Hello Doctor. I am a patient treated for hypothyroidism caused by Hashimoto's thyroiditis. My thyroid hormone therapy has never relieved my fatigue but I have other ongoing symptoms as well. I was also diagnosed with vitamin D deficiency about 3 1/2 months ago but 14 weeks of a 50,000 unit D2 caplet each week, has not resolved my muscle weakness. I was also found to have low-normal B12 and have been getting B12 shots for about the same length of time (twice monthly - now once a month).
My other symptom of concern is tingling and light burning sensation bodywide with occassional stabbing pains that can be anywhere and sometimes everywhere, including my trunk area and mildly on my face. As strange as it sounds, this worsened after I was on the D and B vitamin treatments. Previous to this and going back more than five years, I've had these symptoms more mildly and intermittently. One past doctor suspected I might have CFS and I feel this may be true with some crossover of fibromyalgia, although muscle weakness is more my problem and actual pain in them is generaly not there (apart from nerve type pains) but I do suffer mild joint pain. I've never been tested for Lyme but tick bites as a child never had rashes around them and I didn't start to become ill until I was nearly 40 years old (now age 47).
What I DO NOT HAVE is any noticable muscle atrophy, in fact my muscles are as intact as they have always been. I also do not have slurred speech or eye pain/blurniness and I had a normal brain MRI in July of 2007. Hopefully these factors point away from MS or ALS but would appreciate your opinion in regard to these and alternatively what might be 'possible' causes of my symptoms.
I have a neuro apppointment this early this month but despite knowing he can very likely zero in on a cause, I would like some ideas to discuss with him or ask questions about.
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.
Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.
Fibromyalagia is a medical condition that leads to whole body pains. Its cause is unknown, but it is characterized by diffuse aches, sometimes GI symptoms similar to irritable bowel, sleep abnormalities, low pain threshold, and other features. It is best treated with medications such as lyrica and neurontin, exercise, and physical therapy. Fibromyalgia occurs frequently in patients with chronic fatigue syndrome. If no cause of the condition is identified, it is best to look for other contributing factors such as anxiety or depression.
Chronic fatigue is diagnosed by disabling fatigue for at least 6 months, episodes of recurrent somatic or neuropsych symptoms (which may be low grade temp), cervical/axillary adenopathy of the lymph nodes, muscle aches, sleep disturbance, headaches, forgetfulness, and difficulties with concentration.
The tingling and burning sensation that you are having throughout your body could be secondary to the vitamin B12 deficiency. Vitamin B12 deficiency classically begins with mild general weakness and pareshtesias – however, mostly in the hands and feet. As the disease progresses, if left untreated, can cause gait abnormalities. Cognitive changes can occur ranging from apathy, irritability, somnolence, and emotional instability. Treatment is with B12 supplementation.
Additionally, hypothyroidism can cause cognitive slowing and also muscle weakness. Treatment is with supplementation.
It is difficult to say what you have and don’t have. ALS and MS have specific criteria for diagnosis and involve a thorough neurological examination. The normal MRI of the brain is reassuring. Hopefully, it was done with contrast and includes FLAIR and sagittal views. The neurologist will evaluate for these.
If your neurologist feels that you have neuropathic pain (which is pain coming from nerves and is commonly felt as burning, gnawing, pins and needles, etc), the treatment options include neurontin and lyrica, and medications such as elavil and, as the previous poster mentioned, cymbalta (which are antidepressants but has actually been found to be helpful with neuropathic pain as well).
I agree that you should be seen and evaluated by a neurologist. You have multiple reasons to have the symptoms that you are having. You should have your thyroid (TSH and free T4) and B12 (including methylmalonic acid) levels checked if not done recently. I am not clear on your muscle weakness locations, but if found on examination, an EMG/NCS may be performed to assess the extent of damage and help with the finding the cause.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
I had hypothyroidism, multinodular goiter and hashimoto. My calcuim & D were fine until a month ago when it dropped in half. Oddly enough after that it went back up to normal.
I had my entire thyroid removed and started experiencing numbness, tingling and sharp pain in my arms, legs. Every doctor i had seen tells me they cannot help me. All my levels are currently normal, tsh, calcuim, D, B.
I experience pain usually when it rains, but i also get it when it doesnt. There is no consistancy in the pain that atars, It attacks my joints in my fingers mostly but my shoulders have been swelling up. randomly. My thought was that Rheumatiod arthritis could occur from a hormonal issue, which i had experienced, but all my ANA tests are negative.
Have they tested you for arthritis? I have read that fibromyalgia does not attack the joints, have they tried you on the cymbalta to see if that cures it? They tried it with me and it amplified my pain, like my body went into shock. I have tried for over a year to get a doctor to help me, and i have not found any yet. There is always hope that the pain subsides or a doctor can listen and help, as of so far, it's tough to deal with.
Dr., Thanks so much for the detailed answer. I actually had my neuro appointment moved up to today due to a cancellation by another patient!
I do have muscle weakness but the Dr. believes "thyroid neuropathy" might be a possibility. He had a large number of blood tests ran and has me scheduled for a a test of my nerve conduction on June 29th.
I will update here on the thread when I get results in. I do know that one blood test they did not send off and that was ready today was the "SED RATE (WINT)" which was flagged elevated at "10" (range 0-9). Hopefully this doesn't indicate something like Lupus (I had a normal ANA not long ago) but I'll just have to play the waiting game.
I read you post with interest and sounds like you've had similar problems to mine. Be sure to stay on a watch list for this thread, to see my updates as my tests come in a week or two. I believe the huge battery of blood tests includes ones for arthritis - so will let you know on those as well.
Your input is really appreciated!
Yes, as a matter of fact, the neurologist I went-to last week ordered huge amounts of blood work, including Lyme Disease and results should be back any day.
I doubted Lyme to be a cause in the past but have been seeing people attest to having it found positive in them and they do not even remeber having a tick bite.
I have had tick bites, mostly as a child but no rash appeared around them and if I was infected, it certainly seems the illness took it's slow time manifesting. Despite this, I know it's a possibility and I'm anxious to get results on that and my other tests, which I will add to this thread when back-in, plus any of my neuro's evaluation on them.
To be continued....
First of all, my results have all come back good, other than my ESR (inflammation marker) which was flagged one point above normal. My Lyme Disease test was negative as where my Lupus and Rheumatoid Arthritis tests.
What really floored me was that my vitamin E result showed severe deficiency @ "0.04" (Normal Range: 3.0 to 16.0). When my neuro-doctor ordered this one, I knew there must be a significance and when looking up symptoms of E-deficiency, "muscle weakness" and "neuropathy" symptoms were the most commonly listed ones for adults.
I feel it's very possible that E replacement therapy will be an answer to my symptoms, at least in-part if not very significantly.
I was already found to be vitamin D deficient (flagged low) and B12 insufficient (low -normal), so I apparently have a malabsorption syndrome of some type, possibly a fat malabsorption problem.
I'm somewhat excited to see how well I will do when the low E is corrected! It can definitely be a cause if not "the cause" of my symptoms.
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