Palpitations Slow Release T3

[Thyroid_mum]

Hi everyone,

Hope you're all well. I have started getting palpitations, quite bad where it continues for over 5 minutes multiple times a day.

I am on 100/125mcg Levo and 17.5mcg of compounded slow release T3. I have been on this dose for a few weeks and the past two days I'm experiencing the palpatations and wondered if anyone had anything similar that could shed some light?

My latest results from 9th of March - the T3 hasn't moved even though I increased from 15mcg to 17.5mcg and instead of 24 hours before testing, I took my T3 at 13h00 the day before, so 18 hours.

My folate has increased 👍

Many thanks

[MrPeaPaw]

I've had heart palpitations for decades, with and without thyroid hormone replacement. I discovered that if I apply thumb pressure on my inside left wrist 3 or 4 inches below my palm crease, this stops them immediately. I don't know why this works, how I discovered it, or if it would work for anyone else.

It has never failed me and I used to be terrified of the runaway palpations that would last over two minutes.

Edit: My dear wifey (and family archivist) informs me "my discovery" was actually gleaned from class on Shiatsu we attended back in the olden days, 1983 in Manhattan, NYC.

Should add that I'm on T3 only, 40 mcg and sometimes still get heart palpitations even though my heart checks out "fine". Last blood test showed T3 at the top of the range.

[GlowCoach Administrator]

Its difficult to tell whats happening with your FT3 as the 18 hour gap between last T3 and lood test means it is now showing a false low FT3. See graph below for the peak of when T3 is taken. Guidance suggests a gap fromn last dose of 8-12hours to get stable blood levels.

Also it is usual to allow 6-8 weeks on a stable dose to get accurate blood levels. The increase you made was very small.

I can only guess that your T3 dose isnt high enough but that really is a guess as to why you are getting palpitations.

FT3 graph

[Thyroid_mum in reply to GlowCoach]

I am on slow release T3 so it's difficult to gauge when to test - the compound pharmacy says its compounded for 24 hours.

[GlowCoach Administrator in reply to Thyroid_mum]

I don't think there are studies on testing for slow release T3. Sorry, the graph I posted was for immediate release. Perhaps you're just not taking enough T3 but testing only a few weeks after a dose increase is pointless. A 5 mcg increase might have been an improvement. Palps are a hypo symptom.

[Thyroid_mum]

I can also add that I dont have any palpitations before I take my thyroid meds and they start about 1-2 hours after my SR T3 is taken.

[MrPeaPaw in reply to Thyroid_mum]

Wow, that's the way I was when put on NDT. However, upon reading this forum, I found out I was left on a ridiculously small amount for way far too long time. Thyroid care in the US is in as dire shape as it is in the UK.

[MrPeaPaw]

That's an interesting dilemma as to when you should test. My intuitive response would be it might not matter.

What I noticed was your T3 is quite low--near the bottom of the "normal" range.

[SlowDragon Administrator]

Why slow release T3

I don’t think we have ever had anyone do well on slow release T3

Why not standard T3 at 3 x 5mcg doses across the day

Probably a lot cheaper too

[Thyroid_mum in reply to SlowDragon]

was getting anxiety on standard release.

[SlowDragon Administrator in reply to Thyroid_mum]

Anxiety is common hypothyroid symptom, especially as dose is increased

Did you reduce levothyroxine by 25mcg 4-5 days before adding just 5mcg T3 initially

[Thyroid_mum in reply to SlowDragon]

I will try that. Do I keep the slow release while I reduce the T4 and then switch to 5mcg T3 immediate release?

[SlowDragon Administrator in reply to Thyroid_mum]

I guess so

it’s all trial and error

Perhaps initially reduce levothyroxine by 12.5mcg

Then after 5 days change to ordinary T3

You will probably need to swap over to 3 x 5mcg T3

Each T3 dose …..Approximately 8 hours apart

[Thyroid_mum in reply to SlowDragon]

Thank you.

[SlowDragon Administrator in reply to Thyroid_mum]

it’s often high Ft4 that makes us feel wired and anxious

[Thyroid_mum in reply to SlowDragon]

I was 200mcg of T4 before adding T3, I dropped to 100mcg and I didn’t have any anxiety on 200mcg. Which is why it’s so weird with T3

[SlowDragon Administrator in reply to Thyroid_mum]

So how long since you reduced levothyroxine from 200mcg to 100mcg

That’s a massive drop

What were Ft4 and Ft3 results on 200mcg

Do you always get same brand levothyroxine at each prescription

[Thyroid_mum in reply to SlowDragon]

I dropped ages ago, November/December I think. I don’t convert well - had a high reverse T3 so wanted to include T3 and dropped T4

[SlowDragon Administrator in reply to Thyroid_mum]

Approx how much do you weigh in kilo

[Thyroid_mum in reply to SlowDragon]

on 200mcg T4 I was 73kgs.

I’m 68 now. I try to eat very healthy and exercise. Dairy, gluten and sugar free

[SlowDragon Administrator in reply to Thyroid_mum]

So guidelines on dose by weight if ONLY on levothyroxine would be around 116mcg levothyroxine per day ….. at 73kg x 1.6mcg

Adding T3 …..small dose reduction….and 100mcg per day might be about correct

Was this test here done early morning and last dose levothyroxine 24 hours before test

Ft4 20.5 (12-22)

Ft4 was on high side

Which brand of levothyroxine do you get

Do you always get same brand at each prescription

[Thyroid_mum in reply to SlowDragon]

Thanks SlowDragon, my endo has suggested we try compounded desiccated as I did well on thyroid granular (forefront health) but had issues getting it into the uk - hence hence changing to T3 and then compounded Slow Release T3.

What are your thoughts on compounded desiccated thyroid (pig)

[Thyroid_mum in reply to Thyroid_mum]

The test was done 24 hours for T4 and 18 for T3 (i took my T3 at 13h00 the day before the test)

Always get the same T4 (Acccord)

[TaraJR in reply to SlowDragon]

SlowDragon , that's a worry. As I hear several 'top' endos saying that slow release is what they're focussing on now. They think it'll be more readily accepted by drs as there won't be the 'dangerous highs' from the T3 most of us take.

[Thyroid_mum]

does high reverse T3 really block T3 from getting into cells?

[tattybogle in reply to Thyroid_mum]

no it doesn't .. (well not directly anyway , but it's a bit complicated ~ there are good explanations on here by Radd~ i'll try to find them for you later/ tomorrow)

Reverse T3 simply cannot 'fit' on to the T3 receptors inside the cells (it's the wrong shape ) the only thing that fits onto T3 receptors is T3.. so reverse T3 does not 'block' the receptors .

That idea was an oversimplification that used to be thought to be true several yrs ago ,, unfortunately some thyroid sites on the internet have not updated their thinking in line with what is now known .

[tattybogle in reply to tattybogle]

These two post have links to articles from ThyroidPatientsCananda which explain why reverse T3 doesn't 'block' the T3 receptors (or cause T3 'pooling' )

healthunlocked.com/thyroidu... a-picture-is-worth-a-thousand-words-deiodinases-and-transit-vans-and-a-very-polite-correction-of-sttms-pooling-theory

healthunlocked.com/thyroidu... thyroid-hormone-journey-metabolism.-aka-tania-s-smiths-dot-to-dot-horse

This post had a good explanation by  radd : healthunlocked.com/thyroidu... explaining-reverse-t3

 greygoose also has a good explanation of Reverse T3 somewhere .. will add when find it.

[Thyroid_mum in reply to tattybogle]

thank you, will read through and hopefully will understand 😂

[tattybogle in reply to Thyroid_mum]

i read it about 18 months ago , and several times since.... and i still only 'half' understand it ., lol