Trying to understand.

[Jafib53]

Hello, I am new here so forgive me if this is a silly question. I was diagnosed with hyperthyroidism a couple of months ago after seeing a doctor for a fast and irregular heartbeat. The hyperthyroidism is thought to have caused AF, but I am not sure what is normal for AF. I haven't had (touch wood) any major attacks like some I have read about but my heart rate is fast and remains constantly irregular. My question is this; in AF does the heartbeat go into regular rhythm when you are not having an AF attack or can you remain with irregular rhythm like me without having noticeable attacks? Or put another way, does my near constant irregular rhythm mean I am constantly in AF.

[BobD Volunteer]

AF is a mongrel condition and there are so many ways people experience it. Paroxysmal AF comes and goes at will but many are in persistent AF which may require electricl or chcemical cardioversion to return NSR (normla sinus rhythm) and some are premanent and never in NSR. Add to that many are asymptomatic and are quite unaware of it. Anticoagulation is important to prevent strokes.

[Jafib53 in reply to BobD]

Thank you. Yes, I am on anticoagulants.

[Tommyboy21]

Sounds like you are in permanent afib. But what treatment and specialists have you seen. Someone should be explaining things to you. Including what different treatments you can have.Although I know from my experience first diagnosis from a GP is just beta blocker prescription then off you go This site is great for information.

[Jafib53 in reply to Tommyboy21]

Well, originally I went to see a cardiologist but he quickly realised it was my thyroid that was causing the issue and I think was hopeful that as the thyroid issues resolved, so my heart issues would improve. At that first meeting I had an ECG, an ultrasound and an X-ray and was told my heart itself was in good health. I was prescribed beta blockers and an anticoagulant, was well as thyroid drugs. I was passed on to an endocrinologist as my thyroid issues are the underlying cause and right now am being treated by him, while continuing the beta blockers and the anticoagulant. Thyroid issues can take a while to resolve and whilst mine do seem to be improving, I still have a while to go. I have read that thyroid patients with Afib can often go back into sinus rhythm once the thyroid levels are normal, but I am worried that this is less and less likely the longer my AF remains. I guess I have to wait and see what happens when my thyroid leaves get in range.

[Hidden in reply to Jafib53]

About 9 months after my second ablation I started to have a number of AF episodes which were quickly stopped using Flecainide as a PiP (pill in the pocket). When first diagnosed with AF back in 2014, my TSR was low but T3 and T4 were in range so my cardiologist wasn’t concerned. However in 2019 when I started get the AF episodes, my T3 was out of range. I was referred to an Endo and had Radio Active Iodine treatment and since then the episodes ceased. RAI treatment is not to be taken lightly but I thought I should share my experience with you…..

[Jafib53 in reply to Hidden]

Thanks. My thyroid problem is a bit odd as it doesn't seem to be Graves disease and nor do I have toxic nodules. It seems I just have thyroiditis although we can't figure out what has triggered it (usually and infection or something). The good news with that, though, is that it may well be self resolving without surgery or RAI, and indeed has been improving since I came off the thyroid drugs (they can slow recovery if it is not Graves or nodules).

[JOY2THEWORLD49 in reply to Hidden]

Hi

You had RAI for hyper or hypo thyroid?

RAI kills the thyroid and you would need to be on thyroid - synthetic hormones daily,

I seem to have reverted back as mornings checked and my heart rate is 65. Therefore I have stopped Diltiazem.

I have started Bisoprolol again am and still the 1.25mg at night. All the way through my heart rate has remained 47 through the nights.

I can now focus on my BP now with heart rate sorted.

I have rapid, persistence heart rate but I don't feel it.

They told me thsat I couldn't have an ablasion as my heart was enlarged.

Please read what I have replied to Jafib53.

Cheri Joy. 73. (NZ)

[falah12345 in reply to Jafib53]

It would be no harm to see a cardiologist or a specialist in AFib (EP)otherwise It sounds like you are on the right track and hopefully every thing will get back to normal after you sort out your thyroid issues🙏🏻

[Jafib53 in reply to falah12345]

I was originally seeing a cardiologist and he was handling the thyroid as well. But when it turned out to be a more unusual case of hyperthyroidism he referred me to the endo who said he would look after the heart, too! But either way, it seems I have to get the thyroid sorted and see then what happens with the heart.

[Hidden]

Firstly, welcome to the forum and there is no such thing as a silly question. AF is normally referred to as a mongrel condition which means it can affect patients in a wide variety of different ways therefore there is no “normal” way in which it can affect patients.

The thyroid function can have a significant effect regarding AF. Generally, an overactive thyroid is more likely to cause AF but under active can also cause AF problems. This is sometimes overlooked, but AF specialists will normally require the thyroid to be brought into normal range before treating the AF.

There are basically 2 types of AF, paroxysmal AF is when the heart beats normally, but episodes occur when the heart beat becomes irregular, generally but not always faster, and and some stage returns to normal. Sometimes, the patient can be asymptomatic and not be aware of the changes. The other type is known as persistent AF and this is when the patient is constantly in AF 24/7. Again, for some they can be asymptomatic, but provided the the rate is controlled by medication, many go on to live normal lives and it doesn’t reduce life span. There is a 3rd type known as permanent AF which is essential the same as persistent, but the patient and medics decide not to pursue treatment which could stop AF.

This is a fairly simplistic explanation and I’m sure others will provide more information but almost all of us are not medically trained therefore we are only able to share our own experiences. The best thing you can do to expand your knowledge and understanding of AF is to read all the information freely available on the AF webpage. Always feel free to ask any questions, we are a friendly and helpful bunch 👍

[Jafib53 in reply to Hidden]

Thank you very much. Yes, it seems my doctors are just focussing on the thyroid for now, which I'm glad to hear seems the normal course of things. I see my endocrinologist again in January so will ask more about the heart issues then.

[Ppiman]

My elderly friend, currently getting over a covid infection (I hope!) has had what you have for very many years now and has never had a racing pulse from it - nor any treatment save warfarin (an anticoagulant that prevents blood clots that form in the atrium of AF sufferers). For his advanced age, he's in good shape. My son's colleague, in his 70s, is much the same but has had, I think, six ablations (i.e. catheter procedures to try to stop the atrium shivering uncontrollably). His AF has returned but he's coping entirely well.

Some cope better with AF than others, and you sound as if you are going to cope well, as those two friends do (and, so far, as I have). I think there are three reasons why people cope differently. First, when the atria fibrillate or shiver, they cannot pump blood into the ventricles, or lower chambers (these remain largely unaffected, by the way); instead, the blood has to be sucked down or drop by gravity. How well it can do this varies and will surely affect the way you feel - some hardly notice, others have breathlessness and chest discomfort. Second, some people have a hard-to-cope-with fast racing heart with their AF, and that, too can reduce the flow into the ventricles and be very hard to deal with in general; thirdly, the high rate and reduced flow can bring on dreadful anxious feelings, as if death is imminent (which it isn't) - an awful presentiment of impending doom. Coping with that it nigh on impossible.

So, how it affects you individually will be in the lap of the gods!

Steve

[Singwell in reply to Ppiman]

Very good description Steve. Racing and the Doom - those are/were my challenges.

[Ppiman in reply to Singwell]

Same here - a dreadful feeling on occasion. Anxiety is something to be believed and those who don't suffer it are blessed indeed.

Steve

[ETHEL103]

Hi I thought I was in constant a fib all through the pandemic and after private investigations and referral on for an ablation I was found to have flutter and multiple ectopics which gave me a permanent irregular heart rate except when it went very high 140 plus unbeknown to me was in fact atrial flutterAblation for flutter in May worked well so now in normal rythmn but still do get ectopics on almost a daily basis but when they finish back into sinus again.Hope this makes sense.

[Jafib53 in reply to ETHEL103]

Yes, makes sense. Thank you.

[JOY2THEWORLD49]

Hi

You are telling my story Jafib53.

But I had the Ischaemic (Clot to my left frontal lobe).

A CT scan showed it and 4 days later showed a shadow on my Thyroid on the carotid (perfectly clear) scan.

Lucky you have been diagnosed hyperthyroid. How are you managing that.

Because I ws diagnosed with Papillary Cancer I had mine out and 12 lymph nodes (2 infected).

Do have a neck scan or carotid arteries scan to look at your thyroid. Please.

I had rapid persistent Heart Rate.

But after struggling with it (I don't feel my AF) for 1 yr 5 months and asked for a public cardiac specialist. She changed me off metropolol (breathless, fatigue etc) to bisoprolol which is better for AF patients but I remained uncontrolled.

9 months after I saw a recommended private cardiac specialist. I attended. He introduced me to CCB Diltiazem. 180mg too much so reduced 120mg am and I took 2.5mg Bisoprolol at night.

My Heart Rate went down 105 Heart Beats per minute.

I was then controlled 77-88 and under 100.

There is a possible chance to revert.

and

last Friday it reverted.

So I'm having an ECG on Thursday.

And now my heart rate 9am every morning since is 65. I have stopped the Diltiazem and replaced it with 2.5mg Bisoprolol.

I hope this helps.

Yes, hyperthyroid can cause AF. Mine did.

cheri JOY. 73 (NZ)

[Jafib53 in reply to JOY2THEWORLD49]

Thank you. Glad you seem to be getting back to normal. I went to my regular doctor for a racing and irregular heartbeat and she sent me to a really nice cardiologist. He did all the scans of the heart etc and gave me some anti-arrhythmia meds (I think)but took blood 'just in case'. Called back the next day to say it was my thyroid and said the heart drugs he had given me would have no effect while my thyroid was overactive so not to take any more. As you will know, hyperthyroidism is basically treated with one of two drugs, so he suggested I stay with him as he could prescribe those drugs and also work on getting my heart rate down. So I got anticoagulant, bisoprolol and the thyroid meds. I saw him for six weeks with little change to anythin (not unusual in thyroid stuff as hot can take a few months for the drugs to start working), but another test showed I didn't have Graves disease and that's when he said I should see the endo. They checked my heart etc again and also I had an ultrasound of my thyroid which revealed I didn't have nodules. If it's hyper but not Graves and not nodules, thyroid meds can delay the recovery of the thyroid so I was taken off my thyroid meds but kept on the bisoprolol and anticoagulant. That's been the case for the last 6 weeks but two weeks ago my bloods showed good improvement in my thyroid levels, although still out of range. My heart rate seems to be anywhere between 60ish and 130 ish but mostly around the high 80s or 90s and I think the average has come down a bit since I was diagnosed. But the irregularity is still there. I suppose I am lucky in that i have an underlying cause for the AF while many don't and my hope is that when that cause gets better so too will the AF. It's still all quite confusing to me but glad I have found this place with all the helpful advice. Thank you.

[JOY2THEWORLD49 in reply to Jafib53]

Hi

Bisoprolol regime am and night did not bring down my heart rate enough. The 24 hr monitor day was 156 whereas under Metroprolol was 186!

Night was 47 throughout.

I've finally able to regulate TSH to 2.0 as advised by my surgeon after following top Thyroid man Gary Clayman.

I had no nodules, no lump or anything pertaining to the fact that I had Thyroid Cancer.

I did not have Graves or Has.... either.

Care must be taken to prevent you from having a stroke or heart attack.

Sometimes it seems the thyroid can be trouble and to wait it out with a TSH 10 or more.

But the anti-co-agulant will go some way to prevent these to hapen and usually it is two things like anxiety and thyroid problem with hyper or hypo tension.

My thyroid and 12 lymph nodes were removed Feb 2020.

I wonder whether it is the stable TSH 2.0 which has helped? And prayers for Christmas yes, ha ha. I wrote a poem for Season's Greetings for AF to leave me as the synthetic thyroid hormones SYNTHROID pills are here for life.

I wonder what your TSH is??????

Latest it should be kept to TSH 0.3 I think - 2.5 and not the 4.2.

Dont worry about the T3 or total because it is the TSH which is most important.

Also I take my Synthroid via dissolving under the tongue. 125mcg except 14th day 150mcg!

Take care. It all sounds easier not to have a thyroid and regulate the hormones which regulate all body functions including your pulse!

1 year of CCB which controlled my pulse rapid and persistent kept me safe. Under 100 aesthetists are happy otherwise they refuse to operate, Rerember at rest is the important factor. Wait 20 mins at rest before you take it, no talking, bladder empty, keep still.

cheri JOY. 73. (NZ)

[DawnTX]

When your heart not regular like that it stresses your heart only your doctor can answer having seen your EKG etc. just how much you have going on.

[Desanthony]

Sounds like you are in persistent AF like I was diagnosed with about 6 years ago. So you are constantly in an irregular rhythm. this is easier to deal with I think than paroxysmal AF - a close friend of mine had paroxysmal Af and certainly had a far worse time than I have had. I am now in permanent Af after having 3 successful cardioversions which put me back into Normal Sinus Rhythm (NSR) for a total of 3 years in all but missed out on an ablation which would likely also have been successful for a longer period because of Covid. Still I am doing fine and going to the gym about 4 times a week and keeping fit as anything. I am lucky in that I get low rate AF so my resting heart rate is 60 or under and when I exercise I am keep my heart rate under 120 - it sometimes goes up to peak of 130 but at my age that's unusual now. Being an athlete all my life I wonder just what peaks I used to reach before.