Chest pain on levytheroxine

[1234Cp]

I am 26 year old female. I had RAI treatment for hyperthyroidism in November and was became hypothyroid shortly after that. I was put on 100mg of levythyroxine and now have daily chest pain. Did anyone else experience this when they started the medication?

[elaar]

Yes, chest and back pain about 1-2 weeks in, on occassion it got worringly bad. It calmed down after a bit. I subsequently learnt later that 100mcg is quite a hefty dose to start on, especially if you've been Hypo for quite some time.

[SlowDragon Administrator]

welcome to the forum

Which brand of levothyroxine are you taking

Do you always get same brand at each prescription

How long have you been on 100mcg

And were iron/ferritin, folate, B12 and vitamin D levels tested

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[Caradoc1a]

I had RAI for hyperthyroidism Jan 24. Was given 100mcg levothyroxine and was in A&E later that day with ischaemic irregularity and chest pain. It was too much too quickly. I ended up on 25mcg Levothyroxine and 20mcg Liothyronine. 8 months later is 50/37.5 alternate days. I'm 69. In 4 week's time after a blood test, I'll probably up it to 50 each day.

[pennyannie]

Hello 1234Cp and welcome to the forum ;

Do you have Graves Disease and did you first try the Anti Thyroid drug for around 15-18 months - Carbimazole or PTU - to try and lower your T3 and T4 levels rather than have definitive treatment ?

Graves is an Auto Immune disease that tends to only get diagnosed when the thyroid and / or eyes start getting attacked from ones own immune system - there can be a genetic pre-disposition to your having been diagnosed with Graves - and quite why this has happened to you is a whole other question - but we do know that stress and anxiety are common triggers for this poorly understood AI disease.

The RAI will burn out and disable your thyroid is situ rendering you Primary Hypothyroid - with most people immediately placed on T4 - thyroid hormone replacement.

Are you still under the hospital medical team to find the best dose of Levothyroxine for you or have you already been discharged back out into primary care - and if so, do you have a letter from the hospital detailing your T3 and T4 when discharged back out in into primary care ?

It is essential that you are now dosed on your FreeT3 and Free T4 blood test results and not your TSH - as with Graves Disease the TSH is a very unreliable measure of anything as your immune system has likely Hi-Jacked the TSH thyroid receptors and may never recover.

RAI is also known to trash vitamins and minerals - and we need optimal levels of ferritin, folate, B12 and vitamin D for any thyroid hormone replacement to work well - so suggest you ask that these core strength vitamins and minerals are run and we can advise where best these need to sit in the ranges - to support your body and thyroid hormone conversion.

T4 - Levothyroxine is a pro-hormone and needs to be converted in your body into T3 which is the active hormone that runs your body - much like fuel runs a car - with your thyroid much like a gear box synchronising all your bodily functions from your physical ability an stamina through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

So I would imagine the 100 mcg T4 daily was a guess estimate of what you may need - and will likely need adjusting up or down by 25mcg at a time, until your body settles down after this definitive treatment - so itis quite early days for you and please tell your doctor about these pains you are experiencing.

Initially we all start on T4 only - it is the cheapest option and works very well for some 80% of all those prescribed it and we generally feel best when the T4 is up at around the top quadrant of its range - 75/80% through - as this should then convert within your body to a decent level of T3 at around 70% through its range.

Should you not find your symptoms of hypothyroidism resolved on synthetic T4 only - we can consider the other treatment options that will need to be sanctioned and treated by an endocrinologist .

those being the addition of synthetic T3 - to replicate what your thyroid once supported you with making a T3/T4 combo - or the most full spectrum of all thyroid hormone replacements - Natural Desiccated Thyroid - NDT - which contains all the same known hormones as that of the human thyroid gland and derived from pig thyroids, dried and ground down into a powder and then made up into tablets or capsules as required which is now the most expensive treatment option which you'll likely need to go Private to get prescribed.

I'm with Graves and post RAI thyroid ablation back in 2005 -

The most rounded of all I researched is that of Elaine Moore's first book and archived website - web.archive.org/web/2024120...

[Hashihouseman]

Have you had your TSH freee T4 and free T3 blood levels checked? I don’t know if what follows is relevant to your exact situation but there is substantial research which links high free T4 with increased risk of atrial fibrillation, which can cause chest pain. This association increases above normal from the median value of fT4 (about 15-16 ) to a doubling of risk at the upper end of the lab range (20-22). Levothyroxine alone can give rise to excess (upper range and beyond) free T4 and is often tolerated (even prescribed) to compensate for lower T3 production from synthetic exogenous T4 compared to normal healthy thyroid metabolism… If your fT4 is high (TSH likely low) then the association with increased risks of atrial fibrilation may warrant reducing levothyroxine. If free T3 is sub optimal at lower T4 doses the answer may be combination replacement e.g. Levothyroxine plus liothyronine, at roughly 10% of the amount of levothyroxine dose. The answer to low T3 should not be increasing Levothyroxine to give abnormally high free T4, normal is statistically normal for healthy thyroid populations eg c.14-16, anywhere lab range is not usually healthy normal, somewhere in the lab range may be for some individuals and it needs referencing alongside free T3 and TSH to figure out and perhaps confirm a particular fT4 is normal for an individual but for the population as a whole (including treated thyroid and euthyroid individuals) normal is normal ie 14-16!