Thyroxin and throat/ neck pain

[Porridge98]

Hi,

I’ve been on thyroxin for four weeks now. I’m getting a weird ache in my neck/ throat, like it’s harder to swallow. It’s not painful as such, it just feels weird.

Is this normal? Is my thyroid just adjusting to the meds?

Thank you

[SlowDragon Administrator]

How much levothyroxine are you taking

You need bloods retested 6-8 weeks after each increase in dose

Likely getting ready for next dose increase in levothyroxine after you get test results

[Porridge98 in reply to SlowDragon]

Thanks for your responce. I’m currently on 50mcg.

My TSH was 4.2, and needs to be 2.5 to start IVF treatment. So accordingly to the NHS guidelines, it was still within normal range.

I wasn’t really feeling any symptoms before, this weird throat feeling has only happened since starting the thyroxin.

Thank you

[SlowDragon Administrator in reply to Porridge98]

Well Levo doesn’t “top up” failing thyroid…..it replaces it

So you will need further increases over coming months

always test early morning, ideally before 9am and only drinking water between waking and test and last dose Levo 24 hours before test

Even if we frequently start on only 50mcg, 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

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.

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

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

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

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

[TiggerMe]

Yeah pretty normal 😕 week 4 is often the worst when changing dose and the fact you have only just started means you will certainly be under replaced as you need to work your way up in stages 🙃

[greygoose]

Is my thyroid just adjusting to the meds?

Levo doesn't do anything to your thyroid. It's not 'meds' in the normal sense of the word, not a drug. It's thyroid hormone replacement, the thyroid hormone T4, replacing the hormone your thyroid can no-longer make enough of.

It's not unusual for new hypo symptoms to appear when you start taking thyroid hormone replacement, and with a TSH over 4, you are hypo.

[momindenver]

Might you be able to request a more complete thyroid panel next blood draw? e.g. TSH, FreeT4, FreeT3? I wonder how well your body converts T4 to T3 ? Also, if you're having symptoms in the area of your thyroid gland, perhaps a thyroid ultrasound could be helpful.