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Natasha asked...

Auto-immune thyroid disease

I have auto-immune thyroid disease, and have been prescribed 200mcg Thyroxine for nearly 20 yrs. I have always dealt with flare ups of debilitating fatigue and joint/muscle pain. My flare ups have become much more severe; with concerning cognitive issues, such as memory problems, speech and inability to think of words. It's as if my brain has a shut down mode during a flare up. I also have vision issues, pain, stiffness and neuralgia..all left side. I get dizzy, light headed, and am sometimes off balance when walking for lengthy periods. I am now concerned that I may have developed a second auto-immune condition, as I don't believe my symptoms are down to the Thyroid disease. What should I do? My GP puts everything down to my ongoing condition, Do you think it could be something else? I am fed up with feeling so unwell. I had a flare of symptoms from New Year, for 8 weeks...I then had 4 weeks of respite...felt absolutely fine...now I'm unwell again with fatigue and terrible neuralgia.

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The answer

Stiffness muscle aches and cognitive issues can all be found when there are imbalances in the thyroid and the level of circulating hormones as you are probably aware as can fatigue. Neuralgia is less associated with thyroid issues and may be a separate presentation, dizziness and light headedness may or may not be associated.

You have been on the same dose of thyroxine for some time which obviously is thought to be keeping your thyroid hormone within the normal range. However, given your symptoms you may wish to see an endocrinologist who might be able to shed some light as to why you are feeling as you are.

The majority of thyroid testing focuses on measuring the quantity of T4 and free T4 available in the system, an Endocrinologist will also be able to test the levels of your circulating T3 and free T3 hormones in addition. T3 is the active hormone which delivers energy to the cells and is derived from T4 (thyroxine) it is possible that your T4 may be showing within the normal range but if the level of T3 is in fact sub normal this could account for many of the symptoms you have been experiencing.

Under the circumstances and given your symptoms it would seem sensible to speak to your GP again and ask for an endocrinology opinion to enable more in depth investigation of these symptoms and a full diagnosis.

Answered by the Health at Hand nurses

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