Levothyroxine and propranolol

[Chasing-rainbows]

Hi, I'm taking Levothyroxine 75mcg and have been prescribed Propranolol for heart palpitations.

I'm a bit worried about taking it though in case it affects the levothyroxine. Does anyone here take both of these together?

Thanks in advance.

[PurpleNails Administrator]

What dose of propranolol?

Levo should always be taken on its own, away from other medicines, supplements, food.

Propranolol lowers uptake of T4 & conversion to FT3, many are prescribed it when hyper.

closely monitor thyroid levels. Are these optimal? As low or high levels might be causing palpitations.

I remained on low dose it as a migraine preventer. Should always be stopped gradually.

Can also lower magnesium levels.

Have folate, ferritin, B12 & vitamin D been tested?

[Chasing-rainbows in reply to PurpleNails]

40mg up to three times per day.Latest TSH 1.44 (0.55-4.78)

T4 15.2 (11.50-22.70)

Ferritin 21 (15-300) This has dropped from 50 when I did a medicheck test recently, so whether it's due to different lab or its actually dropped I'm not sure.

[Chasing-rainbows in reply to Chasing-rainbows]

These were about a month ago. I was on 50mcg levothyroxine then but Ferritin seemed better?

Results

[PurpleNails Administrator in reply to Chasing-rainbows]

That ferritin is very low under 30 is deficiency. Over 80 is optimal so 50 was also low.

See if GP will do iron panel or arrange one privately. As if you have Anaemia it is strongly associated with shortness of breath & palpitations. You cant assume without iron panel & should supplement iron without checking.

120mg is high daily dose of propranolol. Doctor may have assumed palpitations are anxiety related rather than investigate what cause is.

Your TSH is better from 3.8 to 1.44 but your FT3 was very low and we don’t have a comparison to see if that has significantly improved.

TSH isn’t always reliable to assume FT3 is optimal.

[Chasing-rainbows in reply to PurpleNails]

I've only been on the higher dose of 75mcg for about a month so I will get another medicheck test in another 2-4 weeks to see how things are then, that way I'll get a FT3. I didn't realise it was low before, I was only looking at the TSH, I'm still not very good at understanding it all!

I've had this low ferritin for so long now, but actual iron levels are good usually. I've got some ferrous fumarate tablets so I'll try and get those up if I can.

Unsure what to do next about the palpitations, stress/anxiety definitely playing a part. Hopefully not cardiac related. ECG was ok but GP mentioned 24 hour tape to get a better look if the palpitations continue.

[SlowDragon Administrator]

Your high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Are you on strictly gluten free diet

If not that’s next step

Get coeliac blood test via GP FIRST BEFORE cutting gluten out

I was stuck on propranolol almost 20 years (4 x 10mg per day) and it significantly reduced conversion and uptake of my thyroid hormones …..you might find my profile info helpful

You’re currently very under medicated for thyroid

Retest 6-8 weeks after latest increase

Approximately how much do you weigh in kilo

Unless extremely petite likely to need to eventually be on at least 100mcg daily

Which brand of levothyroxine are you currently taking

Is it different from previous brand

Only brand that makes 75mcg tablets is Teva

Teva brand upsets many people

That’s a high dose propranolol

[Chasing-rainbows in reply to SlowDragon]

I'll post back when I retest later this month. I'll have a read through your profile/experience of propranolol. I weight 50kg so I'll see how things are looking on 75mcg. My 50 mcg are Teva and the 25mcg are wockhardt? They are prescribed separately and I combine them at the moment.Tried the gluten and dairy free but didn't see long lasting improvement unfortunately so gave up!

[SlowDragon Administrator in reply to Chasing-rainbows]

So guidelines suggest daily dose levothyroxine at 80mcg per day

80mcg x 7 days week = 560mcg per week

Currently 7 x 75mcg = 525mcg per week

So you shouldn’t be far off correct dose……however depends how good your absorption of levothyroxine is

Some people need higher dose than guidelines

Or different brands levothyroxine give better results

You do need to improve low ferritin levels. If iron is good/high, you can only increase ferritin by increasing iron rich food in your diet. Red meat daily, liver or liver pate once week. Orange juice or vitamin C to increase iron absorption etc etc

[Chasing-rainbows in reply to SlowDragon]

That's interesting about the dose guidelines thanks. It's frustrating about the ferritin, I eat red meat, drink orange juice etc but think my heavy periods mean I'm fighting a losing battle. I'll post back when I retest, thanks for your help.

[SlowDragon Administrator in reply to Chasing-rainbows]

Heavy periods often improve when thyroid levels are optimal

Low ferritin can cause palpitations

[lynnwin in reply to Chasing-rainbows]

Doesn’t orange juice hamper absorption of Levo ?

I’ve been taking propranolol for 19 years took it originally for Thyroid toxicosis I have Hashimotos and was taking Levo for 11 years but recently my T3 was dropping all the time .. I went to see a private endocrinologist and now on T3 started on 5mcg and now gradually upped to 20mcg T3 and 50mcg T4

I’m starting to think the propranolol is the reason my T3 isn’t good ? I stayed on the propranolol as when I was weaned of it after treatment for my hyper symptoms with carbmonazole I got my bad migraines back 😞 I take 30mg a day propranolol xxxx

[thyreoidea]

I used to take my propranolol 40mg with my Levothyroxine & Omeprazole together for years until I developed ectopic heartbeats during 2021 and looked into each medication closer and realised the Propranol and especially the Omeprazole could affect absorbtion, took separately but didn’t improve ectopics but ultimately I went from 150mcg Levo to 100mcg now. Through the years it use to vary between 125-150mcg.

I Took my propranolol after realising, about 2 hours after Levo but others may advise a shorter period.

I never felt any different through all my Levothyroxine dose changes.

[Chasing-rainbows in reply to thyreoidea]

Think I'll try and hold off taking it for now and see how the palpitations go. If I do take it I'll make sure to take it separately to Levothyroxine. Wish the palpitations would go away though they're horrible!

[thyreoidea]

I agree about the palpitations being horrible, are your skipped beats of the heavy fast beats?

[Chasing-rainbows in reply to thyreoidea]

Sometimes it feels like it's skipping a beat but usually it's fast sometimes going up to 150 bpm. Feels like it's either pounding or fluttering.

[thyreoidea in reply to Chasing-rainbows]

Mine were the fluttering type and a strong beat after a missed one, it is very worrying at the time. Every time I literally moved or walked about for about 10 months. Hopefully you will get a holter recorder to monitor but the waiting list is very long. The good news it that they are usually harmless.

[Chasing-rainbows in reply to thyreoidea]

That's reassuring thank you, I've bought an at home ecg that connects with my phone so I'll keep an eye on it in the meantime.

[shaws Administrator]

I've always taken my thyroid hormones with one glass of water .when I awake and wait an hour before I eat .

I also had severe palpitations when initially on levothyroxine and was prescribed propanolol but these palpitations resolved when I was prescribed liothyronine (T3).

I now take T3 alone when I awake with one glass of water and wait an hour before I eat.

I am prescribed T3 (liothyronine) and feel well and energetic again. No unpleasant symptoms.

I hope you can resolve your symptoms.

[Chasing-rainbows in reply to shaws]

Thank you, fingers crossed!

[lynnwin in reply to shaws]

I thought it was ok to eat straight away with T3 ? and not the usual hour wsit like with Levo ? Xxxxx

[shaws Administrator in reply to lynnwin]

Well - I don't want food or anything else to interfere with the uptake of T3. as I am well with no symptoms. I take it when I awake with one glass of water and an hour passes very quickly.

I follow the advice of Dr John Lowe who was an Adviser to TUK before he died due to a fall that caused a brain bleed. He was also a scientist/researcher and expert on T3. He took his T3 in the middle of the night when he awoke.

If there's some 'change' in a T3 it can affect me badly andI my body is aware of any 'change' that I have to change to 'another' make of T3.

[lynnwin in reply to shaws]

Hi thank you shaws for replying.. my problem is I work as a phlebotomist and my shifts are early so would mean me taking my T3 and Levo at 04.45 am .. I was told that I could get a problem with my adrenals by taking it so early 😞 so I take Levo on waking wait a hour before breakfast and take my T3 to work and take it around 9am .. I do sometimes eat when I take the T3 as was told it’s ok to eat with T3 ?? l loved all Dr Lees work have some of his books

I have been on T3 since July this year and have to take Thybon Henning as allergic to the fillers in the UK ones

it’s a pain having to take it to work but I don’t want to cause myself anymore problems xxxx

[shaws Administrator in reply to lynnwin]

You could take your dose of thyroid hormones at bedtime - as long as you've last eaten a few hours previously. Some might take their dose during the night if they awaken. I think a number of people may get up during the night to go to the toilet.

Dr John Lowe - was a scientist as well as an expert on thyroid hormones and an Administer to Thyroiduk.

It's unfortunate that Dr Lowe had a bad fall that caused a bleed in his brain and that was the cause of his demise.

I'd never take a chance that my dose of thyroid hormones could be affected by food.

I feel well on my dose and am symptom-free.

[lynnwin in reply to shaws]

Thank you but will the T3 run out ? as thought it was almost instant?

I suppose it trial and error ?

Xxx