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Q. I have a low functioning thyroid which my doctor is unable to regulate. Please help.

Answered by
Dr. Ashaq Hussain Parrey
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 10, 2018

Hello doctor,

I have been searching for answers for over three years. The past two years, my quality of life on a scale of 1 to 10, has been a 2. I am grasping at anything to find the answers. My doctors have not helped. I was diagnosed 15 years ago with fibro/CFIDS, and very low thyroid, which they cannot get regulated for some reason. The fatigue and brain fog have been unbearable. Then came the IBS, severe pain and diarrhea after every meal, low magnesium, and vitamin D levels. Then, five months ago, I developed a severe pain in my wrist, throbbing, piercing pain that never leaves and I cannot use my arm at all. I had an MRI of my wrist and it showed 'severe edema and erosion of the bones, most likely due to an autoimmune disease as RA.' On some days I cannot get out of bed and those days that I do, I am not able to do anything productive. My orthopedic specialist referred me to a rheumatologist but they cannot see me for six months. I have also developed dental infections and have had two abscessed teeth in the past year. From my research, I found that all of these symptoms may be related, but my GP has never mentioned it. He even suggested I may be depressed and prescribed antidepressants. The pain all over, and the severe pain in my arm and wrist, I know are not from being depressed. I need any advice you can give me. I am about to give up and living like this any longer is not an option. I do not want pain meds. I want a diagnosis. Thank you.

Dr. Ashaq Hussain Parrey

General Medicine Internal Medicine Rheumatology
#

Hello,

Welcome to icliniq.com.

I went through your post. I will try to address each point one by one.

  • You have been labeled as chronic fatigue syndrome (CFS). It is a diagram of exclusion, and there are no effective meds except sometimes treatment with antivirals have been seen effective. However joint inflammation does not occur in CFS as is evident on your MRI. So, I do not think you have CFS.
  • IBS (irritable bowel syndrome) is predominantly seen in people with a lot of stress in the day to day life. I think dietary modification with a restriction on non-vegetarian foods and tablet Rifaximin 200 mg twice daily for one week should settle the problem.
  • Your thyroid function test is abnormal with a low T3 T4 and high TSH (thyroid-stimulating hormone). You are hypothyroid. All your symptoms can be related to it. You need to increase the dose of replacement of Levothyroxine.

Regards.

For more information consult a rheumatologist online --> https://icliniq.com./ask-a-doctor-online/rheumatologist


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Thank you doctor,

My TSH has been as low as 0.039 while my T3 and T4 are also low, which should not be the case. My MRI report is attached as a photo, thyroid labs were: free T3 3.0 (range 2.3 to 4.2), free T4 0.77 (range 0.89 to 1.76) and TSH 0.070 (0.550 to 4.78). The thyroid test before this one was TSH 0.049, free T3 3.0, total T4 4.9 (range 4.5 to 10.9). My new endocrinologist said he only looks at the TSH, and the rest is useless. Even though my T3 and T4 were low and borderline low, I was having hypothyroid symptoms. He decreased my meds and I was very sick for two months when my TSH was 24. So, my GP increased my meds back to what I was originally taking and my TSH is now 0.070, free T4 0.77 (low) and T3 is 3.0 (again is borderline low considering my TSH is under 1. My CCP is 5 units, which is negative I believe. The CRP was done a few years ago and it was less than 4.0. ANA was negative. I only have a photo of my MRI report. Thank you for any feedback.

Dr. Ashaq Hussain Parrey

General Medicine Internal Medicine Rheumatology
#

Hello,

Welcome back to icliniq.com.

  • You seem to have central hypothyroidism. If your endocrinologist says he only sees TSH, he is absolutely wrong because the TSH level is dependent on T3 and T4 level. It is T3 and T4 which are the functional components of the thyroid, while the only function of TSH is to regulate the levels of T3 and T4. TSH is produced by the brain. So, if your T3 and T4 are low, you need to increase the dose of Levothyroxine further despite the low TSH and get investigated for pituitary hypofunction.
  • You have inflammatory arthritis of the wrist and no other joint is inflamed. Your markers for rheumatoid arthritis are negative. So, it is highly unlikely that you have rheumatoid arthritis. If I was your treating doctor my diagnosis would be inflammatory monoarthritis and I would treat it with a single intraarticular shot of Triamcinolone, and look for signs or spondyloarthritis and gout instead of thinking of rheumatoid arthritis. Rheumatoid arthritis involves multiple joints especially small joints of the hand and causes fever and stiffness.
  • For the time being, I suggest you increase the dose of Levothyroxine (Synthroid) by 25 micrograms and receive a shot of Triamcinolone in your wrist joint while continuing Cymbalta 40 for few weeks and increase it to 60 (30 mg twice) after two weeks. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent.

Regards.

For more information consult a rheumatologist online --> https://icliniq.com./ask-a-doctor-online/rheumatologist


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