Palpitations and thyroid

[Minsan]

Hi Dr,
I am a 43 years old woman.I was on eltroxin 100 mcg for the last 13 years without any compliacations. In 2004, I started concor 2.5 for high blood pressure. Everything continued to be under control. I was moderately active and healthy. My BMI is around 25. In May 2006, I started to have palpitations,continuous and disturbing. I doubted excess thyroxin, but blood results showed normal T3,T4 and TSH. I was asked to increase my tab to concor 5. It was blamed on work, stress etc.I was asked to relax, which I did. Palpitations subsided, but returned in October. This time a Holter Monitor test was done. The cardiologist dismissed the few occasional beats and said there is no heart problem.I was asked to relax, but palpitations continued. Then I stopped eltroxin for a trial and then palpitations stopped. I felt a lot better. But after two months when I took blood test, T3 and T4 were below normal and TSH very high (20).My cholestrol also went upto 235. Since this indicated hypothyroidism again, I was asked to start eltroxin. In Jan 2007, I started eltroxin 25 mcg. I continued to take concor 5 all this time.

Now for the last one Month, I get palpitations. Now my blood pressure is also high.The new endocrinologist I met this time says I should never have taken a beta blocker like concor with thyroid disorders.No one had said this before. Now Iam advised to take eltroxin 50 mcg, Librocol and one invoril-10mg.I just started this combination,results are yet to be seen.But I dont feel alright. Even the new Dr is saying I should ignore this and everything is fine. With this fluttering heart, tight chest and throat, I feel bad. My pulse is 80/min.
Please advise me about what to do. Is this serious?
Minie James
P.S. My father died of heart failure at 51. My mother is taking tabs for high bp but under control and is otherwise healthy at 80.

[Mark Lupo, M.D.]

Tough situation.  I do not know of any reason to not take a beta-blocker with thyroid meds.  Sounds like you need some eltroxin (50mcg makes sense) to keep TSH reasonably normal (?2-4 range given the palpitations).  Also, would suggest another cardiac eval with heart monitor and heart ultrasound.

[saro]

I am a 47 years old woman. I have been on eltroxin for approximately 10 years.  Last December the doctor found nodules growing on my thyroid. January this year I saw a suregon who did a physical examination and looked at my thyroid with the sonar.  He said that we should wait 6 months to see if anything develops. He did not ask me to do a blood test. At the end of March, on morning I woke up with panic attacks, heart palpitations, shortness of breath, sweating in my palms.  I thought I was suffering from post traumatic stress but the symptoms were very "Physical".  After about 10 days when they did not pass I went to me GP who did a blood test and found my eltroxin level to be too high. He halved my dose beginning April 13th.  Things did not improve.  Last week Wednesday (May 2nd) I stopped all eltroxin and the doctor gave me inderal 10 for the heart palpitations - one morning, afternoon and night.  I have noticed a slight improvement each day in my condition but I still suffer from the anxiety, nervousness, palm sweats. My heart palpitations have lessened so I am decreasing the inderal (one per day at night).  Last Saturday, May 5th, another blood test was done and it indicated that my T3 and T4 levels are now within acceptable range BUT I am still having the symptoms of anxiety, shallow breath, sweating in the palms, and headaches.  Do you think this is just the effects of my body flushing out the eltroxin even though the T3 and T4 levels are OK?  How long does it take for the eltroxin to clean itself out of my system?