Can a 38-year-old woman's thyroid imbalance worsen MS?

Question

Hello doctor,

I am a 38-year-old woman diagnosed with relapsing-remitting multiple sclerosis (RRMS) four years ago, currently on Ocrelizumab infusions every six months. I have recently experienced increased fatigue, leg weakness, and occasional blurred vision.

My latest MRI (magnetic resonance imaging) showed new T2 lesions in the periventricular area. My EDSS (expanded disability status scale) score has progressed from 2.5 to 3.5 in the past year. Alongside MS, I have hypothyroidism (TSH (thyroid-stimulating hormone) of 7.2 µIU/mL) and take 75 mcg of Levothyroxine daily.

I was also diagnosed with iron-deficiency anemia. My hemoglobin is 9.8 g/dL, and serum ferritin is 10 ng/mL. I suffer from moderate depression, with a PHQ-9 (Patient Health Questionnaire-9) score of 14, and take Sertraline. My vitamin D level is low at 16 ng/mL despite supplementation. I feel increasingly exhausted, have trouble concentrating, and sometimes skip physical therapy due to low energy.

Could my thyroid imbalance, anemia, or depression be worsening my MS (multiple sclerosis) symptoms?
Should my treatment plan be reassessed?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Yes, your worsening fatigue, leg weakness, and cognitive fog may not be solely due to MS (multiple sclerosis) progression but also from other treatable factors like hypothyroidism, iron-deficiency anemia, vitamin D deficiency, and depression, all of which can worsen MS symptoms and interfere with recovery.

Your TSH (thyroid-stimulating hormone) level of 7.2 mIU/L suggests that your current Levothyroxine dose may be inadequate and needs adjustment. Your hemoglobin of 9.8 g/dL and ferritin of 10 ng/mL indicate significant iron-deficiency anemia, which can cause fatigue and worsen exercise tolerance.

Low vitamin D (16 ng/mL) is associated with increased MS disease activity and may require a higher or prescription-strength dose. Additionally, your PHQ-9 (patient health questionnaire-9) score of 14 reflects moderate depression, which can amplify physical and mental fatigue.

These factors can contribute to reduced energy and difficulty attending physical therapy. I recommend discussing with your healthcare team about optimizing your thyroid medication, starting iron supplementation, increasing your vitamin D dosage, and reassessing your depression management.

Since your latest MRI (magnetic resonance imaging) showed new lesions and your EDSS (expanded disability status scale) has increased, it may also be time to review whether Ocrelizumab is adequately controlling your MS or if a treatment switch is needed. Addressing all these areas together will give you the best chance of improving your overall health and slowing further progression.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.