Palpitations

[Cat-222]

I have hypothyroidism and am taking 75mg thyroxine. When I lie down and in bed I get palpitations, it wakes me up where my heart is beating fast, sometimes I get it when I eat and it catches me out during the day. I also get very bad indigestion but don’t know if I have low or high acid. I would be grateful for any advice. I have had my heart checked out and had an ECG and a monitor and because all was fine doctors don’t want to know.

[greygoose]

Palpitations can be a hypo symptom. You are only on a low dose of levo, at the moment. How long have you been on that dose? Do you have copies of your blood test results and ranges?

To know if you have high or low stomach acid, try the home test at the endo of this article:

healthygut.com/3-tests-for-...

[Cat-222 in reply to greygoose]

Thank you so much for your reply. I have been on 75mg for 11 years. My TSH is 1.6 doctors only test that and if it is in range will not check anything else. I am sure it is a side effect of thyroxine as it mentions it in the leaflet. But doctors say there are no side effects. I will try the home test thank you 😊

[greygoose in reply to Cat-222]

What they mean is, there are no side-effects to the hormone T4. But, there can be affects from the fillers in the tablets.

However, the leaflet doesn't really play fair, because what it lists as 'side-effects' are often just the effects of taking too much or not enough. And, if your TSH is 1.6, you're more than likely not taking enough. 75 mcg is a very low dose. Yes, it's in-range, but that doesn't mean it's the right level for you as an individual.

Have you tried asking for an increase in dose?

[Buddy195 Administrator]

I had similar symptoms when I was on a low dose of Levothyroxine like yourself & ended up in A and E. Like you, subsequent investigations on heart were fine. I reduced my dose Levothyroxine slightly until palpitations passed then slowly re- introduced (eg 12.5mcg Levo alternate days). I’m very sensitive to any changes in my medication & always increase or decrease super- slowly.

[SlowDragon Administrator]

Previous post a year ago

healthunlocked.com/thyroidu...

You never answered which brand of levothyroxine you are currently taking

Teva is only brand that makes 75mcg tablets

Teva brand upsets many people

Just testing TSH is completely inadequate

Low vitamin levels are more common as we get older

What vitamin supplements are you currently taking

When were vitamin D, folate, ferritin and B12 last tested

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

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 hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test

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...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

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...

[SlowDragon Administrator]

Vast majority of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Hashimoto’s frequently affects the gut, especially if under medicated

Gluten intolerance and/or lactose intolerance often develop

Gut issues result in poor nutrient absorption and low vitamin levels as direct result

Essential to test vitamin D, folate, ferritin and B12 at least once a year

What vitamin supplements are you currently taking

Request GP test vitamins now or include in full private testing

Just testing TSH is completely inadequate

Was last test done early morning, ideally before 9am to get highest TSH

Many people will have TSH around or below one when adequately treated

Approx how much do you weigh in kilo

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/files/docs/...

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

bmj.com/content/368/bmj.m41

Perhaps…..Request 12.5mcg dose increase in levothyroxine (cutting 25mcg tablet in half) as a trial and then get FULL thyroid and vitamin testing done privately 6-8 weeks after increase

[shaws Administrator]

I also developed palpitations when first on levothyroxine (T4). I also had the cardiologist taking overnight records - one night pulse was 144 p.m. but I could control them by sipping ice-cold water but it was very unpleasant.

Palpitations resolved when I was prescribed T3 (liothyronine) and stopped T4. T3 is now rarely prescribed unless an Endocrinologist confirms we should have T3 (which is also called liothyronine). .