I've been aware of and been treated for my underactive thyroid since November 2019. As you'll see on my profile I'm currently still experiencing some symptoms and I'm having the on-going battle with doctors to find answers.
Does anyone else with an underactive thyroid experience a dull ache in the centre of your chest?
I find it usually happens in high-stress situations or when I haven't eaten much / or anything that day.
I intend to speak to my doctor about this but I wanted to get some feelers to find out if this is related to my thyroid or not
Thanks
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yroid
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Dose levothyroxine should be increased slowly upwards in 25mcg steps until on, or near full replacement dose
Replacement dose is roughly 1.6mcg levothyroxine per kilo of your weight
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 and especially if been left under medicated
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)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
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.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
Hello, thanks for replying. Still only on 50mcg and latest results were borderline but not low enough for them to up my dose. I have another blood test this week and intend to do as you say - take my last dose 24 hours prior.
I’m also waiting on results from an adrenal test I had done in hospital but because of covid results seem to be delayed.
Think my vitamins have been normal the last few times - I take regular boosters for this
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
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)."
(That’s Ft3 at 58% minimum through range)
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor
the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing
Being under medicated for thyroid will result in low adrenal levels
If the dull ache remains constant then see you doctor. He may very well send you for a scan.
I had a dull ache in my side some years ago. Left it until one day the dull ache turned into substantial pain. Into hospital in an ambulance, scan showed I had kidney cancer, any further delay could have proved fatal.
Go to emergency and get checked out. My friend had chest pain she put down to Haitus Hernia but had a mild heart attack and just had two stents but only got the treatment at late stage so any woman with chest pain should suspect cardiac issue.
Do you have an update? In one of several EKGs had AF. Made it thru two recent surgeries no problem. My Doc ran thyroid test and said my thyroid is essentially no longer working. But he won't increase thyroid meds until Cardiologist clears me. Said meds can affect heart...either way.
You need to get onto your doctor. Under active thyroid can cause AF as well as over active. I live with AF. You can’t ignore your thyroid results. My cardiologist seems to know nothing about hypothyroidism at all.
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