When I was first diagnosed with hyperthyroidism (22/5/24), I thought it would be a simple road to recovery. Just take my medication, my hormones would normalise, my hyperthyroid symptoms would go away, and life would be hunky dory. Well, it is now 9 going on to 10 months since I started treatment and the road has not been straight. In fact, it has been a little bumpy with the occasional hairpin turn thrown in for good measure. The human body truly is quite fascinating, albeit a little annoying.
Thyroid problems seem to affect women more commonly than men, with as many as one in eight women experiencing some issue at some point of their lives. Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone. This is as opposed to Hypothyroidism, when the thyroid gland produces too little thyroid hormone. There are various reasons why this happens but the most common cause of Hyperthyroidism is Grave’s Disease. About 70% of Hyperthyroid cases are due to Grave’s Disease, an autoimmune condition that affects the thyroid gland. Although the cause of Grave’s Disease is not known (idiopathic), there is a familial link (it can be genetically inherited).
On Thyroid Hormones Normalisation
There are three hormones that the doctor monitored with blood tests:
- TSH (Thyroid Stimulating Hormone) – which is quite self-explanatory. It stimulates the thyroid to produce T3 and T4. This is usually low in Hyperthyroidism.
- T3 (Triiodothyronine) – which is important for regulating metabolism, heart and digestive functions, muscle control, brain development and function, and bone maintenance. This is usually high in Hyperthyroidism.
- T4 (Thyroxine) – which plays an important role in regulating metabolism, heart rate, body temperature, and other bodily functions. This is also high in Hyperthyroidism.
The primary treatment for Hyperthyroidism is with medication that stop the thyroid from producing excess hormones. For my case, I took the drug carbimazole. From the time I commenced treatment, it took about 3 months for thyroid hormones T3 and T4 to return to normal levels. TSH took a little longer to normalise – about 6 to 7 months.
For me, once T3 and T4 dropped back to normal range, my weight started to increase and I no longer felt hot all the time. In fact, I started to feel cold again – especially my hands and feet.
On Muscle Cramps and Myalgia
About 3 months into treatment, I started experiencing muscle cramps. It started with a cramp in my shoulder, and then my ribs. I was traveling at that point and the weather was cold so I attributed it to the weather. I started taking magnesium as well since that was supposed to help. When I got back to my tropical climate, the cramps increased in frequency and severity. I thought it was very unusual since I am not a person who usually get cramps. The only time I’ve had them was during pregnancy and during the Spartan Beast Race in Ipoh.
I suffered cramps most frequently in my quads, glutes, neck and toes, but I also had them in my ribs, shoulder and triceps. Sometimes there was a clear trigger, like when I was working out or stretching my muscles. Other times, I would cramp for no reason at all, for instance, when I was sitting on the couch watching TV and all I did was shift my legs. There was one time, I suffered a cramp in my neck after yawning.
When I told the doctor about the cramps, he explained that it was most likely myalgia (muscle pain). It sometimes occurs during treatment of hyperthyroidism because of the rapid drop in thyroid hormones. The condition is call Relative Hypothyroidism – the body detects the drop in thyroid hormones and behaves as though it suffers from hypothyroidism even when thyroid hormone levels are within normal range.
Myopathy can be caused by a rapid reduction of thyroid hormone during the treatment of hyperthyroidism. This relative hypothyroidism syndrome should be considered if patients make complaints about fatigue and myalgia, even when thyroid hormone level is within the normal range during the antithyroid treatments.
To check for muscle damage, the doctor took a blood test to check my creatine kinase levels. Since elevated creatine kinase levels are a sign of muscle injury, I took it easier with my workouts until my CK levels returned to normal. While the younger me would have ignored the signs of pain from my body, the older (wiser) me has learned that pain is the body’s way of communicating when something is not right.
On Fatigue
Fatigue is one of the symptoms of hyperthyroidism, although it seems like there is some confusion over this. Since hyperthyroidism increases metabolism, there is an initial surge in energy levels. However, when the body stays at this elevated state for long enough, the body begins to break down and that is when the fatigue sets in. When you add in the other symptoms of hyperthyroidism like anxiety, difficulty sleeping, and muscle weakness, it’s not really surprising that fatigue would be a common symptom of hyperthyroidism.
Although I knew I wouldn’t get better immediately, I really didn’t expect to feel so much worse during treatment. Since fatigue also is a symptom of hypothyroidism and treatment of hyperthyroidism can lead to relative hypothyroidism (which it did in my case), there was a period during treatment when I really struggled with energy levels. During a morning walk I had with a friend, I had to tell her to slow down because I couldn’t keep up. It felt ironic considering that I used to get annoyed with people who walk too slowly.
On Exophthalmos (Protruding Eyes)
Exophthalmos is the protrusion of one or both eyes anteriorly out of the orbit due to an increase in orbital contents within the rigid bony orbit. It most commonly manifests in thyroid-associated eye disease such as Graves’ disease ophthalmopathy.
The Exophthalmos on my left eye was a lot worse than the one in my right eye. I can’t believe I never noticed it until the doctor pointed it out. Exophthalmos gives the appearance of being a deer in headlights, perhaps even a little worse depending on the severity. Thankfully, my eyes have improved after 6 months of taking selenium. My left eye still protrudes a little more than the right, but at least it doesn’t look like my eyes are about to fall out.
On Hair Loss
Hyperthyroidism can accelerate the hair growth cycle, leading to hair shedding prematurely and causing thinning. While I have noticed the increase hair fall for a while, I was totally unprepared for how bad it can get during thyroid treatment. I thought my hair loss was bad until it started falling out in clumps. It was all over the floor until my vacuum cleaner brush was choking on it. I could vacuum the whole house and it would not make a difference because the hair on my head would fall off as I was moving and replace the hairs I was cleaning up.
I asked the doctor about my hair loss and he explained that the strands of hair falling out were likely the ones affected during the hyperactive period of my thyroid. He assured me that once these weakened strands have fallen out, my hair would return to normal. I snarkily wondered if I would have any hair left by that point. The doctor suggested I try using anti hair-loss products and I did – the whole shebang. Well, okay, there was one thing I didn’t try – minoxidil. But supplements, tonics, shampoos, conditioners, and hair treatments – I used all of those. If they did anything at all to save my hair, then I surely would have become bald if I hadn’t used them.
On Joint Pain
Around about 6 months after I started treatment, I had joint pain in my left knee. I didn’t think it was related to the hyperthyroidism or the treatment because I’ve always had on and off issues with my left knee since I was in my 20s (more about this another time). What was odd was that I would go to sleep feeling fine and wake up in the middle of night when my knee felt stiff and uncomfortable. Straightening it from a bent position would hurt a little but it would be fine once I got up and walked around. I attributed it to various other possible causes and didn’t even think to tell the doctor about it until I stumbled across this:
Joint pain is also reported by some patients taking Carbimazole. While not typically severe, it can affect quality of life. Over-the-counter pain relievers may help alleviate this symptom, but persistent or severe joint pain should be discussed with a healthcare provider.
So is it related? Did it aggravate a pre-existing condition? Or am I creating a scapegoat? I honestly don’t know at this point.
On the Resolution of Symptoms
The recovery period from about 3 to 8 months after the commencement of treatment was an incredibly frustrating period for me. Between the muscle pain and the fatigue, it was as if I was rolling a boulder up a hill. I worked out regularly despite the fatigue, but I couldn’t get stronger and I couldn’t build endurance or stamina. Sometimes it felt like I was getting worse – weaker and less fit. Even after my hormones were back on track, my body still wasn’t functioning right. It was hard to feel optimistic and I confess that the fear of having a body failing with age was constantly on my mind.
It was about 8 months after treatment started that I noticed an improvement in my symptoms – the hair loss, the muscle pain, and the fatigue. I was at a boxing class and the thought that popped into my head was, “I feel like myself again.” It was my first class without muscle pain that forced me to stop. It had been such a long time since I felt like the me that was stronger, fitter, and less plagued with pain that the difference was stark. The muscle pain hasn’t stopped completely, but it has certainly become a lot less frequent than before. I can also stretch when I wake in the morning without suffering from leg cramps.
I have also noticed a marked improvement in strength. Up until the last month or so, I would be supine after the functional rounds in boxing class. Whether it was core work or lower body work, I struggled and failed them all. In spin classes, I could not complete the arm workout round with 2kg dumbbells without lowering my arms to rest – several times. Now, I won’t say that I am flying through these rounds with ease, but I certainly feel a lot stronger as I execute the moves.
In the gym room, I have been able to increase the weights above and beyond what I should have achieved through training alone. There is definitely something different about my body now compared to how it was two months ago. I feel certain that it is related to the normalisation of my body after the adjustment period when my hormones returned to normal. Dare I say that things are finally looking up?
It has been an interesting journey. Although I have not reached the end, it has taught me this:
The path to recovery is never straight. Like a river, it meanders, sometimes heading in the wrong direction. Nevertheless, no matter how many bends it may take, the river always ends in the delta.
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