carpel tunnel and thyroid issues

[dodi1978]

Any experiences with the above?

I developed quite bad carpel tunnel late in my first pregnancy (2013). Symptoms persisted for a while after and then got better, but things never quite improved back to normal.
Fast-forward to second pregnancy (gave birth end of September 2016), and problems were back, and have stayed to far. I often wake up with hands so numb I struggle to "wake them up".
Went to the docs last week and it was suggested that thyroid issues may be underlying this. I had a thyroid test this morning and am waiting for results now.
There are some other symptoms that suggest that thyroid issues may be a possibility - I have been unusually tired (but have put this down between pregnancies to having a child and working full time whilst renovating a house), and have also not had my usual "drive" (but certainly wouldn't say I am feeling depressed, which is another symptom of an underactive thyroid). I also had not problems conceiving whatsover!

Any experiences appreciated

Hm, we will see! All my symptoms point towards hypo- rather than hyper!

I'll pick up a copy of my results next Tuesday and hope I'll learn more then!

Hello,

Definitely always get a copy of your results as it's worth knowing what they are and how you feel at the time. Also incase of borderline results as some gps might have a different take on it.

They're likely to have taken tsh which is the thyroid stimulating hormone. If this is a bit raised (between 4 and 10) they'll have taken t4. If this is too low you might get thyroxine; if in range they may monitor. That's the frustrating bit as you will get bad symptoms at that level. At the moment they don't treat yo see if it improves. Ideally theyd test for antibodies - which will show auto immune attack on the thyroid, but sometimes they don't. (Believe me thyroid stuff is rather frustrating!) They are unlikely to do t3 as it's half life is very short and so can fluctuate during the day. T4 is longer lasting and so more reflective of your state as is tsh.

If you can't get an appt could you ask for a phone call? That's a long time to wait!

The British thyroid foundation are a good website and have volunteers you can ring.

I have no idea what MAP or MAK is!

If tsh is over 10 you should be given thyroxine, no quibbling.

I don't mind waiting for the two weeks. It's not as if I am feeling absolutely dreadful.
I will pick up a copy of my results on Tuesday and run it past you knowledgeable people (and Dr. Google).
Turns out I a from a family of wonky thyroids. My dad has the hypo version, my sister, as I said, doesn't know (but she takes the same tables as my dad, so I guess she is hypo, too). My aunt (now deceased) also had thyroid problems and a few other people in the wider family too.

I never knew!

Yep do post here. I'd tell gp it runs in your family.

This book is very helpful indeed if you do have any possible issues. It's by the BMA.

(It's the current nhs line, though Toft and others are moving towards thinking treatment should be different as reflected in the reviews. The majority of people are well on thyroxine if the tsh is at the right level for them, usually around or just below 1. Some aren't or have other issues possibly not yet worked out hence some of the lower reviews. You do need to have ferritin, vitamin d and b12 in upper levels to feel well, these can be low in thyroid disorders.)

OP here!

I picked up my results today. The doctor has already commented on them.

It says

Serum free T4-level: Normal (12.4 pmol/L)

Serum TSH level: Thyroid levels slightly low (7.1 mu/L). TFT results indicate subclinical hypothyroidism. Suggest exclude non-thyroidal illness/drug effect, repeat TFT in 3-6 months and consider anti-TPOAb.

Haemoglobin A1c level: Normal (28 mmol/mol)

So, I translate this as

• my thyroid is underactive, but not massively so
• drugs or other illnesses may have an effect on these levels (I don't take any drugs (other than having the contraceptive implant), no known other illnesses
• another blood test in a few months
• let's try drugs (TPOAb)

This is my rather liberal translation :-)! Did I get this right?

Do you have the ranges? If your TSH is 7.1, you are well over the range to start treatment. Range is usually around 0.4 to 4.5. FT4 is bottom of range.
AntioAB is to test for antibodies- for Hashimotos so insist on this.
You should make an appointment to trial levothroxine. He might suggest 25mg but 50mg is a more effective starting dose. A referral to an endo would be goid to test FT3 and gain more specilist input.
Ferritin, folate, vit D and B12 should also be tested.

TSH at 7.1 is high not low - hypothyroidism

I would do as Beb says - 7.1 tsh is quite high if it's that. Frustratingly they usually prescribe thyroxine at 10+ hence why they're asking to retest at the mo.

If you have antibodies they're more likely to prescribe thyroxine as it shows autoimmune thyroiditis.

I'd maybe ask to speak to gp and say that given you have symptoms could they investigate further e.g. Antibody test and possibly trial 25 thyroxine, possibly second opinion. Emphasise the symptoms - I think in nice that can lead to treatment. (Off to check)

Yep:

• Many people with SCH do not need treatment, but if a decision is made to treat, prescribe levothyroxine (LT4).
◦ Do not prescribe combination therapy (LT4 and LT3) in primary care.
◦ Aim (in most people) to reach a stable TSH level in the lower half of the reference range (0.4–2.5 mU/L).

And:

• If TSH is between 4 and 10 mU/L and FT4 is within the normal range
◦ In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.

Plus that if pregnant or planning pregnancy to refer or discuss with endo (tsh must be under 2.5 in this scenario).

cks.nice.org.uk/hypothyroidism#!scenario:1

Sch = sub clinical hypo

Link

(Hopefully works!)

cks.nice.org.uk/hypothyroidism#!scenario:1.

Thanks for all this information and the links!!!

So I guess, I may get medication, I may not....

My only 'clear' symptom is really the carpel tunnel... fatigue etc. could be down to anything, really!

I have also read that some people get hypothyrodism after pregnancy, and I am only 7 months post-pregnancy. I guess it may well be that they want to see whether I am stabilizing or not.

Another question from OP:

When I researched hypothyrodism, I read that it is associated with difficulties conceiving and miscarriage.

I conceived both of mine quite easily (first one after two months, second one after five months of trying) and had no major problems in pregnancy (small bleed at 10 weeks with the second one, but turned out all ok). Can I simply count myself lucky?

Luckily I don't want any more kids, so that's not something I need to think about any more.

It can cause issues with early miscarriage if your tsh is over 2.5; it's possible you were fine then or lucky.

To be honest you are ticking many of the symptoms. Your t4 is within range but on the low side. (See here though some ranges vary locally www.btf-thyroid.org/information/quick-guides/97-thyroid-function-tests )

The funny thing about depression is that they've worked out it's not directly a symptom. In my experience its can be a secondary symptom that comes from slightly foggy head / memory issues and being in a high pressured position where you can't keep up with life. You know you're not functioning at normal standards and it becomes stressful. I become extremely anxious as I'm forcing myself through adrenaline to do important stuff, no energy for nice stuff and then that can lead to frustration and low mood.

But I think it's up to you - many in your situation are feeling frustrated and would like anything to help, so if between the tsh 10 and 4, a trial of thyroxine can be done. But, as you say at post baby 7 mo you could have post partum thyroiditis so waiting 3-6 mo could see how that either corrects or progresses. (Personally I'd ask for thyroxine trial; they'll monitor you anyway)

The British thyroid foundation are a good source of info and have a help line you can ring to discuss anything. (Link above)

My link didn't work upthread; this book is very helpful, BMA too.
www.amazon.co.uk/Thyroid-Disorders-Understanding-Family-Doctor/dp/1903474191

Are you bf? It is one of the very few things that can actually impact milk production and cause low supply.

I really did not know carpal tunnel syndrome and thyroid level were related!

I have had terrible carpal tunnel syndrome since having DS2, have had a steroid injection that didn't work. Wear wrist splints at night which sometimes work and sometimes don't!

However I have also felt utter exhaustion and cold - my diet is fairly healthy etc really don't think it's anaemia.

Thanks to this thread I will be getting my thyroid levels checked out!

It's tricky as Ive never had it as a symptom in 20 years. Having a baby and carrying them can cause carpel tunnel. But apparently is a symptom so worth checking out.

Hello OP - and others with carpal tunnel. Sorry I can't help on thyroid issues - good luck with that - but can I ask, if carpal tunnel is affecting your life that badly, would you/have you considered surgery? I had a nerve conduction study performed and was told my right wrist was so extreme that surgery was option. Had the release performed 2 months after giving birth, this was about 2.5 years ago. Never looked back. It's an option worth considering if injection and wrist supports aren't working for you.

In my experience its can be a secondary symptom that comes from slightly foggy head / memory issues and being in a high pressured position where you can't keep up with life. You know you're not functioning at normal standards and it becomes stressful. I become extremely anxious as I'm forcing myself through adrenaline to do important stuff, no energy for nice stuff and then that can lead to frustration and low mood.

Ekphrasis - exactly!!!! This was me in the last few years!

I really really wouldn't call myself depressed - I think that's on another level. But, yes, slight anxiety, low mood at times, forcing myself through adrenaline to do important stuff.

I would really like to trial the medication, in particular as I am going back to work in 2 months and my life will become more stressful again. The question is - will the docs belief me retrospectively with regards to the other symptoms? I originally only went because of the carpal tunnel.

Popsskipiekin - I wouldn't say that carpal tunnel is affecting my life badly, in particular during the day. But in the morning, in is extremely annoying at times. It does wake me up and to really wake my hands up, I need to get up - just shaking them in bed doesn't work. I must admit that I haven't tried wrist supports yet. I would consider surgery, a GP at my surgery does it apparently. But I do want to have the thyroid things cleared first now.

(Dashing out, blunt reply!) Women put up with a lot of symptoms as they think it's the 'normal women's/ mother's lot!.

Just tell gp you've other symptoms, they may ask anyway. You just didn't think it was anything that could be helped and we're stoically putting up with it as best you could. But actually it's been quite shit.

Hoping @Ekphrasis or @brbraveagain are still around! I've posted in the autoimmune topic too. I followed up the good advice upthread and had a private blood test, it showed raised tsh - 4.6 (range was 0.2-4.3) and raised TGAB - 131 (range 0-115). Everything else was within range. Does this indicate hashimotos?

Yes your antibodies are above range so i think that confirms Hashimotos. Your TSH is high. Did you have anything else tested. Ft4, ferritin, folate, B12, vit D?
You should go to your GP with these results.

Remind your GP that just because you have B12 deficiency, it doesn't mean you aren't hypothyroid! If fact, it makes it more likely if you already have a autoimune disease...if your ft4 was 9, even with your TSH flogging your thyroid at 4.6, your thyroid needs help!

Yes I had some other tests, all thyroid ones.

Ft4 15.39 range 12-23
Ft3 4.46 range 3.1-6.8
T4 89.7 range 64.5- 142
TPEX antibodies 11.78 range 0-34