My wife was diagnosed with AF in Jan 21 and subsequently Hypothyroidism, possible through taking Amiodarone
When this all started her thyroid test results were April T4 TSH 23.3, May T4 9 TSH 22, June T4 12.9 TSH 5.6, Now T4 17.2 TSH 0.22.
She has been taking 50mcg Levothyroxine from day one and been fine until end of January this year when she started going into AF after walking.
I was thinking given the change in her results she could be going from Hypo to Hyper.
What are you're thoughts?
Just testing TSH and Ft4 is not enough
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Has she had change in brand of levothyroxine?
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
plus both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common on levothyroxine,
especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis) diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease
Recommended on here that all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test
Is this how she does her tests
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
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
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
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...
No change of dose or brand, Levothyroxine is normally taken at 10pm. Currently on Bisoprolol as well, which is taken separately from levothyroxine. She is no longer on Amiodarone.
If you are hypo - meaning that your thyroid is not producing enough thyroid hormone - you cannot suddenly go hyper - which means that the thyroid is over-producing hormone. The thyroid cannot regenerate enough to do that. And, your wife was definitely hypo.
She could be over-medicated, but as you haven't given us a range for the FT4 result, we don't know. Besides, you are only over-medicated if the FT3 is well over-range. And that hasn't been tested, so we don't know. But, that FT4 does not look that high.
You cannot tell thyroid status just by looking at the TSH. Yes, it's gone down, but that's what it's supposed to do when taking thyroid hormone replacement. TSH is not a thyroid hormone.
50 mcg is just a starter dose, and should have been increased by 25 mcg after her first retest. Do you know why the doctor didn't increase her dose when her TSH was at 22? Or even when it was 5.6, which was still much too high. It's possible now that, despite her low TSH, she is under-medicated. And, being under-medicated is as bad for the heart - if not worse - than being over-medicated.
AF can be linked to LOW thyroid levels……not just high levels
thyroidpatients.ca/2020/09/...
Is she currently taking any vitamin supplements
If normally taking levothyroxine at bedtime
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
REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
Thanks for the advice, currently she isn't taking any supplements and the only additional information I have are her ranges which are T4 [9.0 - 19.0]
TSH [0.35 - 4.94]. So as you can see her T4 is towards the upper limit.
The last blood test was taken 24 hours after her last dose of levothyroxine. We'll endeavour to get a more thorough blood test done and hopefully post back with results.
Hi Bob, Has your wife been off Amiodarone for a while? It has a long half life (about 100 days) so the protection against AF takes a long time to wear off. In my case it was about a month to 6 weeks before AF episodes returned. I eventually had an AF ablation which more or less dealt with the AF although I am still on bisoprolol and have only had two AF outbreaks since in 8 years (when the bisoprolol was reduced to 2.5 mg - it's now at 3.75mg). The ablation may have had a cost though which is worth bearing in mind. The contrast medium used had a high iodine content and it was the likely cause (along with the Amiodarone) of the extremely high thyroid levels that I experienced soon after (which had to be treated with Carbimozole for two months). As you will be aware Amiodarone can cause both hypothyroidism and hyperthyroidism! I hope your wife gets the right treatment and is freed from these troubling issues soon.
Thanks Weatherman, she's been off amiodarone for a good while now. It was January 2020 when she went into hospital with stage 1 heart failure, had a cardioversion, blood thinners, amiodarone etc.
We don't know if the thyroid was already an issue or whether the amiodarone was what started it.
The af was fine for a year, but now we've had 6 occasions where she has gone into af while out walking.
The first time I had to take her to hospital and that was when her last bloods were tested and that's why I'm linking the dropping TSH with the increase of af episodes
Obviously this has all happened during covid which means I haven't been involved in any of the patient doctor chats.
Ablation has been suggested as an option, but for the meantime they are giving her flecainide
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