Hyperthyroid with neurological symptoms

[saeed123]

27male5'10"180lbs. Father dx Lupus. cousin born with thyroid problems. Currently on Lorzaepam 1 mg for anxiety attacks and Propranolol 20 mg 2x daily for rapid heart rate
symptoms:
1-Four months ago:I went swimming,after a few days,I felt pressure in my left ear and I lost +50% of my hearing in the same ear only.dx with ear infection. recurrence after two weeks, finished second course of antibiotics a few days ago. Several days after the ear symptoms my upper left eyelid started a very fine but almost constant twitching
2- three weeks ago, I woke up with a very stiff neck and shoulder right side I also felt something in my throat (still do but to a lesser degree) when I swallow and have a funny feeling in front and back of my neck.
3- Two weeks ago: I have had four "attacks" when my heart rate went to +180 beats per minute, chills and was rushed to hospital. Three attacks in three consecutive days.5- Started three week ago: I woke up in the middle of the night and could not feel my left leg for two minutes. since then twitching, tingling(needles) and numbness in all my four limbs and since yesterday I have been feeling weakness in my right arm. The twitching is all over my legs and arms and almost nonstop. Fingers twitch as well (move laterally several times then stop
Tests:
1- First CBC potassium level 4.7 and WBC(neutrophil) normal. The repeat CBC in ER (two days later)potassium level 3.3 and elevated WBC(neutrophil) the ER doctor thought was stress but first doc thought potassium shouldn't go from 4.7 to 3.3 in two days. Third CBC normal.
2- Urine test normal
3- Thyroid function: repeated this test three times: first one: TSH:0.32 fT4: 23 second one: TSH:0.66 fT4: 22 third one: TSH: 0.78 fT4: 28 all done within one week
4- thyroid ultrasound: normal
Questions:
1- Can thyroid cause twitching arms/legs numbness tingling weakness?Or I slept in a funny position?
2- Can these symptoms be caused by GBS, MS or ALS (linked to ear infection)?

[saeed123]

Considering that the thyroid is apparently not overactive according to one doctor and slightly overactive according to another, I have three questions for you and I greatly appreciate your comments.
1- Can it be that I slept in a funny position and my neck disc was herniated? (stiff neck and shoulder, feeling something is in thoat, funny feeling when swallowing, sometimes some difficulty swallowing, tingling and needles sensations and numbness and widespread twitching in both legs and arms and also index finger jerking around plus the weak and painful right shoulder and arm after three weaks ago stiffness )
2- Arn't the above mentioned symptoms of ALS, MS, GBS or MG?
3- As a neurologist, what do you suspect?

[saeed123]

I also asked the same question from two endocrinologist. One being the endo that I go to for diagnosisand the other one an endocrinologist in one of MedHelp forums.
Here is what they think:

My endo: tingling, numbness, twitching are NOT related to thyroid
Endo on MedHelp: thyroid levels are basically normal. So probably neurological nature (please see above post for the notes that I had regarding the T4 vs. Free T4 and reference ranges).

[saeed123]

Thanks for your reply.

The only things that I need to mention is that the measured hormone was "free T4" and not T4 with a lab reference range of 12-22 pmol/L and considering this range, my numbers are just borderline high (22, 23, 28). This is why I am thinking that maybe this minor elevation in Free T4 is just a coincidence and the problem (especially twitching and jerking movements of my arms and legs - sometimes rhythmic like my index finger going back and forth several times in a minute and then stop) and all numbness and tingling and now the alarming arm weakness can have primary neurological causes. As I mentioned, All of this is following a recurrent ear infection after swimming from four months ago that was treated with two courses of antibiotics. I am suspecting GSB, ALS or MS attacks following the ear infection. The heart rate may be a separate issue and truely independent panic attacks due to hypochondriasis. I know most doctors dismiss ALS, GBS and MS because they are rare and also suggestive of hypochondriasis problems with patients especially in online forums but I a comment  that I would like to make:
"Low chances of having certain diseases  is not a good reason for overlooking the symptoms. If we do this, how are we supposed to identify those people who suffer from these "rare" diseases? A good example is my situation. I am a 27 year old male with Graves' disease? what are the odds? *very rare*. This being rare has caused me months of horrible life because I had to go to doctor to doctor and beg to be tested and hear that "it is all in your head, take advil" until I was diagnosed with hyperthyroidism (I was even diagnosed with having mental disorders and anxiety attacks and was given lorazepam by the ER doctor - turns our it actually is anxiety, but secondary to hyperthyroidism and my rapid heartbeat to over 180 beats was not just a benign anxiety attack and could have been or lead to thyroid storm and the ER doctor did not even guess Graves because it is rare.)"

questions:

1- Does a borderline over active thyroid cause muscle spasm and twitching in both arms and legs?
2- Does a borderline over active thyroid cause numbness and tingling in both arms and legs?
3- Can these symptoms be choreia secondary to hyperthyroidism (especially the rhythmic lateral movements of my finger and twitching all over my body?)
4- I have very strange pains in muscles unlike all other muscle pains that I have ever experienced more like sudden stabbing pains in arms and legs muscles. I only injure my muscles much more easily, If I extend my arm fully when I am yawning, several muscles in that arm will go sore for weeks. It is related to thyroid too? Is it reversible after thyroid treatment or this muscle disease will stay and get worse?

Thanks

[Abhijeet Ghosh]

Dear Saeed,
Many thanks for posting the question via my forum.
Let me first refresh you with the normal thyroid hormone values.

T4 - 4 to 11 mcg/dl
TSH - 0.4 to 5.0 mIU/L

So you can now clearly see that the T4 levels are a bit raised.
Increased levels of T4 can definitely cause arms/legs numbness/tingling. So your first question is answered.
And please don't check the values too soon.
Please don;t think og other conditions like GBS,MS or ALS in the present scenario.
It really is due to increased T4 levels and you need to meet a good Endocrinologist for a good helpful follow up and better control of the thyroid gland.
Keep the stress away.
Regards.

Feel free to post  more for any sort of discussion.