Bradycardia help: Hi, I can’t go much higher on... - Thyroid UK

Thyroid UK

125,621 members147,200 posts

Bradycardia help

Cade83 profile image

Hi, I can’t go much higher on my levothyroxine as my last blood tests end of April were,

TSH 0.44 Range 0.27-4.2

FT4 18.8 Range 12-22

FT3 4.9. Range 3.1-6.8

I have bradycardia constantly and I’m really worried I’m just gonna drop dead. Even standing not doing anything it can be 48. An I just had a nap and my watch woke me up saying my heart rate was low at 39. It’s been like this for pretty much since I gave up drinking and smoking 5 years ago but I also started sertraline and nebido around the same time. I’ve noticed over the last year it’s gone down further than it was. I’m always tired even though I can manage to go gym 3 times a week but as soon as I stop I’m pretty much asleep. Could this be just because I’m not on enough thyroxine?

35 Replies

I don't think it's lack of thyroxine the problem...

FT4 18.8 Range 12-22 68%

FT3 4.9. Range 3.1-6.8 48.65%

it's just that you aren't converting it very well. Your FT3 is pretty low, and it's the T3 that is the active hormone, needed by every single cell in the body.

You don't want to increase your levo by too much, or it could make conversion worse. What you need is to either improve your conversion - check nutrient levels, try taking selenium - or try and obtain some T3 to take with your levo. :)

Cade83 profile image
Cade83 in reply to greygoose

My vitamins are all in range. What does selenium help with?

greygoose profile image
greygoose in reply to Cade83

Conversion. Selenium is essential for conversion.

Just having nutrients 'in-range' is not the same as optimal, which is what you need. Do you have the results and ranges?

Cade83 profile image
Cade83 in reply to greygoose

How much selenium is good to take?

Results
greygoose profile image
greygoose in reply to Cade83

Good! Vit B12, folate and ferritin are all optimal. No result for vit D?

Cade83 profile image
Cade83 in reply to greygoose

Vitamin D right at the end by itself.

greygoose profile image
greygoose in reply to Cade83

Oh yes! Missed that. :) That's optimal, too.

Well, that was just a suggestion. There can be many, many reasons for poor conversion, and the likelihood of you finding it is pretty small. So, you need that T3, I'm afraid.

Cade83 profile image
Cade83 in reply to greygoose

Would taking T3 increase my heart rate?

greygoose profile image
greygoose in reply to Cade83

It should do, yes. The heart needs a lot of T3.

Cade83 profile image
Cade83 in reply to greygoose

What type of T3 is best? liothyronine or natural T3?

greygoose profile image
greygoose in reply to Cade83

Whichever one suits you best. I can only take synthetic. Everyone's different.

Cade83 profile image
Cade83 in reply to Cade83

What’s a typical selenium dose?

greygoose profile image
greygoose in reply to Cade83

Sorry, can't remember. SeasideSusie?

SeasideSusie profile image
SeasideSusieAdministrator in reply to Cade83

Cade

100-200mcg is said to be a safe dose but some people prefer to test first.

Cade83 profile image
Cade83 in reply to SeasideSusie

As in test selenium levels or test out a low dose first?

SeasideSusie profile image
SeasideSusieAdministrator in reply to Cade83

Test selenium level first.

Guost profile image
Guost in reply to greygoose

When my TSH was your level my T4 was 19

SlowDragon profile image
SlowDragonAdministrator

How much levothyroxine are you currently taking

When was dose last increased

Do you always get same brand levothyroxine at each prescription

Previous posts show you have Hashimoto’s

Have you had coeliac blood test done

Are you on strictly gluten free diet

Cade83 profile image
Cade83 in reply to SlowDragon

I’m currently taking 87.5mcg which I’ve been on since around February. I always get wockhardt brand at every prescription. I stick to taking the 25mcg tablets because otherwise I end up with TEVA if I get 50mcg tablets so I just take 3 and a half 25mcg. I’ve had a coeliac blood test which was negative and no not on strictly gluten free diet.

SlowDragon profile image
SlowDragonAdministrator in reply to Cade83

Suggest you consider trying strictly gluten free diet

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Cade83 profile image
Cade83 in reply to SlowDragon

So this could have an effect on my heart rate?

SlowDragon profile image
SlowDragonAdministrator in reply to Cade83

Going gluten free can

Reduce anxiety

Improve absorption of levothyroxine dose, in effect giving you small dose increase

Can significantly improve symptoms

It’s always worth trying strictly gluten free diet with any autoimmune disease

You might be astonished

Can also enable you to possibly go increase dose levothyroxine

Your results show you are under medicated

Has any endocrinologist suggested adding T3 alongside levothyroxine

Cade83 profile image
Cade83 in reply to SlowDragon

Ah ok, I do eat mostly non gluten foods, but have been eating fibre one bars so that would have to go. Never seen an endocrinologist for my thyroid. I doubt a dr would prescribe it?

SlowDragon profile image
SlowDragonAdministrator in reply to Cade83

Are you in the U.K.?

Presumably you wear a Fitbit or equivalent that records your heart rate?

Gather up records ready for a consultation

Record of

Average resting heart rate

Lowest heart rate at night

Activity levels

Weight

Plus FULL thyroid and vitamin levels over time on spreadsheet

Meanwhile might want to consider doing Dio2 gene test

thyroiduk.org/deiodinase-2-...

If you test positive this can help get T3 prescribed on NHS

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3 or NDT

tukadmin@thyroiduk.org

Cade83 profile image
Cade83 in reply to SlowDragon

Yeah I’m in the uk. Yeah I have a Apple Watch so it records all the time. I just ordered Deiodinase 2 test on country health. I’ll do some searching for endocrinologists. Thank you.

Guost profile image
Guost in reply to SlowDragon

Definitely gluten free worked for me. If I eat it now I get joint pains headache and feel sick

Hi. Could your low heart rate be a side effect of the sertraline you're taking?

Cade83 profile image
Cade83 in reply to Lulu2607

I did think that and I’m trying to come off it to see, I’m down to 12.5mg and I was on 50mg. I’ve read conflicting information on sertraline, some sites say it can cause mild bradycardia and some say it doesn’t. It’s not easy coming off it though.

Lulu2607 profile image
Lulu2607 in reply to Cade83

No, not easy to come off if, you'll need to taper very slowly. Depends how long you've been taking it as well.

Cade83 profile image
Cade83 in reply to Lulu2607

Been on it over 5 years but only so much tablet cutting you can do before it crumbles too much.

Espeegee profile image
Espeegee in reply to Cade83

I have an Apple watch too, it consistently records low heart rate at various times of the day, I've been as low as 36 but that's rare, usually low 40s but it goes up and down a lot. I'm tired a lot but don't have an official diagnosis of anything thus far despite my T4 being consistently at the very bottom of the range. I self medicated for a while up to 100mcg of Levo and my stats were similar to yours, 0.02 was the lowest TSH and 19 the highest T4 and I felt fine. I stopped taking anything in order to see how much the stats changed, they did and I'm back where I started. I don't have Hashi's though. It is all to do with how you feel and if you aren't feeling as well as you would like to then I'd push if you can to either see an Endo (most don't seem to understand about T3 though) or try, as advised above, to take your records and persuade the GP to trial T3. Good luck.

Cade83, has your doctor sent your for any cardiovascular work ups? ECG, exercise challenges, ultrasound to visualise the chambers of your heart?

It can be all too easy for a doctor to assume it’s something to do with a thyroid problem and it have absolutely nothing to do with it.

If your doctor hasn’t done any of that, it might be worth asking for a referral to a cardiologist.

Cade83 profile image
Cade83 in reply to Jazzw

I went to a&e 2 weeks ago because I was getting constant ectopics. Stopped by the time I got there. Had ecg and blood tests. I also paid for an echocardiogram about 3 weeks ago and all was fine. I’d like to get an exercise tolerance test but it’s hard trying to get a dr to get a referral and the last cardiology appointment I had, I waited over a year for.

Hi there, I was very similar a year ago, really ridiculously slow heartbeat. In the end I trialled a combination T4/T3 and the t3 really worked (in a good way) to normalise my heart rate. Feel a lot better for it.

Thanks for this, I’m really starting to worry. Was your bp also low? Mine is around 105/46 at rest?

You may also like...