treatment for hashimoto's

[sunflower72]

I was diagnosed with Hashimoto's and a benign nodule about 10 years ago by my PCP.  I have been stable on 200 mcg per day for most of that time, even during breast cancer treatment, 5 years of tamoxifen, surgical menopause and 25 pounds of weight loss.  My health has been stable for about 18 months and when I went in for my annual checkup, tsh was.01 (0.27-4.20), ft4 was 2.26 (0.8 - 1.7) and I am hoarse, have neck pain, night sweats, intolerance to cold during the day, etc.  He changed my dose to 175mcg and told me to come back in a few months.  I have been on the new dose for a month, still feel awful and have started to do some research and am more confused than ever.  

Does this course of treatment make sense?
Should I be concerned that all of a sudden - for no apparant reason - my labs are so off and I am feeling so awful?

[sunflower72]

Thank you.  I do understand the tamoxifen connection - what concerns me is I have been done with that treatment for two years - during and in the first year afterwards, my thyroid levels were all normal.  I would not think the impact of it would be that delayed.  I have had no changes in meds, diet or routine in the two years since my treatment ended and I have never had symptoms or issues like this before.  My PCP, who has been great through everything else, seems to think this is not big deal.  Do you think I would be better served by a specialist?

[Mark Lupo, M.D.]

If you had stopped tamoxifen then there is usually a decrease in thyroid dose requirement.  Otherwise it could be due to change in supplements/other meds or due to changes in stomach acid status.  Would repeat thyroid labs (usually 5-6 weeks after a dose change in this setting) and if normalized, talk to your general physician about other potential causes of your symptoms.