Newbie from Florida... AF and Thyroid problem

[adriatico]

Hello everyone. I have recently joined this nice family and found so much good information - some of which (I admit) also scared me. I had a few AF episodes last year but I didn't know what it was. It would go away after 5-6 hours. This year I had probably just two going into April and when I mentioned it to my GP he gave me Bisoprolol to take if I get another episode. No AF word was mentioned EKG was good. Soon the perfect storm started. Sciatica hit me so hard that I couldn't sit for more than 5 seconds. It was even worse in bed. Sleeping pills were the only help. After two weeks of torture and exhaustion my heart started to beat so irregularly and hard - Bisoprolol no help. After 3 days of (on and off) AF I finally called the ambulance and then I was admitted into hospital after emergency room.

The blood test showed low TSH (thyroid reading) of 0.116 (std range 0.358-3.74).

The EP dismissed it as probably the lab error and informed about what AF is.

He prescribed Flecainide to carry with me and to take 3 if another episode starts.

Sure enough, 10 days later another AF. This time I was so scared so I called emergency again. This time, the blood test shows TSH reading of 4.24 - above high standard limit. My EP dismissed it again as "crazy emergency room lab".

I read that thyroid could be connected with AF and I insisted that we take the full thyroid test (TSH, T3 and T4).

This time it comes normal but T3 and Free T4 right at the bottom of the standard range. The EP gleefully says "You see, I told you, thyroid is OK." He prescribes Flecainide twice daily. So, I've been AF free for the last 3 weeks.

I went to another GP and she ordered all tests. All blood thyroid tests were normal.

However, the ultrasound reveals "Left thyromegaly with complex nodule 1.2x0.7x1.1 cm". She wants biopsy done.

My world fell apart at that moment. My hands started trembling and my head was shaking. That was too much to handle. I am now on antidepressants. My dilemma is whether to go and have biopsy. I heard that 90% of time it comes as non malignant but still...

One member said that ablation should be done early. My question is: If ablation should be done early why bother with Flecaidine and other medications?

Sorry for such a long story. Thank you for reading.

[BobD Volunteer]

I don't know the protocols in USA but here in UK (England) under our NHS system two drugs regimes need to have failed before ablation is considered.

One must understand that "Cure" is an emotive word and the thrust of any AF treatment must be control and relief of symptoms. There is currently little medical evidence to suggest that ablation extends life or has any other benefit apart from stopping those symptoms. Like any invasive procedure it carries risks if only theoretical. Long term, AF may return so it can never be thought of as a cure.

Whilst early intervention stands the best chance of success in that aim again it does not extend life.

Now there are other factors to bring in. not least the suitability for ablation. Not everybody is suitable and even if they are. a period of preparation is needed. By that I mean that before an ablation can be performed the patient needs to be on anticoagulation for probably three months to ensure that there are no blood clots hiding in the heart which could fly out and cause a stroke.

Seeing all this one must accept that trying to control symptoms is the first priority and if that means drugs like flecainide then fine.

Right now your priority I suspect is to follow through on the thyroid aspect since this may well be causal of the AF

For lots of information on drugs. ablation and all other aspects of AF go to AF Association website and download fact sheets.

[PeterWh in reply to BobD]

You no longer have to have two failed drug regimes in the uk.

[Dodie117 in reply to PeterWh]

Agree. I had mine in 2013 in London with no drug regime failure.

[SRMGrandma Volunteer]

Hi to you in sunny Florida. Your GP is not the person to be treating your AF. You need to look for an EP who is willing to listen to you and work with you. You already have a lot on your plate worrying about your thyroid, which can exacerbate AF. However, once you have the substrate for AF, the underlying disease process, then you need to figure out how you want to treat it. The GP is putting a band aid on it with the flecanide and it sounds like the EP isn't taking you seriously because of the thyroid. Surely there is more than one EP in your network. Start calling for another opinion. Meanwhile, try to manage your stress as effectively as you can, get your sleep, exercise as much as you are able, and knock the alcohol and sugar and processed foods from your diet. AF is manageable and you don't have to be scared, but it is a marathon, not a sprint so make sure you do everything you can to be well. Get the thyroid biopsy. Even if it is malignant, thyroid cancers are among the most manageable and successfully removed.

[Finvola]

Hello and welcome to the forum and to the crazy world of AF. I can understand how concerned you feel about the worry of a biopsy but once you have the result, you can have a plan of action, rather than limbo and anxiety - and hang on to that 90% positive statistic.

Your question re Drugs v ablation is one which most of us think about - some more than others. My own feeling is that for my PAF Flecainide is working at the moment and I have good quality of life at 72 - ablation will be an option but, for me, only when it is unavoidable to retain that QOL when the risks involved are outweighed by the potential for improvement. My EP agrees with this but if I were 30 years younger, things might not be so easy to decide.

There is a post from yesterday headed 'ablation' and it has some superb answers as to why ablation may not be for everyone.

I hope your thyroid problem can be resolved easily as it may lead to an improvement in the AF situation and a good outcome all round.

Best wishes

[Rellim296]

Sorry to hear that you are battling on more than one front. Do try to find the courage to grasp the biopsy nettle because it will move you forwards and could give you peace of mind. You will find that elusive if you are imagining the worst, although a diagnosis of cancer can, believe me, turn into no more than something in your distant past.

[PeterWh]

I fully agree with the above replies. You must get that biopsy done. As we say this side of the pond - better the devil you know than the one you don't know.