Chiropractic Management of a Patient With Chronic Fatigue: A Case Report
SOURCE: J Chiropractic Medicine 2016 (Dec); 15( 4): 314—320
Christopher T. Arick, DC, MS
Clinical Sciences Department,
National University of Health Sciences,
Pinellas Park, FL
OBJECTIVE: The purpose of this case report was to describe the examination and management of a patient with chronic fatigue.
CLINICAL FEATURES: A 34-year-old woman presented to a chiropractic clinic with complaints of fatigue and inability to lose weight for 2 years. When tested, she was found to have high serum thyroglobulin antibodies, low serum vitamin D3, low saliva dehydroepiandrosterone-sulfate, and low saliva total and diurnal cortisol.
INTERVENTION AND OUTCOME: The patient was placed on an anti-inflammatory ancestral diet and given recommendations to decrease the aerobic intensity of her exercise routine. On the basis of the result of conventional and functional laboratory tests, she was prescribed a treatment plan of targeted supplementation. After 12 weeks of application of dietary, lifestyle, and supplementation recommendations, the patient reported experiencing increased energy and weight loss of 15 pounds. Her thyroglobulin antibodies returned within reference range, salivary cortisol increased and closely followed the proper circadian rhythm, and dehydroepiandrosterone-sulfate increased.
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CONCLUSIONS: This report describes improvement in a patient with chronic fatigue with the use of nonpharmaceutical polytherapy involving dietary changes, lifestyle modification, and supplementation.
KEYWORDS: Adrenal Insufficiency; Hashimoto Thyroiditis; Hypothalamic Dysfunction Syndromes
From the FULL TEXT Article:
Fatigue is a common symptom seen in clinical practice; however, it is difficult to define, measure, and specifically relate to the chief complaint within the clinical encounter. Because of its subjective nature, clinicians often ignore fatigue as a symptom and rely on objective findings to steer the diagnosis. Evaluation and management of patients who experience fatigue as their major or only complaint could then be difficult for the clinician. 
Fatigue frequently is a major part of the complex pathophysiology of the presenting patient. Fatigue can be described broadly as being either acute and self-limiting or chronic and debilitating.  Fatigue is also categorized as being peripheral or central in origin. Peripheral fatigue is caused by peripheral neurotransmitter imbalance and causes impairment in the peripheral nerves and muscular contraction. Central fatigue relates to abnormalities of neurotransmitter balance within the central nervous system and is often present with psychological complaints, such as anxiety and depression.  Without proper and ample focus on fatigue as a symptom, the underlying problem may not be identified, and multiple medications, including antidepressants, antipsychotics, and benzodiazepines, could be prescribed. Long-term use of these and other medications could prolong fatigue and affect the patient to the point that chronic fatigue syndrome (CFS) and other chronic conditions could develop. 
Chronic fatigue syndrome is characterized by persistent fatigue that may be associated with many other debilitative conditions.  Chronic fatigue syndrome is not necessarily caused by exertion and not usually relieved by rest.  Common symptoms of CFS include sudden onset of an infectious-type illness, subsequent chronic and debilitating fatigue, pharyngitis, and postexertional malaise.  As the cause of CFS is still not known, and its multifaceted mechanism is not understood, effective treatment is difficult.  Treatment of CFS conventionally has been restricted to cognitive behavioral therapy and medication.  The effectiveness of medications, including antidepressants and immunomodulatory agents, has not been confirmed.  There is a growing body of research that supports acquired abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis, including decreased levels of cortisol, enhanced cortisol negative feedback, and blunted HPA axis response in patients with CFS.  Reduced activity of the HPA axis and, thus, the hyposecretion of cortisol has been associated with fatigue, although a temporal association has not yet been established.