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Carpal Tunnel and Thyroid

Dear Dr. Roach: I have been diagnosed with a severe case of carpal tunnel syndrome, which developed within the past two years. I also have peripheral neuropathy not due to diabetes. I had thyroid cancer, and my thyroid was removed. I am on Synthroid.

My physician is recommending that I seek operation for the carpal tunnel. My shoulders, arms and hands have tingling sensation, with numbness in my fingers.

I read that a cause of carpal tunnel could be related to hypothyroidism. Would a mere increase of my medication help this issue? My current thyroid stimulating hormone level is 0.12. My endocrinologist recommends keeping this number below the normal numbers (0.55-4.78).— D.C.L.

Answer: Carpal tunnel syndrome is caused by the compression of the median nerve as it goes through the wrist. Hypothyroidism is clearly a risk factor in developing CTS, and the mechanism is thought to be swelling of the nerve due to the low thyroid.

If the CTS is being caused by the low thyroid, then treatment of the low thyroid usually improves the symptoms of CTS. However, your situation is more complex. Because of the history of thyroid cancer, your endocrinologist is quite correctly treating you with replacement thyroid but aiming on the high side. That’s why you are taking a fairly large dose, and that’s why your TSH is below the normal range. TSH (thyroid stimulating hormone) is made by your pituitary gland (in your brain) when your body needs to stimulate your thyroid gland (which would be in your neck, but yours was removed) to make more thyroid hormone. Because you are taking a little extra thyroid hormone in the form of Synthroid, your pituitary has sensed the high level and the TSH has come down, so that your thyroid is not stimulated to produce thyroid hormone at all. The concern is that any possible cancerous or pre-cancerous thyroid cells that may have been left after surgery could be stimulated by the TSH. You actually are slightly hyperthyroid, not hypothyroid, to reduce the likelihood of recurrent thyroid cancer. So increasing the dose of hormone wouldn’t help the problem. In your case, the thyroid probably has nothing to do with the carpal tunnel syndrome.

Dear Dr. Roach: My wife suffers from painful osteoarthritis in her left hip, both ankles and left foot. She is not overweight, maintains a healthy diet and lifestyle, is in very good health and walks about one mile each day.

She is in her 18th month of acupuncture treatments, and has tried biofeedback. Do you have any opinion on the occasional use of Harpagophytum, commonly known as “devil’s claw”?

I sincerely thank you for assuming the role of, may God bless him, Dr. Donohue. — J.M.

Answer: Devil’s claw is considered by the Natural Medicines Comprehensive Database as “possibly effective” and “possibly safe” in approved doses up to a year. The most common side effect is diarrhea.

I think the jury is still out for both acupuncture and devil’s claw. There have been some studies showing modest effectiveness, and some that have shown them to be no better than placebo. It is worth a try, but it might be helpful to keep a record of symptoms to see if it really is helping.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.