I had a very stressful and combative cardiology appointment yesterday. A 24hr ECG back in May showed I’m having a load of ventricular ectopic beats (over 20,000 in a 24 hour period). Palpitations was one of the many hypothyroid symptoms I’d been having, I was feeling heart flutterings when sitting quietly, particularly in the afternoons. A recent echo was fine though, and my GP, who is a lot younger than me, said she would be happy if it was her echo.
Back in May, before taking NDT, my FT3 was below range at 2.65 (range 3.1-6.8pmol/l) and I felt absolutely rubbish. I’m currently on 1.5 grains of Thiroyd (1 in the morning, 0.5 in the afternoon) and feeling great on it.
My last Medichecks results from 14/10/19 were:
TSH 0.014 (0.27-4.2mIU/L)
FT3 5.36 (3.1-6.8pmol/l)
FT4 18 (12-22pmol/l)
The cardiology registrar I saw yesterday could only see my low TSH and nothing else. He said the NDT was causing the ectopic beats. Until I pointed out to him the ECG was done about 2 months BEFORE I even started taking NDT!!! That set the tone for the rest of the appointment really, and there was a lot of talking over each other. I did manage to point out that circulating T3 is vital for good heart function, and cardiac tissue needs T3 because it cannot convert T4 itself. Told him NDT contains T3 so that's why my TSH is suppressed. He admitted towards the end he’s not a thyroid specialist, and could see I’d done a lot of reading! I didn’t say I seem to know more than you about the thyroid, but I certainly did think it.
I have tried a low dose beta blocker but it made me feel awful so I stopped it after a week. They are going to repeat the ECG and do another echo. It feels like he’s looking for/wanting to find a deterioration in heart function so he can talk me into stopping the NDT. I said the alternative to NDT was to spend the rest of my life either asleep or lying on the sofa, and at 60 I’m not prepared to do that, I still want a life. He didn’t seem the slightest bit interested in all the improvements in many of my other blood results since being on NDT (better creatinine/kidney function, MCV, haemoglobin, RBC, lipid ratios). Had a brief disagreement with him about refusing to take statins, but wasn't worth wasting time on that red herring.
He’s going to contact the private endocrinologist I saw in May (who basically told me to go away), she is also an NHS Consultant at the same hospital. Not expecting anything useful to come from that mind you. Was clearly a bad decision at the time to pay to see her, I should have got more advice from Thyroid UK first. He wanted to do another TFT blood test yesterday, but having taken my NDT that morning, plus I’d eaten, had caffeine, have been taking my B complex containing biotin, and it was late morning, I refused - which he didn’t much like as you can probably imagine.
I still have an irregular heart rhythm and a quick ECG yesterday shows the ectopics are still happening, but I rarely feel anything now. Don’t know if that’s because I’m so used to the sensation that I don’t even register it, or whether anything has changed.
Anyway please could you lovely people point me in the right direction for the best research to print out to show them I’m not doing myself massive harm with this mildly suppressed TSH (I remember seeing diogenes clarifying in one post that a TSH below 0.01 is suppressed, and so at 0.014 I’m still technically in the mildly suppressed range). I have seen several articles mentioned on here over the months, but they’re not so easy to find now that I need them.
Unfortunately I’ve read similar stories many times on here about having to fight with health professionals like this. It’s nice to know I’m not alone though, and I have no doubt that helped prepare me to stand up for myself yesterday, so thank you to everyone who takes the time to read, post and reply on here. I certainly appreciate it’s not a 5 minute job!
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Your bloods look good, but they look like the bloods of someone on a full thyroid replacement dose.
So you are taking 1 1/2 grains. This is 54mcg T4 and 13.5mcg T3. Quite small doses really.
In the background you may have an absorption issue happening. I am not sure if this is common with the heart beats, but looking at the bloods i am thinking this person is not sucking up the T3 fast enough and so it is hanging around a bit to long.
I am pretty sure if you add more T4 you will get over 20 quickly. A typical T4 replacement dose is 125-150 and a typical FT4 on this level is high teens / low twenties. When T4 starts to go to high it indicates the body is not processing it quick enough.
So your FT4 looks great, but on a small amount of T4 intake it does suggest this issue is occurring here.
IF you can help increase absorption then you might find 1 1/2 grains is not enough and the TSH will move up. Increasing absorption is the main issue for patients and is not an easy task. I am sure you will know what issues affect absorption, so is iron ok, how are the adrenals ?
Have you ever tried T4 only? Sometimes this can be a better fix. I do prefer to ALWAYS try T4 first to see if this helps and then look at adding in the T3. After T4 only, the next stage for me would be T4/T3. This gives you much more control over the T4/T3 amounts you consume and you can tailor a specific fit for your adrenal capacity, eg. use more T4 and less T3. In this case i would like to see what bloods you get on 50 T4 and around 5mcg T3. These small differences will make a difference believe it or not.
Re dosing I agree it sounds like a small dose, but I’m very petite, I only weigh 7st 2lbs, 5ft 2ins tall with a small frame. Depending on which multiplier you use for the T3 part of NDT, 4 or 5, I calculated 1.5 grains to be around 102-115mcg equivalent of levo. So for little me, that could well be enough? The Thiroyd Thai brand of NDT I’m taking has 35mcg T4 and 8.31mcg T3 in 1 grain.
My FT3 and FT4 are both about 60% through their ranges – I thought it was a good sign that they are about the same % through range? Long list of other hypo symptoms are loads better with my current levels, it’s just the ectopics that are still an issue.
On the absorption question you raise, remember I had the ectopic beats for months, if not years, before I started on NDT, so there wasn’t any extra T3 to be hanging around for too long, my T3 was below range before starting NDT. Sorry if I have misunderstood you on that.
Naturally I was hoping NDT would make the ectopics magically disappear. Maybe I’m being too impatient and they still might, it’s been less than 5 months so far on NDT. Hypothyroidism generally creeps up on us slowly doesn’t it, so why shouldn’t the improvements take time as well.
My GP’s notes recorded me as having an “irregularly irregular pulse” 6 years ago, but nobody bothered to mention it to me, I only picked it up myself this year when trawling through my old medical records online, trying to track the history of my thyroid results.
I haven’t tried T4 only as I wasn’t given the opportunity to try it, NHS GP described me as subclinical hypothyroidism (which we know means go away and come back when you can no longer function at all!). She’s actually a nice GP and did at least admit in the past she would have been able to prescribe me levo, but couldn’t now under their current guidelines. Hence buying the NDT myself. Plus as NDT has T3 in it, and my T3 was below range to start with, it seemed a good fit. I did start to feel the benefit of the T3 very quickly, within a few days I had more energy which was brilliant.
On the iron levels question my current ferritin is 108mcg/l (15-200), so that seems ok. My serum iron was last checked about a year ago and was 16.4 (10-32 range), so could be a bit higher. My MCV was over range at 103 (80-100), but on NDT has improved to 100, and I'm hoping will continue to reduce. RBC was too low at 3.58 (3.8-5.8), on NDT is now up to 3.97.
Adrenals is something I’ve read up on a little bit, can’t say I understand it all, but don’t really seem to have the main symptoms of problems there. I don’t sleep as long at night as I would like (around 6 hours at night), but that really is the only possible one on the long lists I’ve seen. I just seem to wake up naturally after 6 hours sleep. That’s been going on for about 12 years, since the start of the menopause.
I do then flag a bit in the afternoons, I have a short nap quite often, but keep it under half an hour so as not to affect the following night's sleep.
It’s quite useful to think it all through again though, thanks for your input and help!
If your pulse is " irregulary irregular" then it's Afib caused by the electrical system going haywire and you should be on rate control meds plus anticoagulants as a stroke is highly possible, don't assume it's thyroid related because it may not be.
Hi bantam12, if it was Afib wouldn't it have been picked up by the 24 hour ECG? I've never had any episodes of an increased heart rate at rest.
The "irregularly irregular" comment was on my GP's notes about 6 years ago, but nothing said about it.
I've just looked at a list of Afib symptoms and I don't have any of them apart from the fluttering, which I've been told is ventricular ectopic beats, not atrial.
Paroxysmal Afib won't show on ECGs if you don't happen to have an event when you are being monitored, that is why it can take a long time to diagnose. A 24 hr monitor is pretty useless if you aren't having regular events, you need one for at least a week if not more, some people have recorders implanted so they can record events over several years !
You say you are feeling ectopics and flutter and a doctor has recorded an irregularly irregular rhythm, these are some of the many symptoms of Af, many people aren't even aware they have Af.
I was initially diagnosed with benign ectopics, I went back to Cardiology several times over 6 years with the same non specific symptoms until 1 Consultant did more tests and finally I have a diagnosis of Af and I'm on the waiting list for surgery and possible pacemaker.
All I'm saying to you is don't assume its thyroid or meds related, it may well be but equally may be something more serious.
That's very helpful and informative, thank you. I know you are experienced in all of this and I am most definitely not!
Again purely from a quick Google, doesn't Paroxysmal Afib usually involve a rapid heartbeat? If so, wouldn't I probably be aware of a speeding up like that?
I certainly did hope it was thyroid related, but totally appreciate it could be completely unconnected.
It doesn't always involve a rapid rate, it's the irregular rhythm thats the problem. I actually have PAF with bradycardia which is why I can't take meds for it.
Just reading your last paragraph again - you mention 50 T4 and 5mcg T3 - that's about the equivalent of 70-75 of levo, or 1 grain of NDT. So that would be quite a reduction wouldn't it? Complicated stuff eh!
I do have an earlier GP blood result from when I was on 1.25 grains, doesn't include FT3 as GP's lab won't do it:
TSH 0.02, FT4 14.7 - so a similar TSH,but lower FT4.
I feel better overall now on 1.5 grains than I did on 1.25. On 1.25 some hypo symptoms had started to return, hence the increase. I have had no symptoms at all of being overmedicated. I monitor my basal temperature daily which has improved slightly with that increase. I use a graph to monitor my basal temperature and it's clearly more stable on 1.5 grains. BP and pulse have stayed the same.
Like you I'm very active, now that I'm feeling back to being what's normal for me. Before NDT I didn't want to do anything, had to drag myself off of the sofa to do anything. Now I'm back to doing various activities 6 days a week, playing badminton, tennis, weight training, yoga and a once a week HIIT treadmill session. I've read when we are more active we need more thyroid hormone, so that would well explain why I'm feeling so good on 1.5 grains.
If you feel good this is the most important indicator, so i wouldn't worry to much about the suppression.
For me my TSH was suppressed for many years but then i tried low dose progesterone at 3mg per day. Ever since then the TSH has ticked up and the FT4 came down. This shows the progesterone was having a cortisol effect and so uptake of T3 was greatly improved and so the body moved back into its natural balance.
TSH may well be a marker which cannot reset very well once we start to add in thyroid hormones. It isn't a good marker, but yes it is nice to have it normalised rather than suppressed.
Remember drops in thyroid meds are very important as part of your routine. It allows us to work out where we are in the replacement range. Are we on to much ?? Very often people are. So decreases are great ways to test this out and you get the feedback very quickly. For me it is one day approx. For others it may take a week to notice things are not so good again.
I no longer use progesterone, or if i do it is every so often. However, the TSH acts pretty normally.
That's interesting, I don't think I've seen on here before that regular drops in thyroid meds are a good thing. I thought with NDT having T3 in it, a regular and consistent dose was the way to go? Unless having symptoms of possible over medication of course?
I read your post earlier this morning and showed hubby who commented your post sounded familiar and that I could have written it ! I am currently experiencing unpleasant symptoms with heart rate and pulse and at times feel unwell.
It was a funny heartbeat that took me to my GP in Greece back in 2004 - something I had been aware of from time to time and called it my stress heartbeat - in the days when work and family were demanding. Am now 73.
A recent move back to the UK has had quite an effect on my health as heart discomfort keeps rearing its ugly head.
I have been T3 only for 6 years and have recently changed brands - I take 75mcg daily in one go ! - self- medicating having been prescribed T3 in Greece.
At great expense I bought the book - Thyroid and Heart Failure - from Amazon. You can go to the site and Look Inside at the Chapter details . All research papers from around the world brought together by an Endo and a Cardiologist - working together for the purposes of research - something that should happen more often ! Liothyronine seems to be the star of the show. If you search on-line for - hearts and low T3 syndrome PubMed - things of interest will appear. Having moved countries I have lost so many links - sigh !
Currently I hope to manage these funny turns as I am fearful of sharing with new GP as I feel a battle emerging - enough to increase blood pressure !! Also have read about the side-effects of meds. Am pleased to say new GP was accepting of higher blood pressure levels for the elderly - phew ! She is allowing me to self monitor levels. This morning the average of 3 tests was fine but pulse was high - so now off to research and make sense of them ...
Thanks for replying – but sorry to hear you’ve had to move back to the UK just in time for the worst of the weather! We lived abroad for 8 years, in France, moved back to the UK about 10 years ago, so another thing we have in common! You’ll probably have to take plenty of vitamin D now you don’t have all that wall to wall sunshine available ….
I did see one of your posts previously about that book, and I have been on Amazon to have a read. Was a few months ago mind you, so can’t remember much! Will have to revisit. I do remember T3 being in a positive light though, and I knew I was below range in T3.
A definite phew for your new GP accepting blood pressure! My GP is great in that she lets me check it myself at home, I write down the readings and take them in with me to give her – is that how you do it with her? The other thing I do now and then is go to a local medical centre that has a BP monitor that anyone can use, in a private quiet area. It gives a print out of the reading which I can give to my GP. Quite reassuring to check it’s roughly the same as the readings I get at home.
Such a shame we have to live with the dread of these battles with medics. The stress of it certainly increases blood pressure, and I expect does a lot more harm than that. We will both have to try and rise above it as much as we can, and not let them make us ill from the stress they cause us! I can totally understand now why some people on here say they do everything they can to avoid doctor visits. A part of me wishes I’d never mentioned palpitations to my GP in the first place, but it’s on the Thyroid UK list of hypothyroidism symptoms so at the time I hoped it would help my case to be medicated.
Have you read Humanbean’s response to me about her triggers for heart issues? She mentions blood sugar levels. My blood pressure has been very good since I first reduced carbs about 6 or 7 years ago, was always at the high end of normal before that. But my BP certainly did spike much higher yesterday at the hospital, luckily they didn’t say a word about it though. Are you having episodes of a fast heart rate then? What pulse rate do they consider high for you?
I agree with Marz that it would be a good idea to get hold of the book, Thyroid and Heart Failure, eds. Iervasi & Pingitore, and use it to fend off the docs when they're not listening or pressing you to a course of action that does not feel comfortable.
Ectopic beats can be a real nuisance. I know when they happen to me that something is amiss, but that something can often be stress, severe fatigue, or just that my body has run low on T3 and the heart isn't happy about that.
Marz I didn't know you'd been feeling unwell and having ectopics. You've had a huge upheaval recently...these things have a profound impact on health. Hoping you feel better very soon. x
Thank you ! Am actually feeling better - the episodes have calmed down for the time being. Have also reduced T3 having recently changed brands. Am not as busy as I was in Crete so perhaps I am more aware of things going on in my body. Am seeing an Osteopath who seems to have fixed a few things with Cranial Osteopathy . Hard to understand but there is a definite shift . The hairdresser I found on-line also hosts the Osteopath - Accupuncture - Massage - Yoga more ... all overlooking the river Torridge less than 10 minutes away.
Hope you are coping with these wet and colder days and keeping as well as possible .
That's good to hear. 😊 I've heard good things about cranial osteopathy, including from a trainee dentist, with whom I had to have a whispered conversation so her senior colleague didn't overhear!
Thank you for your Reply. GP happy for me to monitor my own blood pressure - which seems better at the moment. I gave her an average reading which she accepted. I was not given an acceptable level so will go with reading the research on levels for older people ! My pulse runs around 80. An not sure what is going on - it's just uncomfortable and has prevented sleep on a few occasions. I do remember both my Mum and Nan drinking bi-carb to ease their indigestion !! Both had blood pressure issues but also undiagnosed thyroid.
Blood sugar being tested next week along with other basics. My diet has changed a little but carbs are low. Although Ferritin has always been good I may ask for serum iron to be tested to check.
Bicarb lowers stomach acid though doesn't it, so shouldn't be used when food in stomach. So can slow down digestion and make things worse, especially if stomach acid low already, which if often is when hypo.
Yes I agree. I think in the old days it relieved what they thought was indigestion due to a good ... burp !! - especially after home made bread - pickled onions and cheese !! We lived on a farm and produced most of our own food ...
Thanks for your reply. Would be so lovely if it was something I could fix myself.
My ferritin last month was 108mcg/l (15-200), so that seems ok. My serum iron was last checked about a year ago and was 16.4 (10-32 range), so could be a bit higher. I purposely eat beef 4 or 5 times a week, and manage liver about once a fortnight. My MCV was over range at 103 (80-100), but on NDT has come down to 100, and I'm hoping will continue to reduce. RBC was too low at 3.58 (3.8-5.8), on NDT is now up to 3.97.
I've been low carb/keto for the last 18 months, and moderate carb for several years before that, so we're on exactly the same page on avoiding the dreaded high blood sugar! HbAic from last year was 38mmol/l.
I've never had any chest pain at all, I've just had the fluttering sensation. Before starting NDT I got out of breath too easily, (felt like I had a fuel pipe blockage, no gas getting through) but that's completely gone now. I don't even get a fast heart rate, except when I'm exercising hard and it's to be expected.
In the back of my mind I'm thinking it could be faulty electrical signalling, shame I can't just be rewired eh!
Alarm bells...if your MCV went over range, that may point to an insufficiency of B12 or folate, which can certainly lead to the symptoms you've described. Have you had these tested?
While I was having various tests over the past couple of years, searching for answers as we’ve all had to do, I luckily found the perfect references below, quoting raised MCV/macrocytosis due to hypothyroidism, which made sense to me with my results.
Prior to NDT my MCV was over range at 103 (80-100 range), it had been gradually creeping up over a few years. My GP's knew that but couldn't find a cause. After 4 months of NDT MCV was back down to 100, so within range but at top of the range. I'm hopeful it could still fall further in time, once I’ve been on a stable dose for longer. In the past my MCV was 94. My RBC, haemoglobin and haematocrit also fell below range during that time alongside MCV, and are on the way back up now too.
B12 was over range at 1559 when last tested in March 2019 (was supplementing), folate 18.6 (9-30), so weren't an issue in my case, but yes you're quite right they are amongst the first things to check.
Gosh don’t we have to learn a ton of stuff ourselves! Luckily I do find it quite interesting myself, but most people I know wouldn’t think that way.
Macrocytosis is found in up to 55% patients with hypothyroidism and may result from the insufficiency of the thyroid hormones themselves without nutritive deficit.
The commoner causes of a raised MCV that should not be missed are: (a) megaloblastic anaemia; (b) alcoholism; (c) hypothyroidism; (d) myelodysplastic syndrome; and (e) medication, particularly with cytotoxic drugs.
All patients who are hypothyroid have abnormally large red blood cells. Even those with a normal MCV show a fall of 5 to 6 fl 2-3 months after becoming euthyroid.
About 25% of patients with hypothyroidism (without associated pernicious anemia) have macrocytic red cells; the macrocytosis seems to result from a deficiency of thyroid hormones.
The MCV of hypothyroid patients falls when they become euthyroid.
In addition to your references, there is a new book available on B12 deficiency syndromes by Dr Joseph Chandy. It contains a lot of up to date references to the literature, and though I've been reading up on the subject for a good while (I have pernicious anaemia) there's information in it I hadn't come across before. Available from Big A in monochrome and colour versions.
Some research links that may be of some relevance, but I'm guaranteeing absolutely nothing - I'll leave it to you to decide which of them, if any, tell you what you are looking for. Be aware of how old some of the links are - it may be an issue for some links :
I think it is always important for every test to know what is normal for healthy people? Many doctors haven't a clue when it comes to thyroid-related stuff. I link this often, so you may have already seen it.
Title : Serum Thyroid-Stimulating Hormone Concentration and Morbidity from Cardiovascular Disease and Fractures in Patients on Long-Term Thyroxine Therapy
Wow, thank you so much, that's a fantastic help! Makes me almost look forward to the next hospital appointment!
Yes I really love the TSH distribution chart, thank you – funnily enough I was showing it to a friend this morning, her TSH has just come back at 4.18, which of course her GP has said is normal. Was great to be able to show her with the help of the chart how wrong that is! I was pretty gobsmacked when I first saw it, puts everything in a different perspective doesn’t it.
I have Afib & Heart Failure brought on by untreated hypothyroidism. I only take T3 now as have DI02 faulty gene. I was taking T4 for 20 years and it did nothing but damage my heart. My Cardiologist has no issues with T3 only but I make sure my TSH does not become too suppressed or it irritates my Afib. You are taking a combination of meds so think you need to raise your TSH slightly, you will work that out. You do a lot of exercise and believe it or not that can irritate your electrical signals in the heart. Lot's of athletes have this problem. Over exercise can trigger a flutter in your heart. The other thing to get rid of is real ground coffee and any caffeinated drinks. Alcohol in strict moderation. It's the tannins or sulphur that irritates. Especially red wine, dark spirits. If you are teetotal it's no issue but if I am at a celebration I stick to Prosecco, skip the champagne. You also need some healthy carbs in your diet. This is my experience anyway, but we are all different. Exercise wisely. I sat next to a slim fit man in Cardiology who was a keen competitive cyclist. He peddled his way to a heart attack!
Hi Lulu2red, yes I have read that about athletes, marathon runners etc having issues, but I definitely wouldn't call myself an athlete. I have never been a fan of endurance types of exercise.
Apart from the one short HIIT session a week (which is 30 second sprint intervals then walk/rest inbetween), none of the rest is enough to make me sweat or get properly breathless, it's all at a moderate intensity, it doesn't get my heart rate up very high. My echo last month was completely normal, as was an echo done 6 years ago. My GP who is only in her 40's said to me last week she would be very happy it if was her echo! No signs of any Afib or heart failure, no enlargement, only the ventricular ectopics.
Very low alcohol intake, the occasional 100mls of wine. I haven't found any triggers, but because I'm very rarely aware of the ectopics anyway that makes it impossible to tell if there are any triggers.
I'm afraid I couldn't agree less with you on needing to eat "healthy carbs" - but the world would be a boring place if we all thought the same wouldn't it! Although we should clarify on that as it depends what you specifically mean by healthy carbs - I eat plenty of vegetables every day, excluding the starchier ones except for the occasional meal out, and vegetables are mainly carbohydrate plus fibre.
Just wanted to say that if the pharmacy change my brand of T3 is can trigger a flutter or AFib. Might apply to different supplies of NDT. Also even if you have a structurally healthy heart it doesn't mean you can't develop AFib and you don't want that. GPs are pretty clueless about thyroid and the heart, you need a Cardialogist who is an EP specialist. Bear in mind AFib in the over 60 s is quite common. Two of my neighbors have developed it recently. One a slim Vegan who walks 5 miles a day, with a clear Echo. There is no cure for it and AFib just begets Afib. You need to get rid of the flutter so you don't develop it. Take it seriously because sometimes you can actually have it and not notice it. However my best guess is that as your diet/exercise is not to blame them just tweaking you thyroid meds should sort it. Listening to your own body is best because in my experience most Endos & Doctors just like the sound of their own voice. I have had only a couple of amazing Doctors in my lifetime and the one thing they had in common was an open mind and listening to patients symptoms. All the best.
Found these guidelines this morning from the American Heart Association in 2017, very relevant to my situation.
Vital point here:
"Treatment of PVCs with antiarrhythmic medications HAS NOT been shown to reduce mortality"
Again, I am most definitely not a trained athlete, but as it's been mentioned:
"However, PVCs are common in trained athletes who have palpitations, in whom there DOES NOT appear to be increased risk of death based on studies of small numbers of athletes, at least in those WITHOUT other cardiovascular abnormalities.
"
2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death
What I’ve learnt thus far I hope it helps you and others on a similar journey including @Marz..
Being undiagnosed hypothyroid for many years can lead to low stomach acid and the liver/bile duct not detoxing effectively becoming clogged. The fats are not being emulsified efficiently and therefore assimilated. inevitably means oil/fat based vitamins are at risk as well I.e A,D,E.K..
Bile is recirculated approximately 19 times and becomes sluggish and a breeding ground for pathogens who love starchy/sugary food and iron amongst other heavy metals.
Neurotransmitters are diminished with poor protein assimilation.
The adrenal glands inevitably become challenged.
Essential to get and monitor the correct dosage for T3 as the heart and brain only utilises T3 but the T4-T3 conversion is done in the liver and gut.
Microbe Formulas (sold in U.K. as Cellcore Biosciences by Amrita Nutrition or Beaumedltd) have a good self heal detox protocol. The Full Moon one is a good place to start. TUDCA + thins the bile.
Diet wise it’s probably best to ease back on fast release carbohydrates as the adrenals kick in with the afternoon and early morning slump to raise blood sugar.
Ensure stomach acids and enzymes are giving a helping hand BioOptimizers products such as Masszymes, P3-OM, Betaine HCl seem to be effective. BioOptimisers have a good series of podcasts that are informative.
Replenishing minerals (especially magnesium) and vitamins is crucial and I’ve found ReMag, ReMyte and ReAilgn (Botanicahealth) to be my delivery system of choice. These products are formulated by Dr Carolyn Dean who has written numerous relevant free ebooks does a weekly call in radio show and has written The Magnesium Miracle.
This stuff works however the sequence is imperative.
Most of the research about heart function and low TSH isn't really very good quality as, in most cases, there is no differentiation between low TSH with high thyroid hormones and low TSH with normal thyroid hormones but on meds. However, there are studies that show that low T3 means that a patient with heart problems is more likely to die
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
I've had trouble locating the colour version at times. I'll investigate. 
suppressed TSH and high FT4
Suppressed TSH AND LOW T4
Suppressed TSH is okay says endo!
Suppressed TSH - evidence of overmedication?
