Aching Joints

[Curious123]

Hi all. I started Levoxine in late August. Currently on 100mcg and T3 and T4 are now in range with TSH around 0.98. History previously hyper now hypo and positive TgAB). However I am getting aching joints a lot on and off and a lot of fatigue. Looking back a lot of these symptoms started just over one month into levothyroxine treatment (around the time my dose went up to 100mcg from 50mcg). I feel awful. Has anyone had similar? Any recommendations for discussing with my GP today?

Latest bloods for reference:

TSH: 0.98 (0.40-3.50)

FT4: 15.7 (9.0-19.0)

FT3: 4.5 (2.6-6.0)

I also had a thyroid ultrasound that said everything looked normal. Other blood results showed my liver function is slightly off (high ALP and GGT, low globulin). My B12, ferritin and vitamin D levels are good (been monitoring these for years). But also slightly low prolactin at the moment (breast feeding stopped over 3 months ago). Thanks!

[Buddy195 Administrator]

How long into your increased dose of 100mcg Levo was the blood test?

[Curious123 in reply to Buddy195]

Over 2 months.

[Jazzw]

I would say, the issue here is that you’re still undermedicated. Looking back at earlier posts it seems you’ve been on 100mcg for at least 8 weeks. There’s a fair amount of wiggle room for another dosage increase.

Have you also had B12, folate, Vit F and ferritin tested? Your TSH was very high before you started Levo—I’ll wager that you’d been hypothyroid for a while, which means that your nutrient levels could be rather low (hypothyroidism prevents optimal absorption of vits and minerals from the gut). So it could be a secondary issue causing the aches and pains.

[Curious123 in reply to Jazzw]

Thanks. Iron but D and B12 are all good. I have PA so do monthly B12 and already take daily due to a past deficiency. I became Hypothyroid start of August after being Hyperthyroid 5 weeks prior so it wasn’t long before medication started. I was diagnosed with postpartum thyroiditis starting with hyperthyroid so we were monitoring bloods every 5-6 weeks and hence caught the swing to hypothyroid.

[SlowDragon Administrator]

Was test done early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

FT4: 15.7 pmol/l (Range 9 - 19)

Ft4 only 67.00% through range

FT3: 4 pmol/l (Range 2.6 - 6)

Ft3 only 41.18% through range

Plenty of Room to increase again

Initially perhaps 112.5mcg daily

Which brand of Levo are you taking

Do you always get same brand of levothyroxine at each prescription

please add actual vitamin results and ranges

with Graves or Hashimoto’s it’s also ALWAYS worth trying strictly gluten free diet

Your profile says you are in Australia…..but posts suggest you are in U.K.

[Curious123 in reply to SlowDragon]

Yep, fasting AM test before daily levothyroxine. I’m on Levoxine. Same brand always.

Ferritin: 97 (30-160)

B12: >1,476 (130-855)

Folate: 28.4 (>6.0)

Vit D: 86 (50-160)

I’m taking 3,000iu vitamin D daily plus vitamin K so this is on its way back up to over 100 vitamin D level (and hasn’t been deficient recently just less than 100 which I try to maintain above 100).

I joined HealthUnlocked from Australia just before I moved to the UK quite a while ago and haven’t bothered to update my profile.

[SlowDragon Administrator in reply to Curious123]

Suggest you

A) get dose increase in Levo

B) trial strictly gluten free diet

[jgelliss in reply to SlowDragon]

👍👍👍👍

[pennyannie in reply to Curious123]

Hello again - and welcome to the UK :

We generally feel best when our T4 is up in the top quadrant of the range with the T3 tracking slightly behind at around 60/70% through the range and it's most important to track on the T3 and T4 readings and not on a TSH reading - which in primary care, in the UK, the usual routine.

The accepted conversation ratio of T4 into T3 is said to be 1 / 3.50-4.50 - T3/T4 with most people feeling at their best when they come in this ratio at 4 or under -

So if I divide your T4 result by your T3 result your conversion of the T4 into T3 is coming in at around 3.92 - so good conversion - and you just need more Levothyroxine to ultimately convert to more T3 and hopefully relieve these symptoms as it is too low a level of T3 for you that gives you all the insidious symptoms of hypothyroidism.

I do not know of the implications of having PA but obviously you need to keep on top of maintaining the core strength vitamins and minerals of ferritin, folate, B12 and vitamin D.

Considering your father has Graves I believe you're looking at Hashimoto's AI disease as mentioned previously -

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