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Nightingale Research Foundation definition
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====10. Testable Endocrine Dysfunction==== These features are common and tend to be of late appearance. They are most obvious in: :'''a) Pituitary-Thyroid Axis''': Changes in serum [[TSH]], F[[T3]], F[[T4]], Microsomal Ab., PTH, [[calcium]] and [[phosphorous]] rarely occur until several years after illness onset. This anomaly can best be followed by serial ultrasounds of the [[thyroid gland]], where a steady shrinking of the thyroid gland may occur in some M.E. patients with or without the development of non-serum positive Hashimoto’s thyroiditis (a seeming contradiction in terms) and a significant increase in thyroid malignancy. In cases of thyroid wasting, serum positive changes tend to occur only after years and often not until the thyroid gland shrinks from the normal 13 to 21 cc. volume in an average adult female and 15-23 cc. volume in male patients to below a volume of 6 cc. (Mayo Clinic averages) (Rumack, Carol). The normal serum analysis of patients for thyroid dysfunction, [[TSH]], FT4, microsomal antibodies etc., the golden rule of most physicians and endocrinologists, is simply not an adequate means of ascertaining thyroid dysfunction in most M.E. patients. Repeat thyroid ultrasound must be performed for all M.E. patients to observe the presence of dystrophic changes. It is also inadequate simply to accept the radiologist’s report of a normal [[thyroid]]. The volume of each lobe and its homogenicity must be requested and documented. Radiologists simply report normal thyroids when in effect they are hypo and hyper-trophic. Although the Mayo Clinic averages cited above may be criticized they are as good as any in ascertaining normal thyroid size. The following changes, while uncommon, may also be related to an M.E. disease process: :'''b) Pituitary-Adrenal Axis Changes''': where changes and findings are infrequent. :'''c) Pituitary-Ovarian Axis Changes''' :'''d) Bladder Dysfunction Changes''': This dysfunction occurs frequently in the early and in chronic disease in some people. In some instances this may be due to a form of diabetes insipidus, in other cases it is related to POTS-type illness where the patient is compensating for the inability to maintain vascular pressure by attempting to increase fluid volume. In other cases this may be due to [[interstitial cystitis]] or a form of [[polio]]-type-bladder particularly if the cause of the individual disease is an [[enterovirus]]. Dr. John Richardson also associated this finding with adrenal dysfunction that he measured.
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