[39F] With lower back and abdominal pain, history of Graves' disease

Patient Description

A 39-year-old female presents with lower back pain and lower abdominal pain. The back pain is located on the lower right and left sides, is aching in nature, and has been present for the past 4 days. The pain worsens with standing and moving, and no relief has been found. The pain came on gradually and occurs once a week, lasting for about 2 days each time. No recent injuries or physical activities are reported. Treatments tried include ice, heat, ibuprofen, and etodolac. The abdominal pain has been present for 5 days and is described as cramping with a severity of 6 out of 10. The patient has regular bowel movements, with the last one occurring today, and no unusual stool characteristics. The patient reports nausea but no vomiting, changes in bowel habits, fever, chills, or changes in urinary habits. There is intermittent numbness in the legs. The patient's medical history includes Graves' disease, diagnosed in 2021. Current medications include Adderall (20mg twice a day), Ambien (10mg once a day), Tizanidine (4mg three times a day), Methimazole (5mg once a day), Omeprazole (40mg once a day), and ibuprofen (400mg twice a day) as needed. The patient has no known drug allergies and no history of diabetes, hypertension, or other chronic illnesses. Menstrual periods are regular, with the last one occurring in late August. The patient consumes alcohol but does not use tobacco or recreational drugs and has not traveled recently. There is no family history of heart disease, stroke, autoimmune diseases, diabetes, cancer, or psychiatric illnesses.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

Lower Back Pain

  1. Muscle Strain or Ligament Sprain: Given that your pain is aching and worsens with standing and moving, it could be due to muscle strain or ligament sprain. This is common and can occur without a specific injury.
  2. Kidney Issues: Pain in the lower back, especially on both sides, could also be related to kidney issues such as a kidney infection or stones. However, you haven't mentioned any urinary symptoms, which are often present with kidney problems.

Lower Abdominal Pain

  1. Gastrointestinal Issues: Cramping abdominal pain could be related to gastrointestinal issues such as irritable bowel syndrome (IBS) or a mild gastrointestinal infection.
  2. Gynecological Issues: Given your regular menstrual cycle, it could also be related to gynecological issues such as ovarian cysts or endometriosis.

Numbness in Legs

  1. Nerve Compression: The numbness in your legs that comes and goes could be due to nerve compression, possibly related to your lower back pain. Conditions like sciatica or a herniated disc could cause these symptoms.

Unifying Diagnosis

  • Graves' Disease: While your Graves' disease is being managed, it's worth noting that thyroid imbalances can sometimes contribute to muscle and joint pain, as well as gastrointestinal symptoms.

What you can do

Lower Back Pain

  • Rest and Avoid Strain: Try to rest and avoid activities that worsen the pain.
  • Heat and Ice: Continue using heat and ice packs to manage pain and inflammation.
  • Over-the-Counter Pain Relief: You can continue taking ibuprofen, but be mindful of the dosage and duration.
  • Gentle Stretching: Engage in gentle stretching exercises to relieve muscle tension.

Lower Abdominal Pain

  • Hydration and Diet: Ensure you stay hydrated and eat a balanced diet rich in fiber to support gastrointestinal health.
  • Over-the-Counter Antacids: If you suspect gastrointestinal issues, over-the-counter antacids may help.
  • Monitor Symptoms: Keep track of your symptoms, especially in relation to your menstrual cycle.

Numbness in Legs

  • Posture and Ergonomics: Pay attention to your posture and ergonomics, especially if you sit for long periods.
  • Gentle Exercise: Engage in gentle exercises like walking or swimming to improve circulation and reduce nerve compression.

General Advice

  • Symptom Journal: Use MDandMe to journal your symptoms, track progress, and get insights. This can be helpful for your healthcare provider to understand your condition better.
  • Consult a Doctor: Given the combination of symptoms, it's important to consult a healthcare provider for a thorough evaluation. They may recommend imaging studies like an MRI or CT scan to rule out serious conditions.

What you should look out for

Seek medical care urgently if you experience any of the following:

  • Severe or Worsening Pain: If your pain becomes severe or significantly worsens.
  • Fever or Chills: If you develop a fever or chills, which could indicate an infection.
  • Changes in Urination: If you notice changes in your urinary habits, such as pain, frequency, or blood in the urine.
  • Severe Numbness or Weakness: If the numbness in your legs becomes severe or is accompanied by weakness.

Remember, while I can provide information and suggestions, it's crucial to seek care from real health professionals to receive a formal diagnosis and appropriate treatment.

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4 mo ago

People Also Ask


What could be causing my lower back pain if I haven't had any recent injuries?

Lower back pain without recent injuries could be due to muscle strain or ligament sprain, which can occur from everyday activities. It might also be related to kidney issues, although these usually come with urinary symptoms.


Could my lower abdominal pain be related to my menstrual cycle or gynecological issues?

Lower abdominal pain could be related to gynecological issues such as ovarian cysts or endometriosis, especially if it coincides with your menstrual cycle. It's important to monitor the timing and nature of the pain.


What might be causing the numbness in my legs?

Intermittent numbness in the legs could be due to nerve compression, possibly related to conditions like sciatica or a herniated disc. This is often associated with lower back pain.


How can Graves' disease affect my symptoms of pain and gastrointestinal issues?

Graves' disease can sometimes contribute to muscle and joint pain, as well as gastrointestinal symptoms, due to thyroid imbalances. It's important to manage your thyroid levels to help alleviate these symptoms.


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