Hi everyone, I have never written on here to date but I regularly pop on to see what is going on as my husband has an underactive thyroid and is on Levothyroxine and has been for 8 years. Doseage has generally been adjusted over the years. Hasn’t really had many problems with it to be honest.
Recently was on 200mg one day and 175mg the next. This was changed in last 10 months to 175mg daily.. This is going to be a long post but am looking for any advice really.
I’m not a doctor and don’t understand half of the results I see on here if I am honest- but understand there are a lot of people who know what they are talking about.
Is there anyone on here on Levothyroxine and also has Rheumatoid Arthritis? My husband was diagnosed with this some 2 years ago now completely out of the blue. He got diagnosed with RA and put on Methotrexate.
For most of the time probably the last 18 months he has been on Methotrexate he has had an annoying cough. GP thought Silent reflux, tried a few drugs and did nothing. Never had any acid coming up normally. Then thought Post nasal drip, but spray didn’t clear it up. Chest scan said was ok. Has anyone developed a cough taking Levothyroxine? Just wondered as we don’t know if it could be his Thyroid playing up or his RA. Or his medication causing it. He never had a cough before on the Levothyroxine on its own. I have read about Thyroid nodules but his throat area doesn’t look swollen and he had a camera put down his throat but they couldn’t find anything – would they specifically have to be looking for nodules to find them because if they were doing a general look, which they were, would it be obvious or would it need a Thyroid expert to look for and find them? What are the symptoms of nodules? Sorry if I sound thick but explaining the best way I can. At the moment has muscle ache too, could be either Thyroid or RA. Last docs results at end March were Serum Free T4 level 18.5 and Serum T3 level 4.8. If I am honest he hasn’t been taking his Levo properly and has taken it and then had a cup of tea within 10 minutes and breakfast with 15 minutes for the last 8 years. I have now told him to set alarm earlier take Levo with water and wait half hour for his tea which I have told him to take decaf as his first one with breakfast. He normally has his bloods done on the same day at the same time but in the afternoon every few months. I know on here you are recommending early morning and then delaying dose until after blood is taken, does that normally make much of a difference to the readings? If so I will get him to do this next time. He is also on a statin and Hydroxochloroquine for RA. Been on Statin for a few years and Hydroxochloroquine in the last month. Not on any vitamins.
His cough is dry and he constantly clears his throat and the more he talks the more he coughs. Doesn’t cough in bed at night, No tight chest or wheeziness. Going out into cold air makes the cough worse.
Asking on here as going to have to pay to see Private Consultant for cough as the Doctor is not doing much about it and with Covid he hasn't actually see any Doctors. We need to start eliminating things. Mainly want to eliminate Thyroid problem/nodules.
Any help or advice gratefully received. Thanks a lot everyone and have a good evening.
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Rockky
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Presumably this cough started after they reduced dose levothyroxine?
Which brand of levothyroxine does he get
Is it always same brand
Coungh and post nasal drip could be lactose intolerance and/or being under medicated after dose levothyroxine was reduced
Yes it’s VERY IMPORTANT to test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Because GP will only look at TSH
TSH is highest in morning
Very important to take levothyroxine on empty stomach and then nothing apart from water for at least an hour after
High cholesterol is linked to being under medicated for thyroid
Can you add the ranges on these March results please
(Figures in brackets after each result)
Serum Free T4 level 18.5 and
Serum T3 level 4.8
Ft3 looks like too low, but need ranges to be sure
Do you have results from BEFORE dose was reduced
Suggest you ensure he takes levothyroxine correctly for minimum 6 weeks then get FULL thyroid and vitamin testing done privately ......making sure test is as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
For full Thyroid evaluation he needs TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Vitamin levels often drop when dose is reduced and/or under medicated
Low vitamin levels are extremely common, especially he has autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels (and thyroid antibodies if never been tested before)
RA is autoimmune.....so it’s likely his hypothyroidism is autoimmune too
Ask GP for coeliac blood test
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
Thanks for your answer. No he has had the cough months before the dosage was reduced. Serum Free T4 level 18.5 (range 11.5 - 22.5) Serum T3 level 4.8 (range 3.5- 6.5). Thanks again.
Thank you - am going to get vit test done as soon as seen Consultant on Friday. The calculator link above is not in English and I don't know what figures to put in and how to work it out. I really appreciate your help, thanks again - have a great day.
Hi Slowdragon, a quick question, if my husband's doctor reduces his Levothyroxine will his results go the right way or the opposite way to what is needed, do you know? He is possibly going to drop him down to 150mg from 175mg. Thanks a lot.
May leave until he has finished them then. Cant understand why GP would reduce dosage then on the above results. We will have to see how he goes. Thanks for your prompt reply.
My mum is on methotrexate for RA. She does not have a thyroid problem (well, not one that's medicated anyway) and she has an annoying little cough. She says she has a frog in her throat and is constantly clearing it.
Your husband needs to sort himself out a bit. That statin needs to go. Best way is to take the hypothyroidism seriously and get optimally medicated. And he needs to take responsibility for his meds and to take them religiously at the same time and leave that hour before anything else. I set my alarm for 8am and then pop back under the duvet for 1/2hr. When I get up, by the time I've been to the loo, fed the cat and got the kettle on it's OK to make my coffee (always decaf for me anyway).
A goitre usually brings feelings of a lump or fullness and nodules would likely be picked up with an endoscopy but a dry raspy ongoing cough is more likely to be caused through low thyroid hormone than nodules. RA can also be initiated in those who have uncontrolled Hashimotos Autoimmune Disease, which is the main cause of hypothyroidism.
Levothyroxine must be taken away from foods, otherwise risks becoming bound and unable for use. If too much becomes bound, then hypothyroidism symptoms would return.
Meds also need adequate iron and nutrients to work effectively. In this scenario your husband may have enough thyroid hormone in his blood (adequate Levo) but a possible lack of iron means these meds can not be used effectively and hypothyroidism symptoms would return.
FT3 is the hormone that brings us well being and converted from FT4 when meds are working effectively. Your husbands FT3 looks too low in relation to FT4. Other hypo symptoms would be things like constipation, weight gain, feeling cold and changes in biochemical markers such as high cholesterol.
Before spending money on a private consultant, I would be looking at improving the factors needed to make his meds work better.
Example- Has he ever had thyroid antibodies TPOAb & TGAb levels checked? Has he had iron, VitB12, folate & Vit D tested recently as these may become notoriously low in people with low thyroid hormone.
We are seeing Consultant tomorrow. After that I am going to get his Thyroid tests next week and those Vitamin tests too (using a company recommended here). He is cold a lot also. No weight gain if anything I think he is losing weight. He is taking Statins 40mg Astorvastatin for cholesterol which was in the acceptable range on his last test. He has never had a full vitamins test in the last few years as far as I know and I don't think he has those TPOAb or TGAb levels done either. Are they what they would test for if I do a Thyroid test from say Medichecks on here? Or may mention to his GP next week to test. I just want him to feel normal again. So hard to know if it is his Thyroid or his Rheumatoid possibly playing up. Feel like banging head against a brick wall, no one phones him back re his Rheumatoid and being achy at the moment. I'm trying to help him as best I can but feel by the end of it I will be a fully fledged Doctor, as am spending hours daily researching! Thanks of taking the time to reply. (It would be great if it was something simple like vitamins or just his Thyroid dosage wrong).
Hi there, I’m no expert, but your husband sadly now appears to have two autoimmune diseases, is that right? It might be too late to shut the stable because the horse has already bolted, however I agree with the post that said he might want to try gluten free/lactose free diet. There’s a lot of research it seems on leaky gut syndrome (is it still called that?) and autoimmune diseases. Just read one of Dr Sarah Myhills books (from naked ape to knackered ape), and dietary changes could/might help?
This sounds like an association with the methotrexate. In some people it can affect the lungs, and any dry cough that develops when taking this medication should be reported to your GP, so if your husband has not already made his GP aware of the connection, or the GP has not mentioned it, the matter should definitely be brought up again. Some statins can have this adverse side-effect, too, so well worth a full duscussion with the GP.
Hi, did mention to Gp ( who we are going to see end next week) and Rheumatioid consultant who just said "well you will have to come of your Meds then for 4 months and get your symptoms back", not really very helpful at all and he only wants to do that as a last resort as he doesn't want the symptoms back. Thanks for your answer.We did mention the statins too but he came off them for 2 weeks about 18months ago and it didn't seem to help. Thanks for replying. So difficult knowing if it could be Thyroid related or his RA. Hoping the Consultant we see tomorrow can eliminate either somehow.
Hi Rockky, on top of the thyroid I also have RA (by numbers), although I have no symptoms so I take no medications for it. However, the cough I have quite often, it seems to come out of nowhere at times too. It feels like I slept all night with my mouth open is the best way I can describe it. It was determined I have sjournes by blood test. I have dry throat, mouth, skin and eyes. My rheumatologist said that it could be the sjournes that is making the RA numbers so high but I had a full body scan with no rheumatoid arthritis but some osteoarthritis. At first they thought reflux because of the cough but am treated for that and it did nothing for the dryness that ultimately makes my throat tickle. My suggestion, which I am from the US, is to try Act Dry Mouth lozenges, I have tried others but these work best for me. They work great in coating your mouth and throat, I use them regularly, there are other products such as mouth wash or throat spray, I prefer the lozenges. I go nowhere without them! Hope this helps.
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