Muscle spasms/ fatigue caused by thyroid? With "normal" labs?

[realitysillusion]

I'm a 30 y/o female. My mom has been on thyroid meds for hypothyroidism since she was 39 (no symptoms, just routine blood work and a TSH high enough to merit the doc's office calling in an RX for her); my maternal great-aunt, now 89, is hypothyroid because of thyroidectomy - the when/why long forgotten. Not sure about my maternal grandmother, she was never diagnosed that we know of, but had two miscarriages after she had my mom and from what I've read, that's likely hypothyroidism.

Labs:
Iron, ferritin, TIBC - all normal; B-vitamins just above range.
Antinuclear antibodies (ANA) - negative
Vitamin D level was a 15.2 and despite almost a month of vitamin D therapy with optimized ca-citrate and mg-malate, there's no detectable difference.
TSH 2.900 ref. 0.450-4.500 uIU/mL
note: was 2.20 last Sept and 0.967 in 2005

FT4 1.02 ref. 0.82-1.77 ng/dL
T4 8.7 ref. 4.5-12.0 ug/dL
FT4 index 2.4 ref. 1.2-4.9

FT3 3.0 ref. 2.0-4.4 pg/mL
T3 124 ref. 71-180 ng/dL
T3 uptake 28 ref. 24-39%
rT3 183 ref. 90-350 pg/mL

Antithyroglobulin Ab <20 ref. 0-40 IU/mL
Thyroid Peroxidase (TPO) Ab 31 ref. 0-34 IU/mL

Symptoms:
goiter - first found last Sept, no testing done because TSH was 2.20; new GP got US and I have two nodules and one cyst (all < 1cm), ENT was totally unimpressed and suggested endo, GP agreed with sending me to an endo, though she's happy to monitor thyroid meds, if endo prescribes them. errrr.
moderate to severe fatigue- generally unrelenting, seems worse right after I eat, but ever-present. moving around seems to help, exercise feels good while I'm still moving, once I stop moving the party is over and I need a nap. I sleep well and 8-10 hours a night, I get a 1-2 hour nap in more days than not, because I can't function otherwise. This got worse when I stopped my ADHD meds in May (Adderall XR) and even worse when I tried to quit smoking in July (even my heart beat was down to 64, when it's usually in the low 80s).
chronic muscle spasms - neck/shoulders/upper back are chronic and feel like concrete; lower calves/heels and hip flexors are occasionally sore.
Others - mild hirsutism (I <3 my tweezers), itchy/dry skin, swollen/watery eyes, weight just doesn't change (more specifically, have gained weight, cannot lose it), have also had periodic sinus tachycardia - then ecg, determined "borderline" because of low voltage qrs complex in precordial (chest) leads.

Would be grateful for any information about whether the severity of the fatigue and muscle spasms are consistent with hypothyroidism, even though my labs aren't "that" bad. Would be even more grateful for any suggestions for mitigating either/both for the next few weeks, as I realize caffine and cigarettes aren't exactly 'theraputic interventions' - just exhausted, royally frustrated, and out of options. Generally a happy, optimistic person, but feel like my optimism reserves are running near empty waiting in the queue... Thanks for reading!

[gimel]

Thought you might like to read this link.  FT3 is so important in treating hypothyroidism.  

http://tiredthyroid.com/optimal-labs.html

[realitysillusion]

Thanks for the info and validation of my working hypothesis... as the simpliest explanation is often the truth... really hoping this is just my thyroid!

I actually hadn't come across anything that had me looking at the FT3, before I read your post; that's really helpful information. I know the ratio for FT4:FT3 is cited as 90:10 (says my graduate physiology textbook) or 80:20 (most of the internet, including some highly-regarded sites) and mine is like 77:23 which may (or may not) be a problem. And the FT4 is reportedly supposed to be 60-80% of the reference range for a pre-menopausal woman (where mine's 22.something %).

Here's to hoping it's worth treating now! I've read so many stories about how hard it's been for some people to get it fixed and I just miss my life and feeling like "me." I should add, I'm eternally grateful for the man that's been putting up with me and my fatigue!

[realitysillusion]

I'm *hoping* my symptoms are from my thyroid which might sound weird, but it would be 1 problem, versus I don't know how many to explain all of what's not working right.
I'm not on any meds for my thyroid, at the moment... my PCP initially mentioned giving me thyroid meds to suppress the growth of my thyroid, but after the ultrasound sent me to an ENT, because I think she believed it was already worth removing. When that didn't happen, she thought it was better to have the endo check me out; the only rationalization I can find for that would be to make sure it's not secondary hypothyroidism (i.e. bad pituitary or adrenals) - that seems unlikely to me, given two generations of maternal relatives with bad thyroids, but I'm not a doctor :)

[realitysillusion]

Thanks for the reply! It was the B12 that was tested; my level was 974 pg/mL (ref. 211-946 pg/mL), so definitely no deficiency there! Also, I've had ADHD symptoms since I was at least 2-3 years old, as has my older brother.

The vitamin D is definitely still a problem, not sure how much. My level was actually tested at 21 in Sept of 2010 (really bad doctor at the time, didn't attempt treating it) and I didn't really notice anything was wrong with me until Feb/Mar of 2011. Wondering if it had to tank to a certain level before I felt anything?

The increase in my fatigue isn't from big meals - i.e. breakfast = 2 eggs and two pieces of whole grain toast and still becomes an oppressive weight - my apatite is also sort've shot, so it feels like I'm force-feeding myself three times a day, even though I'm really not hungry at all. I just have no energy whether or not I eat, but eating seems to make it worse, I'm not sure if I'm articulating it very well or not.

[realitysillusion]

Thanks for the information! The endocrinologist I'm waiting to see (two weeks from tomorrow...) was recommended by the ENT, she sends him her surgical cases and I ran it by my GP/PCP and it's the same one they send their "thyroid cases" to see. I'm keeping my fingers crossed, but at least she's experienced with thyroids - heard a lot of endos are more experienced at pancreas/ diabetes and not always great with non-pancreas endocrine disorders.

[LazyMoose]

FT3 3.0 ref. 2.0-4.4 pg/mL  - thats low, but still 'in range'.

Many muscle spasms decrease when FT3 is in the upper third of the ranges. DR's are not aware of this, many on thyroid forums (not just this one) are aware of this.

Like others said, looks like you need to get that FT4 up, hopefully to convert to FT3. If a T4 med does not get the T3 up, then you will need combo meds - synthetic or 'all in one' natural dessicated thyroid.

You have classic hypo symptoms - I was there for many years.

[Ericamegan]

When I was Hypo I had awful muscle spasms and almost every symptom you mentioned.  You should listen to your body and try an increase.   What thyroid medication are you taking currently?

[Red_Star]

I'm assuming this is vitamin B12 when you mention B vitamins. Vitamin B12 deficiency symptoms occur in low normal levels so you are wanting B12 serum levels to be at the upper end of the reference range.  Symptoms of low B12 include fatigue, muscle spasms, heart rhythm problems, ADHD symptoms to name a few.

Also, vitamin D deficiency causes chronic fatigue and your levels are extremely low. It does take time for vitamins and minerals to rise. Give it 3 months and recheck.  Causes of vitamin D resistance include magnesium deficiency, liver or kidney disease, and hereditary defects.

You may also have reactive hypoglycemia which causes fatigue after meals however this can just be due to eating too much lol. Your thyroid labs look alright but as gimel mentioned, this may not be optimal for you.

[gimel]

Eve though your FT3 and FT4 are within the reference ranges, that does not mean that the levels are adequate for YOU.  Have a look at this link.  It is a letter written by a good thyroid doctor for patients that he consults with from a distance.  The letter is sent to the PCP of the patient to help guide treatment.  I think you will notice a huge difference in clinical treatment and what you are going through.

http://hormonerestoration.com/files/ThyroidPMD.pdf

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.