Should I Take Hypothyroid Medication Or Consult Another Endocrinologist With Reports While Experiencing Joints Pain In The Wrists, Fingers And Toes?

Posted on Tue, 20 Feb 2024

Question: Hello Doctor,

For past 4 months I have been going through joint pains in fingers, wrist and toes. I did complete body checkup in XXXXXXX this year and it was discovered that I had deficiency of B12 and Vit-D. I took the medications for 2 months and B12 is now around 500 and vit D is 98.

The pain still persisted and then I went for Rheumatoid Arthritis test, which came out Negative. I then went for Thyroid tests in March, and the TSH levels were high.

21st March
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TriIodothyronine Total (TT3) 93.40 60-181 ng/dL CLIA
Thyroxine (TT4) 7.3 4.5-10.9 ug/dL CLIA
Thyroid Stimulating Hormone 8.42 0.35-5.5 μIU/mL CLIA
(TSH)

I was taking "THYROWEL" by Abott for a month and still there are no improvements in TSH levels as well as joint pains. I did went for another test this week and the results are -

01st May
------
Thyroid Stimulating Hormone 16.17 0.35-5.5 μIU/mL CLIA
(TSH)

02 May
------
TriIodothyronine Total (TT3) 129.77 60-181 ng/dL CLIA
Thyroxine (TT4) 8.8 4.5-10.9 ug/dL CLIA
Thyroid Stimulating Hormone 10.85 0.35-5.5 μIU/mL CLIA
(TSH)

Could you please guide whether I should go with the Hypothyroid medications, or consult another endocrinologist with these reports?

Answered by Dr. Minal Mohit (19 hours later)

Brief Answer:
start the treatment.

Detailed Answer:
dear XXXXXXX if the query is just whether to treat or to change the doctor, the answer is please treat.
but i will take the pleasure in explaining you a bit. your reports clearly say you are a case of primary hypothyroidism. now your symptoms also match your reports. in case you have a first degree relative on either paternal or maternal side, if your antibody profile is also positive, then without doubts, you must start the treatment. thyrowel is a multivitamin with tyrosine, an aminoacid required for thyroid hormone synthesis. it does a little help in borderline cases. vitamin D has gone high rather in your case, so you must stop vitamin D supplementation as Vitamin D toxicity will have similar picture. also please add some calcium, around 500 mg twice a day.
regards!

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Minal Mohit (39 minutes later)

Thanks a lot Dr. XXXXXXX for your response.

I was asked to stop Vitamin D right after the levels reached 98. I had been suggested to continue for B12, as it is around 500 now and may dip slowly. So I will continue B12 supplement. I was taking "Neurorex Forte" for past 4 months, and now came to know about "Nature made Sublingual B12 1000 mcg" which I would prefer, as its herbal. I will have it for around 40-50 days. I wanted your opinion on this B12 supplement - Should I go with this?

I will start calcium 500 mcg also, please let me know for around how many days I should take it?

I will also go for the treatment of my Hypothyroidism. I had been told that normally we don't go for medication unless TSH crosses 10, so I was suggested for Thyrowel instead of Thyronorm (my wife takes it hence I know the name) or something else.

Thanks again Dr. XXXXXXX for your response. I will look forward to your reply to close this discussion.

Thanks and Regards,
XXXX

Answered by Dr. Minal Mohit (20 minutes later)

Brief Answer:
brands can vary, but treatment is needed.

Detailed Answer:
Dear XXXXXXX I am glad we could help you. Thyronorm, thyrox, euthyrox, brands can vary. what is needed is right dosing. As per your body weight you may start the tablet , empty stomach, early morning. do not take anything over the tablet for next 30 minutes.
B12 1500mcg is the requirement, please continue. again I will re- emphasize , brands do not matter.
calcium is 500 mg and not mcg.
recheck all your values in 6 weeks and get back to me.
regards!

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Minal Mohit (25 minutes later)

Thank you Dr. XXXXXXX you were indeed of great help and it is very much appreciated. I will make sure to have 500 mg Calcium tables, and B12 as well as you suggested for 6 weeks.

I will visit an endocrinologist to get the treatment started with the correct dosage.

Is it fine keeping this discussion open for follow up after 6 weeks, or I should close it?

Thanks again Doctor for your help.

XXXX

Answered by Dr. Minal Mohit (4 hours later)

Brief Answer:
6 weeks and subsequent follow up is required.

Detailed Answer:
Dear XXXXXXX you are always welcome, and my pleasure to help you. as to close, or continue the query, reopen a new query, redirect it to me by tagging it to me directly, are precisely technical questions and much of personal choice.
thanks for kind words.
regards!

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Above answer was peer-reviewed by : Dr. Nagamani Ng