Guest Author - Jim Lowrance
I was talking to a woman being treated for hypothyroidism, who complained that she was not seeing her muscle/joint pain and stiffness resolve with thyroid hormone replacement therapy. She stated that her Doctor had her TSH (pituitary hormone that reflects how much thyroid hormone is in the blood) suppressed with the hormone therapy, down to a "3.0". The way TSH or "Thyroid Stimulating Hormone" works in monitoring thyroid hormone replacement therapy is that it is suppressed or goes lower when more thyroid hormone is in a person's system. I mentioned to her in my response, shown below, that she may not be on a dose of thyroid medication that is sufficient because some patients need TSH suppressed lower than hers was, in order to see significant symptom relief.
My general response to her:
Yes, hypothyroidism and under-treated hypothyroidism are notorious for causing joint/muscle aches and stiffness. This was a major symptom for me, before I was well treated and was the symptom that best resolved for me when my hormone replacement was better optimized.
There are Doctors who will treat hypothyroid patients with thyroid hormone replacement, by only getting their TSH down to around 3.0 or 4.0 but according to medical sources, some patients do not feel well or see some symptoms resolve well, unless their TSH is suppressed down to about 1.0 or even slightly lower. Doctors, who avoid suppressing TSH down this low, are concerned about inducing a hyper-toxic state or hyperthyroidism, caused by too much thyroid hormone medication. The fact is however, that lowest normal is approximately from 0.3 to 0.5, so getting TSH down to 1.0 or even between 0.5 and 1.0 doesn't place a patient at risk for medication-induced thyrotoxicity. In addition to this fact, the fear of inducing hyperthyroidism, gives way to keeping a patient in a state of unresolved symptoms and one has to wonder why ongoing hypothyroidism would not also be looked at as serious for the patient.
The new TSH guidelines as revised by the American Association of Clinical Endocrinologists, in 2002, is "0.3 to 3.0", which places 3.0 at highest normal. This would actually now be considered borderline hypothyroidism. The National Institutes of Health, on the MedLinePlus website, states on their page entitled; " MedlinePlus Medical Encyclopedia: TSH", that "If you are being treated for a thyroid disorder, your TSH level should be between 0.5 and 2.0 mIU/L". A TSH reading such as 1.0 fits within that therapeutic range for treatment of hypothyroidism.
Strangely, there are Doctors who can see these sources, which are the most reputable in the world and they will still disagree with them. In my opinion, when you have a Doctor not willing to work with you in optimizing your hormone therapy, using these suggested guidelines, it is time to find one who is willing to better treat hypothyroidism.