I was diagnosed with hypothyroidism just under a year ago, I've been taking Levothyroxine the entire time.
I've noticed on my Apple Watch that my resting heart rate is becoming abnormally low, 45 - 55 range. I've started exercising at the gym multiple times a week and do daily dog walks but I am still by no means super fit.
Has anyone experienced this? Any advice on what to do?
When you say 'becoming' what was it 'before' and when was before. How much has your RHR reduced and over what period? Does the change coincide with starting Levothyroxine or with anything else?
Mine is similar. I'm not saying that is a good thing by the way. I'd rather that it went up.
I don't have a record of what it was just before I started on Levothyroxine (about a year ago), but it always used to be normal the years prior to the onset of hypothyroidism.
It was dropping for January (67bpm) - March (58 bpm), then my levo got increased as my TSH has climbed back up slightly (from 4 in December to 6.28 in March).
From March to June my HR climbed back up, March (58bpm), April (64bpm), May (65 bpm), June (69bpm) and then it has dropped to July (61 bpm) and August (54 bpm).
I had an ECG at the GP today and it has come back as sinus bradycardia, got bloods next week.
what are the bloods testing for?
Thyroid
TSH = 1.29 (0.27 - 4.2)
FT4 = 16.9 (12 - 22)
T3 = 4.2 (3.1 - 6.8)
It seems I'm not converting T4 to T3 very well.
I don't know anything about Apple watches or how reliable they are, but have you thought about checking the old fashioned way? Feel the pulse on your wrist or neck, count for 30 seconds and times by 2, or count for 15 seconds and times by 4. That way you'll know if it compares with your Apple watch. Or do you or anyone you know has a pulseoximeter?
my apple watch is in line with my pulse oximeter and my BP monitor.
Thanks for your reply! For anyone else out there, my GP said my Apple Watch should be accurate and that I can use it to monitor my HR. It's the only way I knew my HR was low, I wouldn't have thought about checking it.
Are you still taking 100mcg levothyroxine
Which brand
What vitamin supplements are you currently taking
When were vitamin levels last tested
Do you have autoimmune thyroid disease, also called Hashimoto’s diagnosed by high thyroid antibodies
What were most recent thyroid results and ranges
Yes 100mcg levothyroxine, this dose hasn't changed since April.
Yes, antibodies were tested in June.
Thyroid peroxidase (TPO) Antibody conc: 247 kiu/L (normal range: 0 - 9)
Please see attached screenshot of vitamins. Currently taking B12, folate & Vit D. As my Levothyroxine has increased it seems that my B12 and folate have gone down over time.
Are vitamins something I should be running by my GP or just implementing myself based on test results? How do I know how much and how often I should be taking the vitamins?
I tested 2 days ago and the thyroid results were:
TSH = 1.29 (0.27 - 4.2)
FT4 = 16.9 (12 - 22)
T3 = 4.2 (3.1 - 6.8)
It seems I'm not converting T4 to T3 very well. Over time, with increased levothyroxine, my TSH is going down and T4 going up but T3 is still fairly low. This worries me, thinking of going to a private endocrinologist for a consultation about T3 meds. What do you think?
Your b12 is extremely low
Are you vegetarian or vegan?
Eat red meat?
GP should be testing for Pernicious Anaemia before starting you on B12 injections or possibly daily B12
Folate too low
Vitamin D is deficient
GP should prescribe 1600iu per day for 6 months
But you might need higher dose
Ferritin improving…..presumably you are supplementing?
Vitamin D
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
GP will often only prescribe to bring vitamin D levels to 50nmol. Some CCG areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
Suggest you start on 3000iu vitamin D per day and retest in 8 weeks
Another member recommended this one recently
Vitamin D with k2
amazon.co.uk/Strength-Subli...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Great article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
FT4: 16.9 pmol/l (Range 12 - 22)
Ft4 only 49.00% through range
FT3: 4.2 pmol/l (Range 3.1 - 6.8)
Ft3 only 29.73% through range
Helpful calculator for working out percentage through range
Was test done early morning, ideally just before 9am and last dose levothyroxine 24 hours before test
Do you always get same brand levothyroxine at each prescription
Ft4 is too low indicating you need dose increase in levothyroxine
Request 25mcg dose increase in levothyroxine
Approx how much do you weigh in kilo
Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilogram of your weight per day
For GOOD conversion of Ft4 to Ft3 we need OPTIMAL vitamin levels
That’s vitamin D at least over 80nmol and around 100nmol maybe better
Serum B12 at least over 500
Folate and ferritin at least half way through range
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
If not already on strictly gluten free diet, request GP do coeliac blood test BEFORE trialing strictly gluten free diet
Thanks for all your help.
Could the low vitamin levels be affecting my HR and be a cause of bradycardia? Struggling to work out how it fits together with the heart
Absolutely yes
You’re not on high enough dose levothyroxine
Being under medicated for hypothyroidism results in low stomach acid. This leads to poor nutrient absorption and low vitamin levels as direct result
Low vitamin levels tend to lower TSH….which is all most medics look at
For levothyroxine to work well we need OPTIMAL Vitamin levels
But don’t be surprised if GP is completely unaware of interconnection between gut and thyroid
If GP won’t increase dose levothyroxine or test for pernicious anaemia you will need to see endocrinologist
Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors
tukadmin@thyroiduk.org
Only 5% of Hashimoto’s patients are diagnosed as coeliac, but a further 80% find gluten free diet helps, often significantly or is absolutely essential
Get coeliac blood test done
Have you had your thyroid bloods checked recently. I also use a Apple Nike watch to monitor my heart rate etc. mine is normally around 56bpm. However, if I’m going over medicated my heart rate drops to about 50bpm or even high 40’s. Once when I was over medicated on Levothyroxine it went into the 30’s and I was taken into hospital for a week for full observations and tests. It turned out it wasn’t my heart but that I was over medicated on Levothyroxine and also I am a poor converter of Levothyroxine T4 to the most important hormone T3. After further investigation privately I was trialed on Liothyronine T3 medication combined with Levothyroxine T3. This has been a huge success. Please check your thyroid bloods to see if you’re over medicated. To do this you need to have the blood draw taken after not before you’ve taken your daily dose of Levothyroxine. Generally we get bloods done prior to taking Levothyroxine or Liothyronine but if you’re checking to see if you are over medicated I’d take meds first myself.
Hi McPammy,
Thanks for your helpful response! I am 29 so it's quite scary having such a low HR, I've read online that it decreases with age.
Do you get prescribed T3 mediation alongside Levo through your GP? My GP has even mentioned it as a possibility.
I'll take your advice about taking my daily dose first.
BEFORE considering adding T3 you must get B12, folate and vitamin D improved
See GP this week
Request 25mcg dose increase in levothyroxine now
Extremely low B12 - GP must test for pernicious anaemia.
Prescription for vitamin D (or start self supplementing)
Make sure you get same brand levothyroxine at each prescription
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Never take levothyroxine before blood test
Always test early morning and last dose levothyroxine 24 hours before test
Yes, I’m on combined treatment of T3 Liothyronine plus T4 Levothyroxine. Being on T4 alone as I was previously was no good for me as I’m a poor converter and have the DIO2 faulty gene. My GP would never prescribe T3 medication as they can’t and they don’t understand it either. I went private to get my T3 trial which has been a great success for myself.
Hope you get it sorted soon.
I just had to Google the DIO2 faulty gene, do you mind me asking how you found out you had this gene?
I'm considering heading to a private endocrinologist for a trial of T3.
I tested 2 days ago and the thyroid results were:
TSH = 1.29 (0.27 - 4.2)
FT4 = 16.9 (12 - 22)
T3 = 4.2 (3.1 - 6.8)
Not sure I'm a good converter either.
I got my DIO2 gene test through Regenerus Laboratories as promoted on this forum. It cost me about £165 for the test plus a trained person to interpret the result. Mine was positive. This result switched a load of light bulbs on for me. Now I understand why I was struggling on Levothyroxine alone. It doesn’t mean you can’t convert T4 to T3. It means you struggle and some struggle more than others. My conversion was only 8% from T4 to the most important hormone T3. No wonder I was in a mess. Anyways all sorted now with the introduction of T3 combined with Levothyroxine T4 👍. Looking at your results they don’t seem bad at all. Maybe a small increase in your T4 Levothyroxine might help you. Or a small dose of T3 could be trialed. You want to aim for a TSH around 1.00 which yours is pretty near. Along with optimal T4 and T3 that suits you and you feel well. My TSH is about 0.90. And my T4 and T3 are in the middle of my ranges. Most importantly I feel very well at those levels. It’s all Individual really. Finding your optimal can sometimes be frustrating. Even when you find it it can go off kilter for varying reasons. I find I have to keep busy, exercise and eat well. Also check your vitamins. B12, ferritin, D and folate are very important. They all need to be optimal for you. Stick to same brand Levothyroxine if you are happy with that brand if you can and same goes for Liothyronine. Some people struggle when changing brands. Have you had heart tests to rule out bradycardia? I had a few heart tests in hospital I didn’t have Bradycardia. I had too low T3 which I had to go private to resolve. NHS are terrible when it comes to T3 issues. Once I was taken to hospital after an episode in my late 50’s. After some checks the nurse said to me ‘so, how long have you been this fit’. I looked my body up and down and turned to her and said ‘are you kidding’. She said she was surprised how low my heart rate was. Never even thought about the link between hypothyroidism which I had and I might be grossly under medicated. Honestly it’s scary how little these Drs and nurses actually know about thyroid conditions.
Mine has been stuck between 40-44 on my running watch for years and 48-50 when doctor checks at annual medical. I thought it was all down to how fit I was rather than low thyroid 
It is actually moving up a bit now due to important diet changes and ensuring sufficient thyroxine dosage
So there are some things you can do to improve it from my experience
Heart rate pulse and hypothyroidism 
Daytime sleepiness, low heart rate, bloating. 
Is a fast heart rate common with low thyroid?
Low heart rate / bradycardia?
