Doctors advise not letting tsh go below 1 with A Fib, but that could mean being under medicated. Any views on this.
A fib low tsh and Hashis : Doctors advise not... - Thyroid UK
A fib low tsh and Hashis
I have Afib and my TSH has been around 0.03 for years but my GP and Cardiologists are fine with it.
Thanks bantam12. Do your doctors bring age factor into it I’m over 70?
I too have AFib and TSH 0.01 for years. Cardiologist says she’s not bothered, it’s keeping the Dr off my Levo which is the problem. I’m 78 this year!
That’s encouraging to hear Hylda. What do you mean about trying to keep Dr off your levo
I take 125 of Levo, luckily my GP is absolutely fine with that and my TSH and she knows not to mess with it !!
My worry will be when they start looking at age in relation to dose, although cardiologist said that was when patient was frail.
Oh well, will have to worry about that if the time comes, I'm rather hoping I don't live long enough to be in the frail category 😬
Gwelos,
The heart muscles that contract & pump blood through the body requires adequate thyroid hormones to function properly. Inadequate thyroid hormone levels can directly slow the heart rate or make it irregular.
Low thyroid hormone can also indirectly cause other causes of AFib such as: high cholesterol & fatty acids build up, high BP, elevated homecysteine (impaired absorption of VitB’s and decreased liver enzymes levels), being overweight, etc, that in turn may cause clogged arteries, heart disease, stroke, heart attack.
Your doctor is another obsessed with the TSH, and thinking low TSH equates to elevated thyroid hormone (as in hyperthyroidism), but it doesn’t work like that in people with thyroid dysfunction & low thyroid hormone issues. Therefore, it is not the TSH that dictates AFib but inadequate or elevated T4/T3 as it is these hormones that slow or drive metabolism.
Your last set of bloods (10 months ago) showed low FT3 but an adequate level is the mediator of a healthy heart. If you have optimised nutrients but low FT3 levels are an ongoing problem, you are most likely a poor converter and might benefit from adding a little T3 to your Levothyroxine. This will really freak out your TSH obsessed doctor but it worked for me and many other members on the forum, and returned our wellbeing as addressed all/many health conditions mentioned above.
“Bioactive T3 is a powerful regulator of inotropic and lusitropic properties of the heart through their effects on myosin isoforms and calcium handling proteins in particular.” (circ.ahajournals.org/conten...
Show your doctor the article below, ask to be dosed by thyroid hormones levels and symptoms, and state you will take responsibility. It is doubtful he will consider adding T3 meds but if you wished to try members source their own and will share advice.
ahajournals.org/doi/full/10...
Other factors that could be contributing to your AFib are low iron and/or adrenals issues also caused by years of inadequate low thyroid hormone. However, in these instances the body can be a little intolerant of having T3 introduced because these issues need addressing before or in conjunction with.
Hi RaddThank you for your informative reply. I must read those articles.
My bloods in January were
Tsh 0.98. 0.27-4.2
F t4. 16.6 12-22
F t3 3.7 3.1-6.8
I was on 100 t4 and 5 of cytomol
My b12 520 197-771
Folate 2.8. 3.9-26.8
They were done this month.
My GP wasn’t concerned about the folate.
I have heterozygous haemochromatisis and my iron and ferritin levels are good. All my other bloods were good.
It’s my apathy and mild depression that bothers me.
My GP will prescribe the t3 but the cardiologist isn’t too happy about it that’s why my dose is cautious.
I’m on t3 5 once daily and t4 650 per week. I’m getting my levels done again this week and thinking of increasing t3, hence my post looking for opinions.
I would be grateful for any opinion on this.
🙏
5mcg T3 isn't helping you. Look at your T3 level. It's terrible. You don't need to reduce your Levo to increase T3 either as your Levo level is good and will decrease naturally with T3 added. You need to move to 10mcg T3 a day. You could either keep it as 2 doses or take 10 at once in the morning with Levo. Retest in 6-8 weeks and be prepared to increase again. Taking too little of this medication is probably worse than not taking any at all.
How does the t4 reduce when you increase t3. I find it hard to understand, I have brain fog at the moment.
Your brain "sees" the T3 in the system and reduces the TSH. It's the TSH that calls for the thyroid gland to produce T4. My T4 level dropped a lot when I started T3 medication. My TSH had been over 4 for years more or less, suddenly it was below 3 and my own body cut it's T4 production as a result.
You should not have brain fog with T3, so that helps show you how low you are. As a percentage, your T3 is only 16.22% into the range. It needs to be over half way. Many say it's best around 3/4 through the range.
Gwelos,
Apathy and mild depression should be helped by adequate T3 which is found in large amounts in the limbic system of the brain, regulating emotions with the action of serotonin, GABA, noradrenaline ,etc. That’s why low T3 levels can result in low mood/depression, loss of motivation, apathy, etc. The usual advice re optimal iron & nutrients is also relevant for the enzymes needed for positive neurotransmitter changes.
5mcg T3 is a tiny dose but sometimes just enough to encourage improved conversion so you achieve more T3 than the amount naturally made & the amount medicated. A bit like supplementing a thyroid glandular alongside Levo, but as your FT3 is still only 16.22% through range I would say this isn’t happening for you so a dose of 15-20mcg T3 may be more beneficial.
Levothyroxine mono-therapy gave me AFib because I had to keep 'free' levels so high but still couldn’t manage to convert enough to T3. I introduced T3 in tiny increments over many weeks and ended up on a dose of 20mcg T3 + 100mcg T4. Erratic heart beats and bangs reduced within a matter of days and stopped when dosed optimally. I initially split the dose into 3 times day to reduce rapidity of its onset and prolong the duration of its action. After 6 months I reduced to splitting twice a day when adrenal issues had improved.
Folate is under range and should really balance VitB12 as they use the same pathways helping to create, develop and regenerate RBC’s and making iron work properly. As folic acid participates in the homocysteine metabolic cycle, adequate levels are required to keep this in check as high levels are considered a significant risk factor in cardiovascular disease & may disrupt thyroid metabolism. It can be supplemented as methylfolate.
I have homozygous haemochromotosis. Treatment not only decreases iron load but all other hard won nutrients & that’s why is so important to keep everything optimal. I am guessing yours doesn't require treatment?
It’s a great relief to get your great reply. That’s very interesting Re the high amounts of Levothyroxine causing A fib. I’m definitely going to increase my t3 slowly and hopefully I’ll start to feel better. I haven’t felt right since diagnosed in 2005. I had a lot of adrenal issues that I think are 95% resolved.
No my haemochromotosis doesn’t need treatment my Ferritin is always within range.
Many thanks 🙏
Gwelos. My heart has never been better on a t3/t4 combination. It’s calm and doesn’t beat out of my chest anymore. My TSH is 0.01.
Being under medicated will do your heart more damage than having a lower TSH. I hope you manage to sort things out with your GP. x
Hi Cat013Thank you, can you tell me your dosage?
I’m on 100mcg of levo and 40mcg of t3 split into two 20mcg doses. x
That seems a lot I’m on 650 per week of t4 and 5 of t3. It’s no wonder I feel crap. I know we are all different but that’s a huge difference
Have you got a recent ft3 result?
Yes it’s 3.7 ( 3.1- 6.7 )
That is very low. I felt horrendous then. Now I’m around the mid 6’s I feel so much better.
In my opinion you need a T3 increase. It’s too low for you to feel good. Your TSH isn’t undetectable it’s still in range. It’s worse for your heart to struggle with an under medicated condition than a dose increase to slightly lower your TSH.
My heart has never felt better. No palpitations, no anxiety and a calm regular beat. I believe I was far more likely to have heart problems under medicated. X
I have P-Afib and take a NDT. My TSH is very supressed at 0.02 but my thyroid hormones remain within range. My endocrinologist said so long at the thyroid hormones stay in range it can do no harm. So its a nonsense your doctor focusing on the TSH range. Lowering your dose will do more harm than good and will put stress your heart too!
Thank you all for your replies I’ve got a lot of information from you all that brings relief, also some good reading once I start to feel better.Blessings to all💕
GPs think that low TSH causes AFib. In fact there is no study to show that low TSH causes AFib. They have noted a correlation though. but correlation is not causation. It may be that too high T3 can affect the heart but GPs don't know a lot about T3, so they try to monitor T3 by looking at TSH. Not very satisfactory!
In addition many GPs talk about "a risk" of AFib but cant say what that risk is. Is it 1 in 10? 1 in 100? 1 in 1,000? 1 in 1,000,000?
Further, GPs must state what YOUR risk of AFib is. Doctors have to treat you as an individual not as a cohort of 2,000 people all of whom have different risks. Most do not.
There is real evidence the untreated or under-treated hypothyroidism actually does cause Afib and Coronary Heart Disease.
Has your GP monitored your heart or referred you to a cardiologist? this means attaching up to 12 leads from an ECG machine to your chest and looking at a trace of your heart beat. A lot can be deduced from such a trace, the easiest is A Fib.
If your GP reduces or keeps your dose low based on the fear of AFib s/he is not looking after your health properly. additionally, GPs/Endos may be stepping out of their areas of expertise by over emphasising the risk of AFib. Many cardiologists do not beleive that low TSH is a high enough risk factor to monitor it on a regular basis. See below. One research paper said the less than 1% of AFib patients admitted to hospital were there because of low TSH.
I told my GP I monitored my heart at home by use of the Kardia heart monitor and by an Omron blood pressure monitor that detects AFib.
Many smart watches also warn for A fib. The Apple watch is one of the best but most expensive. The Amazefit is good, I've read.
I told my GP that I was aware of the unfounded theory that low TSH causes AFib.
I said that Afib was a possibility in the future, but I reduced the risk by not smoking, exercising and monitoring my heart.
I said he not monitored my heart so he had no basis to say such a thing.
I said I don't want my T3 to go above the upper limit of the reference range (for now) and I'm happy for TSH to go below 0.3.
I also said I want to feel better now because I am suffering now. I said I don't want to continue suffering to guard against some unspecified risk in the future which I can take steps to mitigate.
The GP agreed to raise my dose of levothyroxine.
I have A Fib and had an ablation 3 years ago and have been fine since but cardiologist kept emphasising the TSH. My GP will give me the t3 and is ok with increasing it. It’s a matter now for me what to do. I think I’ll start increasing my Thybon and monitor myself. Thank you for this information much appreciated. I feel more confident doing this now from all the replies. 🥰