I am trying to decided weather I should start thyroid medications.
I have had muscle issues for the last 8 months that will not go away. Along with this I have developed some anxiety and slight depression. I really do not get a good night sleep any more. So I have been trying to figure out the cause of these issues.
Most recently my tsh was 6.15 and then a month later it was 7.72. T4 was normal, below mid then on the second test it was normal but above mid.
I do fully understand that I need to get t3 and antibodies testing done as well. I found doc that I like and we agreed that in a month we will do all of them and see if the tsh is rising on lowered as well at that point.
Another doc already prescribed me 50mcg of Levo.
So my question is - based on the last two tests alone is that cause for treatment?
on the one hand am tired of hurting everyday. But am not convinced that it is my thyroid. Is there any harm in trying it for six months to see if it makes a difference.
Seems that most literature states that levels 5-10 tsh has not shown any benefit of treatment.
based on your symptoms and your TSH, I would be taking meds. Please note you should be testing FT3 and FT4 (frees, not the T3 and T4 which are total and include protein bound unavailable hormone).
However, I would recommend starting on 1/2 of the 50 mcg for the first 4-6 weeks, then testing TSH again and adding in the second half if necessary based on both blood work and how you feel.
I don't think 'most literature' states 5 - 10 TSH should not be treated. Most recent reputable literature states the opposite. And the 'normal' reference range was reduced down to 3.5. Knowledgeable doctors would already treat if the patient has TSH above 3 (even with FT3 and FT4 at middle or lower half of the reference range) if the patient has clear symptoms. Of course monitor blood work to ensure that the patient doesn't go hyper (on basis of FT3/FT4 results).
There is definitely no harm to treat with monitoring and see how you feel. I am certain you will be feeling much better with the meds.
just so confused since all this started with an injury and somehow the nerve is involved.
Somehow skeptical that am going down a blind ally again. But am starting to feel even more crud, real bad headaches/ nausea type feelings.. Bad stomach, feeling fluish.. so its making me wonder even more. I think my main concern was if the symptoms were really hypo since they seem so generic and I was already aware of them..
Sometimes stress (such as injury) will bring on flares, especially if it's autoimmune thyroid disease. There are soo many women out there that would love to be given meds b/c they feel like crap, but b/c the endos are going by an outdated ref range, they suffer needlessly. Don't be afraid of the meds, they are pretty harmless, and since you feel bad now, what you could loose? I've researched several articles/sites regarding thyroid disorders, and have never heard what you mention!!
Here is one such article, and there are quite a few, but are buried in medical journals like pubmed and medscape.
some assumptions -
It seems there really is no reason to treat sublicinal Hypo IF there are not symptoms.
An example of why I am hesitant.
They described my injury as a neuropraxic injury, I think to the long thoracic nerve. And that can take up to two years to heal. So then is my inability to heal form this, is it because of the nerve, or the hypo... and how can I tell. Are the fatigue, anxiety, irritability etc from the injury or they hypo.
"It seems there really is no reason to treat sublicinal Hypo IF there are not symptoms."
- All these symptoms and those also in your other post just so happen to be very common hypo symptoms. You have symptoms.
As noted previously, a simple free T3 test along with TPO and TgAb will tell you what is going on. And then you dont have to be paranoid anymore. It really is that simple. No need to make this harder than it is. Being hypo also WILL prolong injury recovery rates.
So talked to the doctor - again - and he said he thought it was most likely Hashimotos...
I also got Skelaxin... to help after physical therapy.. might try the magnesium citrate too I got it but never started it.
Went and got the antibodies test done as well as t3.
In my meeting with the endocrinologist - Here is some feed back please tell me what you think.
1.) Typically she waits till it gets above 10 to treat.
2.) Regardless of if its Hashimotos or not - there is really no reason to start the meds now.
3.) Even though the antibodies are present, it doesn't mean that it will get worse. Better to take a wait and see approach at the moment.
4.) She checked my out and doesn't find any hypo- symptoms.
5.) My t4 was normal to her - indication that it's subclinical and again not reason/benefit to treat.
6.) My muscular aches etc are not related to hypo in her mind.
So thats it folks, will wait on the blood work. and see what happens then.
So there it is, I have talked to about 4 docs and it seems the decision is split and at any rate seems to be not big deal to start or not to start the meds..
I can appreciate your dilemma and the conflicting opinions of the doctors. I would consider that the doctor has said it is most likely Hashis (would be really wise to have this finally confirmed with a simple blood test) Since it may be hashis & you have already done your homework, you probably know it is an autoimmune condition that attacks your thyroid. With a TSH of 7.72, that is an indication that your body is not producing enough thryoid hormone to serve its diverse metabolic needs otherwise your pituitary would not be sending out TSH to stimulate the thyroid for more. Since thyroid hormone affects the metabolism of every cell in the body that includes the healing processes related to your injury.
I was diagnosed with Hashis this past spring. I'd been to several doctors over the last 2 years trying to find out WHAT was wrong with me (long list of aches & pains & elevated anxiety & periodic insomnia, weight gain) My back hurt constantly and I felt like my body had the flu without the fever. My TSH was in range (at that time) so they did no further thyroid testing. Instead they prescribed antidepressants or antibiotics - for two years! (I said no to the antidepressants) Meanwhile my thryoid was going HAYWIRE and nodules developing all the while. Finally in March 2010 my TSH of 7.56 led to an anti-TPO test and confirmation of autoimmune antibodies. I do believe that intervention with modest doses of thyroid hormone (if given after appropriate tests & confirmation of hashis) may have reduced the growth of the nodules. Now I must deal with another needle biopsy in 2 weeks. We all know thyroid hormones do not cure Hashis and that there IS no cure - but if you can give your pituitary & adrenal glands a break with low dose thyroid meds, it may be worth considering. My first endo also said my hypothryoid condition & hashis did not cause body aches & pains. Many patients in this forum including me would absolutely disagree.
I often wonder what set-off my hashis from asymptomatic to symptomatic. I broke two bones in my foot in August 2008. I also was dealing with a great deal of stress at work and financial worries (furloughs at work because of the economy) Then a root canal gone wrong (fractured root) causing dental inflammation & bone loss. It took 2 years of complaints at the dentist before I demanded they extract the tooth - and they finally SAW the root had been fractured for 2 years! Inflammation in your body can strain your endocrine system.
Our bodies are not disconnected parts - there is a delicate synergy especially when it comes to hormones & metabolism. May I ask what kind of injury the doctors are treating? You called it a "neuropraxic injury" and 8 months later you are still having muscle issues? I just googled neuropraxic injury" and read that metabolic conditions including thyroid disorders can contribute to the development of neuropathy in the body. Your muscle issues just might be thyroid related despite your doctors believing that a TSH of 10 is their queue for treatment. That is a surprise to me since the endocrine society even accepts a much lower number as worthy of low therapeutic doses of thryoid hormone. I too was hesitant to take thyroid hormone. I wanted my body to do what it had always done. But I also knew I could not stand feeling sickly. I felt like I was dying.
In the meantime, I recommend taking the magnesium & calicum (important for muscles!) & also selenium & to espescially get your vitamin D levels checked because they are all essential to thyroid function and are often found to be deficient in thyroid patients.
Oh, and also ask for an ultrasound of your thyroid - you might have nodules and not know it. I had several when the doctors finally got around to checking my thryoid - what made them order and ultrasound? My TSH of 7.56.
Thanks for writting all that, it really helps.
I had low Vitamin D (23). So am getting that taken care of. I got magnesium citrate, just have not started to take it yet. As it falls under that "I dont really like taking anything" category.
The injury started with pulling a muscle doing triceps exercises. Then a week later I pulled my whole right side doing a pulled up. I went to a chiropractor a day later and he popped my neck and back 4 times in a week and told me I had bones out of place etc etc. I think this is where the damage happened but o well. HAd all the MRI and xrays etc, they said it looks normal (thought some Cervical DDD) Lower back looked perfect.
Since the, its been and seems to be all muscular. Things like mowing my lawn cause me lots of fatiuge and takes three days to recover. As many doctors I saw, they just told me it was all in my head, and that I needed to take anti depressants. Then 7 months later I finally found a doctor that new what it was, injury to the long thoracic never etc and sent me to the PT to confirm. SO while I had been told to stretch by another pt for 2 months, it was actually the wrong thing to do.
And also 7 months later I found an internist that did full blood work and found those two things and gave me 5mcg of Levo. He said he was most likely hashi.
ANd like you said, it feels like fluish type without the flu.
I also get buzzing in my feet.
A ton more anxiety then normal and am extremely paranoid. I've had nightmares for the past month and am have migranes that I have never had before.
Its funny because the endocronologist I saw today said I had not symptoms. She did say that I needed to check the anxiety out though.. but I thought that was a symptom of thyrooid? Yet I have always had anxiety, but recently its really been bad. The endo has now ordered the free t3 as well as antibody so I should find out in a couple days. She basically was against treatment. The internist was for treatment :(
I know I sound like I am in denial. But as far as the symptoms of being hypo its hard to tell for me. I do have dry skin but it's really dry here in colorado, I think the humidity was 36 the last time I checked. As far as anxiety - I have always had this. I live alone etc, most of my family is at another place. I used to have nothing and have worked really really really hard to be where I am at.
I do get cold feet, even in the summer months.
Are anxiety, insomnia part of being hypo?
Also, to be honest, I have not had a good night sleep for about 4 months now :(
You do have the classic symptoms of being hypo. Your endo is wrong, wrong, wrong in that she won't treat you unless your TSH is at least 10. I'm sorry, but that is simply irresponsible when the new (8 yrs ago) recommended limit is 3.0........
You said you had an FT4 test - could you post the result and reference range from your lab sheet? While FT4 is only one part of the equation, it would give us an idea of where you are........
Aside from that, my most important recommendation is to find a new endo. Don't walk away from her -- run fast!! If she doesn't recognize your symptoms as hypo/Hashi's and refuses to treat you, you don't need her; she will only keep you sick......... I've been down that road and surely don't want to see anyone else have to travel it...........
Congrats on finally getting further testing. I hope the T3 test was actually what is called FREE T3. Free T3 levels reflect how you feel more than any other thyroid test. When you get the results post them here with the ranges. Remember , Low end of free T3 range, but still in range is NOT optimal and will result in some symptoms.
Maybe you are a little more reassured that your symptoms (per previou post as well) are the same as hypo symptoms, now that others have also mentioned it to you. As you can see we all agree on it, from personal experience. Doctors have no 'personal' experience, unless of course, they too have low thyroid themselves.
Confusion/ paranoia/ anxiety / indecisiveness / insomnia - all or some can be the symptoms that can go away in time with proper thyroid levels.
Its really unfortunate your endocrinologist does not know more about Hashimoto. Unfortunately that is common. I have 'fired' a few myself. I would still be suffering If I believed the few that technically did not know how to treat Hashimoto. There are good thyroid docs, but far and few between.
When our thyroids are out of whack it can definitely cause muscle weakness. Hashimotos is an immune disease that causes metabolic disorder because the antibodies attack the thyroid (the disease did not begin in the thyroid) I am suspcious that your injury may have exposed an already underlying condition. (a distressed thyroid gland)
I think I've had hashis for several years like a dormant virus. It was just never diagnosed because the symptoms can resemble so many other things. (such as depression)
Like I wrote earlier my TSH was in range all the while nodules were forming over the last 2-3 years.
Personally I think sometimes an emotional trauma can trigger the onslaught of endocrine (adrenal, pituitary, thryoid) overload and "activate" the immune reaction.
I too have been a rather emotional person all of my life, very sensitive, prone to anxiety. But what I was experiencing the months before I was finally diagnosed was like tremors before an earthquake - hashitoxicosis episodes where I thought I was having a heart attack, crying, feeling paranoid, fearful - shaking, insomnia. I went to my primary care doctor and said I thought I had heart problems. EKG came back fine. I am SURE it was my thryoid spewing out hormones because of the growing nodules.
In February 2010 I went to my chiropractor because of constant back pain that had been going on for weeks - no make that months. I felt unwell. I went 3X a week the month of March. I too wondered if the adjustments "did" something to my thyroid because in April I received my hashis diagnosis - however, those nodules did not grow in one month. My symptoms (aches pains muscle weakness insomnia anxiety etc) were my hypothyroid condition as a result of the hashimotos.
OMG I even had sores develop on my body! They were red round sores that left scars! My body felt like an alien invader had taken over it! My skin had been drying out over a period of about 3 years. I even remembered saying to a co-worker - look at my arms! They are getting wrinkly and I am only 55 yrs old!
There are a couple good websites that helped me understand what I was dealing with. One is Mary Shomon's site (google her name) and also the "Stop the Thyroid Madness" site - which is a bit radical but provides ample evidence that good endocrinologists are hard to fine. Even mine says that TSH is the only test needed - however, I am permitted to ask for the tests I want. Thank goodness!
thanks everyone I really appreciate it. And thanks for the patience as well -
As you can see I still have a hard time with this.
Part of me still wants to beleive that my symptoms are not from this.. but at the same time it would be refreshing to know to that I am not crazy. Also, I just did not beleive that being that little bit off (ie my TSH numbers) would or is the cause of all this stuff.
Barb - Yea I actually went to her for a second opinion. My internist had already started me on the meds for the hypo - I went to the endo for a second opinion. Her basic thing was that thyroid is a pulsotary organ, meaning that some days it kicks alittle more then others. etc she did agree to do the free t3 and anti bodies. I think I will stick with the internist.
LazyMoose - yeah finally got round to doing it. I think the internist seems to be really a good doc - with that my GP also was very understanding and basically told me that they look more at the person and symptoms rather then just numbers so I really felt like they cared. As far as the symptoms. Yes it is more reasurring hearing that it is/could be the Hashi. I think part of it too, to be honest comes from the mentality I grew up around. You don' t get depressed, you don't get anxiety. hardly go to docs etc. Sick meant you needed anti biotics etc. This is such a weird thing for my brain to wrap itself around.
Shelley - how come it take so much for this to be diagnosed and seems like it so ambiguous.. I mean how obvious to these symptoms have to be..
I think the only way for me to tell if I have symptoms is to take the medicine and see if I feel better.
Gosh, I wish I knew why it takes so much for the diagnosis - I guess because the symptoms can be related to so many other things. Out of investigative curiosity I requested all of my labs back to 1999. I read that in April 1999 my PCP wrote "patient presents with fatigue and achiness in front of throat". I also had gained quite a few pounds. I complained of profound anxiety, irritability etc. He did do the standard THS test - came back in range. BUT! I bet if he'd have tested for antibodies, the hashis would have been revealed. Everything I've read about hashis is that it can develop over many years, even decades. It can be relatively asymptomatic and then perhaps, often in middle age, it will finally expose itself having damaged your thryoid during its active period.
There ARE doctors that do not treat hashis with meds until the symptoms become miserable. I question that logic because the thyroid gland is ground zero for the autoantibodies. When a person feels like they have the flu, have anxiety and cannot sleep, have muscle aches & pains with no energy, and suddenly feel 80 years old (and a sick 80 at that) some help with low dose thyroid med would probably help.
Long term loss of active thyroid hormone can cause heart conditions, fatty liver, osteoporosis (I have this) and multiple other organ issues in our body. I swear I had NO idea how important the thyroid was to well-being until I became sick.
Right now I have a large herniated disk @ L1L2 that is causing me much grief - and in truth, it took several months to finally have THAT diagnosed through an MRI (I went to a rheumatologist to find THAT out!) Guess what? It was THAT SAME constant back pain & INITIAL doctor visits that finally revealed my hashis! And look - I've dealt with the hashis FIRST (because it was discovered first) and am JUST NOW finding out that I've had a herniated disk for MANY months! It took months of complaining about back pain before the doctors recommended the MRI!
If there is anything I've learned this past year its that we must become our own health advocates. Endocronologists treat hashis the same as hypothyroid (meds & lab numbers) seeming to disregard that it is an autoimmune disease. It would be good to read everything you can about autoimmune disorders & the body (if your labs return antibody positive which seems very possible)
I am a proponent of natural dessicated thyroid meds rather than the synthetic - but that's based on my own experience with synthetic. I've read that people on T4 only meds
have a more difficult time losing the hypothyroid weight they may have gained and lingering hypo symptoms - but I am sure there are folks on this board that would disagree.
Have you asked about a thyroid ultrasound to rule out nodules? If the labs do returm positive for hashis, ask for one. In the meantime, a small dose of thyroid hormone may just help you with the body aches & pains, muscle weakness and insomnia (and BAD dreams!) It does take a few weeks to build up in your body so don't expect too much too soon! Stay in touch!
I think I may have had similar experience to you. Except mine was in my neck and shoulders etc. It just does not make sense that the endo thinks we should wait till it's past 10 and I have symptoms to treat... ah well.
I will probably start the medicine here in the next couple days. Have to get over my fear of medicine :( It seems like the levo has the same side effects as the actual illness (weigt gain etc.) The doc told me that most of the symptoms are from the wrong dose. ANd also from these boards of people freaking out on Levo it makes me even more paranoid! :(
I talked to the internist about conversion etc and he said that most people convert. His take was its probably hashi's and regardless of what it is we still have to get the tsh down etc. Also seems like, since my numbers are not bad and I have normal t4, to start on a small dose.
The insomnia and bad dreams are whats getting me! I have never been so paranoid, I actually sleep with a knife by my bed...Is that really hypo?
When I look back over the last few years of my life I can see the hyper/hypo symptoms of hashis. It wasn't until I started having strange things going on that I realized I had to find out what was wrong with me. I began having wax buildup in my ears (from my low body temp) I had two ear infections & sinus headaches/ infections within about 6 months. I felt weak, like my muscles did not want to respond. I had cramps in my feet where my feet would gnarl up - distorted. I developed osteoporosis. My hair seemed to be thinning. My eyelids were getting puffy. I was having eye irritation - dry eye. I was gaining weight even though I eat pretty sensibly. At first I just assumed it was middle age. But the body aches & pains started to frighten me. My back was hurting (and I just found out 2 weeks ago it was the herniated disk mentioned above)
I shared all of this with four different doctors from Nov 2009 until March 2010 . It was not until the last doctor that someone finally tested my TSH and found the elevated thyroid stimulating hormone. Then came the antibody test & the ultrasound.
Six months earlier in June 2009 I was having panic attacks, paranoia, insomnia, heart palps, crying in bed at night...I thought my life was falling apart and the doctors just thought I was "depressed". One suggested a psychologist. I told her a psychologist was not going to cure my back pain and insomnia. I said that I also didn't want to take drugs to mask what was really wrong. I KNEW is was physical.
I don't like drugs either. I told my former PCP this and she became upset with me. She said "that's what we do, we give pills". I am not phobic about them, but I choose to avoid them unless I have no choice. I do not take bisphosphonates for my osteoporosis because of the lawsuits involving them (Fosamax, Boniva, Actonel etc) Recently a link between these drugs & esophagal cancer was reported on. I distrust drugs because they scare me. The general population are really guinea pigs IMO.
I would have preferred not to take thyroid hormone. My chiropractor (love the guy) told me once I did begin hormone therapy I'd be on it the rest of my life and that my own thyroid would stop working. I told him my own thryoid was already not working and that was diseased with nodules. I told him I HAD to do something to be able to function.
I am divorced for many years. I am wholly dependent on myself to keep a roof over my head and food on the table. I MUST be well enough to function.
The Armour thyroid I take has helped me a great deal. My TSH dropped to .5 and I feel good at this level. My FreeT4 could stand being higher and also my FreeT3. Just had blood drawn today and will find out probably next week.
My advice would be to try the thyroid med for a month and see how your body responds. What brand of T4 did the doctor give you? Above you say 50mcg of Levo - is it generic or brand name?
Oh yes, and DO begin taking the magnesium! I take Magnesium Malate (easily absorbed) and calcium citrate when I go to bed at night. I do D3 two to three times a day. Selenium is important for hashis patients too.
Heck I even soak my whole body in Epsom Salts in the bath tub from time to time.
Nutrition is VERY important for anyone with an autoimmune situation. I think most of us eat processed foods to some degree.
Heck I even stopped using flouride toothpaste, mouthwash etc because of what I've read about fluoride & thryoid. I have even replaced all but 2 amalgam fillings with resin because of reading of mercury toxicity and its effect on the thyroid gland. (I had lots of amalgam fillings)
I know this sounds very paranoid but I have read some medical studies NOT related to "natural holistic dentists literature" that suggest that amalagam fillings can leech mercury into a persons body.
And afterall, toothpaste with flouride does have warning labels telling us not top swallow or use on a child under X years old. I just never paid attention...
ha, I actually was told the same thing by a doctor." We are here to give you pills." sigh.
It was the same ,I was having back pain spasm neck etc. And then came anti depressants - one doc actually gave me 4! So it has really put me off the meds.
At the moment I have exessive paranoia - like I just picture myself taking the Levothyroxine and then my thyroid swelling up and choking to death. Ah well.
Anyways, it's Levothyroxine 50 mcg that have been given.
Yes, low thyroid can cause tinnitus. There are a few people on the forum struggling with that too. I've read that low Vitamin D can cause ringing in the ears. Since your D was very low (23) you really need to get that up! I'm taking 4,000 IU's a day and mine STILL stays low! I know you are a guy but you need calcium for muscles too - do you know how your calcium levels are?
I was nervous about taking the levothyroxine too - I absolutely hated the idea of it. But I knew if I didn't do something I was going to fall apart.
My suggestion - give it a try. Take it in the morning on an empty stomach - don't eat for at least an hour to let it get into your bloodstream. Don't take with other supplements.
Take a look at the Stop the Thyroid Madness site. If anything you will see how others are struggling with problematic diagnoses.
Stay in touch.
The synthetic levothyroxine brought my numbers into range but I had some side effects that I didn't like. I developed pins & needles (parathesia) and ear pressure. (Just what you wanted to know, huh?) Some people do very well with synthetic. No problems and they've taken it for a gazillion years.
I switched to natural dessicated thyroid (Armour) after the first month. It has made a big positive difference. I'd say about 20-30 minutes after I take it I feel more energy,more normal. The lingering fatigue that I feel when I wake up goes away. But I don't feel juiced up or wired.
BUT! I felt juiced up when I was in the "hyper" stages of my hashis though.That was without medication several months back before diagnosis.
I am really anxious to find out about your anti-TPO level (autoimmune antibodies) if indeed you do have hashimotos.
I have to read up on uric acid now because I wonder what causes it to be elevated...
I do think that is what was meant - that low thryoid may contribute to the incidence of gout. I read that hypothyroidism & gout often coexist.
Probably a good idea not to drink alcohol under the current medical situation. Is your weight in a normal range for you or have you gained recently? Just curious...
TSH is high so you are definitely probably still having symptoms, yes? Too bad they did Total T3 rather than the free T3. I've read that the "Total" hormone counts are not any good for clinical purposes. WHY do they even STILL do them? DUH!
Hmmm, antibodies are interesting. Did the doctor confirm hashis or not? And this is without meds, right?
My lab uses a complete different limit (its not a range) when testing TPO. The limit is something like 50. The chances of someone landing on 51 (that and above is positive) is much less possible than testing at 9.1 (just .1 over the limit of 9). Just basic probability applied here.
With any lab test there is some error, but we dont know how much. Purly by the numbers you have Hashis, but that is not considering anny error factor. Its not possible to say at this time with this TPO limit. If it is Hashi, then this or the test below will increase in value in time.
The other antibody test, TgAb (thyroglobulin antibodies). Most docs do both at the same time. Put it this way. Any doc that knows Hashimoto WILL test both.
I wouldn't worry about Levothyroxin, it works for most. Most people write in here when they have only thyroid related issues. They dont write and complain about something that works you know?
This site complies with the HONcode standard for trustworthy health information.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Med Help International, Inc. is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.