I was diagnosed with Hashimoto's about 6 months ago (34-year-old male), with a TSH of 5.1 and FT4 in the lower quartile, and have been slowly increasing levothyroxine (currently on 75 mcg) but have not achieved the desired TSH level (<2 according to my endocrinologist).
In addition to experiencing fatigue and feeling generally 'unwell', I have also been experiencing pervasive 'dull' pain in my lower right side (lower right quadrant). The pain appears to reside south of my liver, and I have previously had a clear ultrasound.
I'm wondering if anyone else has experienced flank pain, or have had experiences of pain specific to other parts of the body? (I know that many people with hypothyroidism experience vague and nonspecific pain).
Thanks!
Adam
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Slabs
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It is a learning curve if we have hypothyroidism and if levothyroxine is not solving our clinical symptoms.
Pain is a common occurence in hypothyroidism particularly if your FT4 and FT3 are low. These are rarely tested but you can get a private test from one of our labs. Few doctors test more than the TSH and T4. Medichecks in particular have a Special Offer this week:-
Once we are on levothyroxine, which is T4 only, it has to convert to T3. T3 is the only active thyroid hormone needed in our millions of T3 receptor cells.
Most doctors and endos only appear to take notice of the TSH and T4 but a Full Thyroid Function Test will give more information. Sometimes doctors diagnose 'clinical symptoms' as nothing to do with a dysfunction of the thyroid gland and will give us prescription for the 'symptom' but don't check our hormones and pain can be a frequent occurrence. The best way to realise that our dose is working is relief of all our symptoms.
A Full Thyroid Function test - and all tests have to be at the very earliest possible, fasting (you can drink water) and also allow a 24 hour gap between your last dose of levo (which should always be taken with one full glass of water) and the test and take afterwards. This helps to keep our TSH at its highest (it drops throughout the day) and may stop doctor adjusting dose unnecessarily.
A Full Test: TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.
Get a print-out with the ranges and post for comments.
Our researchers have had a Paper accepted which states that many need a combination of T4/T3 but the NHS have recently stopped prescribing T3 due to the supplier increasing one pack from about £30 to £600. Many members source their own now and many patients have been left high and dry with sudden removal of their dose.
The aim is a TSH of 1 or lower with a Free T4 and Free T3 in the upper part of the ranges and relief of clinical symptoms. We don't pay too much attention to the TSH once we're on a dose as the Frees tell us more..
Unfortunately, as you anticipated, my endocrinologist has only ever tested TSH and T4. I asked specifically about the optimal values for TSH and T4, and he told me <2 for TSH but there is no 'optimal' value for T4 as the test has poor sensitivity.
I will read more about how measuring free T4 and free T3 can help me better assess my response to levothyroxine. Since am I still in the process of gradually increasing my dose of levo until I reach a TSH <2 (per my doctor's recommendations; hopefully closer to 1), when do you recommend I get the addition tests done from a private provider? (since I'd want to minimize the number of times I have to pay for these tests).
I was aware that some people (research suggests 1 in 6?) do not respond well to T4 monotherapy alone, as you suggested, but I guess I will cross that bridge when and if I come to it.
As Shaws says you can get all sorts of weird and wonderful symptoms with hypothyroidism. Hypothyroidism is known as the great mimicker....lol. However your pain does sound a little like gall bladder stones. Thats exactly how mine presented. However an ultra sound should have shown them up!
Have you had vitamin D, folate, ferritin and B12 tested?
How long have you been on 75mcg? Should be retested after 6-8 weeks and increased in 25mcgs steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range
As you have Hashimoto's have you had blood test for coeliac disease?
Are you on gluten free diet? If not something to seriously consider
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's gut and gluten connection is very poorly understood
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Ideally ask GP for coeliac blood test first if not done already
Thanks for the insight, I have been on a GF diet for years as I either have a gluten intolerance or Coeliac. I have always refused to do a weeks-long gluten challenge because ingesting any quantity of gluten makes me incredibly ill.
I have had vitamin D, folate, ferritin, B12, calcium, and magnesium tested; all were within normal ranges.
As for levo, I have been on 75mcg for 3 weeks with a blood test due in another 3. As they will only ever test my TSH, that seems to be the only criterion for moderating my dose (unfortunately).
Hi Slabs, Yes to your question, I am only too familiar with right flank pain. It did not go away until I reduced the oxalate content in my meals (& maintain adequate fluids). Foods like spinach & peanuts are high. To view a list google: regepi.bwh.harvard.edu/heal.... I personally think my flank pain was a (later) manifestation of the "leaky gut" that this Healthunlocked site goes into in some detail. Unless you have taken a fall on that side awhile ago & forgotten all about it. In which case you may have a "trigger point" in that area which a Physical Therapist could alleviate. I'll put my money on oxalates however💰.
Thanks Clarrisa, that's incredibly helpful, I will definitely give that a try! As I am on a GF diet, I do eat a lot of potatoes (which are high in oxalate according to the spreadsheet you linked to).
I've noticed over the years that these lists of high oxalate foods vary from site to site. I think it may be due to the methodology utilized to test the food & perhaps the age of the food tested. If you view several different lists you will get a feel for the biggest culprits to avoid. Should you find avoiding them diminishes your flank pain then note that dedicated organizations like the Oxalosis & Hyperoxaluria Foundation will likely have the most up to date information, as this is often a matter of life or death for their family members. I myself try to follow the Mayo Clinic patient management pamphlet called Nutritional Management of Enteric Hyperoxaluria. It is not as strict as some resources I've seen. I do think my flank pain plight was brought on by "leaky gut" because each & every time I've strayed from gluten free I am back to square one with what started out as strictly right flank pain but over time has spread elsewhere too. Take home message: Stay on the straight & narrow gluten free path & never binge on oxalates rich foods like nuts.
Hey i get this pain too but mine makes me feel sick too, i have gp appt next to request a ultrasound for gallstones. I also eat alot of potatoes as i am celiac.😊😊
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