Constant chest pain hypothyroidism or something else??

[Justwannabemeagain]

I was wondering if anyone else has constant chest pain? I have had all sorts of cardiac testing and My Doctor says it's not my heart. I'm having some anxiety because I don't know whats causing it. I'm wondering if levothyroxine maybe the cause. I am very sensitive to medications

[humanbean]

It could be severe iron and/or ferritin (iron stores) deficiency. It was when I had severe chest pain but was told my heart was fine. Once I started improving my iron and ferritin levels as best I could the pain gradually went away and stayed away, as long as I continued to maintain my levels as close to optimal as possible.

Of course, no doctor ever told me that low iron could cause severe chest pain - I found out by doing my own research.

[Justwannabemeagain in reply to humanbean]

Thank you for telling me your story

[Hypopotamus]

Could it be a Hiatus Hernia?

[SlowDragon Administrator]

How much levothyroxine are you currently taking

How long have you been on this dose

ESSENTIAL To test thyroid levels early morning and last dose levothyroxine 24 hours before test

Low vitamin levels are extremely common when hypothyroid

Essential to test vitamin D, folate, ferritin and B12 at least once a year

What vitamin supplements are you currently taking

When were vitamin levels last tested

As humanbean says we see many people with low iron/ferritin with chest pain and/or breathlessness

Do you have autoimmune thyroid disease also called Hashimoto’s usually diagnosed by high thyroid antibodies

[Justwannabemeagain in reply to SlowDragon]

I'm on 25mg and been on it for about 2yrs. My tsh reflex t4 is .82. I was started when my levels were a little over 6. I don't think I need this stuff

[SlowDragon Administrator in reply to Justwannabemeagain]

levothyroxine doesn’t top up failing thyroid it replaces it

ESSENTIAL to be on high enough dose levothyroxine

25mcg is only half the standard starter dose levothyroxine

Likely to have very low vitamin levels if been left on such a tiny dose this long

ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test

Always take levothyroxine on empty stomach and then nothing apart from water for at least hour. No other medications or supplements within 2 hours

Get your Dr to test vitamin D, folate, B12 ferritin and thyroid antibodies plus thyroid levels….TSH, Ft4 and Ft3

Guidelines on dose levothyroxine by weight is that MOST people will start on 50mcg and increase dose slowly upwards in 25mcg steps over 1st year, retesting 6-8 weeks after each dose increase, until on approx 1.6mcg levothyroxine per kilo of your weight per day

Approx how much do you weigh in kilo

[Justwannabemeagain in reply to SlowDragon]

My thyroid levels are on the lower end of normal. I was wondering if im being over medicated. I don't want more levothyroxine

[SlowDragon Administrator in reply to Justwannabemeagain]

can you clarify you’re only on 25mcg ….not 250mcg per day

you need to test TSH, Ft4 and Ft3 together

Test early morning and last dose levothyroxine 24 hours before test

The aim of levothyroxine is to increase Ft3 to at least 50-60% through range, often Ft4 will be higher at 70-80% through range

TSH (the message from pituitary telling thyroid to work) drops low when adequately treated

Levothyroxine doesn’t “top up “ failing thyroid, it replaces it

Being on just 25mcg levothyroxine will result in vitamin levels dropping

Low vitamin levels tend to lower TSH too

Get iron panel test including ferritin, vitamin D, folate and B12 levels tested

[Justwannabemeagain in reply to SlowDragon]

Maybe I'm not understanding my test results. I am on 25mcg not 250.. My tsh reflex T4 is 0.82 does that make me hyper or hypo

[SlowDragon Administrator in reply to Justwannabemeagain]

we need to see results and ranges on

TSH, Ft4 and ft3 plus vitamin D, folate, ferritin and B12

Just testing TSH is completely inadequate

Book early morning test and last dose levothyroxine 24 hours before test

Approx how much do you weigh in kilo

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Justwannabemeagain in reply to SlowDragon]

I asked about testing T4 and 3 and I was told there is no need. I am 67 kilos

[SlowDragon Administrator in reply to Justwannabemeagain]

You need to get FULL Thyroid and vitamin testing done

Either insist current Dr does so or find new Dr or test yourself

Testing in USA

stopthethyroidmadness.com/r...

Standard starter dose of levothyroxine is 50mcg. Dose is typically increased up in 25mcg steps over 6-12 months

Retesting thyroid levels 6-8 weeks after each dose increase

Levothyroxine doesn’t “top up” thyroid……it replaces it

Many medics fail to understand this concept and leave people on inadequate dose levothyroxine years or decades

Guidelines on dose levothyroxine by weight suggests you are EVENTUALLY likely to need around 100mcg levothyroxine per day

The longer you are left under medicated the lower vitamin levels are likely to be

Come back with new post once you get results

[Justwannabemeagain in reply to SlowDragon]

Thanks I will ask

[Ukie]

Hi. Is the pain vertically in the middle of your chest? It could be costochondritis, which is to do with your rib cage, and it’s very common.

[TSH110 in reply to Ukie]

yes I wondered if it might be that. I’ve had it more than once and it can be very painful

[snow22]

also a symptom of long covid

[Justwannabemeagain in reply to snow22]

I don't have Covid

[SarahJane1471]

it may well be the anxiety making it worse. I get pains in the sternum and ribs all the time and then realise it’s when my PTSD/anxiety is playing up. I realise that I have been hunching a lot. Even when walking about my shoulders are curled in etc. Try this exercise. Sit in a chair roll your shoulders back and down and stretch out your chest. This eases the muscles in the chest and rib cage. Also stand/sit and out one arm up and over your head and slowly stretch out the ribs bending at the waist. Repeat for the other side. Whilst doing these take deep slow breaths.

[dtate2016]

The short answer is yes, it could be the Levothyroxine. It was for me - and the solution was reducing the dosage. After more than 30 years on Levo / NDT / other bovine thyroid glandulars, I found myself in a place that sounds very similar to what you describe. It is so scary. I had to find Dr.s that did not treat Hashimotos strictly by the blood test numbers of TSH, T3, and T4, and autoimmune indicators. I had to find Dr. s who listened and took into consideration that I was telling the truth about the chest pains, regardless of what the numbers said. How we feel is just as important, if not more so, than what the numbers say, in my very healthy present state and opinion.

There is a school of thought out there that says about a 1/3 of hyperthyroid disease resolves on it's on.

There are other schools of thought that say autoimmune thyroiditis / Hashimotos is influenced by iodine toxicity / slow elimination of occasional overabundance of iodine. (Iodine is present in almost all foods. Greater amounts of iodine are in all seafood, some table salts, egg yolks, all dairy, and more) If we are slow eliminators of toxins (and up to 25% of the population is - due to genetics) then iodine can build up and become a toxin. The thyroid is the most sensitive to an overabundance of iodine. With an endochrinologist and a personal MD's help, I am now celebrating my 3rd anniversary of pharmaceutical thyroid replacement freedom. drchristianson.com/blog/the...

It is neither possible nor desirable to remove all iodine from our diet / environment. The thyroid needs iodine to function properly (see above article). For those of us who do not eliminate toxins quickly, the margin between too much iodine and too little is very narrow. Once we find what the margin is...it is super manageable. No more chest pains! Sometimes, great thyroid healing does occur. It happened for me. (Even though I did not believe balancing iodine would work when I began monitoring iodine intake - I had tried so many things). I began to feel better within days. I certainly never dreamed I would be able to leave the crutches of Levo and NDT behind. After 3 years, I still wonder if it's going to last, and yet, I have never felt better.

There are other schools of thought that say estrogen dominance contributes to autoimmune thyroiditis. That could have played a part for me as well. At about the same time I discovered and began to implement a more balanced iodine intake, menopause began to occur. (So many pieces to this autoimmune thyroiditis!) drbeckycampbell.com/relatio... I do believe it played a part, as I have been treated (by an MD) for estrogen problems for years.

I have become my strongest health advocate, thanks in no small way to HealthUnlocked. I have learned to listen carefully to what others like myself are saying here and then do my own research, talk with my own Dr., and make MY OWN health decisions. Oddly enough, there are many here who resist the idea that iodine could play such a major role in Hashimotos disease development and chronic condition. From what I have discovered about iodine toxicity (for those of us who are poor toxin eliminators), more than 85% find at least some relief in a 30 iodine balanceing diet. For emphasis, let me repeat. Do find a Dr. to help you explore a lower iodine diet, and be prepared to lower the Levo as well (with Dr.s oversight).

When I had chest pains, they were relieved by lowering the Levo dosage, simultaneously with lowering / monitoring the iodine intake. (When the thyroid is not bombarded it functions very well on it's own). My Dr. agreed to help me with lowering both, helping me as I presented the research, presented her with the idea of a 30 day "experiment"... and the rest, the healing, the relief from anxiety, came quickly.

I hope you can find a Dr. and find relief as well. It is very doable, and possible.

[Justwannabemeagain in reply to dtate2016]

Thank you for telling me your story. I'm only on 25mg levothyroxine. My numbers tsh reflex t4 is .82 ..the highest it had ever been is a little over 6 I don't think I need this medication. How do you monitor your iodine?

[dtate2016 in reply to Justwannabemeagain]

I monitor the iodine in a big picture kind of way. thyroid.org/low-iodine-diet/

Here in the US, the single biggest reduction in iodine came from changing to kosher salt. Here in the US, (as I have been repeatedly and adamantly reminded), unlike in most of the UK apparently, iodized salt is the norm. Other common sources of iodine (mega doses) come in the form of fast foods / prepared foods like sausages, hot dogs, etc. Commercial bread is made here with iodized dough conditioners - apparently unlike the UK. And yet, it seems odd that the same dietary advice is constant - but for different reasons (no bread for gluten reasons, no dairy, no eggs, etc.).

So that is how it is done. There is a whole world of food outside of seafood, eggs, and dairy! It’s the same advice for almost any dietary protocol for health (whether it’s diabetes, or heart, or cancer….). Eat fresh foods, not pre-packaged. It has been three years for me - and honestly, I do indulge in the occasional sausage, cheese, and eggs - even commercial bread - fast foods too. I pay for it physically the next day. Apples are the fastest way back to help eliminate toxins, and get back on track.

Still, I was unloading decades worth of iodine toxcity. My Levo dose was 100 mg. My body was laboring under an unbelievable double / triple handicap (of iodine and Levo overdose and estrogen dominance).

I’m so happy to have discovered Dr. Christianson and the plethora of research he has done. The monitoring is more about feeling well than anything else. I listen to my body. When the chest pains and anxiety return, I know I’ve gone over the line. Pain is red flag kind of teacher! Once you find your balance, you will recognize it - immediately.