Changing beta blockers

[Cavapoochonowner]

Hello everyone,I have Graves disease and had a thyroidectomy in June 2022.I am on levothyroxine only.I am having conversion problems but I am on 20mg proprananol 3x a day for migraine prevention.I definitely need these, but know proprananol can interfere with conversion T4 to T3.I have an appointment with the pharmacist at my GP surgery on Thursday (telephone) and am going to suggest atenolol or metoprolol as they can also be used as a migraine preventative. Has anyone swapped beta blockers,and if so what did you swap to and what was your experience. I am willing to try,as I don't want the palaver of sourcing T3.

I am doing other things like getting vitamins optimum,trying to eat enough and trying to be active(though no actual exercise, as I am concerned about thumping heart).

My endo has discharged me with an over range T4 24(12-22) so I have reduced my levo 25mcg a week to try and get in range.He ignored my email when I said I didn't feel well with T4 over range.But I'm glad now he's thrown me off back to GP as I can try and sort myself out.

Thankyou in advance for any advice.

[Sparklingsunshine]

There are lots of anti migraine drugs GP's tend to offer beta blockers as a first line drug but there are others that dont interfere with conversion. Notably very low dose antidepressants like Amytriptyline or Nortriptyline. There is also Topiramate, an anti epileptic.

Calcium channel blockers like Candestarten are also becoming more widely prescribed. Propranolol was the first drug I tried for migraine but it aggravated my asthma so was discontinued.

[Cavapoochonowner in reply to Sparklingsunshine]

Hello there,thankyou for your reply.I am already taking amitriptyline 20mg per night as a preventative. Sorry ,I should have said.I have been taking that since 2014.It was working fine until I developed graves,then everything went haywire.My GP added proprananol and that is also working, alongside the amitriptyline, except for my very low conversion.I will see what the pharmacist has to say and see what options they have,though I would like to stick with a beta blocker as it is working for the migraines.

[bantam12]

Bisoprolol can be used as a migraine treatment. I’ve been on it for 4 years (not for migraine ) and it’s not caused any Levo conversion issues for me.

[Cavapoochonowner in reply to bantam12]

Thankyou for that.When I went to A and E once with a bad migraine and fast heartrate they gave me a small 5mg dose of bisoprolol and it did help.I was slightly overmedicated on levo at the time(as I am at the moment).That's another one I can suggest,thankyou.

[Buddy195 Administrator]

I had awful headaches when my FT4 was over range, so this may be at play too. I would Levo reduce very slowly, as I found that large adjustments can worsen palpitations. Try 12.5mcg reduction, alternate days at first until well tolerated.

Sending you best wishes Cavapoochonowner 🦋

[SlowDragon Administrator]

if you can improve conversion of Ft4 to Ft3 by getting off the propranolol then Ft4 is likely to reduce anyway

[Cavapoochonowner in reply to SlowDragon]

YJust to add,I am trying to avoid T3 because I think it might be to strong for me.After I've taken my levo I can almost feel it whooshing through my body and I think the beta blockers help with the thumping heart.I went for an appointment with My Future Health last week and she asked me what I'd been doing before coming as my heart rate was 99 and my blood pressure was up.I had just walked 50 yards from the car.I think it was because my levo dose was too high.Hopefully that will improve.

[Cavapoochonowner in reply to SlowDragon]

The reply I just sent was for Buddy,sorry .Yes I have only reduced my levo by 25mcg over the week so if I can get a different beta blocker and improve my conversion it would be great.

[Cavapoochonowner]

Hello Buddy,I too have more headaches when T4 is over range.I think the proprananol is staving them off.My endo had left me over range to get my T3 in range.Ft4 24.8 (12-22)

Ft3 3.7 (3.1-6.8)

But I am feeling it.I was on 112.5mcg levo mon-sat

100mcg levo Sunday

So I've dropped 25mcg over the week going to 112.5mcg mon-thurs and 100mcg fri-sun

I will test again in about 8 weeks.

I'm hoping a swap of beta blockers will help my conversion.

Thankyou for your best wishes and the same to you.

[Buddy195 Administrator in reply to Cavapoochonowner]

I wouldn’t rule out a small dose of Liothyronine in the future. I felt awful with FT4 at the top of the range, but found a small amount of T3 made a big difference (alongside a reduced Levothyroxine dose). This was actually recommended by my TED specialist ophthalmologist and (for me) really helped.

[Cavapoochonowner in reply to Buddy195]

Yes,I'm keeping that in mind,but I want to try everything else first.I would probably use Roseway labs for it.My TED specialist has discharged me now as it isn't active anymore,but he said my thyroid levels must be kept stable as it could flare up again any time.I have to ask to be referred.I to endo if I think anything is amiss.No thanks I'd rather see to it myself.Glad you're feeling better.I don't feel so bad but could probably feel a bit better.Hopefully a change of beta blockers will help.I do know I definitely can't do without them.All the best.