Chest pain from levothyroxine

[Ralph1985]

Hi I been on 75 mcg of levo for three months and my tsh came back at 15 and I was increased to 88 mcg, I been having mild chest pains with this dose increase so what gives? I don’t have any heart problems or and I have dont all kinds of test before including stress test and 24 hour heart monitor and all has comeback normal so why is this happening and should I be concern or stop my dose?

[Docbuster]

Have you looked at foods that block levothyroxine

[greygoose in reply to Docbuster]

Please read Nanaedake's response below. She explains about how to take levo. Talking about 'foods that block levothyroxine' is misleading, and will worry people unnecessarily.

[Nanaedake]

Your TSH is high so you need the levothyroxine and you needed a dose increase. Always make sure you take levothyrxoine with a full glass of water on an empty stomach in the morning or at least 2 hours after food if in the evening. Do not eat or drink for an hour afterwards (except for water). Take other medication or supplements at least 4 hours after taking levothyroxine. Blood tests should be every 6 weeks with dose adjustment until you reach the correct dose and are symptom free. The usual dose increase is 25mcg at a time.

Have you had vitamin levels tested? Vitamin B12, folate, ferritin and vitamin D. We can be low in these with thyroid disease and nutrient deficiencies cause symptoms, especially when starting on levothyroxine.

You are still undermedicated so you will probably be symptomatic until you're on the right dose.

[greygoose]

If your TSH was 15, then your increase should have been 25 mcg. Taking just 88 mcg will leave you under-medicated, and that could very well be your problem.

[Sheffield6]

It's probably your body getting use to the higher dose.

[Hollylodge1]

Why do you have to have a full glass of water ??

[silverfox7 in reply to Hollylodge1]

It makes sure that the tablet gets down to where it is absorbed. Otherwise it could get stuck on the way down and not help you!

[AlasdairM in reply to Hollylodge1]

You need enough volume to carry the tablets not only into, but also to wash them out of your stomach and into the next stage of your gut, where there is less acidity and where the absorption actually takes place.

Recent food means recent stomach digestive acid, so why levo is taken on waking and exit of stomach in most people is also likely open.

The absorption of levo has been demonstrated to be hindered / decreased by increased acidity in gut environment, finally proving the no recent food rule. NHS has yet to fund broad research on what aids or what hinders lio T3 getting into your blood.

[Treepie]

Angina type pains on starting levo are common and Dr.Joan Gomez says can be easily treated with beta blockers.After exhaustive tests I was told I had irregular veins ! My non medical take is that levo speeds up your systems and exposes otherwise hidden blood flow problems.

But beta blockers do affect absorption of levo and a higher dose of the latter is needed.

[Nanaedake in reply to Treepie]

Betablockers can have side effects too so read the patient information leaflet carefully if you take them. Not all possible side effects are listed on patient information leaflets so if adding other medication in when taking levothyroxine it's important to be vigilant and not assume that all symptoms are down to thyroid alone. Doctors will have difficulty differentiating.

[jamesal0]

drugs.com/sfx/levothyroxine... It's normal. Mine never went away in 3 years. I changed to NDT for other reasons and the heart pain disappeared.

[Kangagirl]

Hi Ralph. I was on Levo for 12 years (125 mcg ) until it had a toxic effect on me, and have been on T3 for the past 5 years, starting with a tiny crumb which was all I could tolerate, and working my way up to 30 mcg. It took me 5 years to get my TSH down from 150 to under 1. GP then said my TSH was too low and told me to decrease to 25mcg. I began to get chest pains and irregular heart beat about 9 months ago, after my husband had heart surgery and I was exerting myself a lot more than usual looking after him. I had never experienced any heart symptoms before. I was referred for tests and was faced with a long wait. I was scared, and tried reducing my T3 from 25mcg to 20 mcg, and the symptoms were much less - not entirely gone, but much abated. My TSH went up to 7 but quite frankly I was more scared of undiagnosed chest pain than a raised TSH. I have now had the cardiac tests, including a CT Angiogram, but no news on results after a month so am assuming if and when I hear anything, it hopefully will be 'no serious heart issues'. Reading up on both Levo and T3, there are all kinds of mentions of angina type issues and irregular heartbeat, and my own opinion for what it's worth, is that everybody is different and it may be a balancing act where you take enough thyroid meds to keep you feeling reasonably well, even if TSH may not be perfect and don't have the chest pains etc, or take enough to keep the TSH low and suffer the cardiac symptoms.

I can only speak for myself. Some people may be able to tolerate having a slightly raised TSH, others feel terrible if TSH is raised even a tiny bit. If I were you personally I would try putting my dose back down just a bit and see what happens to the chest pain. If it goes away you could discuss with your GP which is more harmful to you - a raised TSH or chest pain. It may be that there isn't a definitive answer, which isn't much help, I'm sorry. Yes, your TSH at 15 was 'too high' and obviously not to be recommended, but if a higher dose of Levo gives you heart issues, it might be a case of which is the lesser of two evils. Just my opinion - I am NOT saying that having a high TSH is OK, but neither is having chest pain.

[Nanaedake]

If you continue having problems with levothyroxine then try a different formulation. Some people get on better with a different formulation due to the fillers. There are several in the UK to try. Apparently Wockhardt has the least complex fillers but I've never tried it.

If you have been checked out and have no heart problems then I would not reduce levothyroxine dose as your blood tests show you clearly need it.

[mauschen]

All sorts of health issues can cause chest pain for example, stress, gastrointestinal problems some vitamin deficiencies and anaemia... Chest pain should never be ignored or assumed to be of particular origin without the advice of a doctor.

Many off us have met doctors with questionable knowledge therefore getting the best advice in itself is a challenge. However, going it alone can be dangerous if you attribute the symptoms to thyroid medication when perhaps this is not the case.

All I ask is that you keep your mind and options open, seek advice.

Take care!

[Nanaedake]

Agree with mauschen , get your doctor to further investigate chest pains even if it turns out to be something as simple as indigestion which is common with hypothyroidism as it causes gut dysfunction and slow movement of food through intestines etc.

[Polymnia]

Some years ago I was on 100 mcg of Levothyroxine and my doctor increased it to 150mcg (it was a bit more slap dash then as I had only been borderline underactive at first) after about 2/3 weeks I started getting chest pains and I just knew what was causing it so I went back to 100. (I did inform my doctor) . I have very gradually decreased the dose and was on 50mcg one day and 75mcg the next but for some years although was experiencing attacks of uneven heart beat especially when first laying down. very recently I have decreased to 50mcg (25mcg twice a day) I am well and haven't had any attacks of uneven heart rate since.

[Nazi123 in reply to Polymnia]

25mcg twice a day...? when do you take the 2nd dose o levo? deceasin levo raises my tsh AND inceasin gives me palpaaions ?

[SlowDragon Administrator in reply to Nazi123]

Low vitamin levels is most likely

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Vitamindtest.org.uk - £28 postal kit

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

Link about antibodies

thyroiduk.org.uk/tuk/about_...

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Print this list of symptoms off, tick all that apply and take to GP

thyroiduk.org/tuk/about_the...

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

[tgrazzy]

I know when my tsh was that high I had heart palpitations and chest pressure n it was because my thyroid was so out of whack it took about 6 weeks on my Levo before the chest pains stopped. I think your chest problems are from under active thyroid not from the medication

[Ralph1985]

Thanks for all the help guys, I had chest pain also when I was increased from 50 to 75 but thought I didnt know at that time it could’ve been from the medication and that’s why I went to a cardiologist and had my heart checked out and all my test came back great. So I thought it was anxiety but I wasn’t really anxious about anything and now with the increased dose I’m experienced the same mild pain and discomfort I only been on 88mcg for 5 days but the pain started the same day I took my first dose.. I don’t want to go back to my cardiologist to perform the same test he did which are costly and time consuming he did a lot of test on me and for good reason I was scared. So I guess I will stick to this dose for now unless it’s get worse, thanks again I will keep updating this post.. any advice or shared information about this subject is welcome.

[Jomillwood]

I was on 50mcg Levothyroxine for two yrs and had chest pains the entire time. I had many ecg's and blood tests all coming back normal. I put it down to cutting out meat and dairy and never thought it could have been the medication until I stopped taking it. My chest pains disappeared! You need to listen to your body and don't always rely on Drs to know what's best for you. After all you are a customer not a patient when it comes to pharmaceuticals.

[dtate2016 in reply to Jomillwood]

If I may ask, what did you do instead of Levo? I’m having this same problem - and it is so scary. Yes when I stop taking it the chest pains go away - but they are replaced by jittery adrenal gland issues. T 3 makes the chest pains worse. I do not know how things got so out of wack. D3 test slightly low, even the smallest D3 dose increases chest pains. Hashimotos is such a difficult disease.

[Jomillwood in reply to dtate2016]

Hi, I changed my diet and lifestyle, a leaky gut is the root problem and if you eat/drink gluten, processed food and sugar your feeding the wrong bacteria and causing disease. All disease begins in the gut, so eat natural Wholefoods and let go of stress. I used adrenal support and thyroid support capsules from eBay and then decided to buy the ingredients separately and mixed together in a tub and have each day. Look up Dr. Axe on YouTube for thyroid healing tips and techniques. Do your research on healing naturally from various sources to get the gist of it and implement it slowly so it’s not too overwhelming.