Thyroid and joint pain

Contents

Arthritis as a Manifestation of Systemic Disease Clinical Presentation

Diabetes

Diabetic cheiroarthropathy is also known as diabetic hand syndrome with insidious development of limited joint mobility (Prayer sign), Dupuytren’s contracture, stenosing tenosynovitis (trigger finger), carpal tunnel syndrome, Charcot neuroarthropathy, reflex sympathetic dystrophy. People with diabetes have more than 2 times the risk of carpal tunnel syndrome than those without diabetes; 6% of patients with carpal tunnel syndrome carry the diagnosis of diabetes. Diabetic hand syndrome is seen in both insulin-dependent and noninsulin-dependent diabetes. It is associated with duration of diabetes and control of blood sugar.

Charcot joint occurs in < 1% of all individuals with diabetes. Most patients are older than 40 years and have had long standing, poorly controlled diabetes. With progression of disease, patients can develop rocker bottom feet due to midtarsal collapse.

Diabetic osteolysis is a condition specifically occurring in people with diabetes. The osteolysis is characterized by osteoporosis and variable degrees of resorption of distal metatarsal bones and proximal phalanges in the feet.

Diabetic amyotrophy presents with severe pain and dysesthesia involving most commonly the proximal muscles of the pelvis and thighs. Patients are mostly men and may present with anorexia, weight loss, and unsteady gait. Etiology is unclear but inflammatory vasculopathy may play a role.

Diabetic periarthritis, or frozen shoulder, occurs in 10-33% of those with diabetes. It is more commonly seen in females with long-term noninsulin-dependent diabetes. Up to 50% of the patients have bilateral involvement.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier disease occurs in up to 20% of those with noninsulin-dependent diabetes who are typically obese and older than 50 years. Patients present with neck and back stiffness and radiographs show at least 4 fused vertebrae as a result of ossification of the anterior longitudinal ligament.

Unlike DISH, the predisposition of diabetic patients to the development of osteopenia is not clearly defined. To the extent that it does exist, osteopenia is more common in type 1 diabetic patients compared with type 2 diabetic patients. It is reported to involve those patients more frequently who have poorer control of their disease.

Hypothyroidism

Hypothyroidism can present with an arthritis that resembles early rheumatoid arthritis (RA). Patients complain of pain and stiffness, including morning stiffness, in a symmetrical distribution similar to that found in RA affecting small joints of the hands and wrists. Unlike most cases of RA, this is not a deforming arthritis.

Myxedematous arthropathy usually affects large joints such as knees. Patients present with swelling and stiffness. Synovial thickening, ligamentous laxity and effusions are seen but radiographs are frequently normal.

There is a well-known association between the occurrence of hypothyroidism and muscular disease. The spectrum of thyroid myopathy is broad, ranging from asymptomatic elevation in muscle enzymes, proximal weakness (especially in the hip flexors) and polymyositis-like syndrome to a constellation of muscle cramps, stiffness, and pseudohypertrophy, referred to as Hoffmann syndrome.

There can be mild elevations of creatine phosphokinase (CPK), but few patients actually show muscle weakness.

Carpal tunnel syndrome is observed in up to 10% of patients with hypothyroidism.

Raynaud phenomenon may be seen in hypothyroidism.

Aching muscles with findings indistinguishable from fibromyalgia can be seen but are less common.

Hypothyroidism is also a common cause of trigger finger.

Frozen shoulder is more likely to be severe and bilateral than in patients without hypothyroidism.

Hyperparathyroidism

The classic musculoskeletal manifestation of primary hyperparathyroidism is osteitis fibrosa cystica, which consists of bone pain, osteopenia, and bony cysts.

Painless proximal muscle weakness with normal CPK and a neuropathic or myopathic EMG is seen in hyperparathyroidism.

Chondrocalcinosis has been described in up to 30% of patients with primary hyperparathyroidism. Acute pseudogout attacks occasionally may occur, especially after parathyroidectomy. While some patients discovered in this manner are asymptomatic, many of these patients have other symptoms. These include depression, fatigue, constipation, and joint pain. The joint pain is widespread and nonspecific.

Diffuse osteopenia is commonly seen and erosions may be seen in the joints of hands and at the end of the clavicles.

Spinal compression fractures are common.

Discrete lytic lesions due to focal aggregates of osteoclastic giant cells known as Brown tumors may be seen although these are rare.

Advanced renal disease and associated secondary hyperparathyroidism can lead to metastatic calcification of muscles and soft tissues.

Hyperthyroidism

Thyroid acropachy is a rare (1%) complication of Grave disease consisting of soft tissue swelling of hands, digital clubbing, and periostitis. Radiographs are characteristic with periosteal reaction along the shafts of the metacarpals and phalanges. It is strongly associated with ophthalmopathy and pretibial myxedema.

Patients can present with myopathy, with dramatic increases in CPK and severe proximal muscle weakness, similar to disease seen in polymyositis.

Cushing disease

The presenting musculoskeletal manifestation of Cushing disease may be osteoporosis with fracture.

Proximal myopathy with muscle wasting is common in Cushing disease.

It is not uncommon for patients with Cushing disease to present with a vertebral compression fracture. Occurrence of osteoporotic fractures in young adults may be the manifestation that triggers a workup for excess glucocorticoid production.

Patients can also present with osteonecrosis. Iatrogenic Cushing disease is more likely to cause osteonecrosis than Cushing disease.

Acromegaly

Arthropathy is common and is seen in 70% of the patients with acromegaly.

Peripheral arthropathy is common in the large joints, such as the shoulders and knees. Severe osteoarthritis with crepitus and eventually, pain, limited range of motion, and deformity can occur.

An early manifestation may be overgrowth of cartilage and joint space widening.

Most commonly, osteoarthritis of the first metacarpal joint is seen early in the disease.

Symptoms of carpal tunnel syndrome, OA, and proximal muscle weakness with normal CPK and normal EMG often occur.

Hyperlipidemia

Familial hypercholesterolemia and mixed hypercholesterolemia are associated with tendon xanthomas, particularly of the Achilles tendon, as well as Achilles tendonitis. An association may exist between hyperlipidemia and oligoarthritis or a migratory polyarthritis.

Hemochromatosis

Chronic arthropathy occurs in approximately two thirds of patients with hereditary hemochromatosis. With some patients, the arthropathy is the first manifestation of the underlying disease. Any joint may be affected, but osteoarthritislike symptoms and changes in the second and third metacarpophalangeal (MCP) joints are involved most commonly. Chondrocalcinosis is present in as many as two thirds of patients with hemochromatosis.

Hemochromatosis may be associated with an increased incidence of osteoporosis. One study reported 45% of patients with hemochromatosis also have osteoporosis, especially those patients with coexisting hypogonadism.

Sarcoidosis

The clinical features of sarcoidosis may mimic those of many rheumatic diseases. Patients may present with an acute polyarthritis, especially involving ankles and knees. This arthritis may occur in isolation or as part of Lofgren syndrome, which is defined as a triad of hilar lymphadenopathy, acute polyarthritis, and erythema nodosum. Less commonly, a chronic arthritis may occur (typically involving the ankles, knees, and hands) that is rarely deforming.

Occasionally, patients may have enthesitis, especially in the Achilles tendon, or granulomatous myopathy with pain, proximal muscle weakness, or both. Granulomatous bony lesions may occur, especially in the fingers, but are rare.

Advanced disease can show lytic lesions in the bones of peripheral joints.

Malignancies

Adenocarcinoma of the lung, mesotheliomas, and lymphomas can be associated with hypertrophic pulmonary osteoarthropathy.

Lung cancer can present with Jaccoud–like arthropathy.

Colon cancer and multiple myeloma may be associated with pyogenic arthritis.

Paraneoplastic syndromes can manifest as remitting seronegative symmetric synovitis with pitting edema.

Patients with pancreatic cancer can present with a combination of arthritis and panniculitis.

Thymoma can present as lupuslike syndrome.

HIV disease

Patients with HIV disease may report osteomyelitis, osteonecrosis, reactive arthritis, and/or psoriatic arthritis.

Is Your Foot Pain Caused by Hypothyroidism?

Lots of people experience foot pain after wearing uncomfortable shoes or spending a lot of time on their feet. However, if you have frequent foot pain, there may be an underlying issue that is contributing to your pain. Hypothyroidism can lead to several types of foot pain, including joint and muscle pain. Read on to learn more about hypothyroidism and foot pain.

Understanding Hypothyroidism

At this point, you may be wondering what hypothyroidism actually is. It is a metabolic disorder in which a gland known as the thyroid doesn’t function properly. If you have hypothyroidism, your thyroid gland is underactive, meaning that the thyroid doesn’t produce enough of an important hormone.

Symptoms of hypothyroidism include weight gain, tiredness, weakness, muscle aches and cramps, and depression. If you suspect that you may have hypothyroidism, you should see your doctor. Your doctor can order blood tests to help diagnose hypothyroidism. If the doctor determines that you do, in fact, have hypothyroidism, she will probably prescribe medication for you to take to help balance out the levels of the hormone produced by the thyroid.

People who have hypothyroidism often experience joint pain and muscle pain. Swelling in the muscles of the foot can place pressure on the nerves. The joints can become stiff and inflamed, leading to a joint disease known as arthropathy. People who have hypothyroidism can also develop tarsal tunnel syndrome, which is a medical condition specific to the foot. Tarsal tunnel syndrome sometimes develops as the result of a pinched nerve in the foot or muscle damage in the foot. It causes a burning, tingling pain sensation, particularly in the arch of the foot, although the pain can occur throughout the foot.

The most important thing to do if you suspect that you may have hypothyroidism is to see your doctor. Don’t self-diagnose; hypothyroidism is a serious illness that requires medical intervention and the supervision of a physician.

Caring for Your Feet with Hypothyroidism

If you have hypothyroidism, there are a few things that you can do to care for your feet and minimize foot pain. First, be sure to wear shoes that are comfortable and supportive. Wearing shoes that have high heels, are narrow in the toe box, or don’t provide enough supportive is hard on your feet’s joints, muscles, and ligaments.

The condition of hypothyroidism can also aggravate the joints and muscles in your feet. When you combine those factors, wearing unsupportive shoes when you have hypothyroidism can lead to a lot of pain in your feet. Instead, choose shoes that have a low heel, roomy toe box, and plenty of support.

Orthotics can also help to relieve foot pain. Orthotics or custom arch supports, are devices that are worn inside the shoes. They are made from a mould of your foot, so that they fit your feet perfectly and give you support right where you need it. You can slip these devices into the shoes that you wear every day, and they give you a perfect, supportive fit.

Receiving a diagnosis of hypothyroidism isn’t exactly great news, but it is a manageable condition. See your doctor, and be sure to follow through on your plan of treatment. Ask your doctor about orthotics, or custom arch supports too. She may recommend that you visit a specialized shoe store like Foot Solutions to have these devices made.

Foot Solutions has comfortable, supportive shoes for people with hypothyroidism. We can also make custom arch supports for you so that you get the perfect fit and all the support that your feet need. Don’t keep suffering through foot pain; visit Foot Solutions in your area today, instead.

Watch your step: The condition of feet can indicate thyroid, poor blood flow, rheumatoid arthritis

When our feet hurt, we hurt all over — different versions of this quote are attributed to Greek philosopher Socrates. Though it’s a statement made by a man born circa 470 BC, it holds true in the 21st century as well.
Your feet have to be healthy for more reasons than one. Dr Govind Singh Bisht, principal consultant (podiatry) at New Delhi-based Max Super Specialty Hospital, compares the body to a car and says your feet are the tyres. “If the tyres are not aligned properly, they will wear off and the alignment of the whole car will be disturbed,” he said.
Our body weight is distributed between the forefoot and the back foot evenly with an optimum arch, Bisht said. Any factor that disturbs this balance can cause problems.
YOUR FEET MAY BE SPEAKING TO YOU
Dr Prabhat Ranjan Sinha, consultant (internal medicine) at Dwarka-based Aakash Healthcare Super Speciality Hospital, said that since we think our feet are sturdy and can take intense pressure (and that’s true), we don’t generally invest much time contemplating the throbs, agonies and cautioning signs that they may give us.
“Dry or flaking skin around your heel or on the balls of your foot may be a warning sign of a thyroid condition; if you notice that your toes are losing a little bit of hair, or if they’ve gone completely bald, it could be a sign of poor blood flow; morning foot pain could be a sign of rheumatoid arthritis, and bluish discoloration of fingers and toes signifies that blood supply is getting compromised — it could be because of diabetes or vasculitis, and is a common problem among smokers,” Sinha said.
READING THE PAIN
Foot pain is usually caused by mechanical problems such as poor foot biomechanics, muscle imbalances, poor training techniques and improper footwear, according to Dr Ajay Aggarwal, principal consultant and head of the department of endocrinology at Fortis Hospital, Delhi.
“A podiatrist may prescribe an insole and assess your footwear. Shin pain usually occurs because of poor biomechanics, faulty training techniques or over-training; a callus or corn can form in response to pressure or friction, usually because of poor-fitting shoes; one may also witness soft corns that develop between the toes, where the skin is moist; corns and calluses are common among elderly people, and people with flat feet, higharched feet, arthritis and those who wear ill-fitting shoes,” Aggarwal said.
Getty Images Foot pain is usually caused by mechanical problems such as poor foot biomechanics, muscle imbalances, poor training techniques and improper footwear.
Ingrown toenail is a common problem among all age groups. Bisht said it accounts for 6-9% of his patients. “This happens when the nail starts digging into the skin at the corner and sides of the nails. It could be caused due to inflammation in the corner of the nails from using narrow, tight-fitting or pointed footwear, or overenthusiastic fiddling in the corner of nails while trimming them, walking downhill or pressure sports that cause rawness in the corner of the nails,” he said.
It is not uncommon to find people having thick and discoloured nails; they may not be normal in texture and shape too. “It’s called onychomycosis,” Bisht explained. “Fungal infection of nails is caused by trauma to the nail bed, which allows moisture to enter. Once the nail bed is infected, it may stay that way for years,” he added.
TREATMENT OPTIONS
Taking care of your feet also means you will have better overall health. “When you have painful feet, there is restriction of movement, which can lead to weight gain, sedentary lifestyle, (and thereby) diabetes, hypertension, feeling of bloating, sleep disturbance, and even depression and behavioural issues,” said Bisht.
Getty Images Always pick footwear meant for specific activities like hiking boots or football shoes for those activities.
“The treatment options include identifying and removing the cause of friction and pressure, customised padding to redistribute pressure, shoe inserts, proper footwear and proper moisturising. One must wear shoes or chappals in public areas to avoid tinea and apply anti-fungal creams for treatment. To avoid ingrown toenails, nails should not be cut into the corners and shoes should fit properly. Some patients have toenails that are prone to ingrowth, regardless of how they cut them. In these cases, the solution is to remove the outer margins of the nail, which requires a minor surgical procedure,” said Aggarwal.
DIABETICS NEED EXTRA CARE
According to a study published in the Lancet Diabetes & Endocrinology journal, as many as 98 million people in India may have type 2 diabetes by 2030.
Diabetes can make the feet numb and even a small cut can cause serious consequences. “This can cause an infection or a non-healing wound that may lead to amputation. Patients with diabetes should see a doctor regularly as part of their foot care. Specially so if there is a change in the foot’s skin colour, swelling in the foot or ankle, persistent sores on the feet or if there’s an infected ingrown toenail,” said Aggarwal.

Along with following regular foot care, those with diabetes must take care to not walk barefoot even at home, they must wear extra-wide and well-cushioned footwear as well as never use hot-water bottles, heating electric pads or have direct exposure to heaters or blowers in the winter, said Bisht.
Make Your Feet Work Well:

  • Maintain a healthy and balanced diet
  • Don’t smoke as smoking causes blockage in arteries and decreased blood fl ow
  • Wear well-fitting footwear. Pick footwear meant for specific activities like hiking boots or football shoes for those activities
  • Maintain good foot hygiene as this will prevent skin infection, plantar warts and fungal infections. Regular nail care is important too
  • Indulge in physical activities and sports only after proper muscle training and strengthening programmes to avoid injuries
  • Never wear brand new footwear while travelling. Get used to them 10-15 days beforehand
  • Wash your feet with warm water and dry them well, specially between the toes
  • Wear cotton or woollen socks. Change them often
  • Those with dry feet can use a urea-based or paraffin-based moisturiser and those with sweaty feet can use dusting or anti-fungal powder to avoid infections
  • If your feet have a tendency to swell, consult your doctor for compression stockings
  • If you have corns, don’t use corn caps available in the market or try bathroom surgeries — see a doctor
  • Buy footwear in the evening as feet are known to swell as the day progresses

Exfoliate, Moisturise & Detoxify: Tips To Keep Feet Infection-Free This Monsoon

Play Slideshow

Happy Feet!

21 Jul, 2018Monsoon brings moisture, sweat and stickiness due to humidity, which further leads to chances of fungus and moulds. During the rainy season, it is crucial to take special care of feet to guard against fungal infections and other conditions like Athletes feet.Pankaj Chansarkar, Wellness Manager at Six Senses Spa, Jaypee Greens Golf & Spa Resort Greater Noida; Preeti Mahyavanshi, Spa Manager at Juvana Spa And Wellness, Hotel Sahara Star; and Samay Dutta, director of NOIR salon, share some tips to take care of feet this season.

Long Pathetic List of Hypothyroid Symptoms

YOU KNOW WHY THIS IS THE BEST LIST of HYPOTHYROID SYMPTOMS ON THE INTERNET?? Because….

1) This list is based on actual thyroid patient descriptions of their symptoms whether still on the inadequate T4 medication or from being undiagnosed or UNDERtreated . i.e. it’s not culled from all sorts of internet cold lists to build high numbers and empty volume…

2) Like some lists, it does not contain adrenal-specific symptoms to bulk up the list (unless noted in parenthesis as also related)

3) These are also symptoms which patients have reported greatly improved or totally went away once they moved over to having T3 in their treatment and being optimal to prevent the hypo from coming back. To get optimal without problems, you also have to have the right levels of iron and cortisol.

ENERGY LEVELS

  • Less stamina than others
  • Less energy than others
  • Easy fatigue
  • Feeling weak
  • The need to nap more than others
  • Long recovery period after any activity
  • Arms feeling like dead weights after activity
  • Legs getting tired
  • Inability to exercise, or withstand certain exercises
  • Paying a price after activity
  • Inability to hold children for very long
  • Nodding off easily
  • Slowing to a snail’s pace when walking up slight grade
  • Difficulty getting through work day
  • The need to lay on the couch after getting home from work
  • Going to bed earlier than normal
  • “Exhaustion in every dimension–physical, mental, spiritual, emotional”

SLEEP and REST

  • Sleep Apnea (which can also be associated with low cortisol due to continued hypothyroid state)
  • Being so exhausted at bedtime that you have insomnia
  • Sleeping hard
  • Sleeping more hours than normal
  • Dark circles under eyes
  • Yawning all the time
  • Heavy eyelids
  • Getting more fatigued as day goes on
  • The need for naps to get through the afternoon
  • Having trouble studying from snoozing
  • Air Hunger (feeling like you can’t get enough air)

MOOD or EMOTIONS

  • Chronic Low Grade Depression
  • Major depression
  • Sadness
  • Moody
  • Need for antidepressants
  • Suicidal Thoughts
  • Hyper sensitive towards others
  • Crying easier
  • Ruminating/worrisome
  • Anxiety (can be a cortisol symptom, but also a hypo symptom and common with Hashi’s, as well)
  • Need for anti-anxietal meds
  • Complete lack of motivation
  • Extremely crabby or irritable
  • Worse PMS emotional symptoms
  • Intolerant of others
  • Bi-polar symptoms (often associated with Hashimoto’s)
  • Feeling on-edge

COLDNESS

  • Often feeling cold all over
  • Wearing extra clothing compared to others
  • Cold hands and feet
  • Cold knees
  • A cold bum, butt, derriere, gluteus maximus, haunches, hindquarters, posterior, rear, and/or cheeks. Yup, really exists.
  • Cold ears
  • Cold fingers

METABOLISM

  • The need for extra clothing from low metabolism
  • Feeling anxietal (caused by excess adrenaline due to hypo, but can also be related to adrenal issues)
  • High or rising cholesterol (slow removal of fatty acids)
  • Feeling too hot (Hashimoto’s disease usually, but can be due to other issues like low iron, low aldosterone)
  • Low body temperature
  • Less perspiration than others
  • Tendency to put on weight because of low metabolism

THYROID

  • Swollen (especially Hashimoto’s, but can happen to non-Hashi’s patients)
  • Goiter diagnosis
  • Sore
  • Painful
  • Difficulty swallowing (Hashimoto’s)

STOMACH, DIGESTION, FOODS

  • Acid reflux / GERD
  • Low stomach acid (which causes above)
  • Diagnosis of ‘too much acid’ (it’s really about too little)
  • The need for antiacids to quell symptoms
  • Food sitting in stomach a long time
  • Bloating
  • Craving sweets more than normal
  • Burning stomach lining
  • Inability to eat in the mornings
  • Poor appetite
  • No Appetite
  • Reduced motility (slow movement of food)
  • Small Intestinal Bacterial Overgrowth (SIBO, due to reduced motility)
  • Extreme hunger, especially at nighttime (yes, a minority had this)

NUTRIENTS

  • Poor absorption
  • Poor levels of iron
  • Poor levels of B12
  • Poor levels of Vitamin D
  • Poor levels of B-vitamins

CARDIOVASCULAR

  • Heart disease
  • Heart palpitations
  • Heart Fibrillations
  • Diagnosis of A-fib
  • Fluid retention to the point of Congestive Heart Failure
  • High heartrate
  • Plaque buildup in arteries
  • Rising blood pressure
  • Rising cholesterol
  • Orthostatic hypotension (low blood pressure upon standing)

ELIMINATION, INTESTINAL and BLADDER

  • Hard stools
  • Little round stools
  • Constipation
  • Diarrhea (less common than constipation)
  • Candida
  • Colitis
  • Irritable bowel syndrome (IBS)
  • Painful bladder; painful urination
  • Bladder spasms
  • Bladder urgency (can also be due to low aldosterone)
  • Not urinating much

HAIR and SKIN

  • No eyebrows
  • Thinning outer eyebrows
  • Dry Hair
  • Hair feels like straw
  • Excessive frizziness
  • Hair Loss
  • Broken hair
  • White hairs growing in
  • No hair growth, breaks faster than it grows
  • Dandruff
  • Only needing to wash hair once a week or so
  • Dry face
  • Dry cracking heels
  • Dry skin in general
  • Itchy skin
  • Scaly looking skin
  • Easy bruising!
  • Pimples
  • Acne (yes, some reported it went away on NDT!)
  • Swelling/edema/puffiness
  • Breakout on chest and arms
  • Hives (one woman stated hers went away with NDT, thus the connection here)
  • Neuropathy (nerve issues)
  • Vitiligo (especially with Hashimoto’s)

ISSUES in the HEAD AREA

  • Dry Eye Syndrome
  • Worsening vision
  • Headaches and Migraines
  • Slurred Speech
  • Swollen Tongue
  • Scalloped tongue (in spite of other causes, hypo is one)
  • Lowered voice
  • Dry mouth
  • Gum Problems
  • Internal itching of ears
  • Ringing in the ears
  • Hearing problems
  • Dizziness from fluid on the inner ear
  • Puffy face
  • Puffy eyelids
  • Extra fat under chin/on neck

HANDS

  • Puffy fingers/hands
  • Stiff fingers
  • Breaking/brittle nails
  • Broken/peeling fingernails
  • Ridged nails
  • Inflammation/pain in fingers
  • Inflammation/pain in hand
  • Tendonitis diagnosis
  • Carpel tunnel pain (also with Hashimoto’s)
  • Palm pain
  • Wrist pain

LEGS and FEET

  • Bumps on legs
  • Swollen legs that impeded walking
  • Shin splints
  • Difficulty standing on feet
  • Sore feet
  • painful soles of feet (like walking on glass–very common)

BONES, MUSCLES, JOINTS

  • Aching bones or muscles
  • Joint pain
  • Clicking in joints
  • Popping joints
  • Stiffness
  • Inflamed joints
  • Diagnosis of Fibromyalgia
  • Osteopenia
  • Osteoporosis
  • Muscular weakness in activities
  • Carpel Tunnel
  • Back pain
  • Shoulder pain
  • Frozen shoulder
  • Tender elbow
  • pain in knees

BRAIN

  • Inability to concentrate
  • Inability to read long periods of time
  • Inability to retain
  • Forgetfulness
  • Foggy thinking aka Brain Fog
  • Memory issues

WEIGHT

  • Inability to lose weight in spite of trying hard
  • Losing only a little when trying hard
  • Gaining weight too easily
  • Obesity
  • Weight loss (a small minority experience this)
  • Fat tummy
  • Water retention
  • Edema

RELATIONSHIPS or WORK

  • Inability to function well in a relationship
  • No or poor sex drive
  • Argumentative (from not feeling well, but can also be due to low cortisol)
  • Avoidance
  • Inability to work full time
  • Constantly tired at work
  • Lower quality work performance
  • The need for sit-down jobs

SEX HORMONES or FEMALE ISSUES

  • Failure to ovulate
  • Constant bleeding (see Rainbow’s story)
  • Heavy bleeding
  • Longer periods
  • Irregular periods
  • Moody periods
  • Excruciating pain during period
  • Worse PMS
  • PCOS
  • Inability to get pregnant
  • Miscarriages
  • Breast leakage
  • Urinary Tract Infections

IMMUNE FUNCTION

  • Bad head colds
  • Seem to get more head colds than others
  • Poor resistance to illnesses going around
  • Taking longer to recover
  • Recurring viral or bacterial illnesses
  • Recurring sore throats
  • Chronic sinus infections
  • Persistant Candida
  • Tightness in throat; sore throat
  • Swollen lymph glands
  • Inflammation

CERTAIN MEDICAL CONDITIONS (though not saying YOUR condition is caused by hypothyroid, but for some, it appears so!)

  • Asthma
  • Dysautonomia symptoms (overreaction of one’s autonomic nervous system–Janie had this)
  • Hypoglycemia/Low Blood Sugar And a study here.
  • Lactose Intolerance (due to low stomach acid from a poor treatment or undiagnosed)
  • Allergies (which can also be a result of low cortisol–see link below)
  • Dysphagia (nerve damage causing inability to swallow fluid, food, saliva; can also be caused by a goiter or anxiety)
  • Neurogenic bladder
  • Chronic Fatigue Syndrome (which for the vast majority of thyroid patients, is a catch-all diagnosis)
  • Fatty Liver

MISCELLANEOUS

  • Bad motion sickness
  • Sweaty or clammy palms
  • Clumsiness
  • Worsening of other conditions
  • Handwriting nearly illegible
  • Carpal tunnel symptoms
  • Worsening Varicose Veins
  • Tailbone pain
  • Light headed
  • Just feeling sick
  • Breathless
  • Just generally struggling

In other words….

If you have some or many of these symptoms, and have never received a diagnosis of hypothyroidism, it’s time to visit an informed and open-minded doctor.

If you have some or many of these symptoms and are on T4-only, time to talk to your doctor about adding synthetic T3 to your treatment and getting optimal–the latter which is not just how you feel. It’s also about the free T4 and free T3.

If you have some or many of these symptoms and are on Natural Desiccated Thyroid or T3, you are either underdosing yourself (common scenario), or you need to read about the other two main reasons why one may not do as well on NDT. **NOTE that NDT is not the excellent product it used to be.

Check out Chapter 3 in the updated revised STTM book–all to make you more informed with your doctor. YOU are your own best advocate. Get informed with this BIBLE OF PATIENTS EXPERIENCES AND WISDOM. And see if you can teach your doctor!

Have Hashimoto’s disease? Here’s the excellent companion book to the above. It’s to the point, making it an easier book to get through on Hashi’s. Has a NOTES page after each chapter. Friendly. And four patient-to-patient chapters!

Want to order your own labwork to confirm what the above symptoms are telling you? STTM has created the right ones just for you to discuss with your doctor. Go here: https://sttm.mymedlab.com/

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website’s information or outcomes. See the Disclaimer and Terms of Use.

Health Topics

Endocrine Disorders and Joint Diseases

Rheumatic conditions commonly occur in endocrine disease. Nearly all hormones have as one of their targets the connective tissue cells. Hormones are involved in the development and function of connective tissue. If the components of a particular connective tissue are altered by abnormal hormonal influence, the physical properties of the connective tissue vary, and the functional capability of the tissue will change, creating recognizable illness.

Pituitary Gland

Excessive production of growth hormone produces excessive growth in children (resulting in the child becoming a giant) or acromegaly (coarsening and enlargement of features) in adults. The arthritis of acromegaly is a distinct type of degenerative joint disease causing degeneration at the large joints associated with marked bony overgrowth and frequent back pain. Motion in joints is often preserved until late in the disease and excessive motion is common, particularly in the spine. Joint enlargement occurs because of fluid collections but also because of connective tissue overgrowth. Bony overgrowth is particularly prominent at the knuckles.

Later on, postural deformities occur with spinal curvature, bow legs, and loose joints. Characteristic changes occur in the skull, spine, hands, and other joints, and are visible on X-rays. Excessive thickness of the heel pad is also a prominent sign. Growth hormone causes an excessive number of cartilage cells, which causes overgrowth and cracking of cartilage, leading to degeneration of cartilage and overgrowth of bone near the joint. Acromegaly can also cause a muscle weakness and a neuropathy, (effect on the nerve), which may behave like connective tissue diseases.

Thyroid Gland

Rheumatic conditions associated with the thyroid gland include:

Hypothyroid arthritis. Arthritis from an underactive thyroid gland is related to excessive deposits of certain proteins in connective tissues. Thyroid stimulating hormone, produced by the pituitary gland at the base of the brain, may cause the excessive protein collections. Symptoms include vague aches and pains, but usually there are no inflammatory signs. Joint thickening and fluid collections occur in 33% of patients. Knees, ankles, and small hand and foot joints are involved and are unusually thick. Knee x-rays show a characteristic thinning of bone near the joint.

Hypothyroid muscle disease. Muscle disease from an underactive thyroid gland is characterized by slow movements and delayed muscle contraction. Fifty percent of patients will complain of weakness, muscle cramping, pain and stiffness. Muscle enlargement is noted in 15 percent of patients, but muscle shrinkage is rare. Symptoms are aggravated by cold and inactivity. Chemicals from muscle tissue can be quite elevated in the blood. An EMG test (electromyogram) will demonstrate a characteristic abnormality. Examination of muscle tissue under the microscope shows typical changes.

Hypothyroid nerve disease. Nerve disease from an underactive thyroid may cause numbness or tingling. Carpal tunnel syndrome occurs in 5 to 10 percent of patients with hypothyroidism, causing numbness in the thumb, index, and middle fingers.

Hyperthyroidism. Thyroid acropachy is an unusual condition that follows treatment for Graves disease, a type of thyroid overactivity in a small percentage of patients with an overactive thyroid gland. This causes rounding of the finger and toenails, inflammation of the digits and distal extremities, and swelling of soft tissues. It is frequently associated with bulging eyes and a rash on the legs, and often causes pain in the bones.

Bursitis in hyperthyroidism. Bursitis, particularly of the shoulder joint, commonly occurs with an overactive thyroid gland. It may also occur surrounding other joint areas. Joint areas show thickening and soft tissue swelling, and there is significant limitation of motion of joints. Symptoms often improve after treatment of the overactive thyroid.

Hyperthyroid muscle disease. Hyperthyroid muscle disease takes several forms. Diffuse muscle disease is not uncommon with an overactive thyroid gland. This frequently causes thigh muscle weakness that may be mild or severe. Shrinkage of muscle and collection of fat in the muscles does occur. Muscle chemicals in the blood are generally normal. Paralysis of the eye muscles may exist. Swelling of the eyelids and the other layers of the eye, and eye nerve inflammation, are not unusual.

Lupus-like conditions. Several medications used to treat an overactive thyroid gland, especially propylthiouracil, and the thionamides, may cause a lupus-like condition.

Osteoporosis. Osteoporosis (thin brittle bones) may occur in thyroid disease because of a loss of calcium and phosphorus from the body.

Hashimoto’s thyroiditis. This condition is an autoimmune process affecting the thyroid gland. Patients have an overactive thyroid early, but 50 percent develop an under active thyroid gland at a later time. Other rheumatic diseases, such as rheumatoid arthritis or lupus can be seen in the same patients. Vitiligo (loss of skin pigment in some areas) is a commonly associated finding.

Pancreas

Rheumatic conditions associated with the pancreas include:

DISH. A severe form of spinal wear-and-tear arthritis known as diffuse idiopathic skeletal hyperostosis (DISH) occurs in approximately 13 percent of diabetics. Symptoms are usually minimal but most often involve the middle spine. X-rays demonstrate a large amount of bony overgrowth.

Diabetic charcot arthritis. This is a destructive arthritis occurring because the diabetic does not have good sensation in a particular area. It involves the feet, ankles, knees and spine. Typical findings are created by a combination of small fractures, lack of blood flow, and infection. This causes eventual collapse of the foot structures with a poor gait and disposes the patient to ulcers and calluses.

Diabetic dissolving bone. Dissolving bone occurs even without evidence of local nerve disease or poor circulation. There is a patchy or general loss of bone involving the feet, toes, or fingers. Severe pain may be present. The diabetes may be mild or undiagnosed. The X-ray findings could resemble those seen in rheumatoid arthritis. This may progress to complete dissolution of bone, but may also heal completely.

Soft tissue contracture syndromes. Dupuytren’s contracture (a tightening of tendons in the palm) occurs in 15 percent of diabetics. Diabetic wrist stiffness has recently been described in up to 40 percent of diabetics with juvenile onset diabetes. This creates a contracture deformity of the fingers and knuckles, particularly of the 4th and 5th digits. Trigger finger is quite frequently seen in diabetics.

Other types of arthritis in diabetes. About 15 percent of diabetics have calcium deposits develop in their joint cartilage that represents scar tissue. In addition, there is some questionable relationship between diabetes and gout. Probably, the common bond is obesity and high cholesterol. Generalized primary osteoarthritis is somewhat more common in diabetics. In addition, bursitis of the shoulder, particularly with bilateral involvement, is not uncommon in diabetes. It is more common in insulin dependent diabetics and in females, and most often involves the non-dominant side. It may be followed by development of frozen shoulder.

Parathyroid

Bone disease from overactive parathyroid glands in the neck causes early dissolving of bone. Destructive arthritis also occurs in hyperparathyroidism, involving the wrists and knees particularly, with development of holes at the edges of the bone near the joints. The primary problem is softening of bone, with cartilage thinning and stiffness secondary. In many patients with hyperparathyroidism, gout and pseudogout may also occur.

Muscle weakness or abnormal nerve function that causes fatigue, particularly of the lower extremities, also occurs with an overactive parathyroid gland.

The physician must consider all of these possible gland abnormalities when the patient complains of symptoms arising from the muscles, bones, or joints. He or she must then select appropriate tests to prove or eliminate these possible diagnoses.

If medical therapy fails, surgical procedures such as sympathectomy could be considered, along with continued drug therapy.

You’re likely well aware that your body works like a machine—if one part is off, then, well, the whole damn thing can start having issues.

The best example of this is your thyroid, the small gland in your neck that controls your metabolism and regulates your bodily functions (you know, breathing, temperature, menstrual cycle, and so on).

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Most of the time, you don’t notice your thyroid gland is working at all (I mean, why would you?). But when it starts misfiring, like not releasing enough thyroid hormone (a.k.a. hypothyroidism) or releasing too much (hyperthyroidism), all hell can break loose. Even more annoying: That hell can break loose anywhere in your body: your eyes, your skin, your hands, you name it.

That’s because symptoms of thyroid disease can mirror the symptoms of a ton of other issues. “Symptoms vary from person to person and can come on suddenly or very gradually, so they’re hard to detect,” as Valentina Rodriguez, M.D., an endocrinologist at NYU Langone Health previously told Women’s Health in Do I Need A Thyroid Check?.

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That’s why it’s super important to stay on top of—and quickly act on—any of the symptoms below. (Thyroid disease is much more common in women, BTW. One in eight will develop a thyroid disorder in her lifetime, per the American Thyroid Association.)

1. Your hair is thinning.

According to the American Academy of Dermatology (AAD), your dermatologist might be the first doctor to notice signs of thyroid disease since many signs and symptoms show up on your skin, hair, and nails.

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Both conditions—hypothyroidism and hyperthyroidism—can cause your hair to thin. Your eyebrows are hit especially hard: Eyebrows that thin along the outer edges can be a sign of hypothyroidism, Eve Feinberg, M.D., assistant professor of reproductive endocrinology and infertility at Northwestern University School of Medicine previously told Women’s Health.

You may also find less hair on your legs, arms, and other areas, or that your hair has become coarse, dully, dry, and breaks easily, per the AAD.

2. Your eyes feel dry and look puffy.

While dry, irritated eyes can be a symptom of both hyperthyroidism and hypothyroidism, super-puffy, protruding eyes can be a sign of Graves’ disease, an autoimmune disorder that causes hyperthyroidism, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

This happens when the eyelids are pulled back from the eye, per the NIDDK. Along with bulging eyes, Graves’ disease can also cause double vision and swelling.

3. Your muscles feel weak.

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Both hypothyroidism and hyperthyroidism can cause muscles to feel achy, weak, or stiff, according to Rodriguez. But, because thyroid symptoms often develop slowly, many people don’t notice the muscle aches or weakness right away, or brush it off as typical pain that comes from aging. Check in with your doctor if something feels off.

4. You’re feeling low.

Hypothyroidism can be associated with difficulty concentrating or depression, while hyperthyroidism can result in anxiety, says Sona Shah, M.D., an endocrinologist at NYU Langone Health.

Both disorders can leave you feeling out of control mentally and emotionally, according to Rodriguez, so it’s important to seek mental health treatment, along with medical treatment.

5. Your legs and ankles look swollen.

Because hypothyroidism can cause the body’s processes to slow down, it can lead to water retention, which will typically show up in your lower body—your hips, knees, ankles, and feet—because of gravity, says Feinberg.

6. Your neck is swollen, too.

If your neck is super swollen, it may be caused by a goiter, which is basically the term for an abnormally enlarged thyroid gland, according to the American Thyroid Association. See a doc if your neck looks swollen.

7. Your weight drastically changed recently.

With hypothyroidism, your body slows down, which means that you can gain weight, according to Rodriguez. The opposite can happen with hyperthyroidism, she adds.

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While many women can see weight loss as a good thing, Rodriguez says it’s necessary to get treatment, regardless of what type of weight fluctuation you’re noticing. Left untreated, any thyroid condition can be extremely hard on the body, “especially the heart,” she says.

Amber Brenza Amber Brenza is the health editor at Women’s Health, and she oversees the website’s health and weight loss verticals.

Hashimoto’s and Leg Swelling

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Hashimoto’s Leg Swelling and Calf pain

There are many side effects related to hypothyroidism caused by autoimmune thyroid disease. Skin tissues are often affected and one of the most frustrating signs is a condition called myxedema which can happen anywhere on the body, especially on the face and eyelids. It is also troubling when myxedema affects the lower extremities and causes leg swelling. It’s often felt as leg pain along with swelling, itching, and very uncomfortable heaviness in the lower legs.

This happened to me. There was a period of time before I was diagnosed when taking a simple walk resulted in severe pain in my calves – gut-wrenching pain. It would begin after a few short minutes and would disappear as soon as I stopped walking.

Knowing this might be a sign of a heart or vascular issue, I reported symptoms to my doctors and got tested for a condition known as claudication at least 3 times. Fortunately, the tests were negative.

It was odd to me at the time because, in addition to the onset of pain when walking, I also had these “puffy pockets” just below my knees and above my shins. I thought diuretics would help, but typical fluid retention wasn’t the problem.

What is the Cause of Hashimoto’s Leg Swelling?

Although often seen in Graves disease, pretibial myxedema is also a common side effect of hypothyroidism caused by Hashimoto’s.

The cause is triggered by the displacement of hyaluronic acid and the skin of the pretibial area (shin) just below the knee accumulates glycosaminoglycan (a sugar linked with protein that fills the space between collagen and elastin fibers in the dermis) in the deep layers of the skin and infiltrates the area. Appearance wise, it can look a lot like cellulite if the infiltrations are extreme.

The skin can also appear to be “thickened,” and it can be felt as being painful, heavy, and often accompanied by itching – and isn’t relieved much by scratching.

Unfortunately, this type of edema is often misdiagnosed as the type of fluid retention related to kidney dysfunction, and patients are prescribed diuretics or medication for high blood pressure; however, this isn’t the problem!

Pretibial myxedema is directly related to an autoimmune thyroid condition and the displacement of hyaluronic acid in the body – the thyroid in and of itself is not the problem.

What You Can Do About Hashimoto’s Leg Swelling

Although this condition can persist even after balancing thyroid levels, you still must take steps to optimize your levels. You don’t want lab values that are simply “in range,” you want optimal levels for you. Many researchers don’t believe pretibial myxedema related to autoimmune thyroid conditions can be healed. Most studies for treatment options refer to palliative care such as the use of corticosteroids, compression therapy, and comfort measures. However, this study does mention modulation of the immune system.

Applying essential oil of peppermint can definitely help with pain and discomfort. You can apply as often as needed. Frankincense essential oil (Boswellia) has been shown to reduce inflammation and pain. Both are effective for symptom relief.

My issues with pretibial myxedema resolved after I found remission with low-dose naltrexone (LDN). However, my case was “resistant” because it took so long to get a diagnosis (8 years). Had I been diagnosed earlier in my journey, there would have been a greater chance I could have reversed Hashimoto’s with other protocols. I’ve seen it happen in many of my clients. LDN is a life commitment, so it’s worth the effort to try to get into remission with other modalities first.

There are other proven, science-based immune system modulators you can try before committing to LDN. Moducare by Thorne Research is available without a prescription and has been shown in research studies to reduce TPO antibodies by balancing T-helper 1 | T-helper 2 white blood cells. It also modulates the stress response by supporting optimal DHEA cortisol ratios and dampens an overactive immune response. Click here to review the science behind its mechanism of action and monograph on plant sterols.

In another study, researchers found Myo-inositol, when combined with selenomethionine, to be an effective treatment in patients with low thyroid function caused by TPO antibodies and Tg antibodies. The study also showed Myo-Inositol treatment reduced TSH to normal levels and improved patients symptoms.

Regarding selenium, please note there are differences:

  1. Inorganic (selenate and selenite)
  2. Organic (selenomethionine and selenocysteine)

Selenomethionine is the form of selenium shown in research studies to reduce TPO antibodies when using the correct dose (200 mcg to 400 mcg per day). Selenium also helps with anxiety and oxidative stress.

For getting into remission get into remission the goal should be to modulate and balance the immune system to a healthy state. This will help to derail or significantly reduce an overactive immune system from attacking its host (YOU) and potentially reduce the risks for secondary autoimmune conditions and overall inflammation.

If you’re interested in trying Moducare by Thorne Research, use our Patient Express Code: HCP1070153
*Please note that Thorne has provided a statement that they do not have a business relationship with Amazon. Any Thorne Research products seen on Amazon may be by unauthorized individuals or potentially counterfeit and unsafe.

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Hashimoto’s & Shoulder Pain

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Thyroid problems are associated with a variety of conditions that cause pain to your nerves, muscles, and joints. Some research estimates that as many as 80 percent of thyroid patients have some degree of myopathy, a weakening of the muscles that sometimes leads to pain, tenderness, cramps, and spasms.

Paresthesia is another thyroid-related condition, and refers to numbness and tingling usually felt in the hands, arms, legs, or feet. It can also occur in other parts of the body. Also common in people with thyroid disease is acroparaesthesia, which involves burning, tingling, or pricking sensations or numbness in your extremities when you haven’t been moving for a while, such as after sleep.

Untreated hyperthyroidism and Graves’ disease are not typically associated with pain, but rather a condition known as hyperthyroid myopathy. Hyperthyroid myopathy causes weakness in the muscles and causes your muscles to easily fatigue, making it difficult to climb stairs, hold or grip objects, or reach your arms above the head. In most cases, resolving the hyperthyroidism will resolve hyperthyroid myopathy within several months.

Hypothyroidism and muscle and joint conditions

Hypothyroidism ― a condition of insufficient thyroid hormone ― is linked to a variety of general pain-related muscle and joint symptoms, including stiffness, aches, and pains in joints (known as arthropathy). Fluid retention is also common, which can lead to swelling and pain in muscles, known as hypothyroid myopathy.

Hypothyroid myopathy commonly causes what’s called proximal weakness ― a weakness of muscles closer to the body’s midline ― which affects an estimated 90 percent of people with hypothyroidism. Distal weakness ― weakness of muscles further out on the limbs ― is estimated to affect 30 percent of people with hypothyroidism.

Signs of hypothyroid myopathy include:

  • Muscle pain/weakness, often made worse when exposed to cold

  • Diffuse aching, called fibrositis

  • Muscle cramps/stiffness

  • Joint pain

  • Difficulty climbing stairs

  • Difficulty holding things with the fingers or hands

  • Difficulty raising the arms over the head

Hypothyroid myopathy can also lead to a number of other muscle and nerve conditions, including:

  • Tendonitis

  • Carpal tunnel syndrome

  • Tarsal tunnel syndrome

  • Frozen shoulder

  • Peripheral neuropathy

Tendonitis (also spelled tendinitis) is an inflammation and pain in tendons, most commonly affecting the elbows, wrists, fingers, arms, feet, and thighs.

In carpal tunnel syndrome, swelling compresses the nerves in the forearm, causing a variety of symptoms including pain, aches, tingling, weakness, and numbness in the wrists, fingers, or forearms, as well as decreased grip strength. It’s estimated that a third of all patients with carpal tunnel have an underlying disease, including hypothyroidism, that is causing the condition.

In tarsal tunnel syndrome, swelling compresses the nerves in the lower leg, causing pain, aches, tingling, weakness, and numbness in the feet, toes, ankles, and lower leg.

In plantar fasciitis, swelling affects a nerve in the foot sole, causing heel pain and stiffness at rest or when standing, walking, or climbing stairs.

Frozen shoulder, also known as adhesive capsulitis, causes pain, limited range of movement, and stiffness in the shoulder. The pain can radiate from the shoulder into the upper arm, and you may find it difficult to raise your arm or move your shoulder.

Hypothyroidism can cause peripheral neuropathy. In peripheral neuropathy, damage to nerves can cause a number of symptoms, including:

  • Pain

  • Burning sensations

  • Numbness and tingling

  • Muscle weakness

  • Loss of muscle control

  • Cramps

  • Muscle twitching

  • Decreased reflexes

  • Shrinkage and atrophy of muscles

Treating thyroid-related nerve and muscle conditions

For the most part, symptoms related to nerve and muscles resolve when the underlying hypothyroidism is properly and effectively treated. In most cases, symptoms lessen and even disappear within six months of treatment.

Some approaches to relieving muscle and joint pain include:

  • Supplementing with glucosamine, chondroitin, and magnesium

  • Using an inflammatory supplement like curcumin, a specialized form of the spice turmeric. (Many doctors like the high-potency form of curcumin called Curamin and Curamed.)

  • Icing or heat therapy

  • Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil or Motrin) or naproxen (Aleve)

  • Topical non-prescription creams, such as CBD, arnica, or comfrey

  • Braces and splints for carpal or tarsal tunnel

  • Orthotic shoe inserts

  • Anti-inflammatory drugs to minimize swelling

  • Stretches, exercises, and physical therapy

  • Osteopathic manipulation

  • Acupuncture

  • Steroid/cortisone shots into affected joints and muscles

When pain and symptoms continue despite treatment, some patients are referred to a rheumatologist to rule out fibromyalgia or arthritis.

In extreme cases that do not respond to any other treatments, surgery — often performed arthroscopically — is sometimes recommended for frozen shoulder, and carpal or tarsal tunnel syndromes.

The integrative approach

Hawaii-based physician Jacob Teitelbaum, MD, is one of the nation’s leading authorities on integrative and natural approaches to pain management. Dr. Teitelbaum typically recommends avoiding NSAID drugs due to the risks of liver damage. Some of his recommendations include:

  • A prescription for low dose naltrexone (LDN) at 4.5 milligrams at bedtime, to help desensitize against pain

  • A patented form of the anti-inflammatory herb turmeric’s key ingredient, curcumin, called Curamin

  • The herb Boswellia

  • An anti-inflammatory diet

Dr. Teitelbaum shares more of his integrative approaches to resolving pain in his helpful book, Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now.

See more helpful articles:

Thyroid Disease and Your Menstrual Cycle

When to Get a Thyroid Second Opinion

Understanding Autoimmune Disease

Be sure to take this medicine with plenty of fluids. Some tablets may cause choking, gagging, or difficulty swallowing from the tablet getting stuck in your throat. Most of these problems disappear if the medicine is taken with the right amount of water or other fluids.

Do not switch brands of this medicine unless your health care professional agrees with the change. Ask questions if you are uncertain.

You will need regular exams and occasional blood tests to check the response to treatment. If you are receiving this medicine for an underactive thyroid, it may be several weeks before you notice an improvement. Check with your doctor or health care professional if your symptoms do not improve.

It may be necessary for you to take this medicine for the rest of your life. Do not stop using this medicine unless your doctor or health care professional advises you to.

This medicine can affect blood sugar levels. If you have diabetes, check your blood sugar as directed.

You may lose some of your hair when you first start treatment. With time, this usually corrects itself.

If you are going to have surgery, tell your doctor or health care professional that you are taking this medicine.

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