Hyperthyroidism and Covid

[Maddiez]

I was told I've got hyperthyroidism on 29/09/2023. Have been on Carbimazole 5mg three times a day.After 4 weeks still symptoms so put on Propranolol 10mg three times a day.

On 19/11/2023 I tested Covid positive but after 6 days testing negative. Was off work when positive but now on 2nd week off as still short of breath, very tired & easily got vertigo. However I had blood test for thyroid yesterday. Today I nurse called & said blood test shows thyroid now low. She told me it could be down to Covid and that combined is why I'm still suffering post Covid.

I don't know results as was a telephone call but she told me to drop Carbimazole to twice a day then back for blood test in 3 weeks to check again.

Anyone got experience in Thyroid changes & Covid?

[PurpleNails Administrator]

15mg is a moderate starting dose but it’s usual to start on a estimated dose & reduce dose once levels are in range to halt the reduction & keep levels even.

TSH isn’t reliable & can take a prolonged time to rise. Doctors often judge treatment by TSH which can allow FT4 & FT3 to drop too low. Dose needs to be adjusted by FT4 & FT3.

I think it’s more likely you been left on too high a carbimazole dose for you for far too long, but it might be covid has affected your thyroid is some unpredictable manner. It’s also just as likely being unwell has trashed nutrients for example. Ferritin is known to cause breathlessness & this has already been identified as an issue.

You also need to confirm your hyper is Graves & not transient. In which case levels can naturally drop. Positive TRab or TSI will confirm. Note TPO & TG antibodies can be positive with Hashimoto’s and Graves.

[Maddiez in reply to PurpleNails]

Thats helpful information, thanks PurpleNails

[Popscicle]

Propanolol id a beta blocker and one of its side effects is breathlessness. Furthermore it reduces T3 in the blood and increases rT3. Or to put it simply it reduces the amount of thyroid hormone in the blood. So it’s this drug rather than Covid that has caused your drop in thyroid hormone levels. It’s supposed to be a rule of thumb in medicine that you avoid beta blockers in patients with asthma (because of the breathlessness) and thyroid disease. I think this is another example of gps not understanding thyroid disease!

[PurpleNails Administrator in reply to Popscicle]

 Popscicle ,

 Maddiez has hyperthyroidism and takes carbimazole not replacement. The medication is intended to reduce high thyroid levels.

Propranolol does has a mild affect of re-prioritising RT3 over FT3, but this is slight and the main impact on levels will be from the antithyroid. So it can be helpful to prescribe alongside an antithyroid.

Propranolol is usually intended to be temporary as it helps relieves symptoms (not the underlying issue causing the symptoms) & once symptoms are under control it can be gradually reduced. Dropping by 10mg every 4 days could be tolerated by some, but I found lowering dose too quickly an issue & took me much longer.

I was made very unwell when endocrinologist abruptly stopped it & GP resumed it as a permanent migraine preventer.

I was on a much higher dose but reduced by 10mg every other day, every 2 weeks. Once it was under 40mg I reduced by 5mg. Still on 30mg a day.

[Popscicle in reply to PurpleNails]

I realise thanks to you and lalaloot that my comment was confusing. When I said “I suggest you leave your thyroid hormones ,,,,” I was referring to carbimazole not levo but I didn’t make that clear. I never thought the poster was initially hypo, I knew she was initially hyper but I didn’t make those 2 things clear so I apologise. Because she had only been using propanolol a short time it was suitable for her to follow a relatively fast reducing regime. I’ve always found it contradictory in medicine that on the one hand propanolol is included in the treatment of hyperthyroid disease whilst on the other hand it’s advised not to be used in thyroid disease (because for some the side effects can be quite disabling).

[Popscicle]

Ps - propranolol reduces heart rate and blood pressure. This leads to less blood available to carry oxygen all over the body per minute leading to fatigue/tiredness as well as breathlessness. Symptoms are even worse during exertion or exercise. This drug is doing you no favours. I suggest you don’t alter you thyroid hormone dose but wean yourself off propranolol and then retest TSH, T4 and T3. Reduce propanalol to 10mg twice a day for 4 days, then once a day for 4 days then stop. If you were to stop it suddenly you could get extreme rebound hypertension.

[Maddiez in reply to Popscicle]

That's very interesting Popscicle, I had wondered that as was given it after 4 weeks on carbimazole but still having heavy palpitations so the point was reduce heart rate. I was sent another 4 weeks worth of propranolol on Tuesday so without speaking to them do you think I should reduce to 10mg twice a day for 4 days, then once a day for 4 days then stop from today? I've a follow up thyroid blood test on 27th December.

Thanks for your help.

[Popscicle in reply to Maddiez]

I would let the gp know. As you’re probably aware, propanolol is regularly used as part of the treatment for hyperthyroidism because it helps to lower T3 and therefore HR but it also reduces HR independently. But in your case it is causing extreme fatigue and breathlessness which is much more than was intended. It’s for this reason I think you should stop it or at least reduce it but it would be wise to let them now. As I’ve said to others I’ve always found it strange in medicine that on the one hand propanolol is used in the treatment of hyperthyroid disease but on the other hand it is advised not to use it in thyroid disease of either type because of the side effects.

[Lalatoot in reply to Popscicle]

Popsicle hyperthyroid standard correct treatment is propanol and carbimazole.You are assuming the poster is hypo and on levo which they are not.

[Popscicle in reply to Lalatoot]

I know the poster was initially graves. However she was describing symptoms of going towards hypo which of course is what happens in Graves’ disease. The ideal as we know is to find a balance. However, propanolol does Hv some pretty awful side effects and may be contributing to her overall symptoms regardless of its effect on T3. For the poster it doesn’t seem to be helping if she has to put up with the effects of fatigue and breathlessness. I’ve always thought it contradictory in medicine that on the one hand it is included in treatment for hyperthyroidism and of the other it is advised not to be used in patients with thyroid disease.

[Popscicle in reply to Lalatoot]

But Thankyou lalaloot, I can see why you thought I thought the poster was on Levo. My comment “I suggest you leave your thyroid hormone…..” was referring to carbimazole but I didn’t make that clear. Apologies.

[Maddiez]

As I was near my local pharmaceutical this afternoon I called in. I know they can't prescribe like Dr but my Carbimazole & Propranol was only prescribed to me by the surgery nurse with Dr putting their name on it.The pharmacist agreed with Popsicle that as I feel very short of breath it's wise to gradually reduce & see how I get on. I've only had my morning one so will take other later & have that regime for a few days & see if I feel better.

[Popscicle in reply to Maddiez]

Please let us know how you get on. It must be awful for you being so knackered and breathless and I imagine you are quite worried about work and what if they don’t understand why you need more sick leave.

[Maddiez]

Thanks again Popsicle. I understood what you meant & after your suggestion & the pharmacist agreeing I cut down 10mg yesterday. Today I am still easily short of breath but this morning began easier so I'm hoping that continuing 10mg less for a few more days the improvement will last longer through the day. Although it's only the weekend I've already decided I'm not going to be fit to work next week so will call Dr Monday morning