Bit of a long story but I’ll keep it as simple as I can…looking for advice on my latest TSH and T4 results….
Just over 3 years ago my thyroxine dose was increased from 150mcg to 200mcg by my gp. I was early pregnant (unknown at the time of change) 8 weeks when I started experiencing episodes of increased heart rates of 150-160bpm for no reason. It was put down to pregnancy hormones and I continued through an uneventful pregancy with my Son. No episodes during my pregnancy, palpitations and no changes to my medication throughout.
My Son is now 2 years old, but just after he was 1 and I returned to work having stopped breastfeeding exclusively, I began having more and more frequent episodes of heart rates of 150-160bpm with frequent palpitations either when sitting or just standing. It was found that my TSH levels were suppressed at 0.01. My medication was adjusted to 125mcg and I was started on propanolol 3 x a day to control my rate and was referred to cardiology for ?SVT.
My blood results stabilised over the year to TSH 1.9 and T4 14.5 and my gp referred me to Endocrinology at my request who was very helpful but was reluctant to make any further changes to my medication despite me feeling “hypo” . I am still experiencing the following symptoms: cold intolerance, fatigue, hair changes, dry skin, heavy menstrual cycles, tachycardia, palpitations.
This week I was in for an EP study for ?ablation under cardiology. Thankfully no problems with my heart and it has been put down to my thyroid exacerbating a tachycardia.
My bloods were checked at the hospital including thyroid function and my TSH is 19.8 and T4 14.3.
What should I expect the gp to do?
I’m aware high TSH indicates that the thyroid is hypo but t4 is in normal range?
Why would I still be experiencing tachycardia episodes if those are my recent blood results?
I might add, I’m not overly stressed in general, and never when the episodes occur. I was often getting episodes in my sleep which woke me.
I’ve lived with hypothyroidism for 15 years (diagnosed with bloods and thyroid scan) and it has always always been well controlled. Even during both my pregnancies my dosage never changed throughout.
Could it be that two pregnancies and over medication could have caused the problems?
it’s effecting my daily life immensely and I’m unsure how to improve things to move forward and get back to “normal”.
Any advice welcome. Thanks 😊
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Kelwhiteyx
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When you are pregnant you need more T4 but you should be carefully monitored and the dose adjusted during & after pregnancy.
I think that didn’t happen and having a little more than you need can be unnoticeable symptom wise but can cause your TSH to lower.
The TSH is a pituitary hormone, it’s telling the thyroid no more hormones are needed. It’s “shuts down” the trouble is once it’s been low for a period of time it can stay low or lower than it should and not respond - it becomes unreliable, and it can be unreliable for many other reasons too.
Propanolol is good for slowing heart rate & anxiety but it also reduces uptake of T4 and conversion of T4 to T3. Doctors don’t often test FT3 they are taught it’s not important so they don’t consider it, & many don’t seen to know propanol has this affect.
I have propranolol because I was hyper - it’s helpful if hyper- but its not always if hypothyroid.
You mention FT4 - 14.5 “being normal” It may be “in range” but that looks low to me. We need a lab range in interpret accurately . Ranges vary between labs.
Think of T4 as the pro hormone - your body needs to convert it to FT3 the active hormone. You can have high FT4 but if the conversion to FT3 is poor you will feel very hypothyroid & unwell.
Has your FT3 been tested?
With a TSH of 19.8 I’m surprised your endocrinologist hasn’t been willing to raise T4 levels if there’s room for it to move up in range.
Most feel well if FT4 In top 3rd or range. Where is yours?
With other symptoms has folate, ferritin, B12 & Vitamin D been tested?
Deficiencies in these nutrients can mimic / compound hypo symptoms & contribute to poor conversion. You need optimal levels not just acceptably in range.
With heavy period & palpitations ferritin is especially important.
If your doctor / specialist wont test everything you need, strongly recommend you arrange a full private test.
Tachy for me palpitations and racing heart are signs that I am undermedicated and hypo. The lists of symptoms you read on the internet for hyper and hypo are misleading. It is not clearcut and the same symptoms can be hyper overmedicated and hypo undermedicated.I was truly hyper, had RAI treatment and am now hypo. I can say from experience that I had the same symptoms hyper as I did undermedicated hypo. Symptoms tell you that something is not right and blood results guide you as to how it is not right.
Your tsh suggests undermedication. Ft4 14.3 might be in the normal range but what is the top of the range? Is it 22? Because you would be normal too if your ft 4 was anywhere else n range. Your symptoms are telling you that a normal 14.5 is not right for you.
Propanol affects t4 to t3 conversion. So your ft3 could be too low for you as well. T3 is what every cell in the body uses so it is important that you convert t4 to t3 efficiently.
PurpleNails has given sound advice. I'd investigate your thyroid and hormone levels further to see if the levels are out
I just wondered if you had any blood test results recently for more than just TSH and T4? If you could get a full print out and post it here it might be helpful. Especially if for example B12, Vit D, ferritin and folate were checked. This will give a fuller picture of what is going on. I agree with others that the TSH is too high which leaves you under medicated . I hope you will soon get help and things will improve. I also have had palpitations while under medicated
Propranolol slows uptake and conversion of levothyroxine (Ft4) to active hormone (Ft3)
How much propranolol are you currently taking
Propranolol must NEVER be stopped suddenly.
Has to be reduced extremely slowly over many months
Propranolol also lowers magnesium
Essential To test vitamin D, folate, ferritin and B12 levels
Low vitamin D and low magnesium often go together
Your results show you are now under medicated….hardly surprising after an enormous dose reduction
Do you know if your hypothyroidism is autoimmune, also called Hashimoto’s usually diagnosed by high thyroid antibodies
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine or any other significant changes…..eg if go gluten or dairy free or start or stop HRT
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
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually 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.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
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 just before 9am and 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
at first glance , i'd say the changes to your Levo dose were too heavy handed. Some questions for your GP:
The initial increase from 150 to 200mcg... might have been better to try 175mcg first before going to 200mcg . why wasn't this done?
Then same thing again when reduced ... going down from 200mcg to 125mcg .. which has clearly left you increasingly under-medicated ... why wasn't it reduced much more carefully eg to 175mcg , instead of reducing by nearly half ?
Thyroid hormones are pretty sensitive things and adjustments should be subtle and gradual (usually 25mcg at a time, sometimes less) with careful monitoring along the way ,,, not yanked about violently, as yours have been.
Endo should probably have considered an increase to 150mcg or 137.5mcg, when TSH was 1.9 and fT4 was 14.. depending on lab range for fT4...ie: if [12-22] then 14 is low end ... (if 7.9-14 then 14 is top end, so increase might not have been warranted) That TSH combined with symptoms was already hinting that your dose might not be quite high enough. - as most common TSH level for healthy population is around 1 or slightly lower.
The logical next step for GP now TSH has gone much higher, should be an increase to 150mcg, wait a couple of months to see results , then re-assess. The TSH gradually rises in response to 'not enough thyroid hormone', ( it's 'shouting louder' to thyroid ~ requesting more T4 /T3) so the rise to 19.8 is to be expected if T4 level was not increased in response to a more subtle 'message' of 1.9 .
TSH (Thyroid Stimulating Hormone ) is a message from the pituitary to the thyroid asking for more ( or less ) thyroid hormone (T4/T3 _) to be produced. When our thyroid can't respond adequately (and we are put on thyroid replacement hormone ), it then becomes the Doctors job to respond to the message to adjust dose .. if they ignore it , the TSH message will get louder.
Ask your GP to put away his sledge hammer ,and use his ears more carefully.
Strength and Sympathy for you. I experienced very similar situations like you. Palpitations are very frightening at least for me and I'm sure many others that are or went through this experience. In my case it was several factors that caused me to have palpitations. Fillers in my T4 meds. Not being a good converter T4 to T3. Adding T3 to my T4 mix was a tremendous game changer and a Blessing. My Iron was low . Low Iron plays a tremendous role in palpitations. In general low nutrients are not helpful especially when it comes to thyroid meds. I would suggest that if your not taking magnesium you should start . Magnesium is very helpful with palpitations to calm the heart. But please be very cautious to keep 4 hours apart from when you dose with your thyroid meds. Fish oil is also very helpful with palpitations. I'm sure more very helpful members will add more information that you can benefit from. Wishing you speedy resolutions and Healing Hugs.
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