Thyroid, RA and Joint Pain

[ratobranco]

I am a 30 year old male with no family history of autoimmune disease.  

My symptoms are basically strong joint pain in the fingers, wrists, feet, toes, and knees.  The pain began in February and has continued until now.  It tends to get worse toward the night.  I have a very small amount of morning stiffness, not much at all--sometimes, none at all.    

I am under the care of a rheumatologist.  Here are  my results.  RF = negative, Anti-CCP = negative, CRP = negative, ESR = negative.  X-ray = negative for joint damage and inflammation.  MRI with contrast = negative for synovitis and tenosynovitis, negative for inflammation, reported as "no objective signs of RA."  My rheumatologist has conducted the "squeeze" test and has not been able to detect any swelling or inflammation in my fingers.  So she is reluctant to proceed with RA treatment.  

The confounding variable is this.  I was found to have a positive ANA (1:40) and elevated Thyroid antibodies ( > 1000).  My TSH was tested and was high out of spec at 6.1 with normal T3 and T4 levels (both above 1.4)

So this is clearly early stage subclinical hypothyroidism.  However, I have no other symptoms of hypothyroidism besides the joint pain.  No fatigue, no constipation, no brain fog, no weight gain, no brittle nails, etc.  

Were it not for the joint pain, I would not take Synthroid yet.  I prefer to stay as unmedicated as possible for as long as possible.  

My question has to do with what I am risking by taking the Synthroid.  What are the risks if I take a low dose of 12.5mcg or 25 mcg?  If Synthroid does *not* bring down the joint pain in, say, a month or so, would it be possible for me to come off Synthroid without having created a new lifelong need for this medication (I will probably eventually need the medication but right now that need doesn't seem to have manifested itself yet)

What would you recommend to a patient in a situation like this?  

Thanks immensely

[Lori707]

I was diagnosed twice for RA and I do have a positive RA Factor of 157. I went through 4 Endocronologists and Rhuematologists to find out that I indeed have Hashi's. I also have low Vit D which I'm taking higher supplements. My bones and joints hurt me a lot. Then I decided to change my diet and now I have minor discomfort.

I urge you to go to an Endocronologist who specializes in Thyroid, Vit D, etc. Don't leave it all the Rheumatology.

I hope you feel better!

[armywife92]

R.branco, no I do not have RA, even with an old positive RF factor. In 1993 it was over 100. I went through life with mysterious joint pains off and on, and didn't see a rheumy unitil about 07. By this time I KNEW i didn't have RA but wanted to see a rheumy for answers. It wasn't until recently that I learned why it was positive. Thyroid disease, specifically hashi can cause a false RA reading. I also have graves, yet I've remained in remission the majority of my life. My sed rate was also highly increased then. Anyway the rheumy took one look at me, asked me about symptoms, and said that I do not have it. Of course he did follow up blood work and xrays to confirm. I think you are OVER thinking this. Not everyones symptoms are the same. Be thankful you only have the joint pains.. That's all I had too. Some ppl are worse off, and can't function.

[gimel]

Sorry, I overlooked that you already had tested for TPO ab, and your test result was high, indicative of Hashi's.  With that autoimmune system problem, even if not having overt symptoms now (beyond the joint pain), it is only a matter of time until the antibodies will destroy enough of your thyroid glands that your thyroid hormone levels will start dropping and more symptoms will ensue.    

There seems to be two approaches to treating a Hashi's patient.  One is to wait until the symptoms are very overt before starting on meds.  The other, which seems to be more favorable to me, is to start meds early and hopefully prevent a lot of the discomfort.  You can read about this approach in this link.

http://thyroid.about.com/od/hypothyroidismhashimotos/a/preventative.htm

As for the dosage, I would think that you should be able to handle 25 mcg as the initial dosage, but of course that is between you and doctor.  While you are talking with doctor, you might consider that many hypo patients have deficiencies in other areas as well.  So testing for Vitamin A, D, B12, zinc, RBC magnesium, and selenium would be a good idea.  

Thanks for that link you provided.  It is interesting and I had not seen that one before.

[ratobranco]

They ran Thyroid Peroxidase AB and it came in at > 1000.  My TSH was 6.1.  The Free T4 (and it was Free) and Free T3 were 1.61 (.073 - 1.95 ref range) and 3.3 (2.3 - 4.2 ref range) respectively.  

I've read that the TSH itself can cause joint pain,

http://my.clevelandclinic.org/disorders/arthritis/hic_endocrine_disorders_and_joint_diseases.aspx

but I'm skeptical that this explains my symptoms b/c I have no other hypothyroid symptoms right now.  

My rheumatologist wants me to try Synthroid, so I'm probably going to do that.  Given my numbers, any advice on a dose?  I was thinking 12.5 mcg ramping up to 25 mcg.  

Thanks again for the help, you guys are awesome.

[gimel]

Might be a good idea to test for the thyroid antiboides, TPO ab and TG ab to rule out Hashimoto's Thyroiditis.  In addition if the T3 and T4 tests you mentioned were for Total T3 and Total T4, then it would be good to test for the biologically active thyroid hormones, Free T3 and Free T4. These tests will give you a much clearer picture of what you are dealing with.  If your current test results are for FT3 and FT4 , then please post results and reference range . shown on the lab report.   Some members have also related joint pain to low levels of magnesium, so good to test for RCB magnesium as well.

Regarding the trial dose of Synthroid.  If no benefit, just taking it does not create a lifelong need.  

When test results are available then please get a copy and post results and reference ranges here and members will be glad to help interpret and advise further.

[ratobranco]

Thanks for the response armywife.  Do you have RA, or just thyroid issues?  I'm not entirely convinced I don't have RA, which is why I'm trying to figure out what to do.  My main issue is joint pain in fingers, toes, feet, wrists, neck, etc.  Haven't really had any other problems.

[armywife92]

Also as posters will remind you that they shouldn't dose you based on your TSH, your elevated antibodies warrant taking synthyroid.

[armywife92]

I've had those joint pains off and on too. If it got bad (rarely ever) I'd take an anti-inflammatory and that would keep it away for the rest of the day. You may notice some change with the synthyroid you may not. How is your diet? I know nobody likes to hear this, but diet plays a big role. Congrats to it not being RA.