Clinical Studies Update
effect of transdermal T3 (triiodothyronine) on geloid masses
patients with both fibromyalgia and myofascial pain:
crossover N of 1 clinical study
Geloid masses in a patient with both fibromyalgia and chronic
Starlanyl DJ, Jeffrey JL, Roentsch
G, Taylor-Olson C, 2001-2. The effect of transdermal T3 (triiodothyronine)
on geloid masses found in patients with both fibromyalgia and myofascial
pain: double-blinded, crossover N of 1 clinical study. Myalgies International
KEY WORDS: fibromyalgia, myofascial pain, trigger
point, geloid mass, triiodothyronine.
SUMMARY: Some patients with both fibromyalgia
syndrome (FMS) and chronic myofascial pain (CMP) may develop geloid masses
in areas of long-standing resistant TrPs . Recent research indicates
that a subset of people with FMS has been shown to have excess hyaluronic
acid (HA) in their blood . 3,3',5-triiodothyronine (T3) has been shown
to modulate the production of HA. We postulated that if HA, naturally
occurring in the ground substance between cells, was an important
component of these geloid masses, that transdermal administration of T3
may alter their consistency. The majority of the clinical study
participants reported significant improvement in symptoms and/or reduction
of medication with T3 therapy. The geloid mass does not appear to be a
part of the TrP phenomenon per se but may be a discrete phenomenon which
may occur in patients who have CMP as well as FMS and/or other chronic
pain conditions which interact to create the geloid mass. The repeated
close association between the central portion of geloid masses and an
underlying TrP suggests a meaningful relationship that is not yet clear.
T3 therapy improved the geloid mass but did not affect the taut bands or
TrPs directly, merely rendered them more treatable. The presence of these
geloid areas may add to patient discomfort and loss of function,
contribute to loss of range of motion, and complicate treatment even more
than usual when both CMP and FMS are present. It is important that
therapists be aware of and palpate specifically for these masses, as they
may be missed in the routine course of therapy and may provide one reason
why TrPs are responding poorly to usually effective therapy.
PURPOSE: To assess the effectiveness of
topical 3,3’,5-triiodothyronine (T3) on patients who have fibromyalgia
syndrome (FMS), chronic myofascial pain (CMP) due to trigger points (TrPs),
and geloid masses.
SUBJECTS AND METHODS: Ten subjects with
documented FMS tender points, CMP, and geloid masses were enrolled in a
randomized, double-blinded N of 1 clinical trial. Initial questionnaires
evaluated subjective patient perception of their pain and representative
geloid mass areas were measured and rated with a tissue compliance meter.
Transdermal creams, one a placebo, one with topical T3, were compounded
and distributed in increments of 10 days. Participants filled out daily
questionnaires and received a physical examination every 10 days.
RESULTS: Topical T3 generally resulted in a
softening of the geloid masses over time, allowing TrPs and taut bands to
become more accessible and treatable. Some patients reported reduced
pain, reduced medication use, increased function, and/or improved mood and
CONCLUSIONS: T3 therapy did not affect the
taut bands or TrPs directly, but by reducing the firmness of the geloid
areas, made the TrPs more available for treatment. The presence of geloid
masses may add to patient discomfort and loss of function, may contribute
to loss of range of motion, and complicate treatment. It is important
that clinicians be aware of and palpate specifically for these masses.
Recent research indicates that hyaluronic acid is an
important substance in the laryngeal area (Chan RW, Gray SD,
Titze IR, 2001), so we urge people using the T3 or hyaluronic
acid creme to use different areas of the body. Avoid joints and
try applying it directly over areas of the geloid masses. It is
vitally important that this use be under doctor oversight and
with full awareness that it is experimental.
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CASE STUDY: Starlanyl DJ, Jeffrey JL. Geloid masses in a
patient with both fibromyalgia and chronic myofascial pain. Phys Ther Case
Rep 2001; 4:22-31.
PURPOSE: The purpose of this case is to
document the existence of geloid masses occurring in a
patient who has both fibromyalgia syndrome (FMS) and chronic
myofascial pain (CMP) and propose their possible origin.
PATIENT: This patient is a 53 year old woman with
long-term FMS and CMP, with body-wide active and latent trigger points
(TrPs) and 18 tender points. Areas of geloid masses were measured and
rated and the NRS pain scale was used.
CONCLUSION: In this patient, geloid masses were
evident after careful palpation. They were associated with TrPs and taut
bands that were resistant to conventional TrP therapy. These areas seemed
to generate significant pain.
RELEVANCE: Patients with both FMS and CMP may have
geloid masses which are resistant to standard TrP therapy and, in this
patient, required modification of treatment technique.
KEY WORDS: fibromyalgia, myofascial pain,
myotherapy, geloid mass.
1. Starlanyl DJ, Jeffrey JL.
Geloid masses in a
patient with both fibromyalgia and chronic myofascial pain. Phys Ther
Case Rep 2001; 4:22-31.
2. Yaron I, Buskila D, Shirazi I, Neumann I,
Elkayam O, Parran P, et al. Elevated levels of hyaluronic acid in the
sera of women with fibromyalgia. J Rheumatol 1997; 24:2221-4.
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