Hashimoto's :: Sudden Worsening Of Hypothyroid Symptoms

I was diagnosed with Hashimoto's postpartum about a year ago. I was complaining of excessive fatigue/inability to return to running, and pretty bad carpal tunnel. At the time my TSH was 6.893 and Free T3 282.1 pg/dL [230-420] and of course high antibodies. My primary care put me on NatureThroid 32.5mg (25 mcg T4/T3). I felt better within the week and my carpal tunnel completely resolved in about 2 weeks. I felt great on this for a year. I had my TSH tested once during this time and it came to 2.785. I trained for a 50 mile race, including hard training with back to back long runs on the weekend. I then started training for a marathon in January with a goal time of 3:15-3:20. I was training hard but felt great. I did a half marathon March 20th at a 7:04min/mile pace. I felt on top of the world and was on track to run what I had termed my "comeback marathon". The next week I still felt good, but then the following week I came down with a minor respiratory tract infection. I was completely better in 3 days and just thought it was a small blip. I went out for a long run that weekend and felt good for the first 6 miles, and then got progressively worse and felt like I had no energy, completely flat, defeated. It was not normal but I just chalked it up to a bad run. The following week, I had a strange inexplicable flair of wrist pain/carpal tunnel for about 3 days, but then that resolved, so again I kind of dismissed it. I was able to do my weekly workouts and hit my paces although they did feel a little bit harder than normal. But every time I tried to do a long run, I crashed after just a few miles and finished feeling like complete crap. I started to get worried about my race but again just figured I needed a good taper and I would feel better. Well, my race came it was one of the worst experiences of my life. I ran the first half at my goal pace but after 8-10 miles I started feeling sort of ill, dizzy, and had no energy. Again, I have run several marathons and have had bad marathons, and this was above and beyond anything I'd ever felt. I am not prone to cramping, and by the end I could barely walk and my muscles were just spasming uncontrollably. 

Ok, fast forward to the following week. The next day I called my doctor and moved my 6 month follow-up to the next week, and got blood work done (unfortunately he only tested my TSH). That week, I developed progressively worse carpal tunnel. I decided to double up on my thyroid dose, and after a few days of that, I then tripled it (so now I was taking 97.5mg (75 mcg T4/T3). I felt fine energy-wise (although was not running), but still had carpal tunnel. Then I went in to see my doctor. My TSH came to 2.94. He saw that and said my symptoms were probably not thyroid-related but that we could increase my dose by 16.25mg to see if that would help (I knew it wouldn't because I was already taking more than that but I didn't want to say that, and I started second-guessing myself that I was hypo). So I dropped my dose down to 65 mg, then back to 32.5mg. Well a few days later my carpal tunnel got so bad I was waking up in excruciating pain even wearing my braces. I was having shoulder impingement pain as well. I couldn't use my right arm in the morning for 30 mins after waking. I called my doctor asking for further testing and for him to test my free Ts. I did that bloodwork and it came out to TSH 2.58, free T4 0.71 ng/dL [0.6-1.6], free T3 3.59 pg/mL [2.39-6.79]. Seeing that my T4 was on the low end and T3 not super high, I figured that confirmed I was having hypo symptoms, even though they were technically within normal. So I started taking the 97.5mg dose of thyroid again. That weekend I upped my dose, I still felt terrible. I had a horrible run, couldn't move after, my whole body ached, and by Saturday evening I couldn't lift my right arm due to the shoulder impingement. I felt the same Sunday. But Monday (day of three of higher dose), I was SO much better. 

Well my doctor looked at my results on Wednesday and said, "Your T3 is excellent." When I protested, he said rather condescendingly, "I've been doing this 30 years." Mind you, he's not an endo, he's a naturopath MD. I argued with him until he agreed to up my dose to 81.25mg. I knew this would not eliminate my musculoskeletal issues, but figured it was at least a move in the right direction. (note: he also tested for RA antibodies and sed rate and that was normal, and I don't have any joint tenderness)

I've still been taking 97.5mg dose this week, but won't be able to continue this once I run out of the extra Rxs from dosage changes. Still have carpal tunnel and morning stiffness, but my arm got better throughout the week, and then Thursday, I had a great run. However, today (Friday), I suddenly developed this shoulder impingement really bad again where I can't lift my arm. I'm thinking somehow running is triggering it, but I've never had a shoulder problem before. 

Ok, so now for my question. I cannot think of any possible thing this could be other than hypothyroidism. I've scoured the internet and scientific papers for anything at all. But I'm just confused by how suddenly my symptoms worsened, and how my levels are not super low, but even tripling my dose hasn't completely alleviated my symptoms when I was great on a low dose for a year. I'm seeing a new primary care soon and am going to make an appt with an endo instead of continuing to see my current doctor who I'm really p*ssed with. But this will all take time (the endo I'm planning on takes months to get into), and I'm just curious if anyone has any insight into this or has experienced something similar. I'm nervous that I'm going to have to drop down to 81.25mg again and that I'm just going to be miserable, and that when we test my levels again they will be higher, but that I will still be having symptoms, and so my doctor will not listen to me. I know people say that it takes time to have symptom relief with dosage changes, but in my experience it seems like it happens very quickly. Like when I first started on the NatureThroid, I was almost completely better in a week. Is it normal to feel changes so quickly? And does anyone have experience with exercise worsening symptoms - like maybe free Ts are lowish and then exercise is an added stress that sort of depletes the body if it's not able to compensate with normal thyroid function? I'm not completely sure of the biochemistry (I don't know that anyone is actually), so I'm just kind of postulating.