The Hidden Cause of Fatigue and Hypothyroid – A Virus

Epstein-Barr Virus has been linked to autoimmune disorders, thyroid disorders and fatigue. In this video we discuss the common association, and whether or not treatment is necessary.

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The Hidden Cause of Fatigue and Hypothyroid – A Virus

Dr. Michael Ruscio: Could a chronic viral infection be causing fatigue and/or autoimmunity?

Hi, this is Dr. Ruscio, and one of the more common things that I’m starting to see in my practice is people who have chronic viral infections. This is something that I don’t think many people know much about, so I wanted to take a moment to provide a little bit of information and insight on chronic viral infections, what they can look like, and why they may be something that you want to investigate.

How might you know if you have a chronic viral infection. Well, anyone who has any form of autoimmunity is certainly someone who may have a virus, and I’ll give you a little more detail on that in a moment, but anything from Crohn’s disease to Hashimoto’s to multiple sclerosis to ulcerative colitis, anyone with an autoimmune condition may have a virus at the root cause of that autoimmune condition.

Chronic fatigue and especially fatigue that seems to kind of go up and down. In fact, I just got done with a patient whose main complaint was fatigue that waxed and waned, waxed and waned, waxed and waned. This is very stereotypical of a virus or an infection in general because the infection goes through different life cycles. As the infection starts to proliferate, you get more tired, and then when the infection kind of calms down, you have more energy, and that’s why you have this on-and-off sort of fatigue.

Things that also may be associated, but not always associated, are having a sore throat and/or having sores in your mouth.

Now, here’s a chart that was provided to me from Dr. Nikolas Hedberg, who’s at, a very, very smart physician, and what you’re looking at here is the association between viruses and autoimmune diseases. As you can see, there are a number of conditions—autism, SLE, rheumatoid arthritis, thyroiditis or Hashimoto’s—and then the associations with the different viruses.

Let’s just look at EBV, which is the Epstein-Barr virus column. What you’re seeing here is whenever there’s a plus, that means there’s an association between Epstein-Barr virus and that autoimmune condition. When you see two pluses, there’s a strong association between Epstein-Barr virus and that condition. So we can see here that thyroiditis and rheumatoid arthritis have very strong correlation to Epstein-Barr virus. To come back to that patient I was just meeting with earlier here, her two main complaints—or three, I should say—were Hashimoto’s, transient fatigue that comes and goes, and transient joint pain. We can very clearly see that there may be some Hashimoto’s, there may be some rheumatoid arthritis causing the joint pain, and of course, the classical manifestation of fatigue.

Here is a study Trusted SourcePubMedGo to source entitled Immune response to Epstein-Barr virus in individuals with systemic and organ specific autoimmune disorders. To quote the authors, “Our study showed an increased Epstein-Barr virus activation among the autoimmune patient groups compared to the normal healthy controls.” Continuing, 52 percent of patients with rheumatoid arthritis or Hashimoto’s had Epstein-Barr, compared to only 30 percent of the healthy controls. So what we’re seeing here is that people who have Hashimoto’s or rheumatoid arthritis have a higher incidence of Epstein-Barr virus.

I should clarify one thing, and that is 95 percent of the population by adulthood has been exposed to Epstein-Barr virus. It’s kind of like chickenpox, where it’s in your body and it never really goes away, but it can manifest later in life, like chickenpox can as shingles. We can have this reactivation of the Epstein-Barr virus, and that is what seems to be the issue.

Now, this is a paper Trusted SourcePubMedGo to source from Dr. Pender, and it’s a great paper essentially linking having a low CD8 cell count, which then puts you at risk for having an inability to control viruses, and that puts you at risk for autoimmunity. There’s kind of a lot going on here, but I thought for the science geeks I’d put up a little bit of information. What you’re seeing at the very top here are B cells, immune cells, in your tonsils. Those are the little green circles. The little yellow dots are Epstein-Barr virus.

The Epstein-Barr virus infects your B cells and proliferates. It eventually gets into your blood, and then as it overflows into your blood, eventually it gets into a target organ, for example, your thyroid. Once the Epstein-Barr virus gets into your thyroid, it can cause a series of events that will then cause an autoimmune attack in your thyroid. That’s what this diagram is showing from Dr. Pender’s paper, and you see the reference here.

This is the same thing just illustrated kind of in table form. The one thing I want to make a note of is at the bottom here you see CD8 cell deficiency. People with low CD8 cells have a higher risk of contracting or reactivation of viral infections. Now, one of the best ways you can manage this naturally at home on your own is with exposure to sunlight and/or vitamin D supplementation.

Now, here are some lab markers that can help you determine if you have a chronic viral infection: If your white blood cells are below 5, if your lymphocytes are above 40 percent, if your monocytes are above 7 percent, if your neutrophils are below 40 percent, and if your CD4/CD8 ratio is not between 1.2 and 2.

Now, you can also test for Epstein-Barr virus directly, but you want to make sure that you test the viral capsid antigen, the nuclear antigen, and the early antigen, as I have listed here. With those three markers for Epstein-Barr virus, you want to make sure that you’re testing the fraction IgG and IgM.

In recap of that, we have some of our white blood cells we can test here, and then we want to make sure that when we test Epstein-Barr, we’re testing the Epstein-Barr virus, NCA or nuclear capsid antigen, the early antigen, and the viral capsid antigen. I just wanted to make sure I gave that to you in the order that I have it listed on my slide. You also want to make sure that you test the IgG and the IgM fraction. There’s a little bit of gray area in how to interpret these lab results, and if you’re not sure, you can always give the office a call and we can try to help walk you through that.

Now, here are some natural antivirals:  Coconut, garlic, and onion; monolaurin, which I use quite often in my clinic; reishi, which is the mushroom which helps increase white blood cells; quercetin, which is antiviral; silver, which is antiviral, antifungal, and antibacterial; vitamin C; and of course, sunlight and vitamin D.

If you’re someone who has autoimmunity and you can’t get a handle on it, and/or you have cyclical joint pain or fatigue, then investigating a chronic virus may be very helpful because I can say that I’ve been a bit shocked at how many patients actually come back with Epstein-Barr reactivation as I’ve been doing this testing more and more in clinical practice.

This is Dr. Ruscio. I hope this snippet of information on viruses has been helpful. If you have any questions, just let me know. Thanks.

Hi again. This is Dr. Ruscio. This video on viruses I recorded a year and a half, maybe two years ago, and my opinion on the issue of viruses has evolved a bit since, so I just wanted to quickly provide you with that. The article that I review in the video, by Pender, is a very interesting article showing some very interesting mechanism and association data. One of the things that you’ve likely heard me talk about is not solely making clinical decisions based upon mechanism or association data, and what we really want to evaluate—the best indicator for doctors and patients to know if a treatment will have any benefit or not—is the clinical outcome data. In looking at a couple of things over the past, there are a few reflections for you.

One, when I’ve looked at the definition or when I have taken a little bit more of a strict definition protocol for whether or not the Epstein-Barr virus is positive or not, and we’re really looking at that early antigen fraction, I find not as many patients are positive for reactivation as I had previously thought.

The other and more important is what kind of response patients notice when being treated for Epstein-Barr virus reactivation. I would say the majority do not notice a lot of benefit. Some do, but I have been a little bit disappointed in the fact that the response hasn’t been highly consistent. In fact, I would say I’ve observed more patients have seen minimal to a non-appreciable response than patients have noticed a response. I also think that part of the reason why people may respond to these antivirals—the natural antivirals, that is, which are primarily what I use—is because many of the natural antivirals are also antifungal, some can also be antiparasitic or antibacterial, and so it may be that spillover action having another benefit, potentially on an imbalance in the gut.

So I do think there’s a time and a place for treating latent viruses, and like I said, some patients do respond, but because it’s not the majority, I tend to be a little bit more judicious in this treatment, and I tend to reserve it for patients that have already gone through other treatments that are a bit more well established. This would, of course, include diet, lifestyle, anything involving their gastrointestinal system, their gut, potentially looking at a thyroid evaluation and going through responsible thyroid treatment or support. Then this would be one of the things that I would look at next.

It still can be important, it still has its time and its place, but if you’re a patient out there, wondering where this fits in with the thousand things you could potentially do, I would put it a little bit toward the end of the list rather than the beginning. Hopefully, if you do a good job with the beginning of the list, you don’t have to work your way toward the end.

In any case, I hope this is helpful. Thanks.

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