high thryoid levels but back to bradycardia?!

[Pearlteapot]

Good evening.

I am seemingly fully replaced on a combi dose of Levo and Lio and generally feel quite well in myself, can tolerate exercise and lead a normal life.

My partner commented that I was breathing very fast at night so I have started to wear my apple watch again after a few months leaving it well alone. It turns out that my resting heart rate is back down at 48. That's where it was before I was diagnosed with hypothyroidism in 2022. Since I started the medication journey it has crept up to around 59. I just can't understand how my RHR can be so low while I am fully replaced. In fact my blood test suggests that I am over replaced on T3.

Does anyone have any thoughts on how this could be?

I will probably make an appointment with my GP but I am reluctant to go that route since I get my T3 from a functional doctor and don't want to start arguing my low TSH with hospital endos.

I am now on 125mg Levo and 35mcg Liothyronine. My February fasted results with blood taken at 7.30am, (17 hours after T3 dose and 24 hours after T4 dose) are:

T3 6.9 (3.1-6.8)

T4 20 (12-22)

TSH 0.005

many thanks for any ideas.

[SlowDragon Ambassador]

You do look over replaced

You might find heart rate increases by reducing your T3 a little

Try 5mcg reduction.

Wait 8-10 weeks and retest

Are your vitamin levels optimal

[Pearlteapot in reply to SlowDragon]

Hi there. May I ask why do you think a reduction would increase my HR? This morning I re-tested to check the last levels weren’t an aberration. If still high I will reduce by 5mcg but worried about my Heart rate dropping further.

[Incoguto in reply to Pearlteapot]

Hey Pearlteapot, hope you're well! Have you dropped your dose and did increase your rhr? I am in a similar situation right now

[Pearlteapot in reply to Incoguto]

I reduced my t3 by 5mcg. Heart rate horrible low/worse. Waiting for ecg in case heart block.

[Incoguto in reply to Pearlteapot]

Oh dear I'm sorry, so it is worse with the decrease??

[Pearlteapot in reply to Incoguto]

My nighttime rhr is often 43, daytime is average 53. Quite a long wait for ECG which will be mid June. Thanks for reviving this thread. I might retest and increase.

[Incoguto in reply to Pearlteapot]

Good idea to retest and increase, both rhr quite low, my nighttime is 59 on average

[Pearlteapot in reply to Incoguto]

I think nighttime 59 is normal and nothing to worry about. Presumably your daytime rhr is higher

[Incoguto in reply to Pearlteapot]

Yeah I think so, sometimes it goes up to 60-62, daytime is 70-80

[McPammy]

My resting heart rate goes into the 40’s if I’m over medicated. I take t4 levo and t3 as combined treatments. I’m very well and can exercise easily. I wear my Apple Nike watch to check my exercise, steps and heart rate. If I’m going over medicated which I can detect by waking too early or hunger or dehydration I just omit one dose of T4 then the next day I’m back to normal and heart rate resting also back in high 50’s. I never alter my T3 dose as I’m never over range. However, with your levels your T3 is too high aswell as T4. How much and when do you take your t3 and t4. Do you space 8hrs between staggered doses. I also split my T4 dose. Looks like you’re on too much thyroxine both t4 and t3. I get my bloods checked with and without taking my meds to ensure I’m not going over or under

Once I was over medicated on levothyroxine prior to taking T3 my resting heart rate was 37 I was admitted to hospital No bradycardia it’s was over medication of levothyroxine T4 So it’s not always T3 it can be t3 or t4 once I took less Levo my heart rate went higher back into high 50’s

[Pearlteapot in reply to McPammy]

That's really interesting as the general commentary seems to be that over medication leads to medication induced hyperthyroidism, including a racing hear rate.

[McPammy in reply to Pearlteapot]

Mine goes lower. Every time. My sister is the same. Wired and tired Msybe my body saying slow right down

[ainslie]

48 may not be your real heart rate, when on holiday recently I noticed my finger pulse oximeter showed heart rate of 34, confirmed on my blood pressure device, spoke to my GP by phone, he said get a ECG asap. Did that and cardiologist said my real heart rate on ECG test showed 62 but on checking my pulse at same time was 40. This he explained is because I have developed premature ventricular beats or extra ventricular beats, quite common alleg. I don’t know if that explains your heart rate but maybe worth checking with a cardiologist or a ECG if you can get one.

[josephinius1 in reply to ainslie]

I developed PVCS about the same time I started taking levoxythyrone. My resting heart rate also dropped to the low 40s (but I also started running, to try to offset the weight gain/metabolism slow down.) Every doctor I saw seemed to feel my heart rate was because I was running, the PVCs random. I'm not running now (I've developed really bad osteoporosis,of course, also random as far as medical science is concerned,) and my heart rate HAS risen to the low 50s, but occasionally will register in the 90s or low 100s if the monitor they use catches the missed beats. No one seems particularly concerned.

[ainslie in reply to josephinius1]

One cardiologist I saw said PVC’s can be very sensitive to many hormones and unfortunately also alcohol, many develop them after drinking a bit much on holiday apparently

[josephinius1 in reply to ainslie]

I rarely drink and I'm very postmenopausal, but thyroid is a hormone. It was hard not to think the levoxythyrone caused the PVCs since they happened at the same time, but as I say, no doctor included cardiologist has associated the two. Maybe because (in their view?) the only way to treat Hashimotos is with thyroid hormone (synthetic, no less,) and the effects of low thyroid are worse than the effects of even frequent PVCS, which in my case, is 100% true. But the question is, or was, is there a way to treat Hashimotos without drugs? Some might say there is, but as with so many other things, it requires work and there are (probably?) no guarantees? This is a case where I'm okay with the trade-off.

But now that I have wicked osteoporosis, which may also be associated with the whole metabolic mess I have going on, and my PVCs seem to be getting worse (with the potential of cardiomyopathy? stroke?), one does start to wonder if getting at the root cause wouldn't be the better route? I just don't know if I have thyroid function at all any more.

Isn't it fun?

[Incoguto]

If I were you, I'd check bloods again in case something has changed, because it really can. Also,what's your resting heart rate at night? 48 is low. But, it's true that some people have bizarre hypo symptoms when a little overmedicated. I'm saying a little, because when you truly would be gor longer periods of time, after a while your RHR will eventually spike.

[cardsnut]

Perhaps your T4 dose is too high, resulting in high Reverse T3. your free t3 tissue level may not be adequate despite high Free T3 blood levels. Maybe the Reverse T3 is preventing Free T3 from getting into the cells.