# hypothyroid and joint pain



## laff66 (Mar 9, 2012)

I've been soaking up all the info on this board since being diagnosed with Hashi's last November, and finally decided to post a question. 
Is it unusual to have increased pain after starting treatment? I've had aches and pains all my life, but in the last few months both my knees have gotten swollen and painful, my calves ache, and my feet are crazy sore after sitting for a long time or when waking up. 
I know that joint pain can be a symptom of hashi's, but my fatigue got better on Armour, and the pain got worse?? To further complicate things, I've had a lower back problem that came on at age 39 (now 45) that refuses to go away. I have not been without severe pain on waking in probably 4 years. The second day after increasing my armour dose from 60 to 90, I woke up with ZERO pain. In addition to that, I had a very physically demanding day, wore heavy firefighting equipment that ALWAYS aggravates the pain, and had to stand for several hours, which also ALWAYS makes it worse. On that day though, the pain NEVER CAME BACK. It has gradually gotten back to normal (painful) over the last month or so, but is it possible that the thyroid treatment had something to do with a pain free day? If so, how in the world would one part of my body get better and then other parts start getting worse? I'm a 45yo male, relatively ok shape, active, and at 6'2" I'm only 175lbs, so its not like I'm stressing my joints that hard!
Maybe it has something to do with the "swings" I have read about with Hashis, as my fatigue seems to be coming back a little bit as well. Its been about a month since going up to 90, maybe we'll go higher at next appt.

Everyone seems to post their numbers, so here they are:

Before treatment:
TSH 5.2
Free T3 3.3 (2.0-4.4)
Free T4 .99 (.82-1.77)

After 50mcg of levothyroxine
TSH 2.96
T3 3.5
T4 1.28

After the 50mcg, I had to switch dr's due to "normal" TSH and was switched to 60 of Armour, then increased to 90. I don't have all the numbers, but he checked TPO antibodies, which were 803, with normal being less than 35, and reverse T3 of 20 (11-32). He wanted me to come back in 2 months, but I'm going next week due to the leg pain.

Sorry for such a long post, but I'm about to explode with questions, and this is such an amazing resource! Thanks for any help.


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## Andros (Aug 26, 2009)

laff66 said:


> I've been soaking up all the info on this board since being diagnosed with Hashi's last November, and finally decided to post a question.
> Is it unusual to have increased pain after starting treatment? I've had aches and pains all my life, but in the last few months both my knees have gotten swollen and painful, my calves ache, and my feet are crazy sore after sitting for a long time or when waking up.
> I know that joint pain can be a symptom of hashi's, but my fatigue got better on Armour, and the pain got worse?? To further complicate things, I've had a lower back problem that came on at age 39 (now 45) that refuses to go away. I have not been without severe pain on waking in probably 4 years. The second day after increasing my armour dose from 60 to 90, I woke up with ZERO pain. In addition to that, I had a very physically demanding day, wore heavy firefighting equipment that ALWAYS aggravates the pain, and had to stand for several hours, which also ALWAYS makes it worse. On that day though, the pain NEVERY CAME BACK. It has gradually gotten back to normal (painful) over the last month or so, but is it possible that the thyroid treatment had something to do with a pain free day? If so, how in the world would one part of my body get better and then other parts start getting worse? I'm a 45yo male, relatively ok shape, active, and at 6'2" I'm only 175lbs, so its not like I'm stressing my joints that hard!
> Maybe it has something to do with the "swings" I have read about with Hashis, as my fatigue seems to be coming back a little bit as well. Its been about a month since going up to 90, maybe we'll go higher at next appt.
> ...


Absolutely yes!!! Double yes!!! I and others where in so much pain on Synthroid and/or Levoxyl. We needed T3 to heal and heal we have. I had horrible hip pain and feet pain for years and years. No More!

When do you get labs? There is no question but what you will probably require further titration upward of your Armour. At least I think so as I am a 69 year old female and I have stabilized on 3 1/2 grains which is 210 mgs..

Not a fire fighter but I am a gym rat and an outdoors person; very active physically.

Somewhere along the line the doc needs to run your FREE T3 and FREE T4.

Here is info on that.
http://www.mercola.com/Article/hypothyroid/diagnosis_comp.htm

And the titration process does take your through stages. Some are improvements and some not. The goal is to become euthyroid which is where you feel great!

It would be very wise to press for an ultra-sound of your thyroid.


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## sjmjuly (Mar 23, 2012)

I had severe left upper leg pain - felt like a charley horse, horrible feet pain and my thumb joints ached. I am now on a VERY low dose of Nature Throid and a gluten free diet. It has helped a ton.


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## Andros (Aug 26, 2009)

sjmjuly said:


> I had severe left upper leg pain - felt like a charley horse, horrible feet pain and my thumb joints ached. I am now on a VERY low dose of Nature Throid and a gluten free diet. It has helped a ton.


Yay!!! What is your dose of NT? I have been gluten-free for many many years...............; close to 20? Maybe?


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## sjmjuly (Mar 23, 2012)

Andros said:


> Yay!!! What is your dose of NT? I have been gluten-free for many many years...............; close to 20? Maybe?


I started with 1/8th of a grain (which is about 8mcgs) and have increased to 1/4 grain (16mcgs) I feel SOOOOO much better. Plus of course being gluten free. My doctor may want to get me to 1/2 grain, but I will wait and see how I feel and what my next labs are. 
But most of my symptoms are gone. I still have icky days, but man O man, it's nothing like before. When my thyroid was being attacked, it was everything I could do to get out of bed. I have never felt so awful in my life. Sore EVERYTHING, anxiety, depression, fatigue, ears ringing, off balance, you name it - I had it. It's only been a month and I am starting to feel like my old self again. Between the gluten free, Thytrophin, Selenium & the Nature Throid, I feel like I literally saved my own life. Idiot doctor #1 just wanted to shove Levothroid (at a VERY high starting dose!) and Prozac down my throat. The moron. My naturopath was the best thing that ever happened!


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## laff66 (Mar 9, 2012)

Thanks guys, that gives me some hope. I'm really concerned because I played tennis last night, which I do all the time, and today both of my knees are so full of fluid I can't bend them enough to squat down. I didn't do ANYTHING out of the ordinary and this is not pleasant. Plus my mood has been really crappy for about 4 days now when it seemed to be improving for several weeks before that. 
Andros, I have been getting the t3 and t4 tests, but I can't find them for some reason? I seem to recall they were fairly close to the middle of the normal range. I'm just wondering how its possible that after starting treatment, I've got NEW pain that I didn't have before! shouldn't things be getting better, or is it just a complete roller coaster ride with no rhyme or reason to it? 
I'm also wondering now if there isn't a gluten thing going on. I ordered the enterolab kit today and am not excited about the possibility of making that change but we'll see...


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## laff66 (Mar 9, 2012)

oooooh, forgot, one more question: On the slight chance that this pain is one of the hyper swings I've been reading about, wouldn't I likely have some other symptoms? ie, elevated BP, elevated heart rate, palpitations etc? 
I'm just nervous because I read tons of posts from people that were hyper with knee, calf and foot pain.


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## Andros (Aug 26, 2009)

sjmjuly said:


> I started with 1/8th of a grain (which is about 8mcgs) and have increased to 1/4 grain (16mcgs) I feel SOOOOO much better. Plus of course being gluten free. My doctor may want to get me to 1/2 grain, but I will wait and see how I feel and what my next labs are.
> But most of my symptoms are gone. I still have icky days, but man O man, it's nothing like before. When my thyroid was being attacked, it was everything I could do to get out of bed. I have never felt so awful in my life. Sore EVERYTHING, anxiety, depression, fatigue, ears ringing, off balance, you name it - I had it. It's only been a month and I am starting to feel like my old self again. Between the gluten free, Thytrophin, Selenium & the Nature Throid, I feel like I literally saved my own life. Idiot doctor #1 just wanted to shove Levothroid (at a VERY high starting dose!) and Prozac down my throat. The moron. My naturopath was the best thing that ever happened!


Yes; your NP is on it and this is the "best" thing!


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## laff66 (Mar 9, 2012)

Im going to the doc tomorrow to ask about this swollen knee thing and was wondering if there are any other blood tests I should ask for? Its only been 5 weeks, and he wanted to wait 8, but this is crazy. I'm walking around like an old man so I'm thinking it HAS to be related. Also, I pushed hard off of a wall yesterday while playing with my son and had a shooting pain in my wrist which is not extremely sore this morning?? What the heck is going on? I sure hope this is just a sign that the armour dose needs to go up, but I sure can't figure out why there are things happening now that were not going on before I ever even started the armour! 
Last visit he tested TPO Ab, reverse T3, C-reactive protein, lead, and DHEA (results are in original post). If anyone has suggestions, this doctor seems to be open to very thorough testing and might let me ask for others.

Certainly these pains/swelling aren't from too much armour, right? I don't have any racing heart, BP, or shakiness??


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## Andros (Aug 26, 2009)

laff66 said:


> Im going to the doc tomorrow to ask about this swollen knee thing and was wondering if there are any other blood tests I should ask for? Its only been 5 weeks, and he wanted to wait 8, but this is crazy. I'm walking around like an old man so I'm thinking it HAS to be related. Also, I pushed hard off of a wall yesterday while playing with my son and had a shooting pain in my wrist which is not extremely sore this morning?? What the heck is going on? I sure hope this is just a sign that the armour dose needs to go up, but I sure can't figure out why there are things happening now that were not going on before I ever even started the armour!
> Last visit he tested TPO Ab, reverse T3, C-reactive protein, lead, and DHEA (results are in original post). If anyone has suggestions, this doctor seems to be open to very thorough testing and might let me ask for others.
> 
> Certainly these pains/swelling aren't from too much armour, right? I don't have any racing heart, BP, or shakiness??


It is possible that your doctor knows you have myxedema and that is why he started you on such a low dose of Armour which is clearly stated in the prescribing information.

Carpal Tunnel is common during such times. This too shall pass; it really will.

Glad you are seeing the doctor sooner as you have legitimate concerns that need to be addressed so that you are in the patient to doctor loop.

http://www.frx.com/pi/armourthyroid_pi.pdf


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## laff66 (Mar 9, 2012)

I started on 60mg of armour, is that a small dose? I had been on 50mcg of levo from another doctor before going to this guy and starting armour. I thought he said something about 60 being a higher dose than he normally starts with, but since the 50 of levo wasn't doing much he upped it?

**update to original post:

The new doctor who gave me armour also stated that I had adrenal fatigue based on an ANSAR test that he did which measures parasympathetic and sympathetic nervous system response. Mine was way out of wack and apparently my adrenals have been trying to compensate for the fatigue caused by the hypoT. dont know how this affects any advice given previously but thought I'd add it!


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## Andros (Aug 26, 2009)

Andros said:


> It is possible that your doctor knows you have myxedema and that is why he started you on such a low dose of Armour which is clearly stated in the prescribing information.
> 
> Carpal Tunnel is common during such times. This too shall pass; it really will.
> 
> ...


You know? I scanned your thread and picked up misinformation from someone else's post. I do apologize for that.

And no, you did not start on a low dose; most of us get started on 1/2 grain if we don't have myxedema and 1/4 grain if we do.

However, given your height and weight, I believe the doc did right by you.

The titration period is rough as it takes you everywhere you don't want to be until you get to the euthyroid state which is where you feel great.

Again, I am glad you are seeing the doc sooner and please let us know what his input is.


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## laff66 (Mar 9, 2012)

went in today and explained the sudden onset swollen knees, and now a ridiculously painful wrist. 
He said that based on my last lab results (5 wks ago) that the autoimmune attack was not active?? I asked how a TPO Ab test result of over 800 was not active, and he said because there was not an inflammatory response. I guess hes basing that on the C reactive protein result which was normal. We drew blood, and he said as long as he wasn't overdosing me with Armour based on the labs, we could increase the dose. He also agreed to test Vitamin D based on the incredible info I've gotten off this site! We'll see....


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## Andros (Aug 26, 2009)

laff66 said:


> went in today and explained the sudden onset swollen knees, and now a ridiculously painful wrist.
> He said that based on my last lab results (5 wks ago) that the autoimmune attack was not active?? I asked how a TPO Ab test result of over 800 was not active, and he said because there was not an inflammatory response. I guess hes basing that on the C reactive protein result which was normal. We drew blood, and he said as long as he wasn't overdosing me with Armour based on the labs, we could increase the dose. He also agreed to test Vitamin D based on the incredible info I've gotten off this site! We'll see....


And the swelling knees are because? Painful wrist and there is no evidence of inflammation? I am rather confused about all of this; are you? Was your CRP low?
http://labtestsonline.org/understanding/analytes/crp/tab/test

Will you be able to share your lab results and ranges when you get them?

It would be good to get an ultra-sound of your thyroid.


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## laff66 (Mar 9, 2012)

Very confused, yes. I will definitely post the labs. My crp was less than 0.10, range being less than 0.80. That was five weeks ago though, when I didn't have any knee problem. 
Even with low crp though, if the body is churning out the antibodies, isn't the attack currently happening? 
I should have pressed the issue, but with a slight language barrier, a 5 yo son who was ready to get outta there after 90 min (!) and me still learning what to ask, it didn't happen.


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## CA-Lynn (Apr 29, 2010)

You might want to check with a rheumatologist to see if you have any arthritic disease processes going on.

I mention this because it's important to get an early diagnosis on autoimmune forms of arthritis in order to stop further joint damage. Once joint damage occurs, it is irreversible.

Oftentimes one autoimmune disease ignites another autoimmune disease. Almost like a domino effect. At least for me and a number of other people whose stories I've read on arthritis websites.


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## laff66 (Mar 9, 2012)

okay, thanks, thats probably a very good idea.
I keep thinking its going to go away since it came on literally overnight?? The knee that started first has gotten back to pretty much normal. The second one though still feels really "full" and stiff. Its been about 3 weeks and doesn't seem any better.


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## laff66 (Mar 9, 2012)

Here are my most recent labs:

FT3: 4.4 (2.3-4.2)
FT4: 1.2 (0.8-1.8) **no increase since last labs when on 60mg armour??
TSH: .03 (.40-4.50)

Vit D 25OH Total: 38 (30-100)
Vit D 25OH D2: <4 (no range)
Vit D 25OH D3: 38 (no range)

Rheumatoid factor 10 (<14)

Knee hasn't gotten any better and I'm getting pretty worried about it. Doctor didn't seem too worried about it, but maybe thats why he ran the "rheumatoid factor?"

I'm kinda stumped on whether to go back to the internist thats got me on armour, or an orthopedic doc?


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## CA-Lynn (Apr 29, 2010)

I was diagnosed with Hashimoto's first, then about a year later was diagnosed with another arthritic autoimmune disease that came on overnight. A year after that, another arthritic autoimmune disease......and the lists keeps getting longer.

This is not to say I think you might have Rheumatoild ARthritis, but just put this back in your memory bank: a very small percentage of us with sero-negative RA never show evidence of it on blood tests. The RA factor is always normal. It wasn't until I was about 15 years into it that my CRP, CPK, and ESR started showing some abnormality. Luckily, some of the best doctors practice the "if it looks like a duck, quacks like a duck....." method of diagnosing when all else fails.

See a rheumatologist. As I said before: if you have an arthritic autoimmune disease* you need to get treatment now to halt further damage*. This is not something to "wait and see."


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