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Suggest Treatment For Tightness In The Chest And Anxiety

Posted on Thu, 15 Dec 2016

Question: Diagnosed with Hypothyroidism during pregnancy. From 2013 till Aug 2016,had taken Thyronom 12.5 mg. From Aug 2016 onward physician has increased the dosage to Thyronom 50 mg as TSH level went up resulting in obesity. Now from past two weeks, having anxiety, feeling breathlessness, uneasiness in throat and chest tightness.

Test Date: 27th July 2016

TOTAL TRIIODOTHYRONINE (T3) C.L.I.A 91 ng/dl
TOTAL THYROXINE (T4) C.L.I.A 9.8 μg/dl
THYROID STIMULATING HORMONE (TSH) C.L.I.A 9.03 μIU/ml

Test Date: 17th Nov 2016 (Thyronom tab was not taken before test)

TOTAL TRIIODOTHYRONINE (T3) C.L.I.A 84 ng/dl
TOTAL THYROXINE (T4) C.L.I.A 6.7 μg/dl
THYROID STIMULATING HORMONE (TSH) C.L.I.A 69.09 μIU/ml
FREE TRIIODOTHYRONINE (FT3) C.L.I.A 2 pg/ml
FREE THYROXINE (FT4) C.L.I.A 0.81 ng/dl
ANTI MICROSOMAL ANTIBODY (AMA) C.L.I.A 192 IU/mL

Answered by Dr. Minal Mohit (3 days later)

Brief Answer:
TSH is still very high

Detailed Answer:
Dear XXXX, hi ! welcome to HCM! i am dr. XXXXXXX
See madam, there are a few missing links. please tell me when did you increase the dose from 12.5 to 50?
also please tell me what was the TSH when the dose was increased.
if at present you are taking 50 mcg, then also your TSH is 69 , which is actually very high and you would need a further dose increment.
regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minal Mohit (10 hours later)

Increased from 12.5 mcg to 50 mcg in first week of Aug 2016. t
TSH level was 9.03 as mentioned and tested on 27th July 2016. Kindly suggest what dosage should I continue.

Answered by Dr. Minal Mohit (11 hours later)

Brief Answer:
increase the dose further

Detailed Answer:
Dear XXXX, it seems interesting. your TSH was around 9 and when you increased the dose from 12.5 to 50 mcg, your TSH has gome further high to 69.
so now few things
1. please increase the dose to 75 mcg
2. make sure you are taking it empty stomach
3. do not take any other food or beverage for another 30-45 minutes over the tab
4. do not combine the tab with any other drug
5. see that the thyroxine bottle is a new one
6. check expiry date
7. do not expose the tab to sun, moisture or air.
repeat the tests after 6 weeks and let me know.
regards!

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Minal Mohit (2 hours later)

Thank you doc for your prompt response. Do let me know if any restriction in diet.

Answered by Dr. Minal Mohit (22 hours later)

Brief Answer:
you are welcome!

Detailed Answer:
Dear XXXX, you are welcome. no specific dietary precaution is required but yes avoid high calorie food, avoid goitrogens like cabbage.
regards!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar