Tachycardia

[Girl6789]

Hello,

Since my completion thyroidectomy last week I’ve been suffering with tachycardia heart rate up to 140 at times so dr’s ran blood test.

Full blood count

Total white blood count 9.0 10*9/L [4.0 - 10.0]

Red blood cell count 4.34 10*12/L [3.8 - 4.8]

Haemoglobin concentration 131 g/L [120.0 - 150.0]

Haematocrit 0.41 [0.36 - 0.46]

Mean cell volume 94 fL [83.0 - 101.0]

Mean cell haemoglobin level 30.3 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 323 g/L [315.0 - 345.0]

Platelet count - observation 389 10*9/L [150.0 - 410.0]

Neutrophil count 6.1 10*9/L [2.0 - 7.0]

Lymphocyte count 1.7 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.5 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.4 10*9/L [0.0 - 0.5]

Basophil count 0.1 10*9/L [0.0 - 0.1]

Liver function tests

Serum alanine aminotransferase level 22 IU/L [0.0 - 35.0]

Serum alkaline phosphatase level 52 IU/L [30.0 - 100.0]

Serum total bilirubin level < 15 umol/L [0.0 - 17.0]

Serum albumin level 47 g/L [35.0 - 48.0]

Renal profile Either Serum Creatinine has not significantly risen or there is

no previous result to compare from the last year.

Serum sodium level 141 mmol/L [132.0 - 146.0]

Serum potassium level 4.5 mmol/L [3.5 - 5.0]

Serum urea level 4.6 mmol/L [2.5 - 6.7]

Serum creatinine level 57 umol/L [45.0 - 84.0]

GFR calculated abbreviated MDRD > 90 ml/min/1.73m*2

Acute kidney injury warning stage 0 [< 1.0]

All of this has come back normal they had thought potentially anemia, is there anything else I should be asking to be looked at or is it just one of the things I’ll have to put up with for a bit any advice really gratefully received.

Thank you so much

[bantam12]

I can't see a calcium result which is probably the most important as your parathyroids may have been bruised, damaged or removed in the process.

[Girl6789 in reply to bantam12]

They initially tested that in the hospital 12 hours after and said it was fine. Is it something which could have changed?

[bantam12 in reply to Girl6789]

I would get it done again just to make sure as "fine" could mean anything.

[Girl6789 in reply to bantam12]

Will do. Thank you

[jimh111]

Seems they just did a full blood count on autopilot as it's an easy tick on the form. They need to run TSH, fT3 and fT4. Testing iron and calcium levels would be useful also. Have they run an ECG? It could just be anxiety but they should have run these basic tests.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common. These could/should be tested now

Ask GP to do so. These four need to be optimal for synthetic hormones to work well

How much Levothyroxine are you prescribed? It may be too low or too high a dose

Thyroid blood test will need to be done after 6-8 weeks on constant dose of Levothyroxine

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

[Girl6789]

Hello I’ve just had further results from GP only been on 150 Levo for 7 days and had taken my thyroxin in the morning as didn’t know I would be having blood test (3pm test). They haven’t tested t3 or anything else and I will look to get private testing after I’ve been on new dose for 6 weeks? Results from yesterday are:

Thyroid function test

Serum free T4 level 27 pmol/L [10.0 - 22.0]

Above high reference limit

Serum TSH level 0.35 mu/L [0.3 - 5.5]

Dr now wants to reduce to 125 is this a good idea? Thank you

[Nanaedake in reply to Girl6789]

I would be very insistent with GP that you need FT3 testing too, especially when FT4 is over range. It's possible to have an over range FT4 but low FT3. If FT3 is low it could make symptoms worse if you reduce dose. I've had tachycardia when heart is not getting enough thyroid hormone. if Gp will not/cannot get FT3 tested then you can try reducing dose to see what happens or get tests done privately.

The trouble with reducing dose without full test results is that GPs endlessly tinker with dose and you'll never feel well.

When my FT4 has been over range a little like yours, my FT3 has been in range so reducing dose wasn't going to help. If FT3 is over range then you do want to reduce dose.

The only way of knowing is with blood tests, testing FT3 and FT4, TSH altogether as symptoms don't always match results, they could be caused by something else.

Everyone is different but people on this forum often say they feel better when FT3 is at the higher end of normal range. In which case you need to know what it is in order to decide how to manage your thyroid hormone dose going into the future.