Severely swollen knee joints

[Laura141]

Dear Dr. Lupo,

My docs discovered some hypothyroidism during pregnancy and throughout pregnancy I was on 50 mcg of Synthroid.  6-8 weeks postpartum, I developed severe swelling in first my left knee, and then a few months later my right knee.  The swelling was at one point so bad that I could not bend my knees and I had to attend PT to regain some range of motion.  After several months it was discovered my TSH was 29.  My dosage was increased and now I am on 100 mcg of Synthroid--and my knees have since improved.  (I have also had carpal tunnel symptoms off and on, but less severe since my meds have been adjusted).  My lab results last week are as follows:
Free T3 is 3.1 (2.3 - 4.2 pg/mL)

Free T4 is 1.3 (0.7 - 1.5 ng/dL)

TSH is 1.16 (0.40-5.00 uIU/mL)

Last week I did notice a significant improvement in my overall feeling of wellness--so I think I am getting closer to an appropriate dosage.  (I was on 125 mcg previously and that made me go hyper.)

What I am still struggling with, however, is my knees.  They seem better than last week, but each day is an unknown (and they are definitely much more functional than when my TSH was 29--I struggled to go up and down stairs at that point).  But I still have pretty bad swelling and I cannot kneel or squat because of the swelling.  Sometimes the skin around my left knee also feels really thick and tough.  There is no discoloration.

What do you think?  Have you seen this condition before?  What is it called?  Do I need to seek additional treatment or is it a matter of letting my body recover and heal from the period of high TSH?  (By the way, I was tested for rheumatoid arthritis-- prior to discovering the high TSH--and my tests came back negative.)  

Also, my doctor and I are going to try adding some Cytomel.  Can you recommend a dosage on that?

Thank you.  I appreciate your time.

Laura

[Mark Lupo, M.D.]

It may take a few months for any muscle damage to resolve.  However, it may be an arthritis that is separate from the thyroid problem but was then made worse b/c of the thyroid problem -- may be worth seeing a rheumatologist to be certain.

If you are feeling better, would hold off on cytomel -- but if you use it, then we usually start w/ 5mcg am and 2pm and decrease T4 dose by 40mcg -- OR just start with 5mcg along w/ am T4 dose and decrease T4 by 20mcg.  My experience with this reflects the research that states the benefit is minimal in most patients.

[654321j]

I was diagnosed with hypothyroidism in 1995, I have been on Synthroid ever since currently taking .125mcg daily. Started with knee pain in June of this year I now have severve pain in shoulders, elbows, hips, knees and all surrounding muscles. All blood levels within normal limits, as of July 08 M.D advised me to see a Rhumatologists appt. scheduled for 09/11/08. Also test results were negative for Lyme, Rhumatoid, Lupus positive for Epstine Barr. I feel this is all thyroid related should I be seeing an Endocrinologist instead? HELP!