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Thyroid UK
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lower leg (shin) pain

Could anyone please give me som info regarding tenderness I am experiencing along the inside of my shin bone on both legs. Is this tendonitis? I have Hashimotos

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Low VitD ?

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Hi, I'm afraid I can't offer any explanation, but I also suffer with painful shins & have done for years. I was diagnosed with hashimotos and started thyroxine 4 weeks ago. I have a large, painful swelling at the top of both my shins, making me embarrassed to show my legs. I showed my Gp but they just scratched their head & said they didn't know what it could be! So, I'll follow with interest in the hope somebody offers advice about our shins! Best of luck & any advice will be greatly appreciated 😊 x

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I have suffered lower leg pain for years. More specifically on my left ankle and foot. Doctors believe it to be muscular but I also have clicking and painful joints and very painful achilles tendon. There is no rhyme or reason to when I get the pain and I go from almost painless walking to being crippled with pain during the same day often. I also have Hashi's. I have read somewhere that being Hypo affects the achilles tendon somehow. It makes me wonder if it is not weight related but fluctuating hormones. The docs and Endo seem to accept this as being a large part of the problem. However, even though I have asked for an x-ray, the docs won't give me one. They didn't even want to send me to physio because "they will just tell you to lose weight". First indicators that they don't want to spend any money on me because I am obese.

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Sounds like you're vastly Under-medicated!

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I thought that too initially but my TSH is below 1 so not quite sure where I go from here.

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TSH is irrelevant on its own. In many people it will go down as soon as they start taking Levo, so is no indicator that you're on the right dose. What you need to do next is get your FT4 and FT3 and antibodies tested. If your doctor won't do it, then maybe you could do it privately. And, while you're at it, get your vit D, vit B12, folate, iron and ferritin tested.

There could be all sorts of situations that mean you're under-medicated that the TSH will not indicate.

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FT4 and FT3 are good as are folates, ferritin, vit D and B12. Can't afford to do any private tests. I have bloods done every 26 weeks. Next lot due in 2 weeks.

I have felt rubbish since Christmas especially since having a 2 month chest infection. However blood dept are at least doing all the tests now. They stopped doing T4 and T3 for a while saying it didn't help. June 2013 antibodies was 35 but they have not tested since. Adrenals checked and we're fine. Most of the time I just want to sleep.

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Yes, but 'good' and 'fine' aren't diagnoses, they're opinions. Whose opinion, yours? Or your doctor's? Is you B12 900+? If not, it isn't fine. See what I mean?

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No B12 650 approx upper end to above the normal range here. Vit D higher end of range. T4 and T3 at higher and lower end of the ranges where they should be. I am slightly anemic and have been since they started testing. Supplimenting with ferrous fumerate (?) gives me constipation and upset tummies. I do see what you mean but it is very difficult to do anything more than I can do. I am pretty thyroid savvy and won't take their rubbish and they know it. But at the end of the day I also need to be careful not to self medicate in such a way that I cause myself harm. It is very obvious they are not interested in thinking outside of the box. I also was supposed to see my Endo today but I had no reminder phone calls the week before as I usually do. I just rang to find out when it was and got a lambasting because it was this morning. Finally got an appt for September. Could of done with out that happening as I wanted to get my bloods done ASAP. The doc and Endo don't want to suppress my TSH, probably scared I will have a heart attack at my size. I am sitting here 6th June as cold as ice. Yes I am probably not right but on paper I am more than ok.

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But, Daizee, it's not about the paper, it's about how you feel.

Optimal for B12 is 1000, ignore the stupid ranges, you can't over-dose on B12, and you'll feel so much better if it's higher.

So, FT4 is at the high end? And FT3 is at the lower end of the range? Who told you that was where they were supposed to be? They aren't. FT4 should be somewhere over mid-range, and FT3 nearer the top of the range. If the FT4 is higher than the FT3, that means you're not converting properly, and that could be the cause of all your problems - including the weight gain.

I understand your concerns, but it sounds like your doctors are treating you in such a way as to cause you harm. You cannot survive for long with an FT3 at the bottom of the range, it will affect your heart and all sorts of other things.

The TSH is meaningless, a suppressed TSH won't give you a heart-attack no matter what size you are. You Don't need to have TSH. It's major function is to stimulate the thyroid gland, and if you're taking thyroid hormone replacement, you Don't need it to stimulate the thyroid.

OK, so it does also stimulate conversion - but it doesn't seem to be doing a very good job of that at the moment! So, why do you need TSH? Ask them that and they won't be able to answer you. But what probably is going to give you a heart attack is trying to survive on no T3.

Well, it's your decision, but I sure as hell wouldn't settle for that. I'd want to start taking T3 and gradually - very gradually - build up my level.

Oh, and there are other forms of iron that Don't affect your stomach - Solgar's gentle iron, for example. Or you could just try taking a heap of vit C with your iron, to aid digestion and avoid constipation.

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I don't remember exactly the figures for T4 and T3. I will go and check them. Please don't assume til I have given you the last figures. I have asked about T3 supplimentation but they are not interested. Bare with me I will hook out the last lot of results.

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OK From October 2014 - I actually thought it was December.

TSH 0.62 mlU/L (0.3-3.94)

Serum FT3 4.6 - don't know the levels as I phoned the docs for this

Serum FT4 19.5pmol/L (12.3-20.2)

No range for D last time but was 84 back in the Summer of 2014

B12 512 (191-663)

Will get a print out of the rest when I go in for bloods as they are getting repeat blood forms done for me.

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Ok, but when you say something like : FT3 is at the bottom of the range, where it's supposed to be, that makes me freak out. lol

Difficult to tell without the range, but that FT3 could be lower than it should be.

Of course they're not interested in giving you T3, it costs a fortune and they know nothing about it.

Vit D is fine, but that B12, the range is stupid. The Japanese ranges starts at 500. It should be much higher than that, but you'll never get a doc in the UK to admit - or even know - that. It would be best if you started supplimenting on your own, with sublingual methylcobalamin - about 1000 mcg or so.

Anyway, does your doctor only test once a year? They do have the strangest ideas about thyroid - a lot can change in a year. If so, you've got a few months to go til the next one. But, if you start seeing a return of symptoms, you should go straight back and ask for a test. :)

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No they usually test every 6 months. I do suppliment with sublingual B12 Boost spray. I use the vit D spray too. I also take 3000mg Vit C daily too so that didn't help the iron thing. Phoning tomorrow to get blood test appointment.

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Good idea. But do try a different sort of iron, I'm sure it would help.

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...sorry to read about your painful bits. Do you have lower back issues ? Are your hamstrings tight ? When lying down can you raise your legs - one at a time and straighten them ? If not then the hamstrings are tight and need stretching gently - which will have a positive effect on the muscles and tendons of the lower leg.....and surprisingly the lower back ! The muscles above the knee attach to the bone below the knee - and the muscles below the knee attach above the knee - so when both sets are tight or restricted knee pain may also ensue.

When lying on your bed - take a breath in as you raise your leg and exhale as you try to straighten it.

I also agree with all the advice given by Greygoose - this is just an optional extra :-)

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Same for me. I go for a walk and in little time at all have painfully sore feet. I also get inflammatory pain up my shins. I am only slightly overweight for my hight. No doubt it is Hashimotos, but I would really like to know what is actually happening to my feet and legs that is causing the pain. If you have burning feet as well, you should ask for a Vitamin B12 blood test...You could be deficient. Vitamin B12 deficiency often mimics plantar fasceaitis as does Hashimotos.

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Hello Magnolia, it sounds to me as though it could be shin splints, which is muscular and easily dealt with. It might be good to try exercises for this area first and go to a podiatrist second. I had problems with this and still do the exercise. PM me for details.

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Is your Hashi's optimally treated? Are your vits and mins optimal? More information would help us help you. :)

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I am within the reference range (TSH when last tested 2.5), but my doctor (like most) is ruled by the reference range although he says symptoms are important and that going by clinical symptoms is the right way to go. It's just that when it really comes down to it, he believes that if you are within the reference range it must be something else like old age (I am 68)! I am on a gluten free dairy free diet. I eat healthily and consume enough vitamin supplements to sink a battleship! I get plenty of exercise.

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Where TSH is concerned, the reference range is more or less meaningless. What were your last bloods, do you have the numbers? If not, you should ask for a print-out so that you know exactly what he tested and what the results were. You can't take charge of your health groping in the dark. And you have to take charge, because doctors are clueless when it comes to thyroid. I doubt he knows what the symptoms are!

And how much Levo are you taking? For how long? What do you mean by 'plenty' of exercise? What suppléments are you taking? No point in just taking a fistful of pills if you Don't know what you need.

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PS. Have never taken Levo. I belong to folk dancing clubs. I do not have a car, so I do more walking than most. I do zumba once a week. I take magnesium, vit B complex, vit B12 sublingual drops, vit B5, vit K2, vit D3, zinc, selenium, calcium and ashwagandha. I am gluten and dairy free. My serum cortisol levels taken recently were 790 (ref range 250-700). My urine has a strong smell but my doc does not think my cortisol levels are anything to worry about!

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Oh, I'm not criticising the amount of exercise you get! Heaven forbid! I'm just concerned you might be doing too much. Exercising uses up your T3, and if you haven't got enough to begin with, it's going to leave you badly off. If you are having trouble converting, and doing a lot of exercise, your T3 is going to be very, very low and could cause all sorts of problems. But I bet your doctor's never even done the FT4 and FT3 so that we can find out.

We will never find out what's wrong if doctors Don't do the right tests! Sigh.

So, did you know your B12 etc levels before you started supplementing? How much are you taking?

I take it that serum cortisol was done about 8 in the morning, yes? Not a brilliant way to check someone's adrenals. A 24 hour saliva test would be better, because levels change throughout the day. If yours is high in the morning, I'm wondering what it's like the rest of the day. Cortisol tends to get high when the adrenals are struggling to make enough, but that's usually at night, not the morning. Might be something to keep an eye on.

Are you taking plenty of vit C, and getting lots of salt? Adrenals need those. And how about iron? Is that OK?

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Actually, I self-referred for my FT4, TSH and FT3 tests at the local laboratory. Patients can self refer for some tests but not for thyroid antibodies. To have the 3 above tests done, it costs about $38NZ. Since then, my GP has ordered all 3 tests. I did have an extremely low serum level of B12 (85) before prescribed injections but now my serum level is very high (1600!). The question is: Is all that stored B12 available to the tissues. Certainly the perpheral neuropathy caused by the deficiency has stopped, although the tendons in my feet get sore after little walking. I have discontinued the injections and now rely on sublingual drops in a methyl form which can be immediately utilised by the body. Unfortunately the 24 hours saliva test for adrenals/cortisol is not available where I live. I used to wake up at 2-3am every morning (adrenal fatigue?), but now that I have been prescribed melatonin and have a mouth splint to stop the snoring and my airway blocking, I am sleeping much better, now waking up at 5.30-6.00am after 6 hours. The mouth splint isn't so awful as it sounds. The dentist takes an impression of your upper and lower teeth and the device made from a plastic material fits over the teeth, pushing the lower jaw slightly forward to open the airway. This type of device is commonly used by abstructive sleep apnoea sufferers. There are a number of studies available on the net that show a relationship between hypothyroidism and sleep apnoea. Evidently the soft tissues at the back of the tongue and in the airway can swell causing a narrowing and obstruction of the airway. Apparently adrenalin starts to rise soon after retiring to bed at around 3 am and cortisol peaks around 8am. I suspect it is the stress caused by sleep deprivation and by my last GP who insisted upon relying on Lab results regardless of clinical symptoms. My basal temperature is still low (average was 36.2 now creeping up to a 36.4 average), which I attribute largely to the adrenals problem, as the pituitary gland is involved in the production of both TSH and adrenal hormone. I have read that one should try to heal your adrenals before sorting out thyroid hormone production problems. I am so very often frustrated by the ignorance exhibited by most doctors.

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Don't worry about the high B12, it's fine. Good that the neuropathy has stopped.

Sounds like you're soon going to know a lot more than your doctor! But the fact that you need that splint suggests that your T3 is still too low. And it doesn't matter whether the fault lies with the adrnelas or the pituitary, it still needs correcting or it's going to cause problems. Can you not get T3 in NZ?

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I am on compounded NDT 50mg (equivalent 'Armour'). Yes, you can get synthetic T3 in NZ, but not many doctors are willing to prescribe it. Maybe I could convince my doc to up my NDT, but it's the old story "You are in the reference range (TSH 2.5, FT4 10.7, FT3 4.7 on 13/4/2015) so there is nothing wrong with your thyroid. Here, have a 'happy' pill". I shall simply have to resort to the old ploy already used...Have a fasting serum lab test at 7am to take advantage of the circadian rhythm. On the other hand, taking more T3 could put more strain on my adrenals. I have heard that the adrenals should be healed first.

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In an ideal world, they would be, but this is far, far from an ideal world, so we just have to make do as best we can. So, what are you doing for your adrenals? Are you getting plenty of vit C and salt?

Obviously you should get your blood test done as early as possible in the morning, that's what we always tell people. It's not a ploy, it's common sense. If you can possibly have it taken at 7 am, why would you have it done any other time? What time was the last test done?

You are on a very low dose of hormone, and your TSH is much too high, even if it is 'in range' - makes me so cross that they Don't understand about ranges! So, if you can possibly get an increase by any means, then go for it!

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The last test (TSH 2.5) was done late morning. The previous test (TSH 4.5) was done at 7am and my FT4 was just below the range. After the 7.am test , my medication was adjusted upwards by 5mg to 50mg

I am getting plenty of salt. I use Himalayan (pink) salt crystals which are high in trace elements. I have not been supplementin with vit C but I do eat a lot of fruit including kiwi fruit and oranges. My urine smells strongly of ammonia especially at night so I wonder if it is a symptom indicating a problem with my adrenals (high cortisol). I have not been able to find out anything via the internet

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Sorry, can't help you with the ammonia smell, but I've never heard that that indicated high cortisol.

So, TSH 2.5, done late morning. It would have been even higher had it been done at 7.00 am. And it's too high even at 2.5.

An increase of 5... mg? Don't you mean mcg? 5 mg would be huge. But 5 mcg is rediculous. Was there a reason for such a small increase? Increases are usually by 25 mcg at a time. And you still need more.

Do not assume that you are getting enough vit C just because you eat a lot of fruit. It's not about how much we eat, it's about how much we absorb. And hypos are notoriously bad a absorbing. Besides, I doubt you could eat enough fruit for your vit C needs at the moment without ingesting far too much fructose. Best to just take a good vit C supplement. :)

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NDT is measured in mg not mcg. having said that, the lowest compounded dose is 15mg and 60mg is the usual starting dose. You can get a conversion chart converting Armour from grains into mg and the synthroid mcg approximate equivalent

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Ah, yes, ok. Not used to talking about NDT in mgs, we usually talk about grains.

Even so, 5 is a tiny tiny increase when 60 mg is the usual starting dose. And you obviously need more because when one is on thyroid hormone replacement, the TSH should be around 1 or lower, not 2.5, and you have symptoms because your TSH is too high and your FT3 is too low. There's just no getting round that, whatever your doctor says.

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On 11th March 2015, my bloods were: FT4 9.5, TSH 4.9, FT3 3.5. (taken about 7.30am, before thyroid medication)

On 13th April 2015, on the same thyroid medication dose, my bloods were: FT4 10.7, TSH 2.5, FT3 4.7 (taken about 11.30 am after thyroid medication)

Since then, my NDT dose has been increased from 45mg to 50mg but I do not feel any better. My sleep is crap (I wake up 2-3 every morning) and my lower legs and feet ache. I have nerve pain from my right shoulder right down my arm and I have sore eyes. I cannot recall some words that I should know. I have managed to get prescription for NDT but like most doctors, my GP believes in the gold standard of the TSH and the reference range. It is all so damn frustrating!

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Because your dose is too low and your FT3 is too low and your TSH is too high. And whatever your GP 'believes', it is making you ill. Can you not change doctors? Or self-treat? See an endo? You can't go on like that.

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Hi, magnesium spray has really helped the pain in my shins. A.

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