What Treatment for Carpal Tunnel Syndrome with Central Hypothyroidism?

[flutterbylion]

Hi, can you help? Is it worth having steroid injections for carpal tunnel syndrome whilst strongly suspecting central hypothyroidism? To make a long story short, I'm not receiving treatment for low thyroid production yet, but I have been seeing an endocrinologist for the last 6 months who has now referred me for dynamic testing for a pituitary disorder/adrenal insufficiency which seems to take forever. In the meantime the team in another county to whom I was referred for Carpal Tunnel syndrome 3 months ago are moving swiftly. After an electromyography I was recommended to have surgery to relieve the pain and immobility in my hands. I said that my thyroid production is under investigation so would prefer not to have surgery until it's clear what is causing the issue. The consultant suggested steroid injections in the meantime which I agreed to, and have been booked.

Yesterday a new endocrine consultant advised me to postpone the Carpal Tunnel treatment - set for next week - until the pituitary/adrenal tests are done - but they aren't even scheduled yet. So I don't know what to do. I want to relieve the pain, but don't want to go through it if it's all down to 'the deposition of mucinous material or mucopolysaccharides on the median nerve'. I'm 48, female, I have been symptomatic for Central Hypothyroidism for a long time. This year I have also been struggling with muscle, joint and nerve pain and weakness, all vitamins/minerals - D, B12, ferritin folate all bottomed out, my weight has increased substantially, my metabolism is slow. I have hardly been able to get up at times. I struggle to carry shopping more than 2 kilos, or have my hands raised for more than a minute or two without pain.

Would you postpone the steroid injections? Would you put yourself through more pain for a chance of relieving it?

If anyone has experience of this, please reply if you can.

Many thanks x

[Greekchick]

Hi flutter,

Here is an article that directly addresses your question. The steroid can affect your test readings and may give the wrong results to your doctors. It seems the advice in the article is to wait until all your diagnostic tests are over. I realize you have a tough decision as I can imagine the pain you are in.

Hope this helps and here’s the link:

ncbi.nlm.nih.gov/pmc/articl...

Wishing you all the best and hoping you feel better soon.

[flutterbylion in reply to Greekchick]

Many thanks for that. Very helpful. I will postpone it.

[Greekchick in reply to flutterbylion]

You’re welcome! If you are not afraid of needles, acupuncture might provide pain relief and reduce inflammation to help you feel better - and does not affect any blood work readings. I know it works wonders for my back issues, but it’s an individual thing and doesn’t work for everyone. And Tylenol does not affect blood work readings so that might also help with pain relief - it’s stronger than people think. Wishing you good luck and feel better soon.

[LuluCops]

I would also suggest postponing the steroid injections. I have adrenal insufficiency and I’ve also had the steroid injections for my knee and my spine, it is a type of steroid that will impact the test results as it’s the synthetic form of what your body is not able to produce (cortisol) when you have a deficiency.

I know how painful CT is as I had it when my son was born and still have issues now, all I can suggest which I found helpful is to wear wrist splints (I found the ones without the metal in comfier on one wrist, whereas the other wrist I found I needed the extra rigidity of the metal support so I guess that’s down to personal preference as to which to use!??) and nsaids may also help?

Hope this helps

Shelley xx

[flutterbylion in reply to LuluCops]

Many thanks for your advice.

Looks like I need to postpone it.

Kind regards,

Helen

[Gcart]

I suffered with carpal tunnel prior to starting thyroid hormone therapy . 90% better now . I would suggest managing for now rather than messing with any so called treatment !

[flutterbylion in reply to Gcart]

I am sure that most of the pain is down to untreated hypothyroidism. That's why I'm desperate to get it sorted.

Thank you for your advice, I will follow it.

[Bertwills]

Have you seen a physiotherapist? I had 2 steroid injections, which I was surprised to find really painful by the way, but the effects didn’t last long. I didn’t expect much from physio but it was really helpful. They will fit you for supports and give you exercises. I’m much improved with just occasional relapses. At my local hospital you can self refer. I’d see if they can help. You’ve nothing to lose.

By the way, ibuprofen etc affect thyroxine uptake so might make your situation worse.

Good luck,

[flutterbylion in reply to Bertwills]

Thank you for that. I had a steroid injection in my hip joint a few years ago and it was painful and worse for a couple of weeks then much better. I will wait for test results first before following treatment.

Many thanks, H

[meme]

I would be on the phone to the consultants secretary to see if there are any cancellations. I would also get my GP to write and hurry things up.

I had CT before thyroid treatment.

[flutterbylion in reply to meme]

Thanks for your reply. I have been going through a private consultant since March who has now got me into the NHS endocrine service. My results didn't ring any alarm bells with GP as all low/normal - but so is TSH which isn't good. GP got me an appointment for December after pushing by my private endo, but now my private endo got me in this weekend. Unfortunately still got to do all the tests. So things are moving faster than through GP, but still slow.

Thank you.

[Marz]

Low B12 can also impact the myelin sheath that surrounds all nerves and can be involved in CTS. I self-inject B12 for nerve pain in back/legs and have done for many years

[flutterbylion in reply to Marz]

Thanks for your reply. I have been going to GP with weakness, pains, fatigue, weight gain and depression for a long time. Even had a slipped disc incident which was apparently not a slipped disc. As all results have been in low normal range, they just put me through to the carpal tunnel service. Didn't even check vit D, B12, iron etc.

So I paid privately to see an Endo, first thing he did was find out & sort out low D, B12, Ferritin, Folate. I realise I can't absorb B12 orally so have been using patches. First time I put one on it was like a shock to my system - as if I never had it before. Within a week most nerve pain had settled down. I'm not aware that we can get injections without a prescription in UK. But patches seem to help.

Many thanks for your advice.

[SlowDragon Administrator in reply to flutterbylion]

Why can't your endocrinologist start you on Levothyroxine?

Have you had thyroid levels retested since improving vitamin levels?

Have you had thyroid antibodies tested? If antibodies are high cause of hypothyroidism is due to autoimmune thyroid disease also called Hashimoto's. Some degree of central hypothyroidism seems common with Hashimoto's

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Once you start on Levothyroxine......Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Carpel tunnel is extremely common hypothyroid symptom and should improve as you start on Thyroid hormones

[flutterbylion in reply to SlowDragon]

Hi, and thank you. My T3, T4 and TSH are all low but in range. Hence GP wouldn't even look at it. I've had antibodies done all negative. Latest bloods showed lowering t4 and lowering TSH which prompted the endo to refer for pituitary/adrenal testing. He won't give levothyroxine until tests are done because adrenal insufficiency needs treatment before thyroid - if that is the case. Although I don't understand why. He says he must do no harm so needs to be sure first. It's pretty obvious to me that its pituitary based as parents and grandparents both had similar. I have considered replacing thyroxine elsewhere. I understand forum members have been able to source t4 and t3 replacement outside the UK. But it sounds a bit risky. I'm hoping the tests will be in the next few weeks so I can get on with things. 🙂

[Gym4me]

I had carpal tunnel syndrome in both hands after many years on Levothyroxine. I wore splints at night until surgery one hand at a time and no longer have any pain, just some weakness as I had had it for sometime before seeing GP.

I am unable to advise in your particular circumstances which differ from mine and I do hope that you have relief from the pain soon.

[flutterbylion in reply to Gym4me]

Thank you

[Ilander]

I also had CT in my right wrist, which I at first assumed was due to too much time on the computer keyboard. I was also somewhat hypothyroid at the time and read that CT could be a result. I increased my Armour Thyroid dose and in 2-3 days the pain was gone, never to return. If you have untreated central hypothyroidism and live in the UK, you are most likely not going to be treated with anything but T4, unless you find some way to get desiccated thyroid med, or be able to add T3 to your T4. Otherwise it is unlikely you will be able to get your Free T3 high enough to relieve hypo symptoms. Also, be aware that getting to a thyroid med dose adequate to relieve symptoms will require a high dose of T4 to get your Free T4 to top of range or above, in order to get your Free T3 high enough. That will also suppress your TSH, which will be erroneously interpreted as you having become hyper, and in need of a dose reduction. For symptom relief expect that you need your FT4 high enough to suppress TSH, and also get your Free T3 into the upper half of its range. The following link is to a study that quantified for the first time the effect of Free T3 on the incidence of hypo symptoms. The authors concluded, "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."

ncbi.nlm.nih.gov/pubmed/293...

[flutterbylion]

Thank you very much for your advice.