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Little off in TSH can cause headache/fatigue
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Little off in TSH can cause headache/fatigue

My doctor recently changed my Levoxyl dose from 88mcg to alternate 88mcg and 100mcg = 94mcg . Before they change my dose my TSH was 1.74 , FT4 was 1.9.
The change was made last month so i have been on this new dose for last 40 days. I have been noticing from last 10 days  , continues headache /muscles and joint pain/fatigue in middle of my work day.
Can any one think high FT4 could be the reason for those symptoms , i felt bit better in 174 TSH value .
Are those headaches/muscles and joint pain really thyroid symptoms ?.
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Avatar_n_tn
Can anyone reply to my thread.
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393685_tn?1325870933
I am confused - you feel better at one hundred seventy four (174) TSH??

That would be hypohe// for me.

I think after I read the post again you meant to say 1.74 right? I'll go on that . OK?

High FT4 could mean a couple of things - First off FT4 testing is good - and much better than bound T4 as many get - but the real answers lie in the FREE T3 testing.

Without having that test - I can only guess here. High FT4 usually means you are not converting the T4 into the Free T3 enough to elimate your symptoms.

Your TSH is your pitutary gland telling your thyroid to pump hormones - so that being in range only tells a very small part of the thyroid story.

FT3 is the actual testing to rid symptoms and that should be in the high end - sometimes even mildly above the high part in the reference ranges of the lab tests to feel well.

Your either pooling T3 - or not converting enough over from the T4 -

If this is true - you may need a T3 - Cytomel or a natural T4/T3 med to elimate symptoms.

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Avatar_n_tn
You were right my TSH was 1.74 about 45 days back ago. I had a conversation with my Endo about an year ago at that time my FT3 was 2.6 (2.2-42),He was not really convincing with  combo protocol  but i force him to subscribe cytomel , he started with mcg in the morning and 5mcg around 3pm  with 75mcg of levoxyl  before combo treatment my levoxyl was 100mcg.
I went to Hyper in a month with my TSH was 0.0004 and FT4 was 1.5 and FT3 was 3.5.

My endo changed stop all my dose for 2 weeks and completely stopped cytomel after 2 weeks he started my levoxyl  0.25 mcg .
I have been struggling for last 2 years and still have same symptoms except neuropathy ones which were stop since 6 months.
I think i felt good at 1.74 TSH when i was 88mcg  not 100% but better then now .
I am also having hot flashes started for last 4 days which seem to me that i went back again to Hyperthyroid .

Can anyone also has good experience with combo T4/T3 treatment ? as i don't find doctor in CA who is in favor of.
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393685_tn?1325870933
I am an advocant of Armour which is T4/T3 meds. I feel this meds is better for me and I know some here who have switched and do very well

Armour is immediate T3 med along with T4. With the T3 already built in is also splits up into the other T's needs to function properly. Synthetic T4 needs to convert all of it's homones into T3 - then function.


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Avatar_n_tn
I am wondering do we have another similar medicine like Armour which make from other animal thyroid rather pig one. My doctor is not inn favor of Armour.

Is this normal to have such symptoms like headache/pain in all over the body /sluggish all the time with such small variation of TSH number .

Is anyone else out there use T4/T3 treatment , if they do what was their dose before switch to  T4/T3 and what is the new amount of dose ?. It could be possible my doctor screw my doses when switch me to T4/T3 treatment.

Please everyone share your symptoms and doses and length of time you are suffering from thyroid . Is it true if your dose is not adjusted for quite some time it takes longer to get rid of symptoms even your dose adjusted  ?
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Avatar_n_tn
I just got my test results .

FT3 =3.5 (2.3-4.2)
FT4=1.5  (0.6-1.6)
TSH = 0.36 ( 0.40-4.0) >>>>>>>>>>>>>>>>>> Last month was 1.74 dose 88mcg
total T4- 10.7 ( 6.1-11.8)
total  T3 =154 (70-180)


Now that my dose increase to 94mcg (88mcg + 100mcg alternate days)

I was thinking TSH will drop to little probably expecting 1.25 or so but it went down to 0.36 which is kind of little low . Do you guys think with this small decrease can cause  these symptoms which i am having these days ( hot flashes /headache/joint and muscles pain, burning sensation and fatigue ) . Another odd thing which make me confuse is that my FT4 was 1.9 when i was taking 88mcg which little increase 94mcg cause it to drop  but i thought it will increase , isn't that suppose to be ?.

Please every one share your stories with me , i am going through lot of stress and need some moral support from you guys if you share you story.
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393685_tn?1325870933
Any medication dosage changes whether on Synthroid or Armour can and will bring on fatigue and headaches This can last up to 2 weeks.

No - your FT4 should be lower. that is good along with your FT3 being raised. Raising the FT3 should tell you your meds are converting.

The key here is - are these numbers still needed to be tweeked more to free you of your symtoms (symptoms)?

I think tweeking your meds is the hardest part of all this. Labs start leveling out - but some symptoms still seem to linger.

We as patients want to be symptom free - so it is difficult when are labs are "close"  and we still feel off.

I only know of natural thyroid homones made from dessicated pig glands. I no of nothing else.

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Avatar_n_tn
If we increase the Levoxyl dose i thought my FT4 should increase along with TSH went down but i think it is other way provided conversion is happening. I surely need some more tweeking as i have lot more symptoms. as compare to when my TSH was in the range of 1.0-1.75 .In my case i don't think combo treatment is necessary as conversion is happening just fine , correct ?.
Should i stop taking levoxyl for 4 or 5 days to see if it helps and then go back to  88mcg which was the one made me felt better.
I believe the life time for FT4 was 24-48 hours , is it correct ?.
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393685_tn?1325870933
Unless your Free T3 is low too - then I would suggest not looking into a T3 or a T4/T3 combo med unless your feel your symptoms are not getting better.

Some people view change as bad - I see it good.

If you are still feeling awful and want to feel better a change may put you in that direction.

If the change is worse and you feel bad - then you know you can return to what made you feel better. This applies to any thyroid formulas

adding only T3 + Cytomel
tweeking your T4 med now
trying T4/T3 Armour.

There's choices and it is up to the patient to find out what works best for them.
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Avatar_n_tn
I am just wondering if you can add your input as well in my thread , the reason is that because you are also male and hormone level in male are different then female although thyroid function is probably same but just curious to know , how other male are doing and  what is their input as they also suffering with this thyroid issue.
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Avatar_n_tn
Just one simple question. If you felt better before (100% better ?) at 88mcg, why did you doctor change your meds to 94 mcg ??  If adding meds is not right, have you considered lower it to like 75 mcg and see what happen ?   Some times you can not all depend on the blood test, listen to your body and find out what your body really want is also important.  good luck to you.
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Avatar_n_tn
Well i had some symptoms even at 88mcg at that time my TSH level was 1.74, FT4 was 1.9. My doctor increase the med to make me feel more better . However it went other way and i felt good after 20 days of change dose and then after 30 days started to dfeel worst even when i had 88mcg .
The most lingering symptoms i had are joint/muscles pain  which are not going away at all.the intensity goes up and down but never 100 % symptoms free.
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Avatar_n_tn
Is it true muscles /joint aches symptoms goes away in last ?. Since 2 weeks i have been having lot of muscles and joint pain specially in my thighs  and upper arms , the pain is too much that i have to take Tylenol which help alleviate  some extend of pain but i have to take Tylenol every day.
My current TSH level went down , it is now 0.36 (0.4-4.0)..and FT4 1.5 (0.6-1.6) and FT3 3.5 (2.6-4.2)..

Please suggest . Is any one has any muscles/joint pain with Hypothyroid/Hyperthyroid.
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393685_tn?1325870933
Yes muscle and joint pain are one of the sumptoms that last the longest until they go away.

If I can remember anxiety and muscle aches were my two that seemed they would never go away.

I felt like I was 80 for a long time - I am so thankful that is gone along with the horrible swelling I had.

I do flare up occassionally with joint pain and aches and I do get minor swelling at certain times of the month - but no where near what it was.

PM AR on this. - he may not read the post. But I am sure if you ask him to view it - he will and respond.
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213044_tn?1236531060
I haven't read the thread till now, because headaches have not really been a problem for me. I've read the whole thing twice now, and will probably read parts of it again, because it is a confusing situation.

I don't understand why your Free T4 dropped when you had the latest med increase. It's good that it went down, but it should have gone up. It is still too high. I would go back to 88mcg (with the doctor's permission) and see how the levels settle out.

Could the headaches be from eye strain or neck muscle tension? The headache I get from time to time is from my neck muscles tightening up.

The muscle and joint pain can be from a shift in your hormone levels. I'm hurting all over as I type this, and I just had a nap. My muscles ache, my BONES hurt. I don't know what my levels are, because I haven't checked them in a month or so, but I have had these symptoms for a long time.

The muscle and joint pain takes a few weeks to subside once your levels are good again, I am told. Sometimes longer. I am waiting for mine to go away.

Your latest tests show you are on too high a dose. Ask your doctor to change you back to 88mcg. I don't understand why it was upped anyway. your Free T4 was already too high. You may end up lowering it to 75mcg before your hormone levels look right. Tell your doctor to ignore the TSH and treat you based on your Free T4 and Free T3 levels.

Hope that helps you.
I hope you are feeling better soon.
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Avatar_n_tn
Thanks a lot for your response. That is exactly what i asked to my doctor why did my FT4 went down instead of going up if i we increase the levoxyl , she could not answer , she decrease my dose to 88mcg but at the same time asked me to NOT take any medicine for 3 days and then start  with 88mcg .
What is your opinion about FT3 , should that be in higher side to help alleviate joint/muscles pain ?.

I was feeling much better after 25 days of my dose change ,not sure my TSH level i assume around 1.0 or b/w 1.0-1.25.
The most significant symptoms i have are muscles and joint  pain which tend to go up and down but never went away since i diagnosed Hypothyroid (may 2006).
Do i need Cytomel as well as i heard FT3 is in high side to eliminate muscles and joint pain , is it true or my FT3 looks fine ?.

how long have you been in hypothyroid condition ?. is this because of Hashi (High Antibody) , the reason i am asking as i don't see enough men out there who are dealing with thyroid as this is consider to be women thing . I am kind of in anxiety because of that and thinking some virus or something else cause this .

Your help is highly appreciate it.
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213044_tn?1236531060
I have met several men around my small town who have had thyroid surgery or thyroid problems. It's not just you and me.

I don't know what triggers autoimmune disease, but it has nothing to do with our manhood nor is it a reflection of our masculinity. Statistics say one out of ten thyroid patients are men, but I think the number is higher.

My condition is a combination of Hashimoto's and Graves, and my antibody numbers are fairly high. My TPOab was 1,250, and my TGab and TSI were around 500. My hormone levels could not be controled, so my thyroid was killed with RAI in January.

I have been told that your Free T3 is in the best range when it is about two thirds up the lab scale from low to high. If the range is 2.6 to 4.2, then 3.6 would be about two thirds up the scale. So your Free T3 looks good to me. If you get above 3.8, you could start feeling hyper.

Unfortunately, I have also read that keeping your Free T3 as high as you can without going hyper is the way to feel the best. It's a balancing act, for some of us.

I was sick long enough and severely enough that my doctors don't expect me to feel better for another year. So I am no expert on how to aleviate muscle aches or joint pain. I am just hoping they go away some day. I haven't worked since October and I can't do more than an hour of labor right now. Then I am ill and sore the next day. But I have aches and pains whether I rest all day or not.

I hope the change back to 88mcg will work for you. I understand your wanting to try Cytomel. Right now, your Free T4 is too high, and the dosage change should fix that. The question is, will your Free T3 also drop, or will it stay where it is.

It should stay where it is. I have seen others who's Free T4 was toward the lower end of the range but their Free T3 was still good. Your Free T4 has to get very low (but within limits) before it cannot support the demand for Free T3.

Keep an eye on the next few tests, and see if the Free T3 stays up there. It will probably take a month or two after your T4 drops and your TSH rises before the aches and pains subside.

I hope things work out well for you. I hope you feel better as soon as possible.
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Avatar_n_tn
I am really sorry to hear that you are having such a bad times these days because of those aches. I am also going through same thing and you are right on that of one hour work at home , i am in same boat i can't do much home work like normal home kind of stuff , my muscles start to contract , i can't walk long enough my calves started to hurt..
My intensity of pain is not that much, in scale of 1 to 10 , i would say around 5 or may be 6.
I like to know what you do when you have pain , i found Tylenol or pain killer seem to help little .I can't climb stairs, is this normal ?
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213044_tn?1236531060
Mine is not that bad. I have been too weak to climb stairs, but not in too much pain to do it.

I drink wine, too much I suppose. If I get a bad headache, which is always from muscles, I take Ibuprofin. Once in a great while I'll take a muscle relaxer.

Other than that I try to ignore it. Right now every muscle in my back aches and burns. I could probably count each muscle if I concentrated on it. I'm trying to ignore it.

Vitamin D3 may be helping a little with the joints. I was taking Glucosomene/Condroitin for about six months and that helped a lot. It takes about a month to start working, but it works. I don't know why I quit taking it.  

Are you taking cholesterol medication?
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Avatar_n_tn
No i don't take any cholesterol medication . I also started taking Vitamin D also with B complex as well. It seems like my thyroid level going up and down because of that my joint and muscles got week which may take longer to resolve after my level get adjusted..
I can climb stairs but not feel pain in my calves,not sure it is all because of thyroid  or something else is going on with me.
Just add as well about my vitamin D level in past two month ago i had first test it Vitamin D level ,it came out border line .. Total Vitamin D is 27 (ref 26-80). Since then i started taking Vitamin D (2000IU), 2 weeks ago i test it again it came out same 27. Do you think Vit D has some connection with my joint and muscles pain and i need high Vit D IU like 50,000 IU /week ..

Also since 2 weeks pain is more as compare to before , may be because my TSH level went down to 0.36 .

Here is my action plan to deal this situation please suggest .

Take 88mcg /day levoxyl
Vitamin B complex one tablet /day
Vitamin D (1000 IU) /day

Any other medication or supporting medication you can suggest which can help in joint/muscles pain ..
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213044_tn?1236531060
You have a good plan.

A GOOD multi-vitamin would be a good idea. It has selenium, potassium, magnesium, iron, zinc, calcium, and you name it. Several of those things would be good for you.

I don't think low vitamin D affects your joints. It just says on the bottle that it's good for joints. I haven't researched it. I take 1,000 IU a day of vitamin D3. And two multi-vitamins. and other pills.
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Avatar_n_tn
Thanks for your reply , really give value to your comments and responses. I would using this plan for another couple of months before i do another test. I read some where in the internet optimum Vit D should be around 45-50 and Vit D deficiency can cause joint pain /tiredness as well.
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