Why do I have heart palpitations with these thyroid results?

[Juliet_22]

Hello beautiful people.

I would love to get your input as to why I get heart palpitations, high pulse and HBP with my current thyroid and other results.

Yes, my TSH is slightly raised, but it actually went down from 6.9 in Nov to 4.9 in Feb on Levo 75 mcg, so it should continue to go down.

I've done ECG and seen a cardiologist, all tests showed a healthy heart. Have never had HBP and palpitations before.

Also have: anxiety, panic, shakiness, feeling wired, head pressure, loose stomach when I have these incidences of HPB.

Signs of too much T4???

We tried lowering my Levo with my GP to 62.5 mcg, but that was too little for me and I soon started to feel hypo, though my heart settled. So went back to 75 mcg.

My TSH raised back last year as a reaction to iodine. I stopped taking iodine right away and my hormones are balancing more now. Won't touch it again.

I take T4 @ 75 mcg, been on the same dose for about 15 years.

When my TSH was at 6.9, my doc and I tried to increase T4 to 100 mcg (but it was a different brand) and that resulted in 5 trips to A&E with high blood pressure, high pulse, heart palpitations and even breathing problems once.

Seen cardiologist, checked my heart, all is healthy.

Dropped T4 to 88 mcg (my regular 75 + 12.5 of Teva), still same racey symptoms. Tried taking 75 and 88 on alternative days, still the same.

Only when I returned back to 75 mcg my symptoms have settled for a bit.

But now they returned again, still on 75 mcg! Cardio exercise now triggers my pulse rate (never done that before!), so I had to go easier with my exercise (as a very avid fitness person, very hard to not do it!)

Been in 75 mcg for about 7 weeks now and TSH went down from 6.6 to 4.9.

Tried adding T3, just 5mcg of compounded T3, and that resulted in racey mind, heart and heart rate. Had to stop after a few days as I felt absolutely awful. That was fast release T3 and I will be trying a slow release T3 now.

My blood tests don't actually look too bad, my TSH, T4 and T3 have improved since last tested in November.

But my anxiety, panic, HBP and pulse came back and with it sleepless nights and inability to do much during the day.

I supplement with D, magnesium, iron, B12, methyl B complex, Betaine, selenium, zinc. My nutrition is great, gluten/dairy free, high antioxidant, been on the same diet for a long time, weight is healthy, know about ideal ranges and strive towards them. I meditate, taking calming teas, etc etc etc - doing all the right things.

I lack energy in the morning, but pick up later and can exercise and stay active (not so much lately with BP and pulse problems). By evening, I feel tired, but wired. I lack focus, hard to concentrate on work, usually I'm productive.

Made an appointment with a private endo, but that's in 3 weeks time and anything I could do now to improve things would be celebrated!

My recent results:

TSH: 4.9

T4: 45% of the range

T3: 33% of the range (I know ideally should be 50%+, but I don't take T3 currently, open to changing that if it could help!)

9am cortisol: 384 (133-537)

Saliva cortisol levels are raised at 2 points of the day:

8am: 25.1nmol/L (high) < 20.3

12noon: 9.9 nmol/L (high) 1.6 - 5.6

4pm: 5.1 nmol/L (normal, but should be lower ideally) < 6.94

10pm: 4.9 nmol/L (normal, but should be lower) < 7.56

Folate: 16.4 (2-26.8)

Vitamin D – 60 ng/ml

B12 – 681 ng/l (197-771)

Ferritin: 80 (up to 150)

Anti-TPO: 195 (<34) (my TPO stay in the same 100-200 range, but I lowered them from 600 before)

Anti-TG: 60 (<115) (my anti-TG has been lowered from 550 before and stays in about the same range)

A1C and blood glucose - very good

Liver, kidney, FBC, CRP all good.

Thank you for your help! I really appreciate this amazing and helpful community and your input.

[Jaydee1507 Administrator]

Likely because yout FT3 is too low. It would need to be above 50% possibly slightly higher to improve your symptoms. Your TSH is showing you need more thyroid hormone, no heart checks are going to show that. Most people feel well with a TSH at or just under 1.

Your TSH is unlikely to continue to go down, you really do need a 25mcg dose increase as discussed previously but due to your sensitivity to Levo increases this is difficult. Have you asked to try liquid Levo? You could then make extremely small increases over time. This issue is not going to go away by hoping for better and symptoms may get worse.

Your vit D level is slightly too low. Better off with it around 100.

[Juliet_22 in reply to Jaydee1507]

Thank you! With vit D, ideal ranges from what I know are 60-80, some say 50-80.

Currently, I am trying a 12.5 mcg increase, I can't seem to jump to 100 from 75 without big issues. I will try to see if 88mcg will do the trick.

Do you think liquid levo works better? How would you recommend increasing my T4, in what doses and how often?

Would 5mcg of slow release T3 help as well?

[Jaydee1507 Administrator in reply to Juliet_22]

Apologies I was using a different measurement so your D3 level is good.

How is it going with the 12.5mcg increase? You can always add that in every other day for an even slower smoother transition. If that's acceptable for you symptom wise that may be all you need and liquid wouldnt be of any benefit. Liquid doesnt work better its just easier to make extremely small increases. Over time, depending on how your symptoms are you need to build that up to a 25mcg increase and then restest after 6-8 weeks on the extra 25mcgs. You can only go as your symptoms permit.

5mcgs T3 would possibly send your symptoms off the chart so I dont think that would be the best idea.

[Juliet_22 in reply to Jaydee1507]

I've only just started increasing 2 days ago, actually splitting 12,5 mg into 2 doses. But same symptoms atm. I will try adding full 12.5 mcg every other day, which is same to what I'm doing now, thank you! Why do you think 5mcg of T3 will send symptoms off the chart if I need to raise my T3? Wouldn't it be better to try slow release T3 instead of increasing T4, or is it best to do straight T4? Or even try to switch to NDT?

[Jaydee1507 Administrator in reply to Juliet_22]

T3 is much more powerful even in slow release form so if you have symptoms from a tiny bit of inactive hormone then adding active hormone will likely make things worse. I know this from personal experience struggling to restart Levo myself a long time ago. NDT contains T3 so likely similar.

[Juliet_22 in reply to Jaydee1507]

That is a very interesting point! So you went on NDT from levo and didn't do well, and struggled to come back to Levo? How are you doing on it now? People swear by T3 or NDT, but not everyone does well on it.

[Jaydee1507 Administrator in reply to Juliet_22]

I have a very chequered history in the distant past. I was not thriving on Levo only so stopped for a few weeks to try and get on NDT, then I struggled massively and became really ill and housebound for the first time,as my levels plummeted very fast and was getting lots of very unpleasant symptoms like yourself including being very weak. I struggled to tolerate levo but at least knew that I had been fine with it before, NDT was like rocket fuel. All these things just took time to get better.

I was awake for days on end and then scared to sleep for fear of not waking up, but I knew I had to take it and just couldn't understand how things changed so rapidly and badly in a short space of time.

When eventually and I can't even remember how I did it got onto NDT I did do better but was kept at a sub optimal dose by an NHS Endo so didnt thrive as I should have.

You seem to be converting fairly well from your blood results. The people that swear by NDT/T3 are poor converters like me. I'm now on a T4/T3 combo and doing a bit better.

[SlowDragon Administrator in reply to Jaydee1507]

vitamin D is 60ng/mL

60ng/mL = 149nmol

endmemo.com/medical/unitcon...

So vitamin D is at very good level

[SlowDragon Administrator]

What brand of levothyroxine is 75mcg

Teva brand upsets many people

Suggest you try splitting your dose levothyroxine

Half waking and half at bedtime

As you have Hashimoto’s are you on gluten free diet and/or dairy free diet

Vitamin D is GOOD at 60ng/mL

Presumably you are not in U.K. if vitamin D is tested in ng/mL

[Juliet_22 in reply to SlowDragon]

Yes, in UK, but used to using ng/ml, so I convert into this value. Thank you for your input!

[SlowDragon Administrator in reply to Juliet_22]

Which brand is 12.5mcg

Which brand is 75mcg (if 75mcg is single tablet it will be Teva)

[Juliet_22 in reply to SlowDragon]

I would love to switch to one brand. Since I do my best to keep it lactose free, I take a lactose free German brand Berlin-Chemie for 75 mcg (been on it for over a decade, but it's not available here in UK) and 12.5 mcg divided into half each day by Teva. I know Teva upsets stomachs, and I have been feeling bloated with loose bowls. But I don't know what else I can do. Take liquid levo? It also has additives. Any advice would be appreciated!

[SlowDragon Administrator in reply to Juliet_22]

you could cut 75mcg into 1/4’s

Either take 1/4 tablet every day

Or increasing slower ….1/4 tablet every other day

[Jaydee1507 Administrator]

There is a way of working out very approximately how much you might require. Weight in kilos x 1.6 Its not 100% accurate but will give you an idea what you may need.

I do better in the warm too, hate English winters. Hoping in time this added T3 will help me with that.

[Juliet_22 in reply to Jaydee1507]

I was hoping for the same with T3, but it ended up not working ... Wishing you all the very best, we'll get there!

[Hidden]

Whatever you may be told, adrenal insufficiency in thyroid disorders is very common indeed and should always be considered at the onset of treatment. Failure to respond to thyroid supplementation, or actually feeling less well, is likely more often than not to involve the low adrenal reserve syndrome. (Peatfield “how to look after your thyroid”) If, upon starting NDT, you experience symptoms, including anxiety, insomnia, shakiness, sweating, dizziness, feeling spaced out its a strong sign that you may need adrenal support. (Tpauk website)

[Hidden]

Low cortisol causes T3 to work less effectively within the cells. This is because T3 and cortisol are partners within our cells. High cortisol also causes problems and can reduce the effectiveness of T3 within the cells, hence thyroid patients with high cortisol often complain of feeling hypothyroid even when they appear to have reasonable FT3 levels. When patients try to raise T3 levels in the presence of low cortisol, they may find that the body compensates for low cortisol by producing more adrenaline. This can cause anxiety, rapid heart rate, the feeling of heart palpitations etc. This is usually the adrenaline response rather than a direct issue with the T3. Very often, it is the low cortisol that is at the root. (Paul Robinson website)

[Hidden]

your high cortisol levels need addressing IMHO. ps100 is a good option x

[Juliet_22 in reply to Hidden]

Yes, I'm working on it. It's not really stress related. I'm doing a lot of things to bring it down. Thank you for the suggestions!

[Hidden in reply to Juliet_22]

that’s good! As long as you’re bringing it down. I think holy basil is effective too 🙂