Low resting Heart Rate after Total Thyroidectomy

[Ray-Man]

Hi just signed up here today to see if anyone experienced/ Is still experiencing a low resting heart rate after having a Full Thyroidectomy. Had mine 5 days ago and with 3 nights in a ward recovering. On 125ug Levo daily. To be honest I felt really good but regular normal Blood Pressure and SP02 readings but noticed my HR was 54/55. No one flagged this up but just asked are you an athlete ?( Far from it ). Back home and my apple watch flagging up Low Heart Rate - Below 50 Bpm for 10 mins. I recall that my HR used to be about 60. I’ll be contacting the Endocrine dept tomorrow seeking advice. Interested to know if others have experienced the same thing. TIA

[PurpleNails Administrator]

Welcome to forum.

I find my heart rate correlates fairly closely with thyroid levels. So too low a thyroid level may be causing slower heart rate.

5 days is really early days your still recovering, your heart rate might be lower as your less active than you usually are.

An approximate full replacement dose is calculated at 1.6mcg of levo per 1kg of body weight. Doctors often start on a lesser dose so you can adjust & increase at a gradual pace.

Do you have a blood retest scheduled to monitor your levels? This should be no later than 6 weeks.

As you have Graves and likely had hyper your TSH level won’t be reliable so you need FT4 & FT3 tested.

For levo to work well you need optimal, folate, ferritin, B12 & vitamin D.

Most feel well when TSH low in range eg 1. FT4 In top 3rd and FT3 at least 50%.

Many test FT3 / nutrients privately as not always tested.

Recommend on forum that blood tests are carried out in consistent way. Which help when comparing results.

I remind myself of things to remember for blood tests with this checklist

A - Always check what’s being tested & collect test results with reference range.

B - Biotin - cease 3 days before draw to avoid possible test interference

C - Consistent unchanged dose - minimum 6 weeks previously.

D - Delay replacement dose on day of test (take after blood draw)

E - Early morning appointment. (Book draw as close to 09.00 as possible)

F - Fast overnight. This can have a slight impact. Drink lots of water to hydrate & easier blood draw.

[Ray-Man in reply to PurpleNails]

Thanks PurpleNails, I guess it is very early days and yes I’m being sent blood forms for 5 weeks away with a follow up in 10 weeks with the ENT surgeon. I will certainly follow your advice regarding preparing for the bloods and have read similar elsewhere.Historically this sort of advice has never been given to me by the Endo. Really appreciate the quick reply 😀

[SlowDragon Administrator]

Were vitamin D, folate, ferritin and B12 levels tested BEFORE thyroidectomy

What vitamin supplements are you currently taking

Which brand of levothyroxine are you taking

Are you taking levothyroxine on empty stomach and then nothing apart from water for at least an hour after

[Ray-Man in reply to SlowDragon]

“Were vitamin D, folate, ferritin and B12 levels tested BEFORE thyroidectomy”

No idea tbh. During preop (Ten days before) they took 3 vials of blood and said it was for Blood Grouping ! perhaps they were testing for more things.

“What vitamin supplements are you currently taking”

None - Nothing was suggested or recommended pre or post Op by anyone.

“Which brand of levothyroxine are you taking”

Levothyroxine Sodium - MercuryPharma issued by the Hospital Pharmacy.

“Are you taking levothyroxine on empty stomach and then nothing apart from water for at least an hour after”

Yes - 125ug on waking with water and nothing else for 1 hour.

I’ve had another thought. In an effort to make me euthyroid, 3 days before the thyroidectomy, the Endo asked me to double my PTU from 150mg bi-daily to 300mg bi-daily. How long does PTU hang around in the system? could this be causing the issue temporally.

I’ve looked back at my HR on Apple Health and can see that my RHR historically, sometimes historically to below 50 bpm but for v.short periods and not for 10 mins as is happening now and getting alerts.

[SlowDragon Administrator in reply to Ray-Man]

NHS rarely considers vitamin testing unfortunately

All thyroid hormones (your own or synthetic) need optimal vitamin levels

Graves’ disease (and Hashimoto’s) frequently results in low vitamin levels

Request GP includes testing vitamin D, folate, ferritin and B12 at next test.

Essential to test TSH, Ft4 and Ft3

Bloods should be retested 6-8 weeks after thyroidectomy

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

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Tips on how to do DIY finger prick test

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Thousands of members test privately to make progress

[Ray-Man in reply to SlowDragon]

Thank you for this comprehensive reply and I will be doing a lot more reading with the info you’ve supplied.

Had the blood forms through today.

Testing for BONE = Calcium/ALK P,

TSH = Serum TSH and EFT 4 = free T4

or testing for TF3 or anything else!

[SlowDragon Administrator in reply to Ray-Man]

GP will need to monitor calcium levels to check parathyroid glands are working ok after thyroidectomy

[SlowDragon Administrator]

examples of private test results

Medichecks

healthunlocked.com/search/p...

Blue horizon

healthunlocked.com/search/p...

monitor My Health

healthunlocked.com/search/p...