Aa
Severe Joint Pain
I think I need to fire my Endo. I messed myself up back in Feb. by taking my meds with milk and it has been a horrible journey getting normal again, and I'm not there yet. I quit seeing my internal med doc and have been seeing an endo for about 4 months now. He doesn't have the best bedside manner and almost seems like he's dismissing all the crazy symptoms that I have. I started experiencing joint pain in my right elbow about 4 months ago, and he told me it was probably tennis elbow. Well....the pain has gotten worse and now it's in both my arms! I have gone from hypo to hyper and I'm going in tomorrow to get my blood tested again. I know I'm not right because I've been hving hot flashes and fast heartbeats. I've also been struggling with weight gain and it's driving me nuts. I'm one of those cases where when I'm hyper {like when I was diagnosed with Graves 7 years ago} that gains weight. I've been doing some research about joint pain and it's link to thyoid but everything points at hypo. Has anybody out there experienced the same thing, and please tell me it gets better.
When you take thyroid med, within hours it spikes thyroid levels and suppresses TSH accordingly for most of the day. Although doctors don't seem to understand this, or ignore it, even the AACE/ATA Guidelines suggests that the morning dose of thyroid med should be delayed until after the blood draw for thyroid tests. I don't recommend taking the thyroid med before the blood draw.
As for your test results, if you took the Armour Thyroid, before the blood draw, then your results were falsely higher than reality. If you were not having any hyper symptoms at that time, why did you switch to Synthroid? Also, how much Armour were you taking at the time?
With your current med dosages, it appears your body is not adequately converting the T4 to enough T3. There is no magic ratio of FT4 and FT3. Your body uses only FT3. FT4 must be converted to FT3 in order to be used. Low ferritin is one cause for poor conversion. Ferritin should be at least 100. A good supplement for iron is Vitron C. A less expensive generic is sold at CVS, as Iron C. Each tablet contains 65 mg of iron. To raise your ferritin to 100 will probably require taking 4 tablets per week. B12 should be in the upper part of its range, so I think you would benefit from taking B12.
To alleviate hypo symptoms, you are going to need to adjust your dosages to get your Free T3 higher in range; however, if you are getting new tests for Free T4 and Free T3 on Saturday, I would wait to get those results before considering what the dosages should be. We will be happy to discuss further at that time.
As for your test results, if you took the Armour Thyroid, before the blood draw, then your results were falsely higher than reality. If you were not having any hyper symptoms at that time, why did you switch to Synthroid? Also, how much Armour were you taking at the time?
With your current med dosages, it appears your body is not adequately converting the T4 to enough T3. There is no magic ratio of FT4 and FT3. Your body uses only FT3. FT4 must be converted to FT3 in order to be used. Low ferritin is one cause for poor conversion. Ferritin should be at least 100. A good supplement for iron is Vitron C. A less expensive generic is sold at CVS, as Iron C. Each tablet contains 65 mg of iron. To raise your ferritin to 100 will probably require taking 4 tablets per week. B12 should be in the upper part of its range, so I think you would benefit from taking B12.
To alleviate hypo symptoms, you are going to need to adjust your dosages to get your Free T3 higher in range; however, if you are getting new tests for Free T4 and Free T3 on Saturday, I would wait to get those results before considering what the dosages should be. We will be happy to discuss further at that time.
14 Comments
Very helpful. Thank you! I will wait for the next set of results and let you know.
I switched to syntroid because i felt hyper and hypo in the same time. High pulse and anxiety. I had high free t3 and low free t4 on 90mcg armour.
A 90 mg dose of Armour should not be a problem for you. Especially since only about 80% is absorbed. The high pulse and anxiety might have been related to the high FT3; however, your FT4 was in the low end of the range, and assessment of thyroid status should take into account both FT3 and FT4. Another possibility I wonder about is that you had somewhat low ferritin at that time. There are reports of similar reactions to raising FT3 levels when ferritin is too low. For that reason it is important that you get started on the iron supplement I mentioned, in preparation for increasing your T3 dose.
Hi Gimel,
I took my blood test yesterday. As i mentioned i am on 88 mcg Syntroid and 5 mg of T3. I still feel a little hypo, get tired easily.
My free T4 came a little low 1.2 with ranges between 0.8-1.8. My TSH came very low 0.08 i did not receive yet my free T3 results but i am assuming it could be high since the TSH is so low. I will let you know as soon as i have my free T3 results.
I started taking the iron supplements i am also taking 5000 units bit D3 4 times a week and B12 2500 4 times a week.
Maybe i need to stop taking 5 mg of t3 and increase the T4 to 100. I am on 88 mcg since December 28. Before i was on 75 mcg for 6 weeks.
I took my blood test yesterday. As i mentioned i am on 88 mcg Syntroid and 5 mg of T3. I still feel a little hypo, get tired easily.
My free T4 came a little low 1.2 with ranges between 0.8-1.8. My TSH came very low 0.08 i did not receive yet my free T3 results but i am assuming it could be high since the TSH is so low. I will let you know as soon as i have my free T3 results.
I started taking the iron supplements i am also taking 5000 units bit D3 4 times a week and B12 2500 4 times a week.
Maybe i need to stop taking 5 mg of t3 and increase the T4 to 100. I am on 88 mcg since December 28. Before i was on 75 mcg for 6 weeks.
I would not change anything until you see your FT3 result. I will be surprised if it is high.
TSH is not even a concern. TSH is frequently suppressed when taking adequate thyroid med. The med dose all at once, spikes thyroid levels, which tends to suppress TSH for most of the day. TSH should never be used to adjust thyroid med dosage.
TSH is not even a concern. TSH is frequently suppressed when taking adequate thyroid med. The med dose all at once, spikes thyroid levels, which tends to suppress TSH for most of the day. TSH should never be used to adjust thyroid med dosage.
I would not change anything at this time. Your FT4 is adequate. We'll see about your FT3. I expect it will be too low.
Ignore TSH. When taking a significant dose of thyroid med all at once, it spikes thyroid levels for a few hours, and causes TSH suppression for most of the day. Thyroid med dosages should never be adjusted based on TSH.
Ignore TSH. When taking a significant dose of thyroid med all at once, it spikes thyroid levels for a few hours, and causes TSH suppression for most of the day. Thyroid med dosages should never be adjusted based on TSH.
Hi Gimel,
You were right, free T3 is 3.8 with the range 2.8-4.2ng/ dL and total T3 is 124 with the range 76-181ng/dL.
Do I switch the Syntroid from 88 to 100 mcg and add the 5 mg T3 or keep taking 88 and 5 mg of T3.
I feel a little better but still a little more tired sometimes.
You were right, free T3 is 3.8 with the range 2.8-4.2ng/ dL and total T3 is 124 with the range 76-181ng/dL.
Do I switch the Syntroid from 88 to 100 mcg and add the 5 mg T3 or keep taking 88 and 5 mg of T3.
I feel a little better but still a little more tired sometimes.
Just a reminder, i took the thyroid med after the blood test.
Thank you,
Marina
Thank you,
Marina
Since your main symptom is being tired, I would not change much right now. I would not increase the T3 until you have time for your iron supplement to increase your ferritin level. That may take 6-8 weeks to get to full effect of the iron. It would also be good to raise your B12 level into the upper third of its range.
Thank you Gimel! I would do that thank you!
Hello Gimel,
I started to develop itchiness throughout my body and nausea sometimes. Do you think i might have a bad reaction to liothyronine?
I am still taking just 5 mcg and 88 mcg of Syntroid.
Thank you,
Marina
I started to develop itchiness throughout my body and nausea sometimes. Do you think i might have a bad reaction to liothyronine?
I am still taking just 5 mcg and 88 mcg of Syntroid.
Thank you,
Marina
Without any change to your thyroid meds and dosages, I can't imagine they would cause your itchiness and nausea. Has anything else changed?
Nope! Nothing changed!
In addition to synthetic T3, Liothyronine contains calcium sulfate dihydrate, corn starch, gelatin, magnesium stearate and mannitol. From what I have read, there are no known, direct side effects from Liothyronine itself.
When did you start taking the T3 med? Are you still having those symptoms?
When did you start taking the T3 med? Are you still having those symptoms?
One other question I should have asked before further comment. Did you take your thyroid med in the morning before the blood draw for those tests?
1 Comments
Fir armour yes but for syntroid i took it in the afternoon. I will take one more set of test on Saturday and i am planning to take it in the morning before taking my medication
Hi Marina,
Please post your test results and reference ranges for FT3 and FT4, both current and when you were on Armour Thyroid. What other symptoms do you have? What are your Vitamin D B12 and ferritin levels?
Please post your test results and reference ranges for FT3 and FT4, both current and when you were on Armour Thyroid. What other symptoms do you have? What are your Vitamin D B12 and ferritin levels?
1 Comments
Hello Gimel,
Below are my results when i was on armour and had anxiety.
FT4=0.9 with ranges(0.8-1.8ng/dL)
FT3 =4.1 with ranges(2.3-4.2 pg/mL)
On syntroid i felt hyper but still gaining weight:
FT4=1.7 with ranges(0.8-1.8 ng/dL)
FT3=2.8 with ranges(2.3-4.2 pg/pg/mL)
B12 = 400 with ranges(200-1100 pg/mL)
Ferritin =65 with ranges(10-220 ng/mL)
D3=50 with ranges(30-100 ng/mL).
Thank you,
Marina
Below are my results when i was on armour and had anxiety.
FT4=0.9 with ranges(0.8-1.8ng/dL)
FT3 =4.1 with ranges(2.3-4.2 pg/mL)
On syntroid i felt hyper but still gaining weight:
FT4=1.7 with ranges(0.8-1.8 ng/dL)
FT3=2.8 with ranges(2.3-4.2 pg/pg/mL)
B12 = 400 with ranges(200-1100 pg/mL)
Ferritin =65 with ranges(10-220 ng/mL)
D3=50 with ranges(30-100 ng/mL).
Thank you,
Marina
Even the ATA/AACE Guidelines for hypothyroidism recognize the degree of fluctuation that TSH has over the day, and even from one test to another performed serially. TSH has only a weak correlation with either of the actual thyroid hormones, and a negligible correlation with hypothyroid symptoms. The only time TSH is useful as a diagnostic is when it is at extreme levels at which it indicates the likelihood of overt primary hypothyroidism. If diagnosed, TSH should never be used to determine thyroid medication dosage. Dosage should be adjusted as needed to relieve hypo symptoms, without going so far as to create hyper symptoms.
What other symptoms, if any, do you have?
Have you been previously diagnosed as hypothyroid? If so, what thyroid med are you taking and what dosage?
If not diagnosed, you should insist on being tested for both Free T4 and Free T3, along with Vitamin D, B12 and ferritin. Those are all very important to know for you.
If you want to confirm what I have said have a look at our paper on the Total Thyroid Process.
https://thyroiduk.org/further-reading/managing-the-total-thyroid-process
What other symptoms, if any, do you have?
Have you been previously diagnosed as hypothyroid? If so, what thyroid med are you taking and what dosage?
If not diagnosed, you should insist on being tested for both Free T4 and Free T3, along with Vitamin D, B12 and ferritin. Those are all very important to know for you.
If you want to confirm what I have said have a look at our paper on the Total Thyroid Process.
https://thyroiduk.org/further-reading/managing-the-total-thyroid-process
1 Comments
Gimel thank you for your continuous help in this community.I have a simple question to your comment. Assuming D3 b12 and ferritin level are in the good level, the ones you mention in previous comments what should i be looking at FT3 and FT4. Currently i am on Syntroid 88 mcg and 5 mcg of Cytomel. I exercise and eat mostly a plant diet however is very hard to loose weight. I would like to know how would i know if i need to increase my FT3 medication and if its a ration between FT3 and Ft4 that i have to check. One year ago i was on armour thyroid and weight was not a problem but 6 months after taking Syntroid weight is becoming a problem. Thank you!
Yes, both elbows and top of one foot. I’ve heard of elbow pain in several of my friend's with Hashimoto’s. I don't know if it is when my TSH is high or low. It fluctuates severely.
I'm surprised that my Endo didn't even mention that it could be especially with my levels being so out of wack-for my last test results were TSH at .04
I have pain in my shoulders, albows, and wrists when I overdo it. Not always all at once. Overdo is a term I use loosely, as I am not working. If I could work, my whole body would feel like your elbow.
I always thought it was a result of being hyper for too long, not hypo. Could be wrong though. Happens all the time.
Tennis elbow and carpal tunnel are related to thyroid disease.
That is not to say it is the only cause of those conditions.
Your Endo should know that thyroid disease can affect joints.
I always thought it was a result of being hyper for too long, not hypo. Could be wrong though. Happens all the time.
Tennis elbow and carpal tunnel are related to thyroid disease.
That is not to say it is the only cause of those conditions.
Your Endo should know that thyroid disease can affect joints.
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