Hello newbie question on medication, propanolol

[HealthyBefore]

I have had years of high BP and high HR, with my boss even sending me home for high BP. I have also ended up in A and E with crazy high BP but only recently when the diastolic failed to drop below 100 was I put on BP meds and had a full blood test... only to find I have high antibodies indicative of hyperactive thyroid. T3 and T4 are ok. TSH<0.01

This makes sense to me as I am getting thinner and always 'run hot', stripping off when everyone else has their coats on! However I am relatively healthy and wouldnt be concerned but my heart rate is sitting above 100 at rest and so I have been put on propanolol and taken off amlodipine.

Here is the question though, it says on the box that I should take it once to three times a day. Thats it? how do I decide? The tablets are 40mg. i am worried my BP will rise back up while i work this out.

Has anyone had similar?

My GP has slotted me in for a check up in 3 weeks, but I feel out of my depth. Thanks so much in advance.

[greygoose]

Hi HealthyBefore, welcome to the forum.

Can you tell us which antibodies you had tested? And the results? It would also help people if you gave your FT4 and FT3 results and ranges. Being 'susceptible' to hyper is not the same thing as being hyper, and if your FT4/3 are 'ok', then you're not hyper. What's more, high blood pressure can also be a hypo symptom. So, I think we need more information.

[helvella Administrator]

The antibodies alone would not be having that effect. They would stimulate your thyroid to over-produce thyroid hormone - which would see T4 and T3 being higher than you need.

The T4 and T3 numbers might even be within the laboratory reference intervals (ranges) - but still too high for you.

Did you get the actual results? And the ranges?

Propranolol not only has a direct beta-blocking effect, but also tends to reduce the rate of conversion of T4 to T3. I'm afraid I have no idea about dosing of propranolol.

[Jazzw]

There’s a chance this is Hashimoto’s Disease rather than Graves Disease, so it’s really important to find out which antibodies are high so that you’re given the correct treatment. The fact that you’ve said FT4 and FT3 are “ok” is making me wonder if this is more likely to be Hashimoto’s.

Do you have any results to share?

Regarding how to take the propanolol, does this article help? nhs.uk/medicines/propranolol/

I think your doctor’s prescribed this as though they’re assuming you’ve got too much thyroid hormone sloshing around (thyrotoxicosis) but as I and others have said, this might not be the case, depending on what your thyroid blood results actually are.

However, it will help bring your blood pressure down, so that’s a good thing.

Doctors are often not very good at dealing with thyroid conditions. Many totally misunderstand TSH results. Telling you this now so that you’re prepared… Has there been any mention of referring you to an endocrinologist?

[HealthyBefore in reply to Jazzw]

yes I am on the list. credit to my GP who has also put me down for a scan of my thyroid gland.

[Jazzw in reply to HealthyBefore]

That’s good. 👍

[PurpleNails Administrator]

When I took a higher dose of propranolol. I took it 8 hourly. 08:00. 16.00 & midnight. Or at bed time or on waking if getting early night / having lie in. Always wean off gradually if stopping or changing medication. I was made very ill when Dr said stop taking 40mg x 3 per day abruptly.

[HealthyBefore in reply to PurpleNails]

oh sounds rough. what did you get switched to?

[PurpleNails Administrator in reply to HealthyBefore]

No, the propranolol was just stopped. It was prescribed alongside and antithyroid which was reduced at same time. GP put me back on propranolol as a migraine preventer. I lowered the dose over many months but never stopped completely. This was 5 years ago. Recently I have had high blood pressure and been prescribed ramipril in addition to low dose propranolol.

[HealthyBefore]

T3 6 just within range 2-6

T4 15.4 within range 9-22

TSH<0.01

Se thyroid peroxidase Ab 496.4 range 0-5.6

thaanks for explaining, it looks like Hashimoto?

[SlowDragon Ambassador in reply to HealthyBefore]

That very definitely looks like Hashimoto’s

Early stage Hashimoto’s often starts with temporary hyper type phase as thyroid cells break down releasing excess thyroid hormones

This is not true hyperthyroid

And becomes increasingly hypothyroid as time goes on and thyroid becomes increasingly damaged

poor temperature control, usually being too cold, but some feel too hot ……typical Hashimoto’s symptoms too

To definitely confirm hyperthyroid- Graves’ disease you would need TSI or Trab antibodies tested

You need vitamin D, folate, ferritin and B12 levels tested

These are likely low

Ferritin is often higher with Graves’ disease

[greygoose in reply to HealthyBefore]

I agree, definitely Hashi's.

FT4: 15.4 pmol/l (Range 9 - 22) 49.23%

The FT4 is low-ish, so no way is it Graves'. But your TSH is low because your FT3 is so high. But it's difficult to get doctors to understand that, and they always leap to the 'Graves' assumption when they see a suppressed TSH.