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Sudden overnight pain

I have posted multiple questions in this forum about my hashimoto's thyroid and my main issue with body aches. But I want to check something else ...

While my body ache continues and mostly severe in the morning, 2 days back I had an episode where I got up
with pain on left knee as if I had hurt it. The kind of pain you get when you exert yourself after a long time or play a game one fine day. Of course, the general pain level throughout the body was also high on that day but this is the first time I am getting this symptom where after resting, I got up with a joint pain as if I had hurt it ...

Anyone has experienced such an issue before?

As a side note, I have been telling my endo that my body aches continues to be my biggest issue. He always tests for ESR levels and he told that if there was inflammation in the body, ESR is generally the first clue. He also did test for CRP some time back and that came back negative (within normal range).

Is it possible that I am probably having depression and the body aches are a manifestation of that. I do feel a bit down for the last 4-5 months but nothing to make me completely down. I always assumed that my depression is mostly due to my physical health as I am very active (or used to be) and as hypothyroid is not allowing me to do regular things, I am feeling a bit down.

Sorry for multiple questions but need inputs please ...
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Avatar universal
Also your Vitamin D3 level is 40 which is almost normal. Anyway if you want to raise it further then you can take mega dose of Vitamin D3. PM'ing you the brand name of one popular one sold in India. Cost is very less like around 20 INR and dose is 60,000 IU in one sachet. Only take 1 during the week and it will almost increase your Vitamin D3 levels 10 units up. So if you need to raise 20 units up then simply buy 2 sachets and take one in a week and next sachet on next week and done.
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Actually, my vit D level is 31. You can see my latest report above. The one with 40 is an old report.
Thanks, I will try the sachet
Avatar universal
Natural dessicated thyroid NDT is not available in India but you can order it from another country, PM'ing you the info regarding how to get it.
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Thanks
Avatar universal
If unable to raise your Vitamin D level with daily supplements, you may have to try weekly injections of D, about 50,000IU to get you started.  

Sending PM with info.  To access, just click on your name and then from your personal page, click on messages.  
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Thanks
Avatar universal
Wow.  So many lab tests.  Your doctor must have part ownership of the lab.  LOL  I know very little about most of them, so I'll leave those to you and your doctor.  What I do see is that your Free T4 is at only 43 % of its range, even though you are taking 125 of Thyronorm.   Also, your Free T3 is only at 48% of its range.  So you need a dose increase to get your Free T4 above midrange, and you need to get your Free T3 high enough in its range to relieve hypo symptoms.  That may require the addition of some T3 to your med.  If the doctor cannot prescribe, I know of a possible source for you.

In view of your symptoms, I think your morning cortisol level is even more important.  Due to the natural rhythm of cortisol levels, it is highest in the early morning and very low in the evening.  Even though your morning cortisol is within range, based on what I have learned, I believe it is too low in the range and that is the likely cause for your body aches.  It would be easy to confirm this by taking some hydrocortisone tablets in the morning and then less at noon and also late in the day.  If the aches are due to cortisol you would notice the effect within days.  Do you think your doctor might be agreeable to try this?

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Hi Gimel,

Actually, these tests were not requested by Doctor. I requested these myself. Actually, doctor does not like to order any tests unless he feels it is necessary.

I don't think it is possible to get T3 medication in India nor would the Doctor support it. So, yes, I will need your help on that. Please PM me.

On cortisol, I will bring up this with my Doctor and see what he says.

On more question - why is that I am unable to bring up my vitamin D levels high. I take 4000 IE every day but still the level is just around 30.

Also, one more thing ... I have started to keep my stress levels down as long term stress is supposed to be detrimental to cortisol level. Let me see if this helps ...
Avatar universal
Lab results and associated reference ranges calculated by the lab can be  different from one lab to another.  That likely is the reason for the difference in Free T4 levels.  Note however that both are over the high end of the range.  

At this point I think you need to be tested for Free T3, to see where you are in that range.  As mentioned previously I also think you need to test for Reverse T3 at the same blood draw as the Free T3.  And last, even though your morning serum cortisol test was within the range, that does not mean all is okay.  That test is for total cortisol, and also hard to interpret by itself.  If possible it would be far better to test for free cortisol, by doing the diurnal saliva cortisol test at different times of the day.  I don't know if the Reverse T3 and saliva cortisol tests are available to you, but in view of the symptoms you have, I highly suggest finding out it you can get those done.
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Gimel,
Below are the results from the lab tests. These were done last Saturday. Let me know what you think.

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

Avatar universal
Sorry to keep asking questions instead of answering yours; however, I need to be sure of a couple of things.  First were you taking the 125 mcg of Thyronorm when tested in Aug. 2015?  Was your dosage decreased, since I see that your Free T4 was lower in the first test data you posted 11/3, which I assume is the latest test data?  What symptoms were you having in Aug. 2015 compared to current?
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No problems. Actually, my dosage is same for quite some time. I might have missed taking it once in a while (like 1 day in a month).

The reference ranges are different in the above 2 tests. Could that be the reason for different values?
Also, these tests are from 2 different labs. (on attached to the clinic and another one with a private lab)

My symptoms are more or less same. I had body aches then and I have them now. I might have  slightly worse symptoms now in terms of body aches becoming chronic.For example, in 2015, I probably used to have 2-3 days with less body ache.

My biggest issue currently is the terrible body ache I am waking up with.
Avatar universal
What was your latest Free T3 result and reference range?  

No, Reverse T3 cannot be calculated from Free T4 and Free T3.  It has to be tested separately and should be done from same blood draw as a Free T3.  
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The following report is from Aug 2015:

Free T3 - 3.65 (2.0-4.4)
Fee T4 - 1.84 (0.93-1.70)
TSH 0.99 (0.27-4.20)
Avatar universal
My biggest concern for you right now is that you do not know your Free T3 level.  If your body is not adequately converting the T4 to T3, then your Free T3 may be too low in the range, even though your Free T4 is above range.  So first thing I would do is get tested for Free T3.  If possible I would also request to be tested for Reverse T3 at the same time.  So you think you can get those done?
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Free T3 is not an issue. I have these from my old report (I did not post all of them) and I am anyway planning to repeat the tests.

I am not sure about Reverse T3 as I have never done that before. I have read somewhere that it is easy to compute RT3 once FT3 and FT4 are known
Avatar universal
What is your thyroid med and daily dosage?
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Thyronorm - 125 mg
Supplements - vitamin D (4K)
                        vitamin B12
                        CQ10 supplement
Avatar universal
Please post your latest thyroid related test results and reference ranges shown on the lab report.  Also, I think you need to be tested for morning serum cortisol.  
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gimel,

detailed report below. All the tests are not from the test at the same time as Doctor is not repeating costly tests every time.

FT4 - 1.20 (0.6-1.1)
TSH - 0.65 (0.34-5.20)

Haemogram:

Haemoglobin - 13.9 (12.0-15.0)
Total WBC - 6420 (4000-10000)
Neutrophils - 64 (40-80)
Lymphocyte - 31 (20-40)
Eisnophil - 5 (1-6)
Monocytes - 0 (2-10)
ESR 30 min - 03
ESR 60 min - 09

Calcium - 9.6 (8.5-10.1)
Phosphorous - 4.5 (2.5-4.9)
25-Hydroxy Vitamin D - 40.7
Vitamin B12 - 1185

Creatinine Phosphokinase - 84 (39-308)
Cortisol - 14.55 (6.2-19.4)
Ferritin - 87.3 (21.8-274)
Sodium - 138 (136-145)
Potassium - 4.2 (3.5-5.0)
Chlorides - 104 (98-107)
Bicarbonate - 25 (21-32)

CRP - 1.0 (<6)
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