RA and autoimmune hypothyroidism

[virtualreality]

Hello all, a happy Monday to you. Has anyone experienced or know about potential interactions between RA and treatment for autoimmune hypothyroidism by any chance?

I've had hypothyroidism for many years which until recently was treated and stable (first with T4 only, more recently with T4+T3 combination); I developed RA last year. Since then, my TSH has started to rise and is now markedly higher than it's ever been on stable treatment (though still technically in the 'normal' range at the moment).

My RA symptoms aren't yet under control and I'm taking a bunch of prednisolone alongside DMARDs, but I'm starting to wonder if some of them (fatigue, brain fog etc) might be at least partially due to slightly undertreated hypothyroidism and not RA. I'm struggling to taper prednisolone at the moment and if some of the issue is actually due to needing a bit more T4 that would be useful to know (and easier to fix!).

Does anyone know if the RA disease process and/or medications (I'm on MTX, HCQ and prednisolone) can disrupt thyroid function parameters by any chance? Or has anyone with both conditions found that their thyroid replacement needs tweaking after developing RA? It's something I'll ask my doctor about at my next appointment, but would be very grateful for any personal experiences or insights here as well. Dealing with this condition feels like a constant balancing act!

[Neonkittie17]

I feel it could be the Pred as I recall my endo saying it’s makes conversion of T4 to T3 harder. Also blood tests not to be done near to a course of oral steroids if possible but difficult if you’re on Pred long term. I got diagnosed in 2005 with Graves/hyperthyroidism which was 10 years after RA diagnosis. My RA was not under good control and both seemed to make each condition worse over the next few years but after a couple of years the thyroid got under control and I’ve been euthyroid/normal thyroid with 10mgs low dose Carbimazole daily since. Regular blood tests show they are right where they should be.

Mtx has never affected my thyroid/med but again doesn’t mean it couldn’t affect others. Hope you can remedy this soon. Do ask your endo and rheumy on this. Good luck.

[virtualreality in reply to Neonkittie17]

Thank you Neonkittie17 , appreciate this. Very interesting about pred affecting T4 to T3 conversion. My free T3 is very low in range which is unusual, so that could certainly be a factor. I did a bit of searching for info about potential interactions before posting but the only info I came across was the pred can suppress TSH - though in this case it looks like the opposite is happening. Very glad to hear you managed to get things under control eventually.

[Neonkittie17 in reply to virtualreality]

Thank you. 💗 I had a very difficult time re weight loss and palpitations, but it got sorted out after a couple of years. I too thought at first that Pred made your TSH lower but seems it can be the opposite. I hope you can ask these things to your consultant too.

[medway-lady]

Its not just the T4 but also T3 and TSH that has to be tested and I had this problem last year and GP looked at the lot to increase the thyroxine by 50% after years of a stable dose. But he said it was just a normal variation and not linked so I know that it's best to get it all checked.

[virtualreality in reply to medway-lady]

Thanks for sharing that, how interesting that you had the same thing happen. Sounds like a thyroid meds review would make sense for me too. My free T4 and free T3 are both unusually low (though in range, just about) which fits with the increased TSH.

[Thingybob]

I developed hypothyroidism after a goiter was removed. Then RA arrived 3 years later. There's lots of info and research around about strong links between both conditions. ( and many others.....) I was told that thyroid levels can be within the general normal range but still not be the right level for the individual person.

I asked my rheumatologist if MTX affected levo efficacy or thyroid function and she said not .

I often wonder whether the symptoms I get are RA or thyroid related as many are similar , particularly the fatigue, foggy thinking, and aches. And is the dry skin thyroid related, RA drugs, dehydration , seasonal or heating..........??? Its so difficult to unpick. I believe the efficacy of levothyroxine can vary between summer and winter and thyroid function can worsen with age.

[virtualreality in reply to Thingybob]

Thanks for your reply, Thingybob , very helpful to know that MTX is unlikely to be the culprit. Narrows things down a bit!

The overlap in symptoms is really hard to unpick when there are so many similarities, then with the medication side effects on top which also include foggy thinking for me. I definitely agree that just being 'in range' with thyroid levels doesn't necessarily mean you're where you need to be at an individual level; I had a lot of help from the Thyroid UK forum on here looking into exactly that a few years ago. Hopefully the doctors can help me get to the bottom of it.

[Marionfromhappydays]

I was diagnosed with hypothyroidism 15 years before my RA struck, so far my thyroid is behaving although mine is quite mild and am a low dose of thyroxine.

I know they've kept an eye on my TSH and Ft4 because of my RA so I would guess that being in the middle of an immune storm could affect it.

Hope you get things sorted on your medication front for your RA.

Sorry I cant be of more help

[virtualreality in reply to Marionfromhappydays]

Thank you Marionfromhappydays , it really does help to know there are other folks out there in a similar situation! And that your TSH/FT4 was monitored more closely because of RA being part of the picture. Makes me feel more confident about raising the question at my next appointment.

[Hidden]

I have my Thyroid function tested regularly for un der active and am on Thyroxine. I have had this for the 20 odd years whilst with RA and have never had any problems. Yes you need to have this looked at via your GP or/and RA team. I have been on numerous medicines whilst with RA.

[virtualreality in reply to Hidden]

Really good to hear you haven't had any problems with thyroid replacement over the years - thank you! I will ask at my next appointment and see what they say about my latest test results.