Tingling, muscle cramping 12 months postpartum

[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 only went to an endo once (years ago, I went out of due diligence) and although this was supposed to be a "top doc," this doc did not say anything that my internist had not already said/did not know - the doc recommended no dosage changes, seemed very focused on the labs, and I missed my very smart internal medicine doc!

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?

It does seem odd to me that this has ONLY occured after pregnancy - although not RIGHT after...

[Jakkt]

Has anyone had any similar experiences?  If so, what has helped?  TIA!!!

[mtkst13]

well, maybe you're having postpartum thyroiditis? or since you're not as heavy, you need less meds?

it's probably more hyper than hypo, but you're right...sometimes it's hard to tell the difference.  what are your free t4 and free t3 levels.  are they at the higher end?

[mtkst13]

with the muscle cramps, have you had your calcium checked?

[Jakkt]

Thanks for your response.  In March, my T4 (Direct) was 1.39 (ref range .61-1.76); triiodothyronine, free, serum was 3.6 (range 2.3-4.2).  

In June, the free t4 was 1.01 (.7-1.5) and no ref. ranges were provided for t3 levels (?).  TSH (3rd generation) was .91 (.4-4 range).

Serum calcium was 10 (8.5-10.6).

I am trying to get to the bottom of this...I love my docs, but since I am "within the normal range," they did not really seem compelled to recommend any dosage change.  But the muscle cramping has forced me to modify/reduce my activities/exercise (not good for overall health!) and the tingling just completely worries me!  

Thanks!!!  

[Jakkt]

About the postpartum thyroiditis, I thought of this, but this has always happened to me between 12-24 months postpartum, so I thought this was too long after.  Then again, what impact does nursing have on levels, because I continued nursing the baby for 7 months postpartum...haven't been able to find anything about the effect of nursing on all of this fun stuff ;)

[redheadaussie]

During pregnancy our bodies go through a lot of changes, and our thyroids try to do the appropriate adjustments. Being on replacement hormone is going to be harder to deal with those changes. The results you have are showing a slight hyper state.
Breast feeding puts demand on the pituitary gland to release prolactin. This gland also controls the TSH. So in effect, it needs to be higher to help produce milk. Once you stp feeding the levels quite quickly disperse back to  non-pregnant non-lactating range. But having taken meds to adjust to a new level and the other levels drop, you end up being hyper!
   So it is probably worth while to drop the dose you are taking for awhile and get tested in 6 weeks. You may need to lower it again as time goes on till your levels are for you, at a comfortable range.
   The muscle cramping etc is not consistent with the serum calcium being in the range it is. More than likely low calcium will do the cramps etc. Yours is at a level of hypercalcium. Meaning you have too much calcium in the blood. Do you take a high dose of VitD?  
  My immediate thought on the tingling etc is anemia. This is very common when nursing a baby and in pregnancy. With all the extra demands on the body, iron is one of the most used and the stores in the body can be depleted very quickly.
Have you had any iron studies done recently? If not, I suggest you get them tested.
  I hope that has helped you a bit.
Cheers

[Super_sally888]

Hi,

Regarding the calcium, they need to do 'ionized calcium' - that is the one that indicates available calcium.  You may try testing magnesium also.  Some people have magnesium elvels out that can cause physical symptoms.

[Jakkt]

thanks for your response.

Yes, I do take a Vitamin D supplement to avoid a deficiency (I am fair and I always wear sunscreen outside).

My CBC serum iron was normal, but my hematocrit and hemoglobin tend to run slightly high (they have for 10 years - my internist says this is normal for me and nothing to worry about)...my OB/Gyn wanted me to discontinue iron supplements b/c of the hematocrit/hemoglobin (not b/c of iron levels)...my internist (who has tracked my levels for 10 years) said one has nothing to do with the other (...and as a patient, I am supposed to figure out who is right...?)

I discontinued iron supplements and the tingling/cramping has started since I discontinued them...but I assumed this was unrelated.

[redheadaussie]

You might find the dose of Vit D is a little too high. Check the label and see what it says. I am fair skinned and redhair and keep out of the sun too. I was found to be extremely deficient in Vit D. My levels increased quite well on 2,000 iu a day, in fact I was too high! So am now down to 1,000 iu a day but keeping an eye on it.
  I am a severe anemic and the iron stores are not the same as the iron circulating in your system. So whilst you might have great stores of it, you will be deficient if it can't get to be used.
  If you use only a ferrous sulfate supplement rather than one with other things added, you should notice a change with in a few days.  
You could ask for a serum ferritin and a total iron-binding capacity blood test before you take any supplements. Then in  a month after taking it, have another test done.
Hope that helps!