Results post RAI and joint pain

[markcomp]

My wife had RAI six months ago and is now working towards a regime that suits her. Other issues are anaemia (previous condition), weight gain plus 3 kg, and more worryingly joint pain particularly in the wrists and elbows that are quite debilitating.

Currently on 25 thyroxine

Test resuklts:

TSH 22.2 mU/L 0.4 - 4.00

T3 4.42 pmol/L 2.6-5.70

T4 11.20 pmol/L 9.00- 19.50

Will go for more tests for anaemia inc B12 and folic acid

Any thoughts on this and the joint pain, is the joint issue related or something else

Many thanks

[cjrsquared]

She is extremely undertreated with a TSH of 22.2, most people feel better with a TSH around one. 25 mcg is only a starting dose, the aim is to increase in increments of 25-50 mcg and have blood tests every 6 weeks until symptoms have resolved and TSH is low in range. The sore joints and weight gain are hypothyroid symptoms. Sadly it often takes 6 months or more to reach an optimum dose and physical symptoms can lag behind blood tests. You are right to also be looking at vitamins and minerals. Once TSH is in range you can then start looking at at ft4 and ft3 to check how well your wife is converting the levothyroxine (t4), the inactive prohormone to t3 the active hormone. It is this conversion process that requires optimal vitamins and minerals. I wish you both well.

[markcomp in reply to cjrsquared]

Many thanks for this, very helpful

[markcomp in reply to cjrsquared]

Just another query (sorry) if T3 and T4 are in range, why is TSH important as it is trying stimulate the production of t4 from the thyroid, which has been removed by RAI. In trying to get the TSH down with the t4 tablets, could she then become overactive again. Especially as she is OK with t3 and t4 now?

[cjrsquared in reply to markcomp]

TSH is a pituitary hormone that is produced in response to the circulating levels of t3 and t4. The pituitary doesn’t know that there is no thyroid gland it is purely responding to levels in the body. Therefore if TSH is high then the ft3 and ft4 may be in ‘range’ but they are not at adequate levels for that person. The only exception to this is if someone has a disease of the pituitary gland itself in which case TSH becomes unreliable.

This is of course a very simplistic model and the reality is much more complicated. There is actually much discussion of the reliability of TSH as it says nothing about the availability of t3 at cellular level, but it is the accepted medical model at present.

It is possible to become overmedicated ( not overactive, as no thyroid gland) but TSH would be suppressed as it was prior to diagnosis with Graves’ disease.

[markcomp in reply to cjrsquared]

so, this begs the question, what harm does high TSH do if t3 & t4 are OK?

[cjrsquared in reply to markcomp]

They are not at the right level for that person, it may be that for that individual their normal is right at the top of the range and that therefore their body will have hypothyroid symptoms. Prolonged hypothyroidism can cause long term damage to bones and to heart and also causes raised cholesterol and increases the risk of type2 diabetes. So short term minimal problems, long term serious problems.

[markcomp in reply to cjrsquared]

many thanks