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.

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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.

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Now, here’s a chart that was provided to me from Dr. Nikolas Hedberg, who’s at InfectionConnection.net, 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.

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Here is a study 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.

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Now, this is a paper  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.

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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.

 

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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.

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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.

Need help managing your fatigue and hypothyroid?  For help, click here

What do you think? I would like to hear your thoughts or experience with this.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

32 thoughts on “The Hidden Cause of Fatigue and Hypothyroid – A Virus

  1. With a positive EBV, hsv2, in my early adulthood and now hypothyroidism with all the symptoms you mention of fatigue,joint pain etc….would daily Valcyclovir be helpful even though I rarely have an hsv2 outbreak? Just thinking perhaps the viral shed would be less as would progression of symptoms. . True or not?

    1. Hi Mary,
      Very good questions. Like I said in the video I have seen most patients respond only mildly if at all to antivirals. If you haven’t done a thorough gut checkup I would start there. If you have (and all is clear) then you could try the antivirals and my advise would be to reevaluate after a few months, if you feel no different I would discontinue.
      Hope this helps!

  2. I’m curious as to the treatment protocol you developed for the aforementioned patient and what success you’ve had with it. What are your thoughts on LDN in this application?

  3. With a positive EBV, hsv2, in my early adulthood and now hypothyroidism with all the symptoms you mention of fatigue,joint pain etc….would daily Valcyclovir be helpful even though I rarely have an hsv2 outbreak? Just thinking perhaps the viral shed would be less as would progression of symptoms. . True or not?

    1. Hi Mary,
      Very good questions. Like I said in the video I have seen most patients respond only mildly if at all to antivirals. If you haven’t done a thorough gut checkup I would start there. If you have (and all is clear) then you could try the antivirals and my advise would be to reevaluate after a few months, if you feel no different I would discontinue.
      Hope this helps!

  4. I’m curious as to the treatment protocol you developed for the aforementioned patient and what success you’ve had with it. What are your thoughts on LDN in this application?

  5. Thanks for this informative article. I’ve looked at my recent lab results and may have an issue. I’m going to ask my doctor for the EB test.

    1. Hi Tammy,
      I am just outside of San Francisco and provide phone/skype consults for distance patients. All the info is located at the ‘Work with Dr. Ruscio’ tab on our homepage 🙂

  6. Thanks for this informative article. I’ve looked at my recent lab results and may have an issue. I’m going to ask my doctor for the EB test.

    1. Hi Tammy,
      I am just outside of San Francisco and provide phone/skype consults for distance patients. All the info is located at the ‘Work with Dr. Ruscio’ tab on our homepage 🙂

  7. Thanks for this information. I listened to you on the Phoenix Helix podcast and was looking forward to reading more about this. Thanks for making Skype/phone visits available to those of us who aren’t close to your office. It’s not easy to find practitioners who are knowledgable. I may make an appointment sometime soon. Thanks 🙂

  8. Thanks for this information. I listened to you on the Phoenix Helix podcast and was looking forward to reading more about this. Thanks for making Skype/phone visits available to those of us who aren’t close to your office. It’s not easy to find practitioners who are knowledgable. I may make an appointment sometime soon. Thanks 🙂

  9. Hi Doctor, Thanks so much for your information. I`ve had a low norm free t3, normal tsh,(lowrange,thankfully) and some heavy fatigue over many yrs. I believe I`ve had lyme,but over much of it now. Would the advice shown in this article apply to me? Thanks again

  10. Hi Doctor, Thanks so much for your information. I`ve had a low norm free t3, normal tsh,(lowrange,thankfully) and some heavy fatigue over many yrs. I believe I`ve had lyme,but over much of it now. Would the advice shown in this article apply to me? Thanks again

  11. What to do when you can’t afford a functional medicine doctor and have already been through several doctors that aren’t knowledgeable about sibo?

  12. What to do when you can’t afford a functional medicine doctor and have already been through several doctors that aren’t knowledgeable about sibo?

  13. At this very moment, I am so sick and tired, that I can’t get out of bed. I’m so depressed, because I thought I was getting better… I got a cold 4 days ago that quickly became a cough. Yesterday, I felt better, but I had an itchy rash. Whenever I get suck, I feel an itch, under my skin, on my left side, from when I had chicken pox. I had chicken pox twice… Even though they say it’s impossible, it’s not. I am living proof. Anyway, yesterday… At least, I had energy! I felt great. (relatively, since I still was coughing up phlegm). However, by evening, I was getting really tired and achey, again.

    Today, I woke up feeling like I was coming down with something, all over again! I have really swollen lymph glands, a really sore throat, and I am extremely fatigued. My throat is killing me. Especially on one side, the left side. I pushed on it, and puss and blood came out. It looks like tonsilitis. My heart is racing. I feel shakey, and nauseas, and my left ear hurts, as well. I feel like I am getting a migraine. I am mentioning all this, because I also happen to have hypothyroidism, and I take medicine for it, daily. I also had epstein barr virus, as a teenager. And now I am wondering if I am experiencing a relapse of epstein barr symptoms. It feels like mono… And it just *sucks*… I feel like my husband thinks I am a hypochondriac. I can’t take care if my kids, or the house, the way I want to… And I feel *so* guilty…. Anyway…. I also hate it, because I feel like it’s my fault, because I don’t see any good reason why I feel this way… Oh, and I also have a problem with stones and bone and joint pain. I have had kidney stones and gall bladder stones, so bad that I had my gall bladder out, and I was told that I had arthritis when I was in my mid thirties. I have pain so bad, on my lower spine, that I can’t ride a bike. I cracked a rib tying a line to a piling, on my boat. I got a stress fracture in my shin from falling on the diving platform of my boat. All in the last couple of weeks. That was my 2nd cracked rib. I cracked one last summer, slipping in a parking lot, in the rain. I perpetually look like a bruised banana… Black and blue, all over. I feel like an old woman. I am only 43. My hypothyroidism was diagnosed my my neurologist, when I was suffering from chronic migraines that sent me to the ER, because I couldn’t even keep water down, I was in so much pain, and throwing up. Half of my face would go numb, too. All of these symptoms started several years ago, after I had the flu, which turned onto chronic bronchitis. I had extreme fatigue. My doctor did my blood work, and found that I had extremely high levels of iron in my blood. Things went back to normal with that issue, but I have fought anemia off and on, and then my thyroid started to function really slowly. I get cold all the time, my heart races, I get ringing in my ears, really fatigued, achey, and all that… Like I said, it’s my migraines that led to the diagnosis of hypothyroidism… Anyway… Do you think these things are related? What could help me? Do I need further tests for diagnosis? I am so sick of being so sick! Right now my throat hurts so bad, that I think I am going to go to urgent care. Any advice would be appreciated. Thanks for enduring my long list of complaints. I hate being this way. This isn’t hypochondria… I am desperate. I tried going off gluten, after my GP suggested it… I can’t tell if it had any affect. Not much. Back on comfort food, now… Or, I would be, if my throat wasn’t agonizingly painful and I wasn’t so nauseous.

  14. At this very moment, I am so sick and tired, that I can’t get out of bed. I’m so depressed, because I thought I was getting better… I got a cold 4 days ago that quickly became a cough. Yesterday, I felt better, but I had an itchy rash. Whenever I get suck, I feel an itch, under my skin, on my left side, from when I had chicken pox. I had chicken pox twice… Even though they say it’s impossible, it’s not. I am living proof. Anyway, yesterday… At least, I had energy! I felt great. (relatively, since I still was coughing up phlegm). However, by evening, I was getting really tired and achey, again.

    Today, I woke up feeling like I was coming down with something, all over again! I have really swollen lymph glands, a really sore throat, and I am extremely fatigued. My throat is killing me. Especially on one side, the left side. I pushed on it, and puss and blood came out. It looks like tonsilitis. My heart is racing. I feel shakey, and nauseas, and my left ear hurts, as well. I feel like I am getting a migraine. I am mentioning all this, because I also happen to have hypothyroidism, and I take medicine for it, daily. I also had epstein barr virus, as a teenager. And now I am wondering if I am experiencing a relapse of epstein barr symptoms. It feels like mono… And it just *sucks*… I feel like my husband thinks I am a hypochondriac. I can’t take care if my kids, or the house, the way I want to… And I feel *so* guilty…. Anyway…. I also hate it, because I feel like it’s my fault, because I don’t see any good reason why I feel this way… Oh, and I also have a problem with stones and bone and joint pain. I have had kidney stones and gall bladder stones, so bad that I had my gall bladder out, and I was told that I had arthritis when I was in my mid thirties. I have pain so bad, on my lower spine, that I can’t ride a bike. I cracked a rib tying a line to a piling, on my boat. I got a stress fracture in my shin from falling on the diving platform of my boat. All in the last couple of weeks. That was my 2nd cracked rib. I cracked one last summer, slipping in a parking lot, in the rain. I perpetually look like a bruised banana… Black and blue, all over. I feel like an old woman. I am only 43. My hypothyroidism was diagnosed my my neurologist, when I was suffering from chronic migraines that sent me to the ER, because I couldn’t even keep water down, I was in so much pain, and throwing up. Half of my face would go numb, too. All of these symptoms started several years ago, after I had the flu, which turned onto chronic bronchitis. I had extreme fatigue. My doctor did my blood work, and found that I had extremely high levels of iron in my blood. Things went back to normal with that issue, but I have fought anemia off and on, and then my thyroid started to function really slowly. I get cold all the time, my heart races, I get ringing in my ears, really fatigued, achey, and all that… Like I said, it’s my migraines that led to the diagnosis of hypothyroidism… Anyway… Do you think these things are related? What could help me? Do I need further tests for diagnosis? I am so sick of being so sick! Right now my throat hurts so bad, that I think I am going to go to urgent care. Any advice would be appreciated. Thanks for enduring my long list of complaints. I hate being this way. This isn’t hypochondria… I am desperate. I tried going off gluten, after my GP suggested it… I can’t tell if it had any affect. Not much. Back on comfort food, now… Or, I would be, if my throat wasn’t agonizingly painful and I wasn’t so nauseous.

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