Can hypothyroidism cause neuropathy?

[hd102classic]

I am a 60 year old male. I have been diagnosed with hypothyroidism for approximately 10 years. Recently my meds were modified. Unfortunately they were 1/10th of what I should have been taking. (I noticed the change but was told it was ok). I started to develope symptoms and within 6 months I was back at the doctors office to discover the dosage was incorrect. My TSH levels were over 116. I had a laundry list of symptoms but the one that bothers me the most is the neuropathy in my feet. It started when I pointed my feet, as if I were standing on my toes, it felt like the skin on the top of my feet would rip from stretching. They have been sensitive to the slightest touch now. It is bad enough that I now take medicine to control that pain.
When checking into the neuropathy issue, the blood work showed an anomaly with my white blood cell count. It was discovered that my bone marrow produces an abundance of white blood cells (8% above normal averages). I would also like to know if this could be a byproduct of the wrong dosage?

Thank you in advance for you input...

[gimel]

I agree that hypo patients are frequently too low in the range for Vitamin D, largely due to low stomach acid from the hypothyroidism, and that they benefit from optimizing D levels; however, to post that deficiency in D can cause poor T4 to T3 conversion requires more.   Facts obtained from scientific evidence should be the minimum requirement to state something like that, not anecdotal information from a few people on internet forums.   Show me the scientific evidence, (I would be very interested in that) or make sure you identify such information as the personal opinion of a few people who had a favorable experience.   We owe it to our members to make sure they understand what kind of information they are getting here.  

[des900]

http://hypothyroidmom.com/92-of-hashimotos-patients-with-vitamin-d-deficiency/

vitamin d surely have a great part in conversion from t4 to t3. many users have reported that in this and other forums.

here is one

https://groups.google.com/forum/#!topic/alt.support.thyroid/YgBGv7JH-Xg

Vitamin D seems to be helping...

Like so many here, post TT, I seem to have problems naturally
converting T4 to T3.  Also like many here, I'm very sensitive to
dose.  Cut my synthroid or levoxyl dose by 10% and I can feel it
within a day or two.  Also, my legs get incredibly weak unless I also
take some cytomel or armour.  Docs have been unable to explain.

On a hunch, I started taking more vitamin D.  Yeah, there's always
been 400 IU in my daily multi, but I added 1000 IU more (Solgar brand,
in case it makes a diff, also has some vitamin A).

Within 48 hours, I felt a burst of energy.  A doc suggested that I try
taking even more vitamin D; he feels the conventional RDA of 400 IU is
too low and that doses up to 10,000 IU daily are OK for a month.
Within 48 hours again, I started getting a certain kind of headache,
and certain insomnia pattern, both of which I had experienced in the
past if I took too much cytomel or armour.

It feels like the vitamin D is increasing my T4 to T3 conversion.
Maybe that's not exactly what is happening, but it is acting just like
that.

I'd guesstimate that each 1000 IU is giving me a boost roughly
equivalent to that of 10 mcg of cytomel.

I have since cut back on my T4 dose, and eliminated taking T3, without
apparent ill effect.  In the past such a cutback would have me quickly
bedridden with hypothyroid symptoms.

I'm now taking 1000 IU vitamin D with each meal.  If anyone decides to
try this themselves, please report back.  I'd love to know if it works
for others too.

[gimel]

/

[gimel]

I'd be very interested in any scientific evidence you have that supports your statement that Vitamin D affects conversion of T4 to T3.  

[des900]

get tested for vitamin d and b12 deficiencies both can cause neuropathy like symptoms. for example vitamin d deficiencies can result in poor t4 to t3 conversion also low absorption of calcium which can result in bone loss and can cause disc and other complaints and then sciatica. vitamin b12 deficiency itself can cause nerve problems.

[Barb135]

I forgot to mention that you should also ask to have ferritin tested, since iron  is necessary for the proper conversion of Free T4 to Free T3.  

Also ask to get vitamin B12 levels tested, since low levels of vitamin B12 can cause severe peripheral neuropathy.  B12 deficiency also causes severe fatigue.  

[Barb135]

Yes, you're right, they don't come in 225 mcg; I forgot that when they get into the higher dosages they don't come in the small increments like the smaller doses do.  

Based on your previous levels and the fact that you have the neuropathy like you do (you aren't diabetic, are you?), it's pretty safe to say that you're going to need a pretty hefty increase, especially, since your FT4 was below target, already a year ago.

You should be sure to ask your doctor to test the Free T3 to make sure you're converting adequately.

[Barb135]

Why are you taking 2 112 mcg pills and not 1 225 mcg pills?

[hd102classic]

I just assumed that a 225 tablet was not available.

[handsinclay]

Just an FYI....
I had blood pooling in my feet with intermittent tingling in toes (among other things) until my dosage was upped to get my Free T's in proper ranges.

[Barb135]

Are you only being tested once/year?  Many doctors think that's enough and as long as you feel well, it is, but when you have things going on, it usually isn't...

Your TSH was too high in the last test - not even within the range, in May of last year, and your FT4 was too low in the range...  TSH is only an indicator of actual thyroid hormone status, but when it's not even within the range, one should take note.

Rule of thumb (where most of us feel best) is to have Free T4 at about the mid range point.  Yours was only at 39% of its range, which is somewhat short of the target.  Rule of thumb is for Free T3 to be in the upper half of its range, but your doctor isn't ordering that, so we don't know what it might be.  

Free T4 isn't used directly; it must be converted to the active hormone, Free T3, which is the one that's used by individual cells.  Many of us don't accomplish the conversion process adequately and have to add a source of T3 to our T4 medication.  We find this out by doing, both the Free T4 and the Free T3 tests, simultaneously.

What medication are you on and what dosage?  How long have you been at this dosage?

[hd102classic]

Generally I've been tested once a year. Prior to 2013 (when all of this started) I was on a dosage of (2) .125mg per day. My script was written for (1)  25mcg per day. Approximately 5 months later when I went back to the doctor with all of these issues, new blood work was ordered. It took about 10 months of adjusting with blood work every 2 months. Anyway, now I'm taking (2) 112mcg daily. The medication is Levothyroxine. I am due to be tested again in June. It will have been 1 year at that time. I was still being tested every two to three months prior to that. The last two tests were scheduled by an Endocrinologist.

[Barb135]

Your should be having Free T3 and Free T4 tested every time you have a TSH test done.  The T4 and T3 tests you had were Total T4 and Total T3, which are considered to be obsolete, as is FTI.  FTI is a "round about" way of calculating FT4, when they should be doing a direct FT4.  

Do you have any current test results you can post?  What the levels were in 2014 are really not relevant now.

Can you get your doctor to order a Free T3 and Free T4 test?  Those are the most important, with Free T3 being the active thyroid hormone.

[hd102classic]

The following levels are from last May (last test)
TSH 4.10 ... Range .30-3.80
T4 free 1.19 ...range .80-1.80
T3 not tested (at least it isn't listed with the results)

[Barb135]

I wanted to mention that just because your TSH (or Free T3 and/or Free T4) levels may have returned to the "normal" range, that doesn't mean it's adequate for you.  

If your doctor did not order Free T3 and Free T4, ask for them and if s/he refuses, you might want to think about getting a different doctor, as those who treat patients only by adjusting TSH, tend to keep their patients ill.  TSH can vary by as much as 75% over the course of a single day, so treating, based only on TSH is like shooting a moving target.

[Barb135]

Hypothyroidism can cause some neuropathy, but it should go away if your thyroid hormone levels are properly adjusted.

Were you only tested for TSH?  What about Free T3 and Free T4? Those are the actual thyroid hormones, while TSH is a pituitary hormone and does not correlate with symptoms.  If Free T3 and Free T4 were tested, please post the results and reference ranges, since ranges vary from lab to lab and have to come from your own results.

There are various white blood cells produced by the immune system to help fight infections, inflammation and other things that go wrong in the body.  It's very possible that the high count you have is caused by inflammation that could be caused either by hypothyroidism or by peripheral neuropathy.  Unless there is something else wrong, it should return to normal when the inflammation that's causing it to be elevated is resolved.

Please note that other things, such as diabetes (both Type I and Type II) can cause peripheral neuropathy, as well.  In addition, long standing vitamin B12 deficiency can also cause it, so if you haven't, you should also have your B12 levels tested and make sure the result is above 500.

[hd102classic]

T3 was 29.0 and T4 was 0.6
The free thyroxine index was at 0.2
I was checked for diabeties. Results were negative.

[hd102classic]

I forgot to leave the reference ranges ...
T4 = 0.6 ... Std range 4.5-12.1
T3 = 29.0 ... Std range 33-40
FTI = 0.2 ... Std range 1.4-4.5
TSH = 116.01 ... Range 0.30-3.8

This test was back in 2014. My levels have since been modified to be "normal". My neuropathy is at a pain level where I now take Gabapentin 3 times a day (800 mg each).
Thanks again, Dave