palpitations starting levothyroxine

[Lanny2010]

Hi I've asked quite a few questions recently as brand new to all this, hope its ok to keep asking! So just over two weeks ago I was prescribed 25mg Wockhart levothyroxine (for the first time) with instructions to go back for a blood test in 7 weeks.

I took only one pill in the morning 2 weeks ago (following all the advice) and that night I could feel my heart racing in the night when in bed.

Long story but I had a family emergency the very next day and had to go away to help out and am only just back.

I decided I would not take any more of the levo and try again when back (also when less stressed). I felt the same racing heart (when in bed, gradually becoming more muted) for that whole week even though I had only taken one pill!

I want to try again and have read that some people start very very gradually, please could someone recommend a strategy for this or should I ask the dr again? Not sure what the other options are so gradual seems like the only one...

Thank you so much again I really do appreciate all the amazing help I've had so far x

[GlowCoach Administrator]

Well done on being diagnosed. As you have found it can be a bit of a mine field even once starting treatment.

You could try cutting the tablet in half but the thing is your body has been crying out for thyroid hormone for a fair while and once you start on a very low dose it isn't enough to replace your own production, so worse symptoms can happen until you get to a higher dose.

I'd recommend taking your levo at bed time as it absorbs better then and you won't be eating. Levo doesn't like being taken with food.

The other thing that can affect symptoms are low vitamin levels. When hypo we get low stomach acid meaning we cant absorb our vitamins well. Thyroid hormone doesnt work well on low vitamins and they need to be supplemented to OPTIMAL levels. Can you get GP to check ferritin, folate, B12 & d3?

[Lanny2010 in reply to GlowCoach]

Ah thanks very much, would you take it just before bed then and always at the same time? I could try that. Sounds like palpitations are pretty common reading through other posts, will start again and hope for the best. I will ask for vitamin check too thank you again...

[GlowCoach Administrator in reply to Lanny2010]

Yes always same time of day on an empty stomach 1hr away from food & coffee. You could try splitting the dose so have half first thing an hour before eating and other half bed time.

Palpitations are a very common hypo symptom, might clear up after a few weeks. Your last ferritin wasn't bad but could use some work to get it to 90-100. Eat chicken livers or pate a few times a week.

Book bloos test for 9am and do it fasting with last Levo 24hrs before.

[Lanny2010 in reply to GlowCoach]

Thank you so much 🙏 very reassuring and will try all this x

[shaws in reply to Lanny2010]

I also had awful palpitations when first diagnosed and prescribed levothyroxine. (although I must state that many seem o.k. with it).

I was very grateful that I was prescribed something as my TSH was at 100 and I didn't feel well at all. The palpitations were worst during the night and then a cardiologist had to do r.ecordings overnight.

When we're first diagnosed we don't have a clue what hypothyroidism is or what causes it.

I am fortunate to have now been prescribed T3 as it resolved all of the palpitations and I also feel well.

[Lanny2010 in reply to shaws]

Thanks that's interesting, glad you got it resolved. I've had palpitations and ectopic heartbeats in the past too and really dread having more...

[Lanny2010 in reply to GlowCoach]

Hi Jaydee just wanted to ask about taking levo at bedtime, can you recommend how much time I need to leave after eating evening meal? I read it's 3-4 hours! Do you think that includes drinks too (other than water)? Thanks so much!

[GlowCoach Administrator in reply to Lanny2010]

3-4 hours would be best after evening meal, the stomach should be empty. Caffeinated drinks are the worst to have near Levo but even others will affect it. I'd say 1-2 hours for drinks other than water.

[Lanny2010 in reply to GlowCoach]

Thanks so much that's really helpful 😊

[Hedgeree]

Hi Lanny,

I'm just echoing what Jaydee has said I take Levo during the night when I wake to use the loo. There are quite a few on the forum that do the same; some take it at bedtime others during the night but always on an empty tum.

I was prescribed levo in August last year after having a partial thyroidectomy. I also started on Wockhardt 25mcg. Due to having hypo symptoms for many years I started very very slowly. I split the tablet into five pieces (sounds a little extreme when I write that) I was very nervous and took one piece just to see how I got on (felt clear headed for a day) and I very slowly increased from then.

Unfortunately I struggled with digestive issues due to the lactose and then changed to a lactose free brand and continued my slow titration. When I tried to increase faster I was getting pains in my chest that was scary and not pleasant so I went back to low and slow and the chest pains stopped.

It took some months but I'm now on 25mcg and am trying to increase again. I'm working on my vit D levels and struggling to get my ferritin levels up. You appear to have good vitamin levels which is essential for your body to be able to tolerate and make use of the levo.

I realise I've got a long way to go before I'm anywhere near taking the right amount of hormones but I do feel better than I did before although I don't feel fully well but there's definitely been improvements. Hope that makes sense?

Forum members are very experienced and will offer suggestions and support.

Best wishes.

[Lanny2010 in reply to Hedgeree]

Hi thanks so much that's really interesting and I think I will try the very gradual and night time strategy too. I also had a pain in my chest after that one pill, sounds very similar. I think I'm very sensitive to any medication. Thanks again, so incredibly helpful to hear about comparable experiences. I hope things continue to improve for you

[Lanny2010 in reply to Hedgeree]

Ps quick question, how did you divide the tiny pills?

[Hedgeree in reply to Lanny2010]

It was difficult but I used a pill cutter at first (that didn't work very well) so they fell into small pieces. The pieces weren't the same size but I did my best to divide the crumbs into approximately even amounts.

At the start I'd take a tiny piece during the day and see how I got on. Once I started to titrate upwards I eventually began splitting them into quarters which was easier to do. I now use a craft knife for this.

Trying to juggle taking levo during the day away from other supplements and medication was a challenge and so I changed to taking it at night which suits me.

Hope that helps.

[Lanny2010 in reply to Hedgeree]

Thanks so much that's really helpful. Going to try dividing and take tonight. Do you take magnesium? I've been taking magnesium glycinate at night but I think I should take 4 hours before levothyroxine... 🙏

[Hedgeree in reply to Lanny2010]

Hi Lanny,

I don't take magnesium but am looking at ordering some today. I haven't done my brand research yet but need to get it done.

I've had a few days with a fairly horrible headache and as I've been taking higher amounts of D3 that coincided with them I did some reading. It seems that magnesium (glycinate?) is also essential to take along with D3 and K2 MK7 and the lack of magnesium could be the cause of my headaches.

I'm not sure of the timings but magnesium is best taken in the evening as it can make you sleepy. Every time I read advice on the forum about timings of supplements and hormones I keep meaning to take a note of the information but then promptly forget to do so?!

[Lanny2010 in reply to Hedgeree]

Thanks so much. I'm pretty disorganised but looks like I need a strict timetable from now on. Rather intimidated by the timings of things but will give it a go. Thanks again and keep in touch!

[Singwell in reply to Hedgeree]

Glad to read others titrated up super slow as people questioned my decision to do this. Still on 12.5 after 3 months and not pushing it as I feel the difference anyway.

[Hedgeree in reply to Singwell]

Hi Singwell,

Yes I was very nervous as when I suggested to the ENT endo nurse that I wanted to start slowly she said I had to take 50mcg. To complicate matters further an endo that I've never met said in a letter to start on 25mcg?

With me having hypo symptoms for many years prior to having the partial thyroidectomy I decided to do what felt right for me and my body. Also I'd been continuously told there was nothing wrong with my thyroid so was feeling quite lacking in confidence by this time.

I was surprised as when I spoke with the ENT on a follow-up phone appointment they were very supportive. I just said that I was struggling to tolerate the levo, had been getting chest pains and had to start very very slowly.

My thinking was also with it being a storage hormone taking such a small amount wouldn't really make any difference but would be a good way of introducing it to my system.

I was pleasantly surprised as I had a day or two of clarity on initially starting it even only taking those tiny pieces.

Now I'm trying to increase again but will do it very slowly so will try to take about 12.5mcg but will most likely have to split that up into smaller pieces too.

[Singwell in reply to Hedgeree]

Introducing it to the system - YES that's just how I felt. I noticed a difference in 3 days. Low mood improved, more energy improved cognitive function. I'm.hoping this will continue to work well for me.

[Singwell]

I have atrial fibrillation- or at least I did until May 2022 when it stopped following a procedure to fix it. AF is a heart Arrythmia and I know all about palpitations! Like you I'm also recently joined. I took the decision to start super slow by cutting my 25mcg in half. An alternative would be to take your dose every other day. Thyroxine does increase the metabolic rate and that's why I made this decision. I had a few palpitations in month 3 and have noticed my heart rate in general is several beats higher. I'm not medically trained and am only sharing my experience. Others here will tell you that palpitations can happen because our dose isn't yet high enough.

Mention it to your doctor is my advice. Track the amount, length and timing of your palpitations, as this helps them to help you.

And a practical tip for when they come on:

Sit or lie in a comfortable position. Breathe through your nose if you can - in for a slow count of 2 - out through the mouth like a big sigh. Usually you'll pause now because your body doesn't need more breath yet. Then repeat. Do it for 5 minutes. The paysesmay get longer - that's a good thing.

[Lanny2010 in reply to Singwell]

Thanks so much, yes chest pain and fast heartbeat is listed as possible side effects but I don't know what the Dr would say as there seems no straightforward alternative... So seems like trying different times/amounts is the only option (I think for now?). I've had ectopic heartbeats in the past, years ago on different occasions which I was told were benign but I felt terrible so rather anxious about all this but will try. Interested to hear how you get on

[Singwell in reply to Lanny2010]

I'll be keeping the group posted. For ectopics the recommendation is to slow your breathing down to 5-6 breaths a minute. You'd need to do 2 in and 4 or more out for that ( breathe out through the nose or pursed lips if nose is blocked). Tip from the AF forum. Always works for me.

[Lanny2010 in reply to Singwell]

Thanks so much that's very helpful 😊

[Digger0]

My palpitations stopped when I started Levo! Good luck

[Lanny2010 in reply to Digger0]

Ah interesting! Thanks 🙏