So for the last 9 days I had constant ectopic heart beats. I normally only get 1-3 a day sometimes I’ll get a couplet and triplet and sometimes I’ll go a week without any. Now it’s more like 1 every 5 seconds. I thought this could be to do with stomach bloating or that the last time I checked my folate it was deficient or maybe I was on too much thyroxine as my TSH was 0.96. However I had bloods done yesterday and my TSH is now 1.6, my folate is 7.1 the range being 3.1-20 ug/L. My B12 is 683 range 187-883 and ferritin 151 range 22-275. My cholesterol has gone up again from 5.8 to 6.7, I’m so fed up right now with one thing after another. I was really hoping it was my folate that was causing it so it was easy to fix and now I just feel so depressed. I’m starting to think Thriva aren’t very accurate. I’m currently wearing a holter for 24hrs and I’m sure it’s going to say I’ve had at least 10000 ectopics by the time I give it back in the morning. Last time I had one 5 years ago I only had 15. I’m not sure what advice I’m expecting, I think I just needed to vent. Merry Christmas to all.
Need help heart palpitations: So for the last... - Thyroid UK
Need help heart palpitations
How much levothyroxine are you currently taking
Increasing cholesterol and irregular heart rate suggest under medicated
TSH rising as well
Obviously you need TSH, Ft4 and Ft3 tested together
Just testing TSH is completely inadequate
Monitor My Health Is cheapest
Only do test early Monday or Tuesday morning and then post back via tracked postal service.
No vitamin D result?
what vitamin supplements are you currently taking
I’m currently on 75mcg, for some reason at the moment my gp surgery don’t have early appointments so my bloods have been taken at around 11 in the morning. But my last 2 tests are so different from 0.96-1.6 is quite a difference. Gp’s never do FT4 or FT3. My vitamin D is on my last post but I have increased that up to 4000iu daily now and take 200mg magnesium. That’s the only vitamins I take. I’m slightly concerned my serum bilirubin has gone from 9-18 in 3 months though. Which isn’t high but only 2 away from the highest.
Replied on previous post re low Ft4 and Ft3
Suggest you retest via Monitor My Health early Jan
How much do you weigh in kilo
75mcg is only one step up from starter dose
Can see you use to be on 100mcg
Why was dose reduced
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
Hi,
Frustrating for sure. I just completed a holter a week ago and currently waiting on my results. Several years ago it showed tachycardia in the middle of the night.
ferritin 151 range 22-275
^ Your results are near midway which is 148. My heart palpitations and tachycardia would increase if I was near midway. Years of keeping records have shown me that my body prefers to be at least 20 points or more above midway.
Also low or high free t3 and t4 can cause or exacerbate palpitations
my TSH is now 1.6,
There you have your answer: you are under-medicated to have a TSH of 1.6 at 11 am - would have been higher before 9 am. And your cholesterol rising says that your FT3 - the most important number - is dropping. You need an increase in dose. 
Yeah but 3 months prior to that at the same time it was 0.96. So it seems it fluctuates. So if I were to go up it may well go too low. An I very much doubt my gp would even let me go up a dose with it being 0.96 before. So I really don’t know what to do.
How much do you weigh in kilo
Unless very petite likely dose guidelines on weight help to get “trial” dose increase
Suggest to GP you would like to try 75mcg and 100mcg on alternate days
Make sure you always get same brand levothyroxine at each prescription
And maintain all four vitamins at optimal levels
Retest FULL thyroid including Ft4 and Ft3 6-8 weeks after dose or brand change
I weigh 75kg, which I know means I should be on around 120mcg. Will alternate days not make me fluctuate day to day and cause symptoms? It’s very hard to get the same brand unless you only get 25mcg tablets and then they are usually wockhardt. I have enough to try alternate days. Although makes it harder to remember doing that but I’ll have to get a day pill tray.
Levothyroxine is storage hormone. It’s perfectly fine to take different dose on different days
You could cut a 25mcg and increase by 12.5mcg to 87.5mcg every day if you have extra 25mcg tablets
Which brand of levothyroxine do you prefer
Mercury Pharma (Advanz) make 25mcg, 50mcg and 100mcg
Accord make 50mcg and 100mcg
Also boxed as Almus via Boots or Northstar via Lloyds
Wockhardt only make 25mcg tablets
New guidelines for GP if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
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).
I think I prefer wockhardt. I have 50mcg tablets which are mercury pharma, so instead of taking 3 25mcg I’ll try a 50mcg a 25mcg and cut a 25mcg in half and try that. An retest in 6-8 weeks. Although there’s no line on the 25mcg so might be awkward to cut them but I’ll give it a go or just alternate.
A sharp craft scalpel will cut
Any crumbs pick up with damp finger
Get a weekly pill dispenser for keeping the other half for next day
Well, obviously TSH fluctuates. It's highest early morning, and lowest around midday. You had that test at 11 am, so it would have been even higher at 8 am.
But, this business about TSH going too low is all in your GP's head. It really isn't that important how low it goes. It's the FT3 the most important number, and if that is too low, it's going to give you symptoms. TSH does not cause symptoms whether it's too high or too low. And, it has nothing to do with hearts or bones, as doctors think.
Your rising TSH and cholesterol levels are saying that your FT3 is too low, and that is what is causing the palpitations. Something you have to get across to your GP.
Greygoose your spot on. The heart has large receptor sights for T3. I was having terrible palpitations for several reasons for one the fillers in Synthroid caused me palpitations. And second that I don't convert my T4 to T3. Adding some T3 was a very big game changer for me. Nutrients are very helpful and very important e.g. magnesium fish oil, CQ10.And Iron. If you are low in Iron that may cause palpitations too.Coffee was also causing me to have palpitations wheat and sugar. I found it very helpful to tune in when the palpitations would come to back track what was that I ate that might have caused it. It was very helpful for me.
Are you taking levothyroxine?
The reason is that when I took levo I had extreme palpitations during the night and cardiologist was considering putting an implant in my heart to 'see what was going on'. Just about the same time, T3 was added to T4 and palpitations resolved and I didn't need an implant in heart. I take T3 only now and heart is calm and no palpitations.
I too have ectopic arthymia and I'm convinced that its frequency is related to stress levels as mine increases when I'm stressed. A doc in the hospital noted it and we talked about it. So maybe less measuring and more chilling? Have a Happeeee!
I too have had bouts of ectopics and having done some detective work looking at my blood tests which have always be taken when it has happened have shown TSH to be OK as far as GP’s are concerned, I noticed my potassium level was on or near the bottom limit of the range. It may not always be thyroid related, high and low potassium can give similar symptoms regarding palpitations. In the past I have had similar episodes of missing beats, sometimes lasting a few days without normal rhythm . When having the halter a few weeks after the first episode it showed nothing has they had gone. In January this year they started and lasted 5 hours exactly like yours, missing every second one and then beating for a few and then back to missing every second one again, my Serum TSH level was
(XaELV) 1 miu/L [0.3 - 4.2 when tested.
I had them every time I Moved from seated to standing and moving around , they settled down after a few minutes, very alarming but was told not to worry about them, they lasted for months. I started taking my Levothyroxine before breakfast and left a gap of 40-60 mins before my 20mg of Propranolol which I was already on. My last bloods in November
Serum TSH level (XaELV) 0.02 miu/L [0.3 - 4.2
Serum free T4 level (XaERr) 27.5 pmol/L [12 - 22]
Now showing suppressed so was advised to reduce from 150 to 125 and retest in February.
Have not had any alcohol, caffeine or any foodstuffs containing stimulants since January but have made no difference at all.
Palpitations still happen now and again but still not convinced of the cause as halter in October and Echocardiogram apparently showed nothing untoward apart from mention of some kinetic activity even though had some whilst being tested on both occasions.
None the wiser and just received message to say follow up appointment with Cardiologist in February as been cancelled.
I do not think people who have not had this problem appreciate how alarming it can be even if told is nothing to worry about. Nothing in the letter from the cardiologist about my test results even took into consideration or even mentioned myHypothyroidism and it’s potential link.
On one of my previous posts on palpitations someone mentioned a sachet of rehydration minerals such as is taken after sickness etc, please look at my posts.
I hope this does not cause you any further concerns and goes to show you are not alone.
Not necessarily anything to worry about. I used to get so many that I gave up pressing the button on the Holter as I had no time to get anything done. I'd get them all day, including 4s and 5s. But cardiologist said that it wasn't life threatening - just annoying. I found increasing magnesium and B12 helped
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