Eltroxin, chest/ stomach pain

[Johnljc]

Hi , has anyone else had issues with being uncomfortable in the left side stomach/ chest area whilst on eltroxin?

[SlowDragon Administrator]

Being under medicated will lead to low stomach acid, low vitamin levels as direct result

Previous post shows you are on very low dose levothyroxine

healthunlocked.com/thyroidu...

Bloods should be retested 6-8 weeks after each dose change and dose increased as fast as tolerated

Low iron and/or ferritin can cause chest pain

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Come back with new post once you get results

Guidelines on dose by weight is 1.6mcg levothyroxine per kilo of your weight

[SlowDragon Administrator]

our thyroid controls our metabolism

As an example....if, when perfectly healthy, your own thyroid made the equivalent of 125mcg levothyroxine....and this metabolism is controlled by pituitary sending messages - TSH (Thyroid stimulating hormone)

Then as your thyroid starts to fail (usually, and in your case, due to autoimmune thyroid disease) ....you might get diagnosed when your thyroid has reduced output to roughly equivalent of 75mcg levothyroxine

Pituitary has noticed there’s a drop in thyroid hormones in the blood....(that’s Ft4 and, most importantly, the active hormone Ft3) ....so to try to make more thyroid hormone ...pituitary sends out stronger message to thyroid - TSH rises up

When GP starts you on 50mcg ....initially you feel a bit better ....as you have 75mcg from your own thyroid and 50mcg levothyroxine

But (here’s the bit many GP’s don’t understand)....levothyroxine doesn’t “top up” your own thyroid output.....well it does very briefly....but the pituitary very soon “sees” the levothyroxine in the blood....and TSH starts to drop

So at the end of week 6 ....TSH has dropped a lot. Your thyroid takes a rest ....has a holiday

So at this point you are now only mainly using the 50mcg levothyroxine....which is actually a dose reduction down from managing on 75mcg from your own thyroid before you started on levothyroxine

So you start to feel worse .....and are ready for next 25mcg dose increase in levothyroxine

Modern thinking ....and New NICE guidelines suggests it might actually be better to start on higher dose .....but many medics just don’t read guidelines ....

and many patients can’t tolerate starting on more than 50mcg and need to increase slowly.

Starting on 50mcg and stepping dose up in 25mcg steps, retesting 6-8 weeks after each increase.

But we still very often need to increase up to full replacement dose

So you are very likely simply ready for next dose increase up to 100/75mcg alternate days

Bloods should be retested 6-8 weeks later

Essential to regularly retest vitamin D, folate, ferritin and B12 as when these are at OPTIMAL levels it makes it much easier to tolerate dose increase in levothyroxine

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Rare to need less than guidelines, some people need higher doses or addition of small doses of T3 alongside

But first steps are to get levothyroxine dose increased and all four vitamins optimal

Frequently strictly gluten free diet helps or is absolutely essential