Thyroid UK
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Falls, fractures and thyroid function, are they connected?

Several people have mentioned falls or fractures recently and they have wondered whether it might be connected to thyroid function. It's a question I've pondered too. My coordination seems to have deteriorated after losing my thyroid. The report below seems to suggest that thyroid imbalance. whether over or underactive. is associated with a poor gait and poorer balance and coordination whilst correcting hormone imbalance improves walking coordination. I would be interested in your thoughts, comments and insight.

Apologies if this has been posted before but if so, I must have missed it.

nature.com/articles/srep38912

"In summary, both low and high thyroid function are associated with worse gait patterns. There is an inverted U-shaped association of TSH levels with Global gait, Tandem and gait velocity, as well as a positive association of TSH levels with Base of support. Subjects with clinical and subclinical hypothyroidism have worse gait patterns than euthyroid individuals. These conclusions might have future implications regarding the prevention and treatment of thyroid and gait disorders. Further studies are needed to confirm our findings, determine the underlying mechanisms linking thyroid function to gait patterns and subsequently investigate the possible motor benefits of thyroid treatment."

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To make matters worse.having too much thyroxine in the system for any length of time can also lead to osteoporosis. Obviously hypers are at risk, but also hypos whose levels are consistently too high.

nos.org.uk/media/1584/thyro...

btf-thyroid.org/information...

mythyroid.com/osteoporosis....

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I'm not sure how high levels of levothyroxine can cause osteoporosis for people who are hypothyroid. If there is too much T3 then its converted to RT3 which locks into receptor cells and blocks T3 from entering.

Is the BTF information reliable ion this point? If FT3 is over range then obviously it can cause problems but over-range FT3 can be caused by a variety of factors such as autoimmune disease and antibodies. I would be interested to know if anyone has actually proved that too much levothyroxine causes bone loss?

"The BTA says in the section - Hypothyroidism and osteoporosis, Too much levothyroxine can cause increased bone loss. Be sure to have an annual thyroid function test to ensure your thyroid hormone levels are not too high."

This seems like rather pointless advice since the NHS does not gnerally test FT3 in hypothyroid patients, how would anyone know whether they have too much thyroid hormone or not? Afterall it's the FT3 level that gives that information.

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On the forum, this is generally seen to be a myth. Being hyperthyroid, usually from Grave's does reduce bone density, but most people that make this argument are just inferring that they same effect can result from a TSH suppressive dose of thyroid hormone, or even freeT4 or freeT3 in the top part of the range. But a person with Grave's will have hormone far in excess of what anyone would take as replacement, and I'm not sure it's even known that thyroid hormone in the blood stream is the cause of reduced bone density in Grave's.

I've had a skin of your links, the first one definitely makes this inference, but the third one is very long so have only had a quick skim. It certainly lumps the two, very different, groups of patients together. But it would be worth going through that article and checking every single reference to see if any of then really do show good evidence hormone replacement can impact bone density. Lots of them seem to be treated that way, but it's quite a stretch.

Hopefully someone who is more knowledgeable than me will come along and comment.

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i don't think there's anything 100% proof either way from what I've read at the mo - might be wrong. I've not seen anything convincing in regards to any proof of osteoporosis occurring from too much levo. I don't think the issue of whether RT3 actually blocks the T3 receptors has been proven either to be honest as seen conflicting evidence in the research.

I would believe the Rt3 theory though as when had only had T3 in system and no T4, there was definitely some form of loss of some control somewhere and felt like too much access for T3 and nothing to block it where not required. This is what it felt like anyway and the obvious answer as it stand would be Rt3 can block - as I couldn't make any Rt3 at all.

Regardless, there are obviously a lot of things your body can do with excess T4 as you say so don't really believe it to be true. I would think high T3 would be more concerning or more likely.

And TSH - fail to see how this would make any difference to your bones?

Either way, I think most would agree that they would be happy to put up with weak bones in the last few years of life rather than not being able to get out of bed or live much at all for twenty so possibly besides the point lol :-)

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Just a thought, it seemed more defined in what I read that different parts of your body require differing levels of thyroid hormone so logically, that in itself means there must be something your body utilises that can prevent parts that already have enough from getting more whilst continuing to provide more for the parts that still need it etc. So yes, RT3 more than plausable anyway?

I imagine that a hypo person taking copius amounts of liothyronine or continuously keeping T3 levels well over range might have a similar result to hyperactive peeps but otherwise, I just don't see it?

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I always try to figure out how high a freeT3 hyper folks get up to, as we don't see blood results that often. My sense is that its typically in the 20s or 30s with a range of 3-6.8-ish. So these are numbers you'd be unlikely to reach with hormone replacement.

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Yes, true lol - I was always stopped by feeling toxic and vomiting completely stopping me from popping another - it makes me more tired than hypo. But..... I have seen one or two with near 20 whom kept thinking their symptoms were hypothyroid not realising that hyper could make you feel just as tired and kept taking more lol ;-)

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I remember there was one girl about a year ago who had been self treating with T3 without help or understanding her test results and finally found her way here seemingly near on heart attack and you could tell it was so bad that it was affecting her decisions - her levels were shocking! I think we advised her to go to the hospital but she still didn't ssem to grasp she could be hyper :-(

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My coordination in general seems better since I have been on t4, I am much less clumsy.

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Loads of different things that have occurred over the years either through thyroid or the NCGS which have caused issues with walking and balance. I had ataxia when first diagnosed as they refused a blood test simply offering ADS for 8 yrs prior so was in a very bad way and falling all over the place the last year, couldn't even put something in the cupboard.

The deficiencies have often made it difficult in in different ways like vit D deficiency made my bones so painful, iron deficiency made me too weak to move properly and would near pass out sometimes and couldn't breath and so on.

I had massive inflammation in my legs most this time too making them too heavy to lift sometimes and made me shuffle more - although this cleared after going GF. My bones were also low density until this time too but recent dexa scans show they have now recovered to normal since.

Never actually broken anything though as was super non clumsy as child and moved too slowly so managed to fall in slow motion and somehow twist into right position lmao!!!

Childbirth was another matter though and best forgotten!!!!!!!

It also appears, according to the chiropractor, that I must have developed a very bad habit when younger and used my bones instead of muscle to move - maybe because muscles were too weak or unstable - like I lock my knees in place with my bones straight on top of one another forcing down to stay standing rather than use muscle which is apparently very bad for bones - knee hyperextension I think it's called . And If I'm walking or even skiiing, I shift my hip bone and somehow use momentum to swing my legs. There's literally no muscle in my thighs because of it ;-)

Anyway, if I'd relied on my muscles through some of these periods, I would have fallen over a whole lot more I imagine.

All these are better for some time now and no more specific issues with legs but I would also say that since thyroid function has gone completely and 100% reliant on Meds, there is something that feels different or off with my balance and coordination - can't really explain.

So yeah I can imagine that's definitely true :-)

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When I was undermedicated it definately affected my balance. I fell down a series of steps and cracked several ribs purely because I couldnt maintain my balace on the top step. Now my thyoid hormones are optimised no more balance issues.

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My balance is affected when I need my B12 jab ..... most thyroid sufferers have low B12. Good test results for B12 just tell us what is in the blood but it needs to be in the cells. When the MMA result is high it could well indicate Low B12 in the cells 😊

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This makes sense to me as before diagnosis I found myself getting clumsier, losing balance occasionally, or bumping into things. Sometimes it would feel like a brief moment of vertigo or dizziness; sometimes I'd just bump into something that I'd normally miss or lose my balance for no apparent reason. Thankfully I never actually fell or hurt myself worse Thana bump or bruise 🙂. I think it's improving now I'm on levo.

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Absolutely no question I am surprised it has taken this long to make a connection between balance gait etc. Prior to T4 therapy I was regularly falling, collapsing etc. Post T4 therapy and undermedicated experience these motor hiccups regularly.

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My balance was more out of whack when my B12 was low, I never noticed much of a problem with just my thyroid. The underactive thyroid just slowed me down and made my legs feel heavy.

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I fractured my patella last August which I put down to stupidity. I was standing on a table scraping the ceiling, slipped and fell to the floor landing on my knee.

Now I'm beginning to wonder if it wasn't 100% stupidity after all!

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When my back really started to 'go' after pregnancies I knew I was walking funny and it wasn't sustainable, so was referred to a physio. At this point I had no idea that it was due to gut issues and problems with thyroid, and absorption of b12 and iron (even though I'd had IBS for years). She helped a bit as she could see where things were badly aligned, but it wasn't a long term solution.

I'm guessing that the people who manage to turn things around with Levothyroxine only are good converters without the added complication of other gut issues / enzyme generating problems and the higher t3 will increase stomach acid and help them take up minerals and vitamins without the need to supplement. The more I've read, the more I believe hypochlorhydria is something we should all try to avoid.

drmyhill.co.uk/wiki/Hypochl...

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I keep falling over and even fractured my wrist on one occasion. My husband now grabs my hand when we are walking together and I'm wearing high heels to stop me tripping up as he has seen my fall down too many times. Pretty much given up on wearing high heels now sadly. I think it is definitely all connected but, as others have said, it could be the vitamin deficiencies caused by hypothyroidism as well as/or instead of the actual low hormone levels.

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