Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Chest Pain And Frequent Cough While On Tirosint?
Question: My wife had radioactive iodine in January. Shes been on synthroid since the first of April. She felt terrible on this. Three weeks later the endo agreed to retest her levels but that it was too soon to see a change. Her TSH had actually dropped from 51.0 to 7.0. He then decreased her dosage from 100 mcg to 75 mcg. A couple of weeks later she spoke with her endo regarding feeling terrible on the synthroid he changed her to tirosent. The thinking was that she may be having some reaction to the fillers in synthroid.
This morning was her 2nd day on tirosent. An hour after taking it she complains of chest pain and her lungs feel irritated. I notice shes coughs frequently. (same results with both meds). Generally she feels terrible. Sore muscles, aches, tired, etc. We're told this is typical but we're not sure about the lungs/chest issue. She's very emotional. She's felt so bad for so long (about 16 months). I'm not sure if her pain is typical and she just doesn't have the energy to deal with it or if her situation is atypical and she's having some reaction to the medicine. Its not reassuring to be told it gets worse before it gets better.
Is this a typical response to tirosent/synthroid? (including chest issues)
Is it possible to give her any relief?
Why do most endocrinologists not use armour? (seems its almost disliked)
Changes, if/when necessary, seem to move slowly. Her endo seems good but its difficult to get in to see him. I need to make certain were not missing something and that she's not having some atypical reaction to the meds.
This morning was her 2nd day on tirosent. An hour after taking it she complains of chest pain and her lungs feel irritated. I notice shes coughs frequently. (same results with both meds). Generally she feels terrible. Sore muscles, aches, tired, etc. We're told this is typical but we're not sure about the lungs/chest issue. She's very emotional. She's felt so bad for so long (about 16 months). I'm not sure if her pain is typical and she just doesn't have the energy to deal with it or if her situation is atypical and she's having some reaction to the medicine. Its not reassuring to be told it gets worse before it gets better.
Is this a typical response to tirosent/synthroid? (including chest issues)
Is it possible to give her any relief?
Why do most endocrinologists not use armour? (seems its almost disliked)
Changes, if/when necessary, seem to move slowly. Her endo seems good but its difficult to get in to see him. I need to make certain were not missing something and that she's not having some atypical reaction to the meds.
Brief Answer:
Chest symptoms are not typical
Detailed Answer:
Good day,
Noted your concern.
Sorry to hear about your wife's symptoms. Could you please tel me what was the indication for radio iodine treatment ? Was it for Grave's disease or a toxic goiter?
After radio iodine i have seen many patients experiecing such symptoms which evntually improve over time. Levothyroxine is the treatment after radio iodine, but the lung symptoms seems very very unsual" / atypical reaction". Sorry to ask, but is she anxious at the time of using Levothyroxine? . It is hard to beleive that , that particular symptom of cough is related to levothyroxine.
Chest pain is seen in elderly people when we use levothyroxine. So in them, we introduce in small doses . Start with 12.5 mcg, then increase to 25 next week, then increase every week by 12.5 to 25 increments till they reach full dose.
What is her weight and height. Post radio iodine, we calculate the dose of Synthroid ( levothyroxine) based on body weight.
Please understand that it can take up to 3-5 months for the entire thyroid to become inactive after radio iodine. Till then, we may not have to use the full replacement dose of levothyroxine ( because, her thyroid will also be producing some thyroxine hormone by itself till it become inactive). The full repacement dose is usually 1.7 mcg per kg body weight.
Armour is a natural animal thyroid extract. Which has variable amounts of T3 and T4. The absorption is very varable and it is extremely difficult to titrate the dose. It is not recommended by any endocrine guidelines.
She surely need reassurance.
Regarding muscle soreness and pains, it is a good idea to get her fasting blood calcium and phosphorus and alkaline phosphatase done. Besides, she also may need to do a vitamin D test.
Regards
Binu
Chest symptoms are not typical
Detailed Answer:
Good day,
Noted your concern.
Sorry to hear about your wife's symptoms. Could you please tel me what was the indication for radio iodine treatment ? Was it for Grave's disease or a toxic goiter?
After radio iodine i have seen many patients experiecing such symptoms which evntually improve over time. Levothyroxine is the treatment after radio iodine, but the lung symptoms seems very very unsual" / atypical reaction". Sorry to ask, but is she anxious at the time of using Levothyroxine? . It is hard to beleive that , that particular symptom of cough is related to levothyroxine.
Chest pain is seen in elderly people when we use levothyroxine. So in them, we introduce in small doses . Start with 12.5 mcg, then increase to 25 next week, then increase every week by 12.5 to 25 increments till they reach full dose.
What is her weight and height. Post radio iodine, we calculate the dose of Synthroid ( levothyroxine) based on body weight.
Please understand that it can take up to 3-5 months for the entire thyroid to become inactive after radio iodine. Till then, we may not have to use the full replacement dose of levothyroxine ( because, her thyroid will also be producing some thyroxine hormone by itself till it become inactive). The full repacement dose is usually 1.7 mcg per kg body weight.
Armour is a natural animal thyroid extract. Which has variable amounts of T3 and T4. The absorption is very varable and it is extremely difficult to titrate the dose. It is not recommended by any endocrine guidelines.
She surely need reassurance.
Regarding muscle soreness and pains, it is a good idea to get her fasting blood calcium and phosphorus and alkaline phosphatase done. Besides, she also may need to do a vitamin D test.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor.
She had the radio active iodine because of "hot nodules".
Many of the symptoms she is currently experiencing, she experienced prior to the procedure in January. Most of 2015 we were in and out of ERs and specialists trying to determine the source of her aches, pains, and fatigue.
Her endocrinologist felt it was thyroid related. She was "hyper" at the time. But advised that staying on medication to bring levels up could not be taken long term.
Her weight is 140 lbs; so based on your variables we may be slightly under medicating with 75 mcg. However, we're having a terrible time trying to determine if the medication is causing the chest pain or if its generalized anxiety. One of our sons was diagnosed with viral meningitis last week. He's better now but at the time we didn't realize the difference between viral and bacterial meningitis. Her anxiety was the worst I had seen it. My point bringing that up is that she hasn't been handling stress well. To help with this, her GP has prescribed Klonopin. She doesn't like taking medicine so she only takes it when she feels really bad. Even then she will typically break one in half.
According to your comment, we should be nearing the end of the time period for her thyroid becoming inactive (5 month mark).
Thank you for the information regarding Armour; very helpful.
I will get her blood work scheduled with the tests you mentioned.
Thank you,
XXXX
She had the radio active iodine because of "hot nodules".
Many of the symptoms she is currently experiencing, she experienced prior to the procedure in January. Most of 2015 we were in and out of ERs and specialists trying to determine the source of her aches, pains, and fatigue.
Her endocrinologist felt it was thyroid related. She was "hyper" at the time. But advised that staying on medication to bring levels up could not be taken long term.
Her weight is 140 lbs; so based on your variables we may be slightly under medicating with 75 mcg. However, we're having a terrible time trying to determine if the medication is causing the chest pain or if its generalized anxiety. One of our sons was diagnosed with viral meningitis last week. He's better now but at the time we didn't realize the difference between viral and bacterial meningitis. Her anxiety was the worst I had seen it. My point bringing that up is that she hasn't been handling stress well. To help with this, her GP has prescribed Klonopin. She doesn't like taking medicine so she only takes it when she feels really bad. Even then she will typically break one in half.
According to your comment, we should be nearing the end of the time period for her thyroid becoming inactive (5 month mark).
Thank you for the information regarding Armour; very helpful.
I will get her blood work scheduled with the tests you mentioned.
Thank you,
XXXX
Brief Answer:
Thyroid is likely to become silent 3-5 monhs after radio iodine
Detailed Answer:
Good day,
Thank you for the reply. The picture is more clear now.
Apart from the thyroid issues, there is an added element of anxiety involved.
Sorry to hear about your son. Hope he is recovering now. Viral meningitis just need rest and supportive care and antivirals in certain types of viral meningitis.
Klonopin should be used in optimum dose , otherwise it will not be effective.
4-5 months after radio iodine, we expect the thyroid to completely become inactive. Then onwards, she may require the full replacement dose of Thyroxine.
In the interim, she may benefit by doing relaxation exercise, yoga, meditation and anti anxiety medications.
Please post the reports of blood results once it is done
Regards
Binu
Thyroid is likely to become silent 3-5 monhs after radio iodine
Detailed Answer:
Good day,
Thank you for the reply. The picture is more clear now.
Apart from the thyroid issues, there is an added element of anxiety involved.
Sorry to hear about your son. Hope he is recovering now. Viral meningitis just need rest and supportive care and antivirals in certain types of viral meningitis.
Klonopin should be used in optimum dose , otherwise it will not be effective.
4-5 months after radio iodine, we expect the thyroid to completely become inactive. Then onwards, she may require the full replacement dose of Thyroxine.
In the interim, she may benefit by doing relaxation exercise, yoga, meditation and anti anxiety medications.
Please post the reports of blood results once it is done
Regards
Binu
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
