I keep choking and coughing if I have to talk loudly for even an hour (say if in a pub) my throat also feels really sore. My TSH is 4.09 and T4 14 - dr says in normal limits - thoughts welcome! Jo x
P.S I’m on 75 mcg Throxine and diagnosed Hashimotos 12 years ago
How long have you had your sore throat? Are you diagnosed with a thyroid condition and are you taking any thyroid hormone?
Are you still only on 75mcg Levothyroxine?
The aim of Levothyroxine is to slowly increase dose in 25mcg steps until TSH is under 2
New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
(Also note at bottom of page 12, that tests should be in morning BEFORE taking dose of Levothyroxine )
sps.nhs.uk/wp-content/uploa...
So you are under medicated and probably need a 25mcg dose increase in Levothyroxine
Bloods need retesting 6-8 weeks after each dose increase
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Is this how you do your tests?
As you have been under treated , ask GP for vitamin and thyroid antibodies tested
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
thyroiduk.org.uk/tuk/testin...
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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
Link about thyroid blood tests
thyroiduk.org/tuk/testing/t...
Link about antibodies and Hashimoto's
thyroiduk.org.uk/tuk/about_...
thyroiduk.org.uk/tuk/about_...
Understanding Hashimoto's
hashimotoshealing.com/under...
List of hypothyroid symptoms
thyroiduk.org.uk/tuk/about_...
If your GP refuses to increase dose, then you will need to insist on referral to endocrinologist of your choice
Important to choose endocrinologist extremely carefully
Email Dionne at Thyroid Uk for list of recommended thyroid specialists
please email Dionne at
tukadmin@thyroiduk.org
Thank you so much, yes still on 75 and have Hashimotos. I saw a lovely locum last week who suggested upping my dose as TSH has been in upper range of normal for years! He ordered lots of blood tests - vit D borderline but GP said no further action on TFTs as in normal range - going into see him on Monday to plead case (unfortunately unable to see lovely locum) he’s asked to see me as my FBC was abnormal but receptionist wouldn’t tell me which part of FBC was abnormal! Feeling v frustrated and low as just want to feel well and not really up to battling with my GP!! X
You are legally entitled to printed copies of your blood test results and ranges
Make sure to bring copies home of ALL blood test results
Very common to have low iron, ferritin, B12, folate, vitamin D as direct RESULT of being inadequately treated for thyroid
If GP refuses to increase dose of Levothyroxine, then you will need to insist on referral to see endocrinologist
Vitamin levels must be OPTIMAL, not just bumping along bottom of range
Vitamin D, at least 75nmol. Many of us find around 100nmol is better
ard.bmj.com/content/69/Supp...
B12 at least over 500
Folate near top of range
Ferritin at least half way in range
Print off pages 12&13 on here
Highlight point 1 in Indications on page 12
Box 1 column 4 on page 13 shows testing required on these vitamins
sps.nhs.uk/wp-content/uploa...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
tukadmin@thyroiduk.org
Yes, they are normal but they aren't good. Bringing your TSH down to 1.0 is what we aim for when taking thyroid hormone. Even then, if your FT3 is low in range you will not feel well. Check your tests. You need to increase your levo or better yet, add T3. Muscles even throat muscles need thyroid hormone . You've been under medicated for a long time and that's not good.
Could be stomach acid coming up. This can happen at night unnoticed. I was constantly coughing then choking after eating. Kept trying to clear my throat but to no benefit. Finally had a camera put up my nose and down my throat to find it's highly inflamed with regular burning from night acid. May be speak to your GP about the possibility of it.
Low stomach acid is common hypothyroid problem
Masses of posts on here about that
Is your hypothyroidism correctly treated, vitamins optimal and have you tried strictly gluten free diet if you have Hashimoto's
Not Hash, just hypothyroidism which goes up and down like a yo-yo, even with Levo. X
If levels are fluctuating it's very likely autoimmune thyroid disease also called Hashimoto's
If TPO or TG antibodies are (or were ) ever high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.
So it's important to get TPO and TG thyroid antibodies tested at least once .
You can have Hashimoto's and never have raised antibodies. Ultrasound scan of thyroid can be helpful
Link about thyroid blood tests
thyroiduk.org/tuk/testing/t...
Link about antibodies and Hashimoto's
HI
I was like that and still am diagnosed with overactive thiyroid just last night I had bad pains in my kneck and under my arms my kneck feels like it's worn out and like you if I talk it aches and I can loose my voice quickly..I was diagnosed in September last year..I have not yet seen a consultant or had a scan on my kneck..given all the pain in that area I think that's bad..my GP has not checked my kneck since September I also think that's bad..if you have funds I suggest you try to get your own bloods done and a scan because I knew something was wrong with me for months before I got my diagnosis I had bloods that came bk normal but I knew I wasn't. ...
Has any doctor examined your neck by palpating the thyroid? Not to alarm you, but choking and coughing is one of the symptoms of a large nodule and even thyroid cancer that is growing. Perhaps an examination and possibly an ultrasound of the neck would be warranted. Note that thyroid bloods are rarely off under these conditions.
Thank you so much for your comments and support - I will try and be brave and ask GP all these things - if I don’t get anywhere I think I may ask to change GPs- I’ll update when I’ve seen him x
I agree with cabro2 that you should ask your GP to examine your neck but would like to point out that, according to my research, over 95% of nodules are benign.
I have Hashimoto's and I do still cough and choke from time to time. I do it much less since starting treatment with levothyroxine.
As far as I know I do not have nodules. My GP says he can’t feel my thyroid at all. I think it must have shrunk to nothing.
I’m still working on achieving the optimal dose of levo for me.
Hope you get some help and proper treatment soon.
Best wishes
Caroline
As you mention being in a pub, are you aware of the possible effects of alcohol on your thyroid functioning and hormone levels? Acetaldehyde is a compound that causes hangovers and is a by-product of drinking alcohol; but unfortunately, it can also interfere with the thyroid receptors. Consequentially the thyroid has to try to compensate for the lack of feedback, which can lead to the development of a goitre, and the choking you describe. So acetaldehyde can cause symptoms of hypothyroidism, (even when the actual function is normal in the absence of alcohol) and hoarseness is of course, one symptom. The primary effect of alcohol concentrates on the liver and adrenal glands, which take the brunt of the demand from drinking. Since liver and thyroid function are so closely related, there’s a definite impact, and if a person is already suffering from a thyroid imbalance, routine drinking can cause their T3 levels to fall even further.
Hi Maisie, thanks for your concern, I’m actually tee-total as I became severely allergic to alcohol several years ago- afraid I’m now the permanent designated driver! xxx
I have a thyroid nodule (1 cm) and have times when I choke and get hoarse but do not cough. It seems your thyroid level is a bit high. I also have a hiatal hernia that causes issues but I don't ever cough with the thyroid or the hiatal hernia and acid reflux. Seems like the doctor would order you an ultrasound for the nodule to rule out the thyroid being the cause.
You are Hypothyroid, shoule be around 1.0 unless you have Hashimotos, then it will be hyper at times and hypo at times.
Well he refused to up my levo as he said TSH ‘normal’ but has booked a thyroid ultrasound and chest x-ray. My platelets were low (98) and ESR raised so he’s repeating those. Really feel like just upping my dose myself but would that be v wrong of me?
In reply to newer post
Email Dionne at Thyroid Uk for list of recommended thyroid specialists
tukadmin@thyroiduk.org
Vast majority of endocrinologists are Diabetes specialists.
You need a thyroid specialist
Though even an untrained monkey can see you're under medicated
Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine
(Many of us need TSH nearer 0.2 than 2.0 to feel well)
See box
Thyroxine replacement in primary hypothyroidism
pathology.leedsth.nhs.uk/pa...
New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking Levothyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
tukadmin@thyroiduk.org
Just an update on this - GP referred me to Endo but Endo said as my TSH within range (4.9) my symptoms unlikely to be thyroid related and told GP to refer me to ENT, which he has done. Think I may have to go private but really finding it hard to get the energy up to fight this.
I got my bloods tested privately recently and T3 and T4 bottom of normal range and TSH 4.83. Both antibody tests sky high. So frustrated about it all 
Choking sensation
hoarse voice and choking 
Feeling worse before feeling better????
