Hi Everyone.I've just had a heart op and have been put on amiodarone for three weeks. I know this drug is known to damage a healthy thyroid.
I'm just wondering what effect it has on someone optimally treated for hypothyroidism with NDT.
My worry is will it lower the conversion of Thyroid hormones.....? And am I at risk of once the drug is stopped a rush of conversion of ft4 to Ft3. I've noticed my temp has lower already from 36.8 to 36.5. However that might be because I've been poorly with a bout of prescribed drug induced diarrohea.... Might not been absorbing NDT as well.
I know this is a bit of a niche topic but would welcome any thoughts from you kind clever people. Thank you.
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waveylines
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The exact prevalence and pathogenesis of amiodarone-induced thyrotoxicosis (AIT) or hypothyroidism (AIH) are unknown, but they are associated with several factors. First, there is a very important relationship with iodine intake, so that in regions where an inadequate low intake occurs, a greater prevalence of AIT and goiter will be detected, while in areas where a sufficient iodine intake is observed, a greater prevalence of AIH can be detected (4). Second, the criteria used to define AIT have to be taken into consideration, since common symptoms of thyroid dysfunction can be masked by the effects of amiodarone, so that thyroid dysfunction can only be diagnosed by active thyroid hormone evaluation (1). Third, the time when the hormone level is determined is very important since fluctuation can occur, especially at the beginning of treatment (4). Fourth, AIT can be caused by direct (drug effect on the thyroid gland inducing a destructive thyroiditis) or indirect (exacerbating subclinical conditions such as pre-existing or “latent” thyroid disease by a multinodular goiter ou Graves’ disease) effects of the drug (1,4,5).
To screen for thyroid disease, thyroid function should be assessed before initiating therapy, semiannually during therapy or whenever clinical features of thyroid dysfunction occur.
Thanks Slowdragon. Yes that's what I'd read. I think Ive also read a 22% reduction in conversion, instead rt3, increasing. Can't find it now!! (I've never been good at the technical stuff.) That the excessively high iodine that it causes lingers for months after treatment..
I'm a bit worried tbh. And am hoping 3weeks isn't long..... The programme they given me tapers the dose down over that three week period of treatment.
I can't answer your question waveylines but I did just want to wish you a speedy recovery after your op and hope too that your pooch is also feeling better. Hugs xx
Awww thanks Delgor. 😍My pooch is feeling much better on the jabs. No longer in pain. Bless her. And as devoted to me as ever. I can't pick her up so we set up a slope up for her so she can climb onto the couch with me. Bless!!
I can’t specifically answer your question but surely your thyroid condition should be included in your care plan medication? (Would it be helpful to ask for an endocrinologist to have input into your care as well?) I do hope and pray you recover quickly and well. All the best!
Thanks TasJSA. I've not been under an Endo for a fair few years and the one I was has now retired. Though he might still do private will check. I've found it best to find my own in the past as many Endo are not very aufait with thyroid treatment and are not familiar with NDT.
Thanks Sleepman. 😊 No not done any blood tests yet only been on it a few days so too early. My thyroid blood tests were all optimal before my heart op. I was tested several times.Can't say the drug fills me with pleasure as it has some other nasty potentials so I will be clamouring to come off it once course is done.
Can’t really answer the already hypothyroid with Amiodarone.
My mum story is …she was put on Amiodarone last August 2022 and she is of May this year now hypothyroid a TSH 6.2 (range was below 5) so slightly out and her FT4 was right at low end but in range…so cardiologists lowered her Amiodarone and put her on 25mcg Levothyroxine. If that’s any use for you to know so I’m guessing they just balance one against the other, I’d assume your thyroid meds will be increased or heart meds lowered to titrate the situation.
My mum after 4days had a reaction to Mercury (assuming it’s acacia) cleared up a day or so after stopping meds and she is not taking anything at present, still waiting confirmation of what next and ridiculously slow process… another story for another day but not happy at all with the treatment she’s had over whole thing .
I'm so sorry to hear this CoeliacMum. Your poor Mum. Really hope they get her thyroid sorted. Are they checking her Ft3, level as well? I'd read the peripheral conversion rate drops. By how much I've no idea. As a poor converter don't need that messing with.
I'd hoped they wouldn't put me on it post op..... It's standard for three weeks as part of the post op care. But apparantly cardiothoraisic surgeon felt it was the best option. It will mess up my thyroid hormones for sure. So now going to have to get back in with an Endo to help me manage the consequences. Depressing after being stable for years..... Lol
No they’ve only done TSH & FT4 and guess the later will drop off too once she’s ok… the usual… her mobility isn’t good so I think some of the delay is that nurse comes out to do her blood tests…. At minute she isn’t getting much done even though cardiologists says each month it’s stretched to 6wks at least.
She’s now getting her results so we can see what’s going off and absolutely disgusting that her B12 is 148 lower range cut off 197 we have family history her mum, brother, niece and both me and my sister have Pernicious anaemia (PA) how long she’s been low is anyone’s guess as she didn’t want to know very stubborn and hard to deal with but I think as she’s so exhausted she’s now on their case with help from my sister and myself … I have other autoimmune conditions my sister just PA so I’m a tad more up with testing etc… and likewise a bad convertor but I’m not on Liothyronine was and maybe back on but having few other issues to deal with … my head can only deal with one thing at a time at moment 🤦🏻♀️
Awww thanks Martz. 😍 It's the collective knowledge on this site that has helped me so much over the years. And I've learnt a lot but will need a friendly big Endo gun on this one I think! 🤣
I'm wishing you a speedy recovery too. Its a pretty pokey drug you are taking. Have you asked if there is an alternative? Sometimes specialists are so absorbed within their own speciality they forget to consider other issues that maybe could be avoided.
Thanks Radd. 😊It's a three week course. I'm hoping that's then the end of it. I wasn't expecting it as I would've thought it is counter productive for my thyroid hormone treatment. I'm supposed to be getting an appointment to see Surgeon in a weeks time. So I think it's probably best discussed then.I think what I'm going to do though is to discuss the impact of this drug on my thyroid meds with an Endo. To me it looks highly likely it will interfere and then cause palpitations due to lower conversion rates. But I'm no expert. I think they are struggling because I also do not tolerate beta blockers either..... They mess with my thyroid hormones and cause my heart to race more not slow down. It's all about managing the time whilst the scar tissue in the maze develops I guess.
Not ideal....but I do see the choices are limited.
Wishing you 'a balance' very soon. You have been so kind and supportive to me in the past , I am not sure I can offer much to help except to suggest perhaps e mail your old Endo and run it by him/her or for a one off appointment to help you through this time......if that's at all possible.
I did notice on the NHS website for thyroid disease info, that they do now reference NDT and mention if a patient transitions from NDT to Levo for eg, that if a patient is on 1grain of NDT to start them with 50mcg of Levo !!!! and retest bloods in 6 weeks .....So well below what may be truly needed. Goodness only knows what would be prescribed for folk on 2 or 3 grains.
That's why I wondered if your old Endo may be more constructive or at least steer you to a sympathetic colleage with NDT knowledge....a rare breed I realise.
Woe that's a low level. Honestly I just don't think they know what they are talking about. 1 grain = 38mcg of T4 & 9mcg of T3. If T3 is 3xs strength that's 27mcg some say 4x 36mcg. I would have thought 75mcg was closer..... But thats ignoring the fact that NDT works differently to monotherapy. Sigh....
Yes have decided to chase up my old Endo who does some private work but not unless I have to.
Yes it is. Should I suspect be 75mcg of Levo and approx 5mcg of Liothyronine to replicate 1grain ,depending on the individual possibly 84mcg Levo........I find the whole thing terrifying if one was to end up in hospital.
Wishing you all the very best Waveylines, you inspire me alot to keep going. Thank you.G
Awww thank you. You will find what's best for you. Bare in mind equivalents are all estimations..... It all comes down to what you find most effective and leaves you feeling the way you did pre Hypothyroidism. That's what really counts.
When it comes to conversion Amiodarone can raise or decrease thyroid levels. After being on it for about 7 weeks my T4 went over range. Levo was reduced from 75/50 alternate days to 50 daily. Retest 8 weeks later still over range. Levo dose reduced to 50 every alternate day. By the way, I don't have a thyroid. Doing repeat test this Tuesday.
Thanks Dizzy. That's really useful. I've been on it a month. I reduced my Armour yesterday by a quarter of grain to the lowest I've ever been on (usually reserved for extended heatwaves) and today my heart rate has dropped to into the 80s and I feel better. I haven't tested yet..... Booked for next week as I need to stop Biotin first but when my HR went over a 100 I thought hmmm.... It must be back stacking and didn't want to leave it another week.
Shall stick with the current dose and see where I go.
Hi DizzyD I was just wondering how you are feeling on Amiodarone? Hope you don't mind me asking. Just nice to meet someone else taking this drug and thyroid hormones.
Hi waveylines I posted a more detailed post yesterday re: Amiodarone and thyroid. To avoid repeating myself suggest you read it if you feel inclined to do so. So far got no feedback because I assume not many people on this forum take this drug. I have come off amiod now (August 10 100mg) but due to long half life of Amiodarone I still have hyper symptoms on 50 levo alternative days. I will have to go back on it (amiod) if or when I get called up for maze procedure with Mr Hunter which is supposed to be in November.
If the Amiodarone has pushed your thyroid levels up I honestly don't think the reduction of NDT you made yesterday would have such an effect so quickly. I am by no means an expert just speaking from experience. See my other post (more detailed) if you up to it.
So pleased your procedure went so well and you in NSR. Yippee! For me the elephant in the room is Amiodarone! I bloody terrified of this drug an length of time iodine stays in the body.
OK will. look your other post up thank u. I'm not staying on Amiodarone it's doing more harm than good tbh. I need a conversation with Mr Hunter. Am not due to see him until 25th Oct. Too long. I think I might have to go cold turkey on the NDT for a few days then restart lower dose but how that will work with Amiodarone blocking thyroid conversion etc I really don't know.... This will not help my recovery. The amiodarone is actually causing stress to my body not supporting it. Surely there's a different drug..... Though I know many of the heart drugs seem to work by lowering thyroid conversion.... Lol.
No worries - comes with the job description - though couldn't understand why I couldn't ' ping you ' to DizzyD 's post - but now the 1d has dropped as I was spelling your name without the first ' e ' !!
Take good care - what a nightmare having settled and found your best place with the NDT.
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