What causes body aches and fatigue after a thyroid surgery?

Question

Hello doctor,

I underwent a hemithyroidectomy in July 2023, and the biopsy confirmed an invasive encapsulated follicular variant of papillary thyroid carcinoma, according to the World Health Organization (WHO) 2022 classification. Until May 2025, my overall health remained stable. All ultrasound examinations and blood tests were within normal limits. My hemoglobin levels consistently ranged between 12 and 12.5 grams per deciliter, which is expected due to my diagnosis of beta thalassemia trait. There were no other abnormalities reported during this period.

However, beginning in May 2025, I started experiencing generalized body aches, malaise, and muscular pain in the chest and upper back region. These symptoms tend to improve temporarily with stretching, but I continue to experience a persistent feeling of being unwell, especially at night. My general practitioner prescribed Vitamin D supplementation and a combination of Levocarnitine and Coenzyme Q10 (Ubinext LC) for four months. This treatment provided noticeable relief within two weeks.

Unfortunately, similar symptoms returned approximately one month after stopping the therapy. I am now seeking further medical advice regarding this recurrence. The results of my most recent laboratory investigations are as follows:

Hemoglobin: 10.9 grams per deciliter.
Serum ferritin: 117 nanograms per milliliter (Reference range: 22 to 322 ng/mL).
Serum vitamin B12: 356 picograms per milliliter (Reference range: 211 to 911 pg/mL).
Serum iron: 175 micrograms per deciliter (Reference range: 65 to 175 µg/dL).
Total iron binding capacity (TIBC): 353 micrograms per deciliter (Reference range: 225 to 535 µg/dL).
C-reactive protein (CRP): 2.3 milligrams per liter (Normal: less than 6.0 mg/L).
Triiodothyronine (T3): 88.86 nanograms per deciliter (Reference range: 60 to 180 ng/dL).
Thyroxine (T4): 7.62 micrograms per deciliter (Reference range: 4.5 to 12.5 µg/dL).
Thyroid-stimulating hormone (TSH): 4.12 micro-international units per milliliter (Reference range: 0.3 to 5.5 µIU/mL).

Hemoglobin electrophoresis confirms the presence of beta thalassemia trait.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on the symptoms you described, it appears that you may be experiencing a functional deficiency of vitamin D and vitamin B12, possibly along with mitochondrial fatigue. The presence of muscle aches, malaise, and fatigue that improve with the use of vitamin D3 (Uprise D3) and a combination of Levocarnitine and Coenzyme Q10 (Ubinext LC) suggests a potential underlying functional mitochondrial deficiency or a mild chronic fatigue-like syndrome.

This may be associated with:

Mild tissue-level vitamin D resistance (despite normal serum levels).
Slight vitamin B12 insufficiency (your B12 level is in the mid-normal range, but some individuals experience improvement at levels above 400 pg/mL).

Based on this, the following recommendations are suggested:

Continue:

Ubinext LC (Levocarnitine and Coenzyme Q10): Once daily, for at least three more months.
Vitamin D3 (Cholecalciferol, Uprise D3 60K): Once weekly for a total of four to six months, followed by reassessment of serum 25-hydroxy Vitamin D level.

Consider adding:

A vitamin B-complex supplement containing methylcobalamin (Vitamin B12), such as Neurobion Forte, one tablet twice daily.
Magnesium citrate – one tablet at night, which may help relieve muscle pain and fatigue.
Regular low-impact physical activity or stretching, such as yoga or light pilates, can help reduce muscle stiffness and support energy levels.

Additional investigations may be warranted if symptoms persist, including:

Serum 25-hydroxy Vitamin D.
Serum magnesium and Vitamin B6.
Antinuclear antibodies (ANA) and creatine kinase (CK) to rule out autoimmune myopathies.
Repeat thyroid function tests in four to six weeks.
Thyroid-stimulating hormone (TSH) receptor antibodies are used if autoimmune thyroiditis is suspected.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.