A pulse of 49 is far too low as you are aware - obviously undermedicated. When I was taking levothyroxine my pulse shot right up 'out of the blue' so much so that amublances had to be called several times. I also learned how to lower/control them myself but it's not easy at first because you have no idea what's going on.
Once T3 was added it was extremely helpful but on T3 only I have none.
I hope you have a nice sympathetic doctor who can help you as you definitely need someone who knows how best to treat you.
I note you are taking T3 separately. You may have answered this query before.
If you are thyroid hormone resistance you may need a much higher dose of T3 than is usual. Dr Lowe has stated that a once daily dose is required so that all cells are saturated and he found that best for himself as well as his patients.
I didn't realise it was levo initially and it is pretty scary if you've never had it before. I had heart checks at hospital several times and was told there was nothing wrong. So I knew my heart was o.k.
I also bought a monitor for blood pressure and heart which I had bought previous, so could also check and take a record.
So, if I felt the palpitations rising and I am sure many know the feeling, I relaxed and remained calm and sipped ice-cold water - if it was really severe I also wrapped an ice-cold towel round my neck either or both brought my pulse down.
I haven't had palps on T3 only. I also didn't have palps on NDT. I must state that everyone is different and what works for one might not for another.
If you think your meds might be affecting you, try taking an anti-histamine 1 hour before levo. (I have read this) and if you aren't affected as usual then try another make of levo and if happens again tell your GP you are having a sensitivity to levo.
I used to take sotalol, it regulates the heart beat rather than slowing the pulse. Other medications work by slowing the heart. There is always a long list of side effects in the drug leaflets but most people have no problem, especially those on low or moderate doses.
I take my liothyroine in divided doses. I'm aware of John Lowe's comments but I think it is safer to split the doses, to mimic the natural process as far as possible. I have found that it is more important to have sufficient T3 at night than during the day as this helps with effective sleep, deep sleep which helps with cognitive function (and produces more growth hormone which reduces muscle pain).
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