I'm just looking for some advice.. I have for a long time been taking a small amount of propranolol to help with panic attacks and palpitations. I am currently pregnant (now 14 weeks) and due to a flare up of palpitations saw the GP who checked my thyroid levels and I'm now diagnosed subclinical hyperthyroid.. unfortunately they've told me I'm no longer allowed my propranolol so kinda struggling with managing the palps and random panic/ tachycardia episodes..
I'm seeing an obstetrician who is going to test my levels again pretty swiftly along with checking for graves (sister found out she had graves after pregnancy, have a history of autoimmune problems in my mum and grandma on same side too).. she was a little concerned about it but was amazing because she actually wanted to explore my palpitations in case it's pots or graves or something etc rather than just anxiety.
So my TSH is 0.03 with normal T3 and T4
My TSH has always been on the low end of normal around 0.3 to 0.6.
My questions really are as follows:
is it really possibly its just the pregnancy causing this? I've had no sickness so can't imagine my HCG levels being out of the ordinary..
Or, could I have always been dipping in and out of hyper causing the palps but masked by the propranolol? Or is this just wishful thinking? I would be absolutely elated to be able to have an explanation for my palpitations and panicky episodes, I've always struggled accepting it's anxiety because the anxiety comes after the palps
If anyone has any shared experiences I'd be grateful for your thoughts.. thank you in advanced!
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Nataliec92
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Drs focus on TSH & often freak when’s it low and assume graves but with Graves your FT4 & FT3 rise very high. Often very high.
There’s lots of reasons for low TSH. Fluctuating thyroid levels as even slight elevations can lower TSH. poor nutrient levels, rarely an issue with pituitary.
What dose of propranolol were you taking? Did you stop due to pregnancy? Did you stop before or after thyroid results?
Propranolol lowers FT4 : FT3 conversion so stopping propranolol will often cause FT3 to rise / fluctuate and this could affect TSH.
The TSH range is wider when pregnant as it’s expected to change more & can often be a trigger for thyroid issues.
Thank you so much for the reply, I think I stopped the propranolol within a day or two of the blood test, I was taking 10mg up to 3 times a day, but was allowed to take a double dose occasionally or an extra dose if having a bad day, so sometimes I may have taken 50mg in a day...
I'd originally had one doctor say I could continue taking it but then another doctor wanted to err on the side of caution and we tried labetolol but the side effects, mainly tremors, took me out for a day so I've gone cold turkey instead...
my FT4 has always been stable, sitting around 11.2 to 11.8, but this is the first time I've had my FT3 (5.6) checked I think so not sure what they've been like over time.. I think the TSH range they use in pregnancy for me is >0.2 but mine is 0.03.. I just want the palpitations and random tachycardia to go away mainly 😅 or an explanation for these flare ups.. I've had full cardiology work up so I'm okay on that front at least though
Thank you for this.. I think fortunately because it is a relatively small dose and prescribed for anxiety, it was low risk I guess.. my palps are levelling out but they just come in flare ups for a few days then tend to to away again for a bit.. ive put my results in another response here but the obstetrician has ordered additional testing for antibodies for me at least, just waiting to hear from someone to go do these and hopefully I'll have some answers
Thank you for this.. yes hopefully it just normalises soon... not that I want to be having any of these issues, but on one hand I was hoping if I am diagnosed graves or something maybe it could explain the years of palpitations and anxiety and would provide some relief knowing it was something treatable... I've never been able to get rid of them, tried CBT, therapy, antidepressants etc.. the propranolol helped but wasn't perfect when I would have a bad flare up
As it transpired, I have come across many women now who did not have a thyroid problem outside of pregnancy. Will their thyroid became a problem much later in life? Perhaps. And, perhaps not.
It just goes to show that thyroid issues are not always life long and there is such variation in people’s experiences.
Thank you very much, so my full results are here:TSH 0.03 range 0.34 to 5.6
T4 11.2 range 7.5 to 21.1
T3 5.6 range 3.8 to 6.8
The ranges look like they're the same on all my previous tests, last tests for TSH was 0.51 and T4 10.1 in 2022.
I currently take the pregnacare multivitamin which has all the vitamins above, but never been tested for them.
I do supplement with magnesium citrate to the full 375mg each day to help with the palpitations, they got worse a few weeks into my pregnancy, forgot to say this was actually accompanied by bad night sweats and some chest pains (seeing GP for this led to the thyroid check) and then a bit worse again when they told me to stop the propranolol..
As I'm with an obstetrician because I was on propranolol, she is ordering a further thyroid panel with antibody checks to check for Graves (which my sister has) asap, but I'm waiting to hear back from midwife or GP to do this but the midwife is a bit slow to respond to me
I think I started propranolol around Feb 2017 for a bit, then I had a little period where I stopped taking it for a while as I was free from panic attacks.. then after a case of shingles went back on it in June 2018 due to palpitations being my main problem...
I had tsh tested in 2014, result was 0.97 same range as above (t4 or 3 not checked)
2019 I had tsh of 0.4 and T4 11.8 same range again but no t3 test... at this time I had a vitamin D deficiency but normal B12 and folate, I had swelling in my neck which is why I was tested and then ultrasound found a small 6mm nodule that nothing further was done about
I didn't know about the biotin though so that's quite interesting, thank you
They've never tested my T3 until now I'm afraid, and I don't think I have any other more in depth results since other than full blood counts.. not sure why there is two vit D results in that one, one may actually be D2 but my records aren't clear
They also didn't bother doing anything about the nodule for some reason, I'm guessing in the UK it needs to be bigger possibly, it was only a singular nodule
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:
Females 18 ≤ age < 40. 30 to 180
Females 40 ≤ age < 50. 30 to 207
Females 50 ≤ age < 60. 30 to 264l
Females Age ≥ 60. 30 to 332
Males 18 ≤ age < 40 30 to 442
Males Age ≥ 40 30 to 518
The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.
Thank you very much.. I actually just found another set of results for Ferritin, in 2021 it had reduced to 30, b12 down to 249, folate 5.9 and tsh 0.63
All the same ranges, so they all dropped a fair bit but never tested the vitamin levels since.. I'll deffo look into the Ferritin and suppose that could maybe increase palpitations too
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
High anxiety has been the worst symptom for me of having issues with my thyroid. This has massively improved now my thyroid levels & key thyroid vitamins are optimised.
As I was initially misdiagnosed as Graves (largely in symptoms- palpitations, tremor, weight loss etc) plus Thyroid Eye Disease- more commonly associated with Graves, I would urge you to ensure that correct antibody tests are completed.
Graves Disease (hyperthyroidism) needs to be confirmed via positive TRab or TSI:
Thank you for this, I've now got my blood test organised for today and I believe they are doing all the antibody checks now as an endo has ordered them all so hopefully there isn't any being missed thank you
Is there a reason for your previous Low B12, were you vegitarian or vegan or were you taking antiacid medications. Were you taking metformin? If not this suggests you are not able to absorb B12 in the gut and taking B12 or multi vits will skew blood results when you really need injections. Maybe take a look at Pernicious anaemia forum for more advice. Anxiety very common with low B12 issues.
Thank you for the above, noo no idea why it was so low, I've never been vegan or vegetarian but haven't always had a perfect diet.. the NHS just doesn't look into any of these things if you're still in range somewhere even if its on the very low end, I'll certainly look into it though thank you
Oh its possible I might of been on lansaprozole at some point around then, had trouble with Gerd and reflux many a time possible bout of gastritis at some point so that could have impacted things
Update: I've had the results from my retest, this is after not taking the biotin for a few days, sadly they've not normalised yet, midwife provided the results of the TSH which has reduced slightly to 0.02 normal T4 but don't have the numbers for these and can't access my maternity records... just waiting on the antibodies results now.
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