe easier: steam inhalations are an effective decongestant facilitating the entrance of the virus into the cells lining the airways. Dr Scott Solomon of Harvard University Medical School acknowledges the “theoretical” grounds for such concerns but maintains this is not sufficient to justify discontinuing the medication. One less thing to worry about.

Can you beat that?

This week’s medical query comes courtesy of Mr HP from Lincolnshire, who describes how recently he experienced a physical jolt in his chest on meeting, totally unexpectedly, a much-loved friend not seen for several years. He wondered subsequently whether this might be the same sensation famously alluded to by William Wordsworth, “My heart leaps up when I behold a rainbow in the sky” – and, if so, whether others might have had similar sensations and what the possible explanation could be.

Covid-19, besides everything else, is the most vivid illustration ever of the

It took just a couple of weeks for her former energy levels to be wondrously restored