Has anyone experienced broad complex tachycardia on a 24 holter ? Should I be worried? GP has requested an echo!
I had two episodes that lasted less than 3 seconds and no symptoms other than felt them. GP said my HR went to 146bpm. The rest was normal sinus rhythm.
Feeling a bit stressed with it all. I’m almost 8 weeks pregnant. I was having palpitations before pregnancy.
A broad complex tachycardia is unlikely to be thyroid related. Tachycardia due to overactive or overmedication is normally a supraventricular tachycardia, SVT, specifically sinus tachycardia or atrial fibrillation. A broad complex tachycardia is normally cardiac in origin often but not only originating in the cardiac conducting system.
Looking at previous post from 8 months ago you had TSH of 16 then TSH of 6 at next test
Were you started on levothyroxine
If yes
How much levothyroxine are you currently taking
When were levels last tested
Do you always get same brand of levothyroxine
TSH over 10 automatically should trigger prescription of levothyroxine
See flow charts on here
gp-update.co.uk/Latest-Upda...
Anyone who is on levothyroxine should have dose increase as soon as pregnancy is confirmed
Pregnancy guidelines
thyroiduk.org/having-a-baby-2/
gp-update.co.uk/files/docs/...
See pages 7&8
btf-thyroid.org/Handlers/Do...
thyroidpharmacist.com/artic...
Essential to regularly retest vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking
After my first endocrine appointment I was started on 25mcgs of levo. I stayed on that dose until recently when my TSH was 4.08 and was increased to 50mcgs. I’m due another blood test in a few weeks. I tend to mostly get the TEVO brand? But it can sometimes be different. Is that an issue?
Vitamin wise I just take folic acid 5mg and vitamin D 25mcg daily. B12 was tested and it was around 450 I think if I remember.
25mcg is a starter dose for child, elderly or heart patient
Standard starter dose of levothyroxine is 50mcg and bloods should be retested 6-8 weeks after each dose increase
Dose should be increased upwards as fast as tolerated until Ft3 is at least 60% through range. Usually Ft4 will be near top of range. TSH always under 2. Usually TSH is well under one when adequately treated
Levothyroxine doesn’t top up failing thyroid, it replaces it
guidelines on dose levothyroxine by weight
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Bloods should be retested 6-8 weeks after each dose increase
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, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test vitamin levels
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, Aristo and Glenmark are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/medications-f...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
When I was given levothyroxine I had constant palpitations.
Fortunately, when small dose of T3 was added it helped resolve them. Other people who have palps might not have the same affect as I had. When I stopped levo (taking T3 instead) I had no more palps.
I have had palpitations for years but just the odd episode unlike now which is pretty much daily. They started in November and I started levo in September. I have wondered if it’s the medication. I have no idea what my T3 level is.
I am not medically qualified and respond to queries through to my own experiences or others' who have posted on the forum.
It was levothyroxine that caused my severe palpitations. When we're new to hypothyroidism, we are unaware of how our body will react and usually we're given another prescription to try to resolve the symptom rather than testing both Free T3 and Free T4.
HR 146 for 3 seconds is like a seven beat run. Often not a concern unless persistent which could then indicate some kind of pacing blockage which would need to be followed by a cardiologist. When rare and intermittent usually related to low oxygen or electrolyte (calcium, magnesium, potassium, sodium) imbalance.
interesting what you say about electrolyte imbalance. I had a spell of atrial fibrillation. Magnesium levels were mentioned by a nurse but when I mentioned this to the cardiologist it was dismissed, saying only potassium levels were relevant.
Theses particular palps happen around every 3-4 weeks. I’ve started taking a magnesium supplement and the ectopic I feel regularly have calmed down. I only started taking recently so will have to see how it goes.
Many of us don't get enough magnesium but you should ask that levels be checked when you get ordinary "chemistry" labs done. Like anything else, magnesium and other electrolytes can be over done. They generally should be sitting nicely in the middle to upper middle of the range.
Patti in AZ
Hypothyroidism and mild tachycardia
Tachycardia after eating and waking up
bioavailable broad spectrum multi vit?
Magnesium Complex 6 in 1
Complex Newbie - T4 Query 
