I have graves disease and have been on Carbimazole for about 9 months - currently 10mg a day. I've just been told not take any more Carbimazole until my blood tests come back as I have a sore throat and feel flu-like. I went to a locum doctor (as I am away) who has prescribed Propranolol - 40mg x3 a day - as my pulse rate is high. I know these are Betablockers and am not sure about taking them; I do feel anxious. Thought maybe I could take one a day... Any thoughts?
should I take Propranolol with an overactive th... - Thyroid UK
should I take Propranolol with an overactive thyroid?
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WestBurrafirth
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Hi West,
What are your concerns about taking them? Do you have asthma? There is apparently some benefit for Graves patients taking beta blockers that goes beyond the reduction in palpitations etc, and they are often used to help those with Graves manage their symptoms. Unless you have a known problem with BBs, it might help you while waiting to optimize your carbimazole dosing. All the best.
No asthma.. I just don't like taking drugs if I can help it! And it mentioned in the leaflet that comes with the medication that one should take special care if have thyroid problems. .. But I will take one today and see how that makes me feel. Thanks for your thoughts
They mean hypothyroid problems. Hypos shouldn't take Propranalol because it affects conversion. It's often prescribed to those with hyperthyroidism. 
I told a GP about Propanolol affecting conversion as she prescribed it even though I am hypothyroidal. She hadn't heard about the conversion issue, so she started searching online whilst I was there. She agreed to monitor my FT3 levels to see if Propanolol has any effect on me. Given how rubbish another GP at the same practice is, I found this one's approach most refreshing. As for whether Propanolol is affecting my conversion, it's still early days. I suspect it is, as my late afternoon/evening fatigue is back. I'll give it six weeks and then get the blood test done (assuming the lab actually does the requested FT3). I'm assuming that I will have to increase my NDT dose if I continue taking Propanolol, which is a pain as I'd only recently identified the sweet spot in terms of dosing with NDT.
As you say, Propanolol is used for hyperthyroidism, although I have to say that the leaflet that comes with the Propanolol is very vague about it. I'd be surprised if my GP practice uses it for hyperthyroidism, as one would hope that they would realise the implications for hypothyroidism were that the case.
One would hope, yes. But, at least this GP isn't dismissing the subject out of hand.
Taken propranolol with no ill effects. This is commonly with hyper patients to help with the symptoms. Once carbimazole is taken at a reasonable dose the need for propranolol goes. Hope you get sorted soon and able to get on carbimazole. I was on a dose of 40mg daily at the start to bring my levels down.
The doc suggested 3 x 40mg daily so I'm going to take 1 x 40 mg and see how that goes. Thanks
Everybody is different so it is trial and error. I ended up on a maintenance dose of 5mg per day. I had 2 trials of coming off but went hyper again quickly. The endo I see was not one to leave patients on carbimazole forever so I ended up with rai treatment. A friend who was also hyper couldn't cope with carbimazole as she had a rash from it so she was given rai early on. We are both now hypo. She manages well now on levothyroxine. I am struggling and am looking to try levo and t3.
I've only been on 10mg carbimazole recently and before that was on 5mg so maybe they didn't see the need for beta-blockers (I think that I might have been offered them right at the start before I had been properly diagnosed but knowing me I refused!
Yes if you need them, which it sounds like you do. Propranolol is one of several in the same class of beta blockers (not all beta blockers act in the same way) that not only address the symptoms of being hyperactive but also has an antithyroid effect - it (or rather one of its metabolites) reprioritises the conversion of T4 to RT3 over T3, it inhibits conversion to T2, and it obstructs elimination of T2, all of which are anti-thyroid in effect, so useful if you are hyperthyroid and not so good if you are hypothyroid.
Thanks, this is very useful info... why don't doctors give this information??!!!
I doubt they know it TBH. When I went back to my prescribing Neurologist to ask him to swap it - it seems somewhat silly following my positive DIO2 SNP result and having my T3 reinstated to be taking a drug that impacted T3 - he had absolutely no knowledge of its antithyroid effects even though he routinely prescribes it ........
I was given Propranolol with Carbimazole when hyperthyroid with no problems, I then had to wean myself off propranolol when my levels came down. If you have been prescribed 3 x day then I wouldn't think taking only one would do you any good and could, possibly, do more harm. If all is well, it won't be for life.
okay, but how could this harm? I guess it might not bring my pulse rate down
Bingo! It's not good for your heart if your heart rate is constantly high. The Propranolol not only brings the heart rate down, it also helps with anxiety.
Hope you are feeling better.
Yes I am, thanks - I've been taking the 40mg x 3 daily dose. will discuss this with my endocrinologist when I get a chance
Good to hear that : )
Let us know how your test results are, if you are able to continue with the carbimazole ... best wishes.
Hi ling , soI have the test results - blood taken Friday 10th the day I stopped taking Carbimazole. I'm not sure what they show as I don't know which represent the white blood cells. There are a lot of them - too many to write here but looking at the results and the ref range I can't see that any are abnormal. The thyroid results have changed a little since my last test which is not good as they increased the dose for 5 - 10mg Carb (although I forgot for a week recently and took 5mg - Duh!). Current test shows - TSH 0.03 L mIU/L (ref range 0.35-5.30) so a little low; Free T4 27.0 H pmol/L (ref range 9-20) - so high; Free T3 14.1 H pmol/L' (ref range 2.6-5.7) - so this is v high. The blood test was taken in the afternoon and not after fasting. Have sent the lot to the endo and awaiting response. Interestingly since I have stopped taking Carbimazole the Uticaria (hives) that I was having to control by taking antihistamine daily has gone.
Best wishes
How's the sore throat and flu now?
FT3 and FT4 are all high so make sure u stay on the Propranolol till the doctor gets back to you on the results.
When is the doctor supposed to get back to u?
Urticaria. Yes carbimazole or the Graves can cause this.
Feeling better now.. flue/sore throat have gone - thanks. Waiting for email from Endo; hopefully today. Yes I am taking the Propranolol - promise! Also have a herbal tincture that helps with thyroid (given by my herbalist) and am still taking this.
That's good to hear.
Herbal tincture. Be careful with that? Things herbal may some times not interact with our bodies in the way they are supposed to given our unique individual constitutions.
I had hives that were controlled by antihistamines when I first began taking carbimazole, but they eventually disappeared altogether.
Have you ever had your antibodies tested (either TSI or TRAb) ? (This is most likely to have been done following your first endo appointment, and isn’t usually repeated every time)
I believe the ‘after fasting’ advice for blood tests given by hypos relates mostly to TSH, because they are typically monitored only via TSH and eating can affect this, and therefore impact their treatment. However, with hypers, FT3 and FT4 are also measured, and in your case, it is the FT3 which is of most concern, and will dictate the dose of carbimazole. Your TSH, although very low, isn’t completely suppressed as is often the case with Graves’.
Assuming your white cell count was ok, your endo will probably want to restart carbimazole (or if the allergy is causing problems, maybe switch to the alternative, PTU) to get your FT3 level down.
Frequent symptoms of being hyperthyroid include a very rapid heart rate, breathlessness and tremor: beta blockers can help resolve these symptoms until your thyroid levels drop.
I had a thyroid autoantibodies test on 10th May 2019: 27 IU/ml (normal range <100), and they said it was normal. Thanks for all the information you've given me - far more useful than any of the doctors I have spoken to! I am continuing on the beta blockers. What is frustrating is that on 4th April 2019 all my thyroid levels became normal and I was taking 5 mg Carbimazole and really hoping that I could stop it altogether.. but then they all went haywire again. Haven't managed to get them back to a reasonable level since.
Which antibodies were tested?
I don't know as that's all it says for the antibodies.. and the T3, T4 and TSH tests are shown separately. I will try to find out.
Yes, do find out. It will be very helpful to you on several fronts.
In fact, given your results are not really stable 9 or 10 months after diagnosis, (please correct me if I'm wrong), you probably want to have antibodies for Hashimoto's and Graves tested.
Some times, the cause of the instability could be because you have both Graves and Hashimoto’s, or Hashimoto's which has hyper flares.
Are the symptoms for both Graves and Hashimoto’s very similar? Are the thyroid levels the same? I have TED as well and was told this was related to Graves. My last test for T3 14.1 (ref range 2.6-5.6), T4 27.0 (Ref range 9-20), and TSH 0.03 (ref range 0.35-5.30) has put me back on daily doses of 20mg Carbimazole, plus 40mgx3 beta blockers.
1) So which antibody was tested on 10 May?
2) What was the infection in your latest blood test? Was your white blood cell level normal?
3) Are the symptoms for both Graves and Hashimoto’s very similar?
Hashimoto's is possibly a more complicated condition to manage as it has hyper, hypo, plateau phases as the thyroid is destroyed. If you have the antibodies for Hashis, then you could move from hyper to hypo or plateau, etc. So you would be on the lookout for symptoms and seek appropriate treatment as required.
I do not have Hashis.
What I understand - for the hyper phase of Hashis, I do not think you are prescribed carbimazole. Carbimazole is prescribed only if your Graves antibodies are positive confirming Graves, and your Graves is active with high FT4 FT3 low TSH.
Graves and Hashis symptoms would be most similar during Hashis hyper flare phase. Which is why doctors frequently mistake a Hashis hyper flare for Graves. WHICH IS WHY ANTIBODIES TESTS HAVE TO BE DONE TO CONFIRM WHICH CONDITION/S YOU HAVE.
4) Are the thyroid levels the same?
I don't think thyroid hormone levels can really tell. My FT4 wasn't very high but I had Graves TRAb antibodies and no TPO antibodies.
5) TED. Both Graves and Hashis can cause TED.
6) 40mgx3 beta blocker.
Yes, carry on taking this till thyroid panel levels stabilise.
When is next blood test?
Consult doctor before stopping the Propranolol. It says on this forum that you should taper off the Propranolol rather than suddenly stopping as it could cause bad rebound effects. Discuss with your doctor how you should taper off it.
Best wishes.
You are welcome
If you have Graves’ you would normally be on antithyroids for 12-18 months, even if your thyroid levels were normal - this is supposed to give the best chance of achieving remission.
A negative antibody test doesn’t necessarily mean you don’t have Graves’, especially if it’s taken after you’ve been on treatment for a while, and are euthyroid (ie within range for FT3 and FT4). However, “thyroid autoantibodies” can refer to a number of different tests: the ones specific to Graves’ are TRAb or TSI.
I only know you need to take what you have been prescribed and you can't just stop taking beta blockers as it can make matters worse. You must wean yourself off them slowly over quite a few weeks.
I am always suspicious of doctors who seem keen to hand out drugs in a cavalier manner.. and it didn't help when he said 'lots of my patients take them'! I haven't had them prescribed before and they haven't been offered, hence my suspicion when seeing a doctor I don't know and who isn't an endocrinologist. So are they addictive? I ask as you said that you have to wean yourself off them.
They are not addictive - it is that they slow down the heart rate and anything that affects the heart is not to be stopped suddenly as it could cause you to have ill effects. Hope this helps.
Hello. If your doctor has okayed it, then I wouldn’t worry about taking propranolol. I was prescribed propranolol when first diagnosed with graves and have never had any problem with them, despite my tendency to worry and imagine side effects. I took them steady at the start of graves and still do occasionally if I’m feeling anxious which I’m wont to do from time to time as my thyroid levels can fluctuate.
Propranolol is safe to take. It is used for racing heart, tremors, anxiety, migraine etc. The dosage should be adjusted as each person is different. My mother and sister take Propranolol just be aware it will reduce blood pressure so when someone has low blood pressure be cautious.
I recently switched from Metoprolol to Propanolol because I noticed that this was the beta blocker of choice for hyperthyroidism. After 3 months, my T3 rose a whole point, so I switched back. Both make me sleepy, but that's it.
Propanolol must be taken twice a day. Metoprolol, just once.
I was prescribed Propranolol with my PTU but stopped taking it because I felt spaced out. Here is link about the drug
Thanks to all for your comments re Propranolol. I'm not taking it anymore, but was told by one of the doctors that if I felt my heart rate was up then I could take one.
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