What is Propranolol prescribed for?

[dizzy864]

Hi,

From August last year I saw an endo privately. ( via telephone consults ) I have previously posted several times about my many problems with hypothyroidism. He told me very early on that my problems were due to mal absorption of liothyronine. At that time I was taking 55mcg liothyronine plus 125mcg levothyroxine daily. My T3 has been consistently just above range and he told me that was because liothyronine was passing straight through me rather than being absorbed and used.

Initially he told me to take herbal forms of eostrogen suppliments - he was convinced that my low eostrogen was causing the problem. I tried two or three different forms of eostrogen suppliment but they all made me very much worse. Then at the end of October 2020, he wrote to my gp instructing her to prescribe Propranolol 10mg three times a day. I only managed three days before I was so ill I stopped taking them.

I've read a couple of articles on this site recently about Propranolol which have said that this is used to treat hyper thyroidism. I've gone back and looked at the packets and the PIL supports this. I react very badly to everything I take so I gave up reading the PIL until I have a problem as I was told my bad reactions are psychological!

My question is :- is Propranalol ever a treatment for hypo or a malabsorption problem? It seems incredible to me that the endo should tell me that I have a problem absorbing liothyronine and then prescribe something to block levo absorption.

This follows on from eostrogen suppliments, which also blocking levo absorption. It explains why I was so ill. Can anyone explain the endo's actions or thoughts? What was he trying to achieve? Am I missing something here? At the time, I was just grateful that he agreed with me that I was hypo inspite of the bloods.

[Hidden]

It is a beta blocker and used to treat high blood pressure and high heart rate. It´s sometimes used in hyperthyroidism. I have also read about it being used to treat anxiety although there are newer and more appropriate drugs for that. Propranolol is known to interfere with thyroid hormone function so is not recommended for hypos. It belongs to the older generations of beta blockers and there are newer ones with fewer side effects.

Didn´t the doctor say why he wanted you on it?

My own experience is that older beta blockers cause weight gain. I briefly took Tenormin and gained 5 kg in one month with no change in diet or exercise routine. I then read that older beta blockers slow down metabolism which is why they are not recommended in hypothyroidism. I was taking it for high blood pressure but requested a differerent treatment as beta blockers are no longer the first line of treatment for hypertension (the doctor who put me it was an older man and probably going by outdated guidelines).

What do you mean by "estrogen supplements"?

[dizzy864 in reply to Hidden]

Hi, Yes he told me exactly why he wanted me on it. He told me it would help me absorb liothyronine properly. I knew no different at that time and was too unwell to find out. He told me to take menoserene, which I really could not tolerate. Then told me to take various herbal tablets containing eostrogen. The problem was that they mostly contain soy and I'm allergic to soy. All of them made me feel much worse but the main problem was they all affected my sleep. I went months with not sleeping properly and I don't believe I'm completely over that now. I did google eostrogen and liothyronine and found nothing. I later learnt that eostrogen has no affect on liothyronine but in some people ( me included ) it badly affects absorption of levo. I developed very severe muscle aches and my hair fell out in clumps!! Not to mention a ton of other severe hypo symptoms.

[Hidden in reply to dizzy864]

I am definitely not an expert on the use of propranalol, but I have never seen anything about it increasing thyroid medication absorption. Is your doctor really a thyroid expert?

[shaws in reply to Hidden]

I agree with you PurpleCat71. It was prescribed for me due to high palpitations. T3 alone, resolved this problem for me.

nhs.uk/medicines/propranolol/

[helvella]

The prime issues of propranolol are:

It reduces the impact of thyroid hormone on heart rate;

It reduces conversion of T4 to T3.

I am not aware that it affects absorption of levothyroxine or liothyronine.

If someone seems to get a fast heart rate when taking thyroid hormone, it can make sense to take propranolol alongside thyroid hormone(s). But it does seem the wrong way of treating the problem... Though for a short time, it might make sense.

[dizzy864 in reply to helvella]

Hi, I never had a face to face meeting with the endo so no medical checks were carried out by him - blood pressure , heart rate etc. I had noticed that the more hypo I became, the higher my blood pressure became. Prior to having a hypo problem my blood pressure was always slightly low. I had been complaining recently that my heart rate had become far too high but no one seemed concerned about it other than me. I was diagnosed with long covid late last year and that had caused the rise in my heart rate. However, I do not believe that this endo was aware of this. I never told him and he never mentioned it to me. So I don't believe that I was given propranolol because of high heart rate or blood pressure.

[helvella in reply to dizzy864]

We have seen many who believe that being hypothyroid made their blood pressure rise.

But we don't generally consider propranolol as a blood pressure medicine.

We quite often wonder what the rationale was for all sorts of treatments.

[dizzy864 in reply to helvella]

I didn't believe that being hypo had made my blood pressure rise. I thought it was an affect of long covid, which has caused mostly breathing problems. However, in the four months since I started on liquid levo, my blood pressure has gone down a lot. I still have the breathing issue and other issues from long covid so that has not changed. My blood pressure was never discussed so it should not have been given for that.

[SlowDragon Administrator]

I was stuck on propranolol almost 20 years …with Hashimoto’s …more on my profile

Can be useful …..in it can spread/slow thyroid hormones uptake and conversion…..

[dizzy864 in reply to SlowDragon]

I only lasted eight tablets not even three days. I was so ill and so zombie like. I don't understand what you mean by, "it can spread/slow thyroid hormones uptake and conversion"? The endo told me that I was hypo due to not absorbing liothyronine and that liothyronine was passing straight through me. I don't understand why it would be necessary to spread or slow thyroid hormone uptake and conversion??

[SlowDragon Administrator in reply to dizzy864]

I am not aware that it would improve absorption

The way propranolol helped me ….I couldn’t tolerate higher dose levothyroxine than 125mcg ….but that wasn’t high enough for me to last through the day …..propranolol slowed up how I used then (limited) thyroid hormones

If you imagine a car that does 45-65 miles on a gallon of petrol ……only having a gallon of petrol, but wanting to do 65 miles. If you drive very fast….you run out after 45miles. If you drive carefully you might get 60-65miles.

Propranolol can stop you “driving fast”….slows down the rate you use up the thyroid hormones

I finally got off propranolol after joining this forum….saw just how common vitamin deficiencies and undiagnosed gluten intolerance were with Hashimoto’s

A) private endoscopy diagnosed gluten intolerance (not coeliac)

Going absolutely strictly gluten free, then improved absorption of levothyroxine

B) private testing and improving low vitamin levels helped improve conversion of Ft4 to Ft3. Especially low vitamin D and low magnesium. Took a year to improve very low vitamin levels

Propranolol lowers Parathyroid levels - reducing magnesium and vitamin D levels

c) over about 9 months I was able (incredibly slowly) to reduce propranolol down from 4 x 10mcg per day to zero

D) was then FINALLY prescribed T3 privately alongside levothyroxine…..because like many Hashimoto’s patients, especially if gluten intolerant, my conversion of Ft4 to Ft3 was poor

E)private testing showed positive for Heterozygous Dio2 gene variation so after 28 years very unwell on just levothyroxine NHS agreed to fund and prescribe T3

[dizzy864 in reply to SlowDragon]

Thanks for that. It's very interesting.

[Hidden]

PS. I find this interesting:rejuvagencenter.com/hypothy...

It´s tricky since Propranolol seems to lower FT4 to FT3 conversion while the TSH and FT4 remain normal so, unless FT3 is tested, you won´t know why you are having hypo symptoms...

[dizzy864 in reply to Hidden]

I'm very confused! If the aim is to lower FT4 to FT3 why not just tell me I am over medicated and order me to reduce T3? Initially, I was very impressed with this guy. He told me that I was not over medicated that I was not absorbing the lio as I should. He said he was not at all concerned about my above range T3 as I clearly was not absorbing lio and it was just passing straight through me. This was giving me a false high T3 level. Which incidentally was exactly what I had been saying for the past six years.Incidentally, four months ago I was changed to liquid levo and have been much better on it. I have reduced lio from 55mcg to 42.5mcg as well. The endo refused to request this for me stating that in ten years of running a thyroid clinic he had never come accross it! I think that says it all!!

[Hidden in reply to dizzy864]

Is the aim to lower thyroid hormone levels? If you are under medicated you are not technically hyperthyroid as your thyroid gland is not overactive so reducing meds should be enough, unless your doctor wants you on beta blockers for a short time only until your FTs decrease. I am not sure lio that is not absorbed results in above range FT3 levels. You read about people who have high FT3 in the blood but it does not reach cellular level which keeps them hypo. But how can your FT3 levels be high if you don´t absorb lio properly? The T3 in your body has to come from somewhere, right?

[heathermr]

Another approach would be to stop the levo and just rely on the T3. I was taking a huge amount of T4 and a full dose of T3 and I was still terribly ill with Myxoedema. The Endos were useless so I went out on my own and stopped all T4. After a couple of days I started to improve and I have never looked back. You don't need any T4 in your body, just need a steady supply of T3. I now know I have pituitary failure as ive lost all my TSH, my sex hormones and my cortisol. Incidentally you can get oestrogen patches now for a steady supply of oestrogen without nasty side effects. Heather

[dizzy864 in reply to heathermr]

I asked the previous emdo I saw about a trial of T3 only. I was very surprised he agreed straight away. Turned out he meant stop all levo immediately (125mcg) stop an additional 5mcg lio in 2 weeks! Then added, '' No need for any bloods as many of my patients do well on 50 of lio"I replied that if I did that I would either be dead or wishing I were!

He wrote to my doctor telling her I had agreed to that. My doctor wasn't working that week. Another doctor stopped my levo and refused to restart it stating he had to obey the endo s order.

My regular doctor knew me well enough to know I would never have agreed. She telephoned the endo and persuaded him to withdraw his order. I refused to pay his bill and would not see him again.

I m doing much better on liquid levo now.