Difficulty swallowing

[scool]

Hi, I've had a feeling as though I have a lump in my throat in the sternum area and constantly feel the need to clear my throat. Could this be related to my hypothyroidism?

[PurpleNails Administrator]

Doctors often say throat clearing & discomfort in sternum is reflux. This can also be related to thyroid (low stomach acid) but doctors automatically assume increased stomach acid.

Do you have a diagnosed thyroid issue or is it something you suspect?

Blood test to check levels are best approach. Full thyroid function includes TSH, FT4 & FT3. TPO & TG antibodies & also important to test folate, ferritin, B12 & vitamin D.

Have you had these checked?

[scool in reply to PurpleNails]

Hi, I read your message in the doctor's waiting room and you were dead right, she said that she thinks I have "silent reflux" and so has prescribed 2 weeks worth of Gaviscon [even though I don't feel as if my issue is related to stomach acid]. I have previously been diagnosed with mild hypothyroidism and have been treated with Levothyroxine for about 6 years - but my skin, hair and nails are dry and brittle despite the medication. I have tried to persuade the doctors on previous occasions to test me for the full range of thyroid function, but they say that I am in the normal range and so those tests are not warranted. My last reading was 2.86 apparently in the normal range. The doctor has given me a blood test for full blood count and for TFTF, so I presume that she will measure my levels. again. She said that I had no obvious lumps or swelling of the thyroid and my stomach seemed fine.

[PurpleNails Administrator in reply to scool]

25 mcg is starter dose for infants, elderly & those with cardiac issues. Do any of those apply to you? The 2.86 is the reading for TSH?

Labs test the Thyroid stimulating hormone which is a pituitary hormone and it’s assumed if in range so are FT4 (thyroxine) & FT3 (triiodothyronine). So you may not have had FT4 & FT3 tested.

Its not always the case. You need FT4 & FT3 tested and you many have to look at private options if Doctor / lab refuses.

For 1 thing if taking Levo the aim is for the TSH to be around 1. Yours is too high. The thyroid is still struggling. Your doctor accepting results as being range is not up to speed on current advice and likely leaving your levels low.

Antibodies are often tested to diagnose cause of hypothyroidism but rarely repeated. Were they negative? What does “fine” mean?

Don’t assume nutrient were tested. Neither thyroid function or blood count will include nutrient testing. You need to get into habit of obtaining your results & checking for yourself, what was tested & results. Either printed copy with ranges or online access to record. Medics only look for results out of range but you need optimal levels of levo will not work well.

The Gaviscon will help if stomach acid high but will worsen symptoms if stomach acid low.

You can do a “do it yourself” home burp test to check.

First thing in the morning, before eating or drinking anything:

1. Mix ¼ tsp baking soda in 4 to 6 ounces of cold water.

2. Drink the baking soda solution.

3. Time how long it takes for a burp to occur. Time it for up to 5 minutes:

4. If you have not burped within five minutes, it may be a sign of insufficient stomach acid. Early and repeated burping may be due to too much stomach acid (do not to confuse this with small burps from swallowing air when drinking the solution). Any burping after 3 minutes is an indication of low stomach acid levels.

[scool in reply to PurpleNails]

Hi,

Thanks very much for all your help. You've all been very kind. I'm now 61, but I've been on this dose since I started 6 years ago and don't have any heart issues - yet. I started recording my results at first, but as the doctors always seemed reluctant to even give me the results, preferring to say I was just fine, I gave up and stopped asking. In July 2015 I was told: T4 level = 11.7 (11-25 range), TSH level = 5.38 (.27-4.2 range),TPO (which measures antibodies) = normal September 2016 my thyroxine level was 12.6, (11-25 range), TSH 6.14 March 2018 TSH = 5.84 [0.27-4.20], T4 = 12.4 [11-25], April 2019 TSH 2.41 [0.2-4.2], T4 15.5 [11-25]

I will update you with my levels as soon as the blood test results are through and I will get my vitamins checked privately. I will also try the burp test tomorrow. Thanks again for your help. I know that I've been a wimp and not stood up for myself with the doctors.

[SlowDragon Administrator]

Welcome to the forum

How much levothyroxine are you currently taking

How long have you been on this dose

Do you always get same brand levothyroxine at each prescription

Have you had thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease

Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12

When were vitamin levels last tested

Please add most recent results

[scool in reply to SlowDragon]

Hi, Thanks very much for taking the time to respond to me. I'm on 25mg of Levothyroxine a day. I have been taking medication and on this dosage for about 6 years. I'm pretty sure that the brand is the same each time, I haven't noticed any difference with the packaging. The doctor said previously that my antibody results are fine, but they only now test my TSH [I think it is] levels. Back in November, my level was 2.86 and I was told that this was right in the centre of the range of results, so my results were normal. I have been given a form for an up to date test and for full blood count, so that would presumably show up any vitamin deficiencies. Am I right? I have made an appointment to have blood taken at 08:45 tomorrow and won't take my medication before the test.. I try to take daily supplements of vitamin D and multivitamins. The doctor has said that she thinks I have "silent reflux" and so has prescribed 2 weeks worth of Gaviscon

[SlowDragon Administrator in reply to scool]

How old are you

Standard starter dose of levothyroxine is 50mcg unless over 65 years old

On levothyroxine TSH should ALWAYS be below 2

Request 25mcg dose increase in levothyroxine and bloods retested 6-8 weeks after each dose change or brand change in levothyroxine

Have you had thyroid antibodies tested if not request included at this test

ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12

Being under medicated for thyroid on too low a dose levothyroxine results in low vitamin levels

Low vitamin levels tend to lower TSH

Multivitamins never recommended on here

Most contain cheap poorly absorbed ingredients and not enough to make a difference

Most contain iodine not recommended for anyone with autoimmune thyroid disease

[SlowDragon Administrator in reply to scool]

The doctor has said that she thinks I have "silent reflux"

Reflux very common when under medicated

Low stomach acid can be a common hypothyroid issue

Thousands of posts on here about low stomach acid

healthunlocked.com/search/p...

But never assume you have low stomach acid

healthygut.com/4-common-bet...

Web links re low stomach acid and reflux and hypothyroidism

nutritionjersey.com/high-or...

articles.mercola.com/sites/...

thyroidpharmacist.com/artic...

stopthethyroidmadness.com/s...

healthygut.com/articles/3-t...

naturalendocrinesolutions.c...

meraki-nutrition.co.uk/indi...

huffingtonpost.co.uk/laura-...

lispine.com/blog/10-telling...

[SlowDragon Administrator]

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

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

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Persevere - have all guidelines printed and be ready to quote them

healthunlocked.com/thyroidu...

guidelines on dose levothyroxine by weight

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

NICE guidelines on full replacement dose

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

Come back with new post once you get results from blood test tomorrow

[scool in reply to SlowDragon]

Hi,

Thanks very much for all your help and advice. I've been really remiss as I've just let the doctors dictate to me for years now. I am now 61, but I was in my mid fifties when I first started on my Levothyroxine and the doctors here, in Wales, are not keen to up the dosage or test for anything other than the absolute minimum. I did try at first to try and get the dosage upped, but the doctors were quite stroppy about it and I just caved. I'm better advocating for my elderly parents than for me.

[SlowDragon Administrator in reply to scool]

There’s over 123,000 members on this forum

Vast majority from U.K.

Current understanding and treatment of thyroid is woefully inadequate

We see hundreds of patients left, like you on ridiculously low doses of levothyroxine

Print out and all the clear guidelines that show you need dose increase

If GP still refuses then you will need to see endocrinologist

Vast majority of endocrinologists are diabetes specialists and useless for thyroid

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors

[e-mail]

[scool in reply to SlowDragon]

Thanks, I will try and toughen up and fight my corner.

I tried the baking soda and, as I feared, I don't have high stomach acid. Do you recommend apple cider vinegar if I've got low stomach acid, or do you think betaine and pepsin would work for me? Or, should I go back to the doctor before doing anything?

[SlowDragon Administrator in reply to scool]

See/have an appointment with GP

Request 25mcg dose increase in levothyroxine and thyroid levels retest in 6-8 weeks

Have guidelines ready to quote and push for dose increase

Request GP test vitamin D, folate, ferritin and B12 plus thyroid antibodies NOW

If GP unhelpful

Test FULL thyroid and vitamins via Medichecks or Blue horizon

Come back with new post once you get results