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Hasmimoto's - several basic questions

Folks,
It seems that body aches is a characteristic of Hashimotos and not so much with just Hypothyroid.
Also, I have read multiple articles and seen videos which indicate that the moment typical hypothyroid patients take hormone, they feel better immediately and if they stop they immediately sluggish.

This does not seem to be the case with Hashimotos, where body aches are the main symptoms (to me and some of the people I know).

For Hashi patients like me, who continue to have terrible body aches despite medicine, this leads to several questions:
1) is it that hormone replacement therapy is resolving only a part of the issue and some of the problems are not addressed
2) has anyone, ever, every got rid of body aches
3) if Hashimotos is indeed autoimmune disease, has any study been done on people whose thyroid has been removed. Does antibodies continue to exist even after thyroid removal
6 Responses
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Avatar universal
Patients with a cortisol deficiency tend to wake up feeling well and deteriorate during the day.  So even though your morning serum cortisol (total cortisol) is lower than optimal, the first thing I would do is see if you can get tested for free cortisol and also DHEA-S.  And if your free cortisol is somewhat low, you could consider slowly raising thyroid levels in order to  increase free cortisol.  As thyroid levels come up, corticosteroid binding globulin (CBG)  goes down, leaving more free cortisol.  But increasing thyroid dosage must be done very slowly to allow the body time to adjust.  Do you think you can get tested for free cortisol and DHEA-S?  If you want to know more about DHEA, try this link.

http://www.hormonerestoration.com/DHEA.html
Helpful - 0
Avatar universal
Cortisol should be highest at around 7-8 a.m..  Yet your morning serum cortisol was only 10.17, with a range of 6.02 - 18.4.  Since morning cortisol should be in the upper end of its range, your level is too low.  I have seen this same pattern with someone I know.  Low cortisol is hard to diagnose, but having body aches and morning cortisol results  below mid-range was indicative of inadequate cortisol levels.  When started on hydrocortisone tablets taken at 3 different times of day, the person's body aches disappeared.  So I think that is something you need to follow up with your doctor, to see about a trial of hydrocortisone.

If body aches are the only symptom bothering you at present, in view of your thyroid test results, I don't know that I would change anything there.  Why add in a new variable?  I would pursue the cortisol issue first.  By the way if you do a trial of hydrocortisone, make sure you also test and supplement with DHEA-S to optimize that as well.
Helpful - 0
1 Comments
Gimel,
body aches are the only symptoms. At least, nothing else is noticeable (probably a little bit of brain fog once but thing to make me inoperable).

BTW, my symptoms do improve as the day progresses.

One more thing - since I remember (probably 10+ years), I don't think I have been sleeping well. Like I take work pressure in my system and I am probably always thinking about it all the time. Most of the times, my sleep is very shallow and even a small thing can wake me up. This was until 2 months back when I was introduced to importance of sleeping and how it is necessary for us to heal and recover. Since then I have been practicing meditation and my quality of sleep has definitely improved.
Avatar universal
Before discussing further, what time was your blood drawn for the morning serum cortisol test?
Helpful - 0
2 Comments
8 am and 5 pm
8 am and 5 pm
Avatar universal
I would like to mention one other possibility for causing body aches.  Low cortisol is well known to cause such aches.  Have you been tested for cortisol levels?  What is your current thyroid med  and the daily dosage?
Helpful - 0
1 Comments
Gimel,
Current medicine is 125 mg of thyronorm. I have been tested for cortisol. The recent test is above. 6 weeks old tests report are given below:


Morning Cortisol 10.17
Reference range - 6 am - 10 am : 6.02 - 18.4
                  4 pm - 8 pm  : 2.68 - 10.5

Evening cotrisol
CORTISOL C.L.I.A 4.22 µg/dl
Reference Range :-
06.00 - 10.00 A.M. : 6.02 - 18.4 µg/dl
04.00 - 08.00 P.M. : 2.68 - 10.5 µg/dl

ESTIMATED GLOMERULAR FILTRATION RATE (eGFR) - 103

Iron 94.2
Reference range
Male 70-180
Female - 60-180

TOTAL IRON BINDING CAPACITY (TIBC) 363
Reference range
Male 255-535
Female 215-535

% TRANSFERRIN SATURATION 25.95
Reference range
13-45

BLOOD UREA NITROGEN (BUN) 10.78
Reference range - 7.9-20

CREATININE - SERUM - 0.91
Reference Range :
Male: 0.6 - 1.1
Female: 0.5 - 0.8

BUN / SR.CREATININE RATIO 11.85
Reference Range :
9:1 - 23:1

TOTAL CHOLESTEROL PHOTOMETRY 175 mg/dl 125 - 200
HDL CHOLESTEROL - DIRECT PHOTOMETRY 22 mg/dl 35-80 **
LDL CHOLESTEROL - DIRECT PHOTOMETRY 66 mg/dl 85 - 130 **
TRIGLYCERIDES PHOTOMETRY 251 mg/dl 25 - 200 **
TC/ HDL CHOLESTEROL RATIO CALCULATED 7.9 Ratio 3.0 - 5.0 **
LDL / HDL RATIO CALCULATED 3 Ratio 1.5 - 3.5
VLDL CHOLESTEROL CALCULATED 50.2 mg/dl 5 - 40 **
NON-HDL CHOLESTEROL CALCULATED 152.8 mg/dl < 160

ALKALINE PHOSPHATASE PHOTOMETRY 78 U/l M:53 to 128 - F:42 to 98
BILIRUBIN - TOTAL PHOTOMETRY 0.32 mg/dl 0.30 - 1.20
BILIRUBIN -DIRECT PHOTOMETRY 0.1 mg/dl 0 - 0.30
BILIRUBIN (INDIRECT) CALCULATED 0.22 mg/dl 0 - 0.9
ASPARTATE AMINOTRANSFERASE (SGOT ) PHOTOMETRY 21.6 U/l M: 0 to 37 - F: 0 to 31
ALANINE TRANSAMINASE (SGPT) PHOTOMETRY 24.6 U/l M: 13 to 40 - F: 10 to 28
GAMMA GLUTAMYL TRANSFERASE (GGT) PHOTOMETRY 22.2 U/l M: 0 to 55 - F :0 to 38
PROTEIN - TOTAL PHOTOMETRY 6.9 gm/dl 5.7 - 8.2
ALBUMIN - SERUM PHOTOMETRY 4.1 gm/dl 3.2 - 4.8
SERUM GLOBULIN PHOTOMETRY 2.8 gm/dL 2.50-3.40
SERUM ALBUMIN/GLOBULIN RATIO CALCULATED 1.46 Ratio 0.9 - 2.0

TESTOSTERONE C.L.I.A 409 ng/dl
Reference Range :-
409.4

TOTAL TRIIODOTHYRONINE (T3) C.L.I.A 118 ng/dl 60 - 200
TOTAL THYROXINE (T4) C.L.I.A 8.1 µg/dl 4.5 - 12.0
THYROID STIMULATING HORMONE (TSH) C.L.I.A 2.50 µIU/ml 0.30 - 5.5
FREE TRIIODOTHYRONINE (FT3) C.L.I.A 2.9 pg/ml 1.7 - 4.2
FREE THYROXINE (FT4) C.L.I.A 1.18 ng/dl 0.70 - 1.80

25-OH VITAMIN D (TOTAL) C.L.I.A 31.26 ng/ml
Reference Range :
DEFICIENCY : 100 ng/ml

HbA1c H.P.L.C 5.4 %
Reference Range :
Below 6.0% - Normal Value
6.0% - 7.0% - Good Control
7.0% - 8.0% - Fair Control
8.0% - 10% - Unsatisfactory Control
Above 10% - Poor Control

Blood Sugar(F) - 82 (70-110 mgs/dl)


Blood routine test:

TOTAL LEUCOCYTES COUNT 6.72 X 10³ / µL 4 - 10
NEUTROPHILS 57.2 % 40-80
LYMPHOCYTE PERCENTAGE 34.7 % M:20-40; F:20-40
MONOCYTES 2.4 % 0-10
EOSINOPHILS 5.2 % 0-6
BASOPHILS 0.2 % < 2
IMMATURE GRANULOCYTE PERCENTAGE(IG%) 0.3 % Male : 0-0.5 Female: 0-0.4
NEUTROPHILS - ABSOLUTE COUNT 3.84 X 10³ / µL 2.0 - 7.0
LYMPHOCYTES - ABSOLUTE COUNT 2.33 X 10³ / µL 1.00 - 3.00
MONOCYTES - ABSOLUTE COUNT 0.16 X 10³ / µL 0.20 - 1.00
BASOPHILS - ABSOLUTE COUNT 0.01 X 10³ / µL 0.02 - 0.10
EOSINOPHILS - ABSOLUTE COUNT 0.35 X 10³ / µL 0.02 - 0.50
IMMATURE GRANULOCYTES(IG) 0.02 X 10³ / µL 0.03
TOTAL RBC 5.27 X 10^6/µL Male : 4.5-5.5 Female : 3.9-4.8
NUCLEATED RED BLOOD CELLS Nil X 10³ / µL Nil in adults
NUCLEATED RED BLOOD CELLS % Nil % Nil in adults
HEMOGLOBIN 14.2 g/dL Male : 13-17 Female : 12-15
HEMATOCRIT(PCV) 48.6 % Male : 40-50 Female : 36-46
MEAN CORPUSCULAR VOLUME(MCV) 92.2 fL 83-101
MEAN CORPUSCULAR HEMOGLOBIN(MCH) 26.9 pq 27-32
MEAN CORP.HEMO.CONC(MCHC) 29.2 g/dL 31.5-34.5
RED CELL DISTRIBUTION WIDTH - SD(RDW-SD) 48.4 fL 39 - 46
RED CELL DISTRIBUTION WIDTH (RDW-CV) 14.3 % 11.6-14
PLATELET DISTRIBUTION WIDTH(PDW) 14.8 fL 9.6-15.2
MEAN PLATELET VOLUME(MPV) 11.7 fL 6.5-12.0
PLATELET COUNT 225 X 10³ / µL 150-400
PLATELET TO LARGE CELL RATIO(PLCR) 38.6 % 19.7 - 42.4
PLATELETCRIT(PCT) 0.26 % 0.19 - 0.39

ARSENIC ICP-MS 1.15 µg/l < 5.00 µg/l
CADMIUM ICP-MS 0.48 µg/l < 1.50 µg/l
MERCURY ICP-MS 0.13 µg/l < 5.00 µg/l
LEAD ICP-MS 18.02 µg/l < 150 µg/l
CHROMIUM ICP-MS 0.71 µg/l < 30.0 µg/l
BARIUM ICP-MS 6.9 µg/l < 30 µg/l
COBALT ICP-MS 0.37 µg/l < 4.00 µg/l
CAESIUM ICP-MS 2.82 µg/l < 5.00 µg/l
SELENIUM ICP-MS 132.55 µg/l 60-340
649848 tn?1534633700
COMMUNITY LEADER
Vitamin D is "not" the basic test for Hashimoto's... sharanbr, you've had all the antibody tests and you're getting the FT4 and FT3 tests, so you're good with testing...

Your thyroid levels look good and I agree that your vitamin D could be higher, but I'm wondering if you've been tested for other conditions, such as Rheumatoid Arthritis (or if you have plain arthritis), Lupus or other conditions, for which body pain is a noted symptom.  

While vitamin D deficiency is common with those of us who are have hypothyroidism, getting vitamin D levels optimal is not a "cure all" for hypothyroidism or for Hashimoto's... There are many conditions that have the same or similar symptoms.

To answer your questions more specifically...
1)  Thyroid hormone medication addresses only thyroid symptoms; as I noted, those same symptoms can be present with other conditions...

2)  "If" the body aches are caused by hypothyroidism, the thyroid medication should alleviate the pain, "if" the medication dosage is optimal...

3)  Hashimoto's "is" autoimmune and people "do" have their thyroid removed, sometimes because of it.  Antibodies will, typically, go into remission following thyroid removal, because without a thyroid there's nothing to attack.  It should be noted that TPOab, which is one of the antibodies used to diagnose Hashimoto's can also be present, in small amounts, with other autoimmune conditions...
Helpful - 0
2 Comments
Barb,
On your comment that if medicine dosage is normal then pain should be alleviated ... actually, after reading various papers, seeing videos, my understanding is that there is a lot of symptom difference between typical hypothyroid and hashimoto's. I also understand that current medicines are very good at alleviating typical hypothyroid symptoms and not so good for hashimotos. Of course, issues related to low thyroid will resolve in hasimotos but not problems like body aches etc.

If thyroid antibodies go away if thyroid gland is removed then is it not good to remove it just to calm down the immune system?

Also, is it a good idea to test my antibodies once as I have done this probably 3 years back, at which time, I did have thyroid antibodies?
gimel has already addressed part of the issue of pain; however, it's important to note that Hashimoto's is treated the same as hypothyroidism - with replacement thyroid hormones.  There is some thought that diet and a group of supplements can help with the autoimmune reaction of Hashimoto's, however, there's no real science to back that up, at this point.

You can always try modifying your diet to eliminate gluten, dairy, etc and see if you feel any better, but that doesn't help a lot of us.  

As in my own case, and many others,  Hashimotos' will, eventually, completely destroy ones thyroid and it will be as though it were removed, in the long run.  It's not often that a doctor will remove a thyroid, simply because one has Hashimoto's, unless that thyroid has unusual characteristics or is problematic, as in swollen and causing breathing issues, etc.  

Please note, that there's no "normal" for thyroid medication... it must be "optimal" for each of us and we're all different, so we're not all going to need the same med/dosage.
Avatar universal
For Hashi and other autoimmune conditions the basic test to be done is the Vitamin D3 blood test. In most the value is either deficient or not in optimal range.

Also levothyroxine and other thyroid replacement pills dosage should be adjusted after bringing vitamin D3 to optimal range as TSH value can decrease after supplementing with Vitamin D3 and thus there is a high chance that less amount of thyroid hormone pills needed.
Helpful - 0
8 Comments
I repeated a couple of tests recently just to get an update. This is how they look like:

TSH 0.91 (0.3-5.5)
FT3 3.4 (1.7-4.2)
FT4 1.38 (0.7-1.80)

25-OH Vitamin D 41.2 ng/ml

Probably, these results would mean that I have a very good lab results but my symptoms remains the same.
Your Vitamin D3 level need little more increase, optimal range 50 - 80.

Seeing your thyroid results its seem very fine one and no need to change the dosage or other things.

Anyway if you are on levothyroxine you can switch to NDT with identical dose and see if its helping. For me levothyroxine on same dose gives joint pain, muscle ache, stiff neck etc and overall sluggishness etc but switching to NDT recently most of the symptoms reduced though thyroid test results almost same. May be its due to more components in NDT like T4,T3,T2,T1 and calcitonin while levothyroxine supply T4 alone.

If you find it difficult to get NDT then PM me I'll send a link from where you can order it from abroad.
The main difference noticed when switched to NDT is waking at morning refreshed and no need of long day time nap. NDT is surely the best treatment for hypothyroidism.
des900, I take 125  mg of thyroid medicine. If I switch to NDT, what would be my dosage. Also, should I be mixing current thyroid med + NDT or just take NDT alone?
If you switch to NDT the identical dose is 1 tablet + 1/2 tablet + 1/4 tablet as each tablet is 1 grain equivalent to 74 mcg of levothyroxine.
You should "not" switch medications without the advice of your doctor...
If he is from India like me then no use visiting doctor regarding NDT or T3 medicine as its not possible to get such medicines in India, this is the case with most who buying NDT online doctors just look at thyroid results but never care about their ongoing symptoms and most times they dismiss it as mental problem and give antidepressants if press on. Anyway I too strongly suggest users to consult a good holistic doctor before switching but finding such a doctor is hard.

For my case though I visited many doctors no one have ever told me about possible Vitamin D deficiency. When mentioned them about NDT or T3 they just made fun and quickly dismissed it and told no other medicine other than levothyroxine.
I understand that there are some countries in which medications containing T3 are not available. We're not doctors and we still can't tell people to switch medications without talking to their doctors, no matter where they live.

As far as vitamin D, I'm very sorry you had a deficiency, as many people with hypothyroidism do, though not "everyone" with hypothyroidism does have... but it's very important to understand that vitamin D can not alleviate thyroid symptoms; it can only alleviate the symptoms of vitamin D deficiency.  It just so happens that some of the symptoms of vitamin D deficiency and hypothyroidism are the same...

Vitamin D and thyroid medications are not interchangeable.  
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