Propranolol with Hashimoto's

[Ladysmith53]

Hi all, I have been a little concerned for a while regarding taking propranolol with Hashimoto's and the effect it has. After reading a few posts on here it has made me wonder if I should wean off it. I mentioned it a while ago to my doctor when I was under medicated and my symptoms were really bad, as I was only breathing 6 times per minute. But she didnt seem concerned so i just carried on taking the dose. I have it for headaches. My question is, should I stop taking it? And will it affect my symptoms again if I do, as I have only just got to a level where I'm starting to feel ok. Grateful for any advice from you knowledgeable people!

[SlowDragon Administrator]

Why were you originally prescribed propranolol and how much propranolol are you currently taking

Is it long acting (slow release) or do you take it several times day

Yes it can affect conversion and uptake of levothyroxine

But it’s incredibly important if wanting to ween off it to do so VERY VERY SLOWLY

Please add latest thyroid and vitamin results

Important to get vitamins OPTIMAL

Have you had vitamin D, folate, ferritin and B12 tested

If not, request GP does so

[Ladysmith53 in reply to SlowDragon]

Hi slowdragon, i was originally prescribed propranolol approximately 3 years ago through menopausal headaches/migraines 10mg three times a day. Had blood test in January and requested vit levels but doctor said they had been done in November so she didnt need to. She said vit d looked low so I am taking 25ug per day.

Tsh 0.99 (0.4-5.5) in January

Vit levels from November

Folate 9.9 (3.9-26.8)

Ferritin 134 (10.0-291)

B12 497 (190.0-910.0)

Vit d 67.7

T3 3.1 (3-6)

T4 19.7 (11.0-26.0)

[SlowDragon Administrator in reply to Ladysmith53]

Migraine is common hypothyroid symptom

Folate is low and B12 borderline when on levothyroxine

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

IMPORTANT......

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

Probably don’t need separate B12

With B12 result below 500, recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

healthline.com/nutrition/me...

[SlowDragon Administrator in reply to Ladysmith53]

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need,

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Propranolol may lower magnesium levels

[SlowDragon Administrator in reply to Ladysmith53]

Have you had thyroid antibodies tested to see if cause of hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

About 90% of primary hypothyroidism is autoimmune thyroid disease so it’s likely

Important to have thyroid antibodies at least once

Low vitamin levels are particularly common with Hashimoto’s.

Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

[Ladysmith53 in reply to SlowDragon]

Yes I have antibodies, I have also gone gluten and dairy free even though the doctor tested for celiac disease and it was negative. But symptoms much better now no gluten and dairy.

[SlowDragon Administrator in reply to Ladysmith53]

That’s what thousands with Hashimoto’s find

Strictly gluten free diet frequently essential

Often dairy intolerance improves after year or two on strictly gluten free diet

[SlowDragon Administrator in reply to Ladysmith53]

Currently your conversion is terrible

Ft4 is currently 58% through range

But Ft3 is only 3.3% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

If you slowly ween yourself off the propranolol you would hope to see this improve

Recommend you ONLY reduce by 5mg at a time

Then wait 6 weeks before reducing by another 5mg

Etc

Last 5mg, perhaps reduce to 2.5mg

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

[Ladysmith53 in reply to SlowDragon]

That's very helpful, thank you SlowDragon!

[SlowDragon Administrator in reply to Ladysmith53]

Now you are on levothyroxine, you probably don’t need propranolol at all ....but it’s essential to stop very, very, slowly .....or you risk suddenly becoming increasingly hypothyroid as conversion improves

Likely to need further increase in levothyroxine as dose propranolol reduces

[Ladysmith53 in reply to SlowDragon]

Ok...yes I will, thank you!

[SlowDragon Administrator]

Other posts that mention propranolol

healthunlocked.com/search/p...

[jimh111]

Propranolol reduces T4 to T3 conversion (type-1 deiodinase) and so is not appropriate for someone with hypothyroidism. If you need a beta blocker they should choose a different one. This might show up if they measured fT3 as well as TSH and fT4.

[Ladysmith53 in reply to jimh111]

Thank you jimh111, I think I will get some recent bloods done from medichecks and see what those levels are like

[jimh111 in reply to Ladysmith53]

I would ask to switch from propranolol first, see if you need a beta blocker and if so get a more appropriate one prescribed.

[Ladysmith53 in reply to jimh111]

Ok, I take it for headaches/migraines so it's not like I need it for my heart. Thank you for your advice

[jimh111 in reply to Ladysmith53]

Try taking magnesium citrate for migrain, it might work it might not.

[Ladysmith53 in reply to jimh111]

I will certainly try it, thank you

[shaws Administrator]

The majority of GPs know little about dysfunctions of the thyroid gland and what may interfere with the uptake of levo. This is an excerpt from the following link:-

Propranolol decreases plasma T3 and increases plasma rT3 in a dose-dependent manner due to a decreased production rate of T3 and a decreased metabolic clearance rate of rT3, respectively, caused by inhibition of the conversion of T4 into T3 and of rT3 into 3,3'-T2.

Propranolol decreases plasma T3 and increases plasma rT3 in a dose-dependenPropranolol decreases plasma T3 and increases plasma rT3 in a dose-dependent

pubmed.ncbi.nlm.nih.gov/168...

[Ladysmith53 in reply to shaws]

Thank you for the link Shaws, I will have a read and try to understand it, it's very complex isnt it

[SlowDragon Administrator]

I know I was stuck on propranolol almost 20 years!

[SlowDragon Administrator]

Propranolol was the ONLY way I could tolerate increasing levothyroxine over 75mcg (due to undiagnosed gluten intolerance, severe untreated vitamin D deficiency and heterozygous Dio2 gene)

Yes, I had extremely low BP before starting on propranolol. (Adrenal exhaustion)

Prior to starting propranolol I was pretty much bed-bound or in wheelchair on 75mcg levothyroxine

Few weeks after starting on propranolol saw astonishing improvement in energy output. So it definitely has a relevance in helping adrenal exhaustion

BP slowly improved on propranolol, as dose levothyroxine was very, very slowly increased. Took 2 years to get dose levothyroxine up from 75mcg to 125mcg.

Testing during that time included, Addison’s, Cushing, MS, brain tumour, MND, phaeochromacytoma etc!

Seen by endless specialists who kept telling me thyroid couldn’t possibly be causing all this ....yet I knew it was

Was only able to ween off propranolol when went absolutely strictly gluten free and corrected vitamin D and magnesium deficiencies in 2016

This was not via medics, but after joining the forum and seeing just how widespread gluten intolerance is with Hashimoto’s and how essential OPTIMAL vitamin levels are.

Private endoscopy in 2016 confirmed severe gluten intolerance, as if coeliac. Despite zero gut symptoms.

More on my profile

Access to medical records in 2016 showed that 25 years ago, Vitamin D, was 12nmol. I was never told or prescribed any vitamin D.