hello there, I’m hoping someone can offer some advice.
I have been feeling very unwell for a while now and put it down to extreme stress.
I have been experiencing extreme fatigue to the point where even every day tasks such as washing the dishes feels too much effort. I thought I was just depressed so I tried antibiotics which did nothing.
I had blood tests which showed my TSH levels are 8.9 and my doctor recommends I take 25mg Levothyroxine. I understand this is a low dose but I have a very high resting heart rate and am really worried my heart rate will become dangerously fast.
I know most hypothyroid sufferers are bradychardic but I am the opposite so I don’t know what to do.
I’d also love to hear from anyone who has similar symptoms and TSH levels. Did the 25mg Levo help and if so how long did that take?
Thank you!
Written by
Jemmalee
To view profiles and participate in discussions please or .
Thank you so much for your advice. My thyroid tests results are shown below but my TSH was higher when my GP took them, I just wanted to check the FT3 and FT4 which I did privately for speed.
You will be much more knowledgeable about the interpretation of these numbers but I did start levo last week (only 25mcg) and had to stop again after my heart rate was consistently above 115bpm even when sleeping. Really not sure what to do for the best at this point but I will consider all you’ve said and go from there. Thank you again.
Suggest you get different brand….either Mercury Pharma or Wockhardt 25mcg
Try different brand
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord or Wockhardt
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots,
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
If still difficult to tolerate….. cut 25mcg tablet in half and take half dose waking up, on empty stomach and then nothing else apart from water for an hour
Add 2nd half mid afternoon
Going to need several more increases in dose of levothyroxine over coming months
Levothyroxine doesn’t top up failing thyroid….it replaces it
unless very petite
Most people will eventually be on at least 100mcg per day …..bloods should be retested 6-8 weeks after each dose increase
Standard STARTER dose of levothyroxine is 50mcg
Dose normally increases in 25mcg steps upwards
But some people have to start very slowly or may need beta blockers to slow heart rate
Request referral to thyroid specialist endocrinologist
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Aristo (currently 100mcg only) is lactose free and mannitol free.
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test
Increasing number of members find it smoother/more tolerable to split levothyroxine as two smaller doses, half dose waking, half dose at bedtime.
I have an odd heart condition. I know now it’s completely down to hypothyroidism. My symptoms were (and I still experience them from time to time because I am under medicated) a sensation that the heart could not raise its game enough to supply me with the correct energy supply to enable it to work properly. Way before diagnosis, if I forced the issue, which I often did, because doctors more or less told me it was ‘nothing’, I gave myself angina symptoms. At my request when I was finally diagnosed hypo, I was prescribed 25 mcg as I tend to be very sensitive to medications of any kind. As soon as I started the meds I felt an increase in heartbeat but I knew this was a likely ‘side effect’. I allowed it to continue without fear but cut the ends of two of my fingers off (sewing) because I could not judge how much faster my body was working. However I was very pleased that my body was somehow waking up.
I could go on but I fairly quickly went up to 50 mcg when I noticed a particular improvement in my getting about capability, which I had not been able to do for years.
25 mcg does not do very much and sometimes you might feel worse. I wish doctors had the knowledge and respect for us and our symptoms. Even a leaflet saying “You might feel a bit worse before you feel better” would be a much more honest approach.
Obviously though if you are concerned in any way about heart symptoms, speak to doc with in mind what I have said about my experience. Even a small dose changes things in an attempt for the body to work more efficiently but is only the first step!
Thank you very much for your advice, I will definitely be speaking to my GP again as after starting only 25mcg of levo for a few days, my heart rate was consistently above 115bpm which didn’t feel great! Thanks again.
This may seem like a strange phenomenon but it is one that I have suffered from. The answer wasn't actually in thyroid hormones but iron. Of course you also need the thyroid hormones but when we are hypo we get low nutrient levels. That is caused by low stomach acid and not being able to absorb nutrients from our food.
I'd recommend asking your GP to run some vitamin tests - ferritin, folate, B12 & D3. When you get the results post them here for comments. You are legally entitled to a printed copy of your results, ask at GP reception. In England you can get the NHS app and ask for permission to see your blood results on that by asking at GP’s reception.
So currently as well as being hypo you highly likely have low nutrient levels which in themselves cause a whole array of symptoms. Low ferritin/iron can cause tachycardia.
The 25mcg Levo you have now is just a starting dose. Most people need 100-200mcgs as a final dose and for their TSH to be at or just under 1. You take 25mcgs for 6-8 weeks then redo bloods and titrate upwards usually by 25 or 12.5mcgs so it can take many months to get to where you need to be.
Many people actually feel worse on 25mcgs as its not enough to replace your own thyroid output. Just a heads up but hang in there for the next increase.
By the way, if you get put on iron tablets make sure to take them 4 hours away from your levo. Also take them with some orange juice to help absorption.
Thank you for your helpful advice and I am indeed extremely anemic at the best of times due to heavy periods. I have been prescribed iron tablets which I take every day but maybe it’s not enough. I’ll ask my GP. I’ve uploaded a pic of my thyroid results just to show the bigger picture but if my iron levels are still too low then I suppose I need to get them sorted before I worry about the levo. The problem is, I began levo a few days ago and my heart rate was consistently above 115bpm even while sleeping so I have stopped again for now. Thank you again.
I would be worth discussing with your GP or a womens clinic a way to reduce your blood loss during your period. That would help you a lot in time.
How long have you been taking the iron tablets? You should get bloods done again in 3 months to monitor treatment. If you level is not improving then try a different type of iron. Also, take the iron 4 hours apart from levo and with a drink of orange juice which will help it absorb.
Increasing iron rich foods such as chicken livers or pate a few times a week can also help and red meat.
It can take many many months to fix iron levels, it is notoriously slow to recover. You could try Levo but also ask GP for some propranalol which will help calm your heart.
Also get the other vitamin levels run either by GP or privately. You are highly likely low in other areas.
I'm hypothyroid, and I have problems with tachycardia.
In my case the main cause of my problem was very low serum iron and ferritin (iron stores). (This was nearly 10 years ago.)
In my experience doctors rarely, if ever, test serum iron, although they will test ferritin sometimes. They think that any result within the reference range is "normal" and requires no treatment.
I managed to get a prescription for two months worth of iron from my GP (wow! Such generosity - not) and she was really annoyed with me because my ferritin was in range. I remember her slamming the prescription down on the desk in front of me, while scowling at me ferociously.
Since then NICE has changed the guidelines and I would now be considered to be iron deficient with the same result as I had back then. I was certain that I wouldn't get another prescription at the time I got my last one so I didn't bother asking for one. And the thing that changed my life and fixed my tachycardia was discovering that iron supplements can be bought from pharmacies in the UK without prescription. I also discovered that I could get an iron panel done privately.
Ever since I made those discoveries I've tested and treated my own iron and ferritin levels.
My tachycardia, having been triggered by the low iron/ferritin, has never gone away completely - but it never gets so bad as it used to, and the episodes I get are much more rare than they were. But improving my iron levels also fixed the chest pain I was getting with the tachycardia, and that hasn't come back.
Thank you for your helpful advice. I am always anaemic and do take iron supplements regularly so it could be that although with supplements my levels are usually low normal but my heart rate goes through the roof on levo. I’ve posted a pic of my blood tests (only thyroid as unable to repeat bloods with GP at the moment).
I have hypothyroidism, Hashimotos and I have been taking Levothyroxine since 2005 starting from 50mcg up to 125mcg and currently at 88mcg and some times I wonder if it is actually working. There are some doctors that say that many people diagnosed with thyroid problems are actually having problems with the thyroid hormones getting to where they are needed due to blocked passage ways or receptors. I am just now learning about this so I don't know a whole lot about it but I watched a video by doctor William (Bill)Cole
I hope that link works, if not, Google his name. What he says made a lot of sense to me and I had heard this from another doctor as well. They say that the thyroid is not the cause but the victim and the video tells you how to find out if you actually have a thyroid issue or a receptor blockage issue.
I have been taking thyroid medication for years but I still have ALL of the symptoms and problems like no energy, brain fog and confusion, skin problems, excessive sweating and I could go on and on but instead I will just say watch Dr. Cole's video. He's not trying to sell you anything and there is a way for you to setup a consultation if you want (I have not done that yet but I'm going to)even if you don't do the consultation it will at least give you more information about your thyroid issue.
thank you for the suggestion, I will certainly have a look. I too have all the symptoms even with a tsh level in the high normal range but when I take levothyroxine my heart rate goes even higher (115bpm). I am at a loss as to what to do so I will check out Dr Cole’s video.
Thank you everyone, you’ve all been so helpful and knowledgable! My GP said my TSH was slightly higher than the results I’m posting below but I had my bloods repeated privately so that I could also test the T4 and T3.
I also began levothyroxine at 25mcg but have had to stop as my heart rate was consistently over 115bpm, even while sitting and sleeping.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Query about suppressed TSH
TSH drop is it too soon?
Latest tsh results 36.52
Rundown of TSH, T3, T4
elevated TPO, but normal TSH and T4
