Q. I have painful and stiff joints in the morning, along with fatigue. Kindly help me.

Answered by
Dr. Thiyagarajan. T
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Sep 27, 2021

Hi doctor,

My TSH, ultrasensitive is 5.110 ml. Do I have a thyroid? My joints are painful and stiff in the morning. I feel fatigued and tired. I do not have a fever. Please suggest to me how to control it. Also, could I take the first dose of COVID vaccine with this condition? I am attaching my reports. Kindly give your opinion.



Welcome to

I looked at your lab work (attachments removed to protect the patient's identity). You have slightly increased TSH (thyroid-stimulating hormone).

I suggest you follow it up with repeating TSH and also check FT4 (free T4). You may have low thyroid (mild). You could feel tired and fatigued by it.

But joint stiffness and pain are usually not because of mildly low thyroid. Yes, you could take the COVID vaccine. There are no contraindications form the information you have provided so far.

PCOD (polycystic ovarian disease) is a diagnosis made with clinical symptoms, lab tests, and sometimes also using ultrasound scans of your ovaries. So far, from what you have said and sent, no PCOD.

For joint stiffness and pain, you may need additional tests.

I hope this was helpful.

Hi doctor,

Thank you.

I will get tested for TSH and FT4 soon. Also, could you please suggest what tests I should run for joint stiffness and pain? Kindly guide me.



Welcome back to

For joint stiffness and pain, you will need to see a rheumatologist.

But you could start with ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), rheumatoid factor, and anti-CCP (anti-cyclic citrullinated peptide). But honestly, you need to be seen in person, get a good history, and be examined before you proceed to these tests.

I hope this was helpful.

Thank you doctor,

I went to a rheumatologist and got the tests done. Along with that, I got the test done for Thyroid profile and CBC. My thyroid levels have increased from last time. I am feeling fatigued, and my legs are paining. However, the stiffness and pain in the hands are not there anymore. Please suggest to me what I need to do.



Welcome back to

The TSH (Thyroid-stimulating hormone) value is high, and also, this time, you have checked total T4 (Thyroxine) and not Free T4 (FT4). But that is fine. I believe you have subclinical hypothyroidism.

I suggest you start Tablet Thyronorm 25 mcg (Thyronorm) daily morning on an empty stomach.

Please recheck TSH and FT4 after two months.

In addition, I suggest the following:

Capsule D-Rise 60K units (Vitamin D) weekly once for eight weeks because you probably have low Vitamin D. If in doubt, you can always check Vitamin D levels before starting the medicine.

Thank you doctor for the reply,

I would appreciate it if you could please let me know if the medicine is necessary. Can the levels be down if I avoid foods that irritate the thyroid and start doing regular exercise? I will definitely start taking the vitamin D supplement as suggested.



Welcome back to

Yes, you can certainly choose not to take medicine and wait to see if this will correct itself.

If you are trying to get pregnant, then I would suggest in favor of taking medicine. If not, trying to resolve this without medication is perfectly reasonable, especially if you do not have many thyroid-related symptoms.

The fatigue or tiredness may improve with diet, exercise, and Vitamin D.

I cannot suggest specific foods to avoid or exercise. But you can look up an anti-inflammatory diet and try yoga.

After two to three months, check TSH, FT4, Anti-TPO antibody (Anti-thyroid peroxidase), and anti-Thyroglobulin antibody.

In the long run, periodically (at least once a year) check TSH if any antibodies return positive.


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