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Can Hypothyroidism mimic neurological disorders?


For the past few months, my feet, toes, and calves have been partly numb and I've had tingling and buzzing nerve pain there. Over the past few weeks it's gotten much worse. All of my symptoms persisted and my legs got really stiff and twitchy. So stiff that I'm not flexible at all anymore.  My balance and muscle control has been affected too. I have a hard time walking. I've tripped and fallen on multiple occasions, and I can't walk up stairs unless I go very, very slow, and use the rail to pull myself up the stairs. When I walk I trip over my own feet and sometimes one foot will stop and drag, or I'll step off to the side all weird. I have to hold onto a wall or desk in order to stand still without swaying or leaning over. At the beginning of my symptoms I assumed it was a b12 issue and supplemented for a few months but when that didn't help I began to suspect MS.

I went to the doctor and had bloodwork done. She had everything tested, over 20 individual tests. My b12 levels were in the high normal range (900) and everything else was perfect except my thyroid stimulating hormone. It was quite a bit above where it should be(11). I found this strange because other than being tired and cranky lately I don't have any other typical hypothyroid symptoms. My doctor prescribed me levothyroxine and I have a phone appointment with her later today.
Does my hypothyroidism explain my neurological symptoms, or are they caused by something else? Should I still be concerned about MS?
I'm 23 F, white, Northern California, overweight but not obese, no other medical diagnoses or prescriptions other than hypothyroid.
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649848 tn?1534633700
COMMUNITY LEADER
While hypothyroidism can cause some tingling and numbness in extremities, I've never known it to cause anything that severe.  I've also known a lot of people with much higher TSH (my own was 55+ at diagnosis) and I've never heard of anything like that.  

It's unfortunate that your doctor only tested TSH for thyroid function, though, because while it's considered the "gold standard", it's a far cry from being adequate.  She should also have tested Free T4 and Free T3, which are the actual thyroid hormones.  Those would tell what actual thyroid function is, since TSH is a pituitary hormone, not a thyroid hormone.  In addition to Free T4 and Free T3, she should have tested for thyroid antibodies to determine whether or not you have Hashimoto's.

What tests did your doctor do, other than the TSH test and vitamin B-12?  If you can tell us what all she tested, perhaps we can pick something out of there that could be the culprit.  

I'm not sure if you should be worried about MS, particularly, but I think I'd ask for referral to a neurologist, because, apparently, your doctor didn't test for everything and some things can be present, even if blood tests appear to be "normal"... Imaging studies are often needed for diagnosis of some conditions, as well.
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1 Comments
I was tested for TSH, b12, complete blood count, WBC differential, serem rheumatoid factor, calcium, bilirubin, alkaline phosphatase, potassium, alanine aminotransferase, fasting lipid, fasting glucose, vitamin d, creatinine, iron, and ferritin. Everything was perfect, right in the middle of normal range, except TSH.

I asked my doctor if my hypothyroidism is autoimmune and she said yes. I have Kaiser and they take forever to do things and don't want to pay for anything. My doctor said that my neurological symptoms are probably caused by my thyroid and that I won't get a recommend for neuro unless I still have neuropathy even with my TSH numbers in normal range. So I just have to take my pills for 8 weeks, then do another blood test.

I really feel like my neurological symptoms can't be explained by hypothyroid, but my doctor wants to believe that they are, so I guess I just have to wait.
649848 tn?1534633700
COMMUNITY LEADER
It's true that most hypothyroidism is autoimmune, but there are other causes, so your doctor was remiss in not testing antibodies.  She was also remiss in not testing Free T4 and Free T3, so when you have your next blood work, don't just ask for T4 and T3... ask for FREE T4 and FREE T3...

I know that sounds nit-picky, but if you don't specify "FREE T4" and FREE T3, you'll get Total T4 and Total T3 and they aren't the same tests, nor do they give the same information.  

I'm agreeing with you that it's unlikely that your neuropathy is caused by your hypothyroidism.  Many people have Hashimoto's for years before they're diagnosed (I think I did) and before they become, clinically, hypo, though symptoms can show up before labs actually go out of range.  I'm just not convinced you were one of those.

Doctors tend to take us for hypochondriacs if they don't have pat answer to our problems.  Don't let that get to you.  Just keep looking for the answer...
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Okay thanks. I'll ask for free T3 and free T4.

I think Kaiser just has wishful thinking and my doctor is just hoping my symptoms are caused by hypothyroid because it's the cheaper, easier thing to treat.

I can't see Neuro until my TSH is normal. I'm on 50 mcg of levothyroxine and I can do another blood test in 8 weeks, Do you have any idea if my numbers will likely normalize by then? I know you can't know for sure, but an educated guess is appreciated.

I'm going to do the gluten and soy free thing until then just in case it is autoimmune because that might help.
649848 tn?1534633700
COMMUNITY LEADER
Yes, you "can" have neurological i.e neuropathy issues with hypothyroidism, but the key is "long standing, untreated" hypothyroidism and the falling down/stumbling, etc is somewhat drastic for hypothyroidism.  These things don't progress over a matter of weeks; is would take months or even years of being untreated to progress to that point, which I believe is very rate.  It's also relatively unlikely with a TSH level of 11, though it would be nice to know what the actual Free T4 and Free T3 levels are.

I've never had Kaiser, but I've heard plenty about the care they provide, so I'm lucky I've never had to deal with them. I'd have been paying a lot of money out of pocket...

I agree that your neuropathy is most likely "not" caused by hypothyroidism, but as usual, nothing can be ruled out completely until it's proven for sure...

How does your doctor know for sure that your hypothyroidism is caused by autoimmune condition?  Did she actually test the antibodies or she is making another assumption, just because most hypothyroidism is caused by Hashimoto's?

Did you have ANA test or any other tests that might indicate other autoimmune conditions, such as Lupus?
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My T3, T4  and thyroid antibodies were not tested. My ANA was negative so no lupus.

My doctor didn't specifically say I have Hashimoto's, but when I asked if my hypothyroid problem was caused by autoimmune she said "yes, hypothyroid is autoimmune". I know that most of the time it is so I'm just assuming I probably have Hashi's. When I have my TSH tested in 8 weeks I'll ask for T3,T4, and antibodies too.


I've been researching hypothyroid and I really feel like my symptoms aren't caused by hypo. ie. my balance problems and spasticity.   I mean I could've been hypo for years before diagnosis (which can cause neuropathy) but with a TSH of only 11, idk.

I think that my doctor thinks I'm just overreacting to my neuropathy which "is 'probably'caused by hypothyroidism"
I've only gone to the doctors twice in the last decade because I HATE going. I'm not being a hypochondriac. I only go to the doctor if I absolutely have to.
1756321 tn?1547095325
Yes you can have neurological symptoms due to hypothyroidism. I had plenty (some severe) due to long standing untreated hypothyroidism. I have read a case study of someone with foot drop due to hypothyroidism but that isn't a common symptom. Common causes of foot drop include a lower back condition, a stroke or tumour, Parkinson's disease, motor neuron disease, multiple sclerosis, adverse reactions to drugs or alcohol, injury to foot or lower leg.

***

"The onset and duration of neuropathic symptoms is generally correlated to the onset and duration of hypothyroidism [83]."*

"The severity of neuropathic symptoms does not directly correlate with the degree of thyroid deficiency, but may be associated with the duration of hypothyroidism."*

* UpToDate - Neurologic manifestations of hypothyroidism.


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649848 tn?1534633700
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