Postpartum >12 months, tingling, muscle strains/cramping with Hashimoto's

[Jakkt]

I have had Hashimoto's and have been hypothyroid (but treated) for >10 years.  I have been on Levoxyl and Cytomel (5 mcg X 1 a day) for quite some time.  I have been fortunate enough to not have many symptoms of hypothyroidism until I had children.  Within 24 months of the birth of each of my two children, I experienced the following strange symptoms: tingling in fingers and toes (worse at night), REALLY painful calf muscle strains/pulls/cramping.  After both pregnancies, despite loosing all of the baby weight, I was initially told my thyroid levels were fine and a dosage reduction was not necessary.  After the first pregnancy, I also tried to switch to Synthroid, and I became hyper, had the above symptoms, before  (by both OB/Gyn and Internal Medicine doc) my dosage was changed (I went back to a reduced level of Levoxyl) and the symptoms disappeared entirely.

I am now >12 months postpartum with baby #2 and the symptoms are back...no brand switch this time, but no recommendation for a  dosage change either since the pregnancy.  this time I now also have tongue tingling (the tingling is really freaking me out!).  I had a CBC (normal) and thyroid labs and then had thyroid labs repeated (at my request), and thyroid is "normal, but high normal" (TSH .49 with lab range .45-4.5)...My internist (who I love - he found the thyroid problem initially when it was barely there when I vaguely complained of being tired...) just lowered my Lexoyl from 137 mcg to 112 mcg.   I am confused - are these symptoms hyper or hypo...or should I be asking my internist to look at something else entirely?  While I know the labs look more like I could be leaning hyper, I see more HYPO patients complaining of these symptoms...or are these symptoms just nonspecific?

[Mark Lupo, M.D.]

Lowering the dose a bit (either to 125 or 112) is reasonable as your levels are "high-normal" and the history suggests improvement with lowering the thyroid dose.  Would also test potassium, magnesium, B12 and calcium with these symtpoms.