Joint pain and swelling after dose adjustment?

[Jackie419]

I reduced my dose of NP Thyroid almost 8 weeks ago as my frees and totals were a bit high. In the last couple of weeks, first one of my index fingers was hurting at the joint off and on- now not bothering me. I woke up today to a painful pinkie finger on the other hand and it was all I could do to get my ring off it was so swollen and quite painful. Has anyone here experienced that just from lowering your med? It wasn't too drastic of a reduction but I have felt some other hypo symptoms. This has never happened to me before btw, and i've raised and lowered med over the years. Thank you!

[gimel]

What was your actual Free T4 and Free T3 levels, along with their reference ranges shown on the lab report?  Also if tested for Vitamin D and ferritin, please post those as well.

[gimel]

I also meant to ask what  dose before and after the change?

[Jackie419]

Hello Gimel!

10/21-test at 135mg per day:

T3 UPTAKE  27  -- 22-35 %
T4  TOTAL  13.5   --5.1-11.9 mcg/dL  -HIGH
FREE T4 INDEX (T7) 3.6  --- 1.4-3.8

T3, TOTAL 198   --- 76-181 ng/dL  -HIGH

TSH <0.01    ---0.40-4.50 mIU/L
T3, FREE  4.5  -- 2.3-4.2 pg/mL   -HIGH
T4, FREE 1.4 --- 0.8-1.8 ng/dL

T3 REVERSE,  20       -- 8-25 ng/dL


I lowered my dose slightly for past 8 weeks to about 126mg per day. (down from 135mg per day) I have not been on a dose this low in 10 years.

I have not tested my vit D in awhile but the last time it was 49 - I'd had some trouble with supplements and gave up. No ferritin tests and may have to wait for omicron to do it's thing before I go test again.

I'd also posted this after last tests. Thanks, Gimel- I hope all is well with you!

https://www.medhelp.org/posts/Thyroid-Disorders/HELP-Thyroid-level-saga-continuespart-20/show/3067771

[gimel]

A number of those tests are a waste of time and money:  FT3 Uptake, Total T3, Total T4, and Free T4 Index.  TSH is not giving you any useful info either, but doctors cling to that test as though it indicates thyroid status.  

Your FT4 and FT3 are higher than usually needed to relieve hypothyroid symptoms; however, everyone is different in the thyroid levels at which they feel normal.   Other than test results what other reasons did you have for reducing med dosage?  What symptoms did you have at the time?

You mentioned other symptoms that you have currently.  What are those, besides the joint pains?

In spite of Omicron, you may need to test for Vitamin d if you are not currently supplementing.  Also, ferritin is very important as an indicator of iron levels.  Ferritin needs to be about 100 for best effect.  I recommend testing for both.  

[Jackie419]

I reduced based on those levels as well as my hands getting shaky when hit with a big stressors and that's about it--I was actually sleeping quite well and gaining weight at that time.

Once I lowered my dose, my eyes started aching, my sleep got less steady and I just felt sleepy a lot, Those things passed but then the joint problems started - could be a coincidence...I will try my luck with D again and get ferritin tested.

I got all those tests as that package included the Reverse T3 and was on sale so it saved me money rather than getting just the frees and Reverse, oddly enough.
Thanks so much for your input!

[Jackie419]

PS-- my sleep is still not great

[gimel]

It sounds like you may be still slightly hypothyroid, even with those test results.  In order to get the best effect from your thyroid levels, you need Vitamin D to be above 50 ng/ml.  Also, low ferritin is an indicator of low iron levels, which can cause symptoms, some of which mimic hypothyroidism.   So before any other change, I suggest testing for Vitamin D, B12 and ferritin.  If you will get those done and post results we will be happy to assess further.

[Jackie419]

Thank you! Will do. Does all the red meat I eat count toward ferritin? I'll try to test this week or next, Happy New Year :)

[gimel]

Yes, red meat provides some iron.  Happy New Year to you also.

[Jackie419]

Gimel, I wasn't able to test until last week due to getting covid and got my results today. I appreciate your having pushed on the ferritin test but now I have to figure out what it means.

January 2022 test results

T3, FREE 4.0    -( 2.3-4.2 pg/mL)
T4, FREE 1.2.    -( 0.8-1.8 ng/dL)

FERRITIN 507  -(16-232 ng/mL) HIGH

VITAMIN B12 274   (200-1100 pg/mL) love how it says "Normal")

FOLATE, SERUM 3.7   (Low: 5.4)

RHEUMATOID FACTOR <14      (<14 IU/mL)  "NORMAL

How I'm feeling now: lingering index finger joint mild pain, sporadic, good otherwise---I had mild covid and was off work for two weeks, but I'm back at it. I also have Discoid Lupus so I avoid the sun---my Vit D level is in a nosedive...but I am shocked my B12 is so low and no idea what to make of high ferritin but about to be doing some reading.

I have to say I had the "stress test" on this dose of NP Thyroid and I may have found the sweet spot. I got hit with major stress, really major- and my hands don't shake and I've handled it all with the calm of the "old me"

So the pains, some weight loss could be from the other levels---I'm still having trouble staying asleep. It's odd how well I was sleeping when I was over the range on FT3 before.

Is my FT4 a bit low now though?

Thank you for your input into my situation- I so appreciate it and I hope you're doing well! Also, thanks again about the ferritin test, because I would not have done that one otherwise!

[Jackie419]

PS - luckily I see my pulmonologist this week so I can address the scarier aspects of high ferritin, but on the other hand, I have several autoimmune diseases as well as having just gone through covid, although it was mild. If it's not one thing, it's another!!

[Jackie419]

Geez! I forgot to list my Vitamin D result:

VITAMIN D,25-OH,TOTAL  38   - (30-100 ng/mL) (love how this one says normal as well)

[gimel]

Following is a link to a good site on iron.  Scroll down to the area under "What does the test result mean?"  There you can see some of the possible causes of high ferritin.   Also note that you need the other iron tests to help identify cause.   I am assuming you were not taking iron supplements along with all the red meat.

Before commenting on your thyroid levels I need to kno if you took your thyroid med the morning of the blood tests?

[Jackie419]

Hi! No iron supplements, and I do eat steaks etc, but not ridiculous amounts.

I always test about 24 hours after my last dose of thyroid med.

[Jackie419]

Post that link! Thanks!

[gimel]

Sorry, I forgot the link.  Here it is.

https://www.testing.com/tests/iron/

Then scroll down to the section,  What does the test result mean?.

With your minimal symptoms it looks like your thyroid levels are good.  I would not change dose.  You do need to get your B12 into the upper part of its range.  1000 mcg daily should do the trick.   Supplement Vitamin D as needed to get it at least 50 ng/ml.

[Jackie419]

Thanks SO much! I do wonder if the covid may have caused the high ferritin, I'm sure my doc will do further tests for that. I appreciate your input- I have 50,000 iu D3 capsules, I'd stopped taking bc I thought it was affecting my sleep but I need to get back on them- I'm glad I got all of that checked. Thanks for still being here and still helping everyone, you're great!!

(Do you have any brand preferences on B12?)

[gimel]

no brand preference.

You are very welcome.  Please let us know how it goes for you.

[Jackie419]

Just to update this thread...it's taken months to get what are really no answers. I saw my doctor today who just shook his head when I handed him my above most recent test results...for thyroid, he said the FT3 is completely unnecessary and he'd only use the T4 and TSH. I said FREE t4? He seemed to pause and then just agreed with me. I asked if that number was ok....sure, it's ok....I then say that my old endo at a well known clinic in the US had told me my TSH is suppressed and has been since going on med 17 years ago....and that's when he said..."if your TSH is suppressed, then you're taking too much". Which is exactly why I never let him or anyone test my thyroid EVER. I only showed him those results to see what he had to say about the extremely high ferritin levels I had then and he rolled his eyes and said it was fine....annnnnd that's what I get for trying to figure anything out.
Just an update but no resolution. Thanks to all who weighed in!!