Heart palpitations and levothyroxine

[Loganrg5]

Hello,

I posted recently about my newly diagnosed subclinical hypo; to recap, I'm a 34 year old male, healthy, fit, tsh of 7.23, t4 on the lower side of normal, same for t3.

I have been on 25mcg of generic Levo for four weeks or so now - for the past week I've had trouble catching my breath, especially when exercising, and today I can add flushing, nervousness, and heart palpitations to the list.

I know that these are listed as side effects of the Levo, and I will mention them to my doctor in a couple weeks when I go for my blood tests, but I'm curious how serious they are. Should I stop taking the meds? Will symptoms like this go away after a while? I'd almost rather be hypo than have heart palms every time I walk up a hill.

(Some important background is that I had some heart palps from anxiety a couple years ago, had a full work up and was given a clean bill of health. No heart disease or structural problems.)

Thanks in advance, everyone - this is nerve wracking!

[Barb135]

It sounds like you should stick with the doctor at the urgent care facility, if you have that option, since he definitely thinks you not only need treatment, but an increase in med as well.  While 7.23 TSH might only be "mildly" elevated, it's not the TSH that causes symptoms in the first place; it's the lack of the Free T3 and Free T4, which are the actual thyroid hormones that causes symptoms.  TSH is simply a messenger from the pituitary, trying to get the thyroid to produce more hormones.  

Yes, we can send private messages on this site and you're welcome to contact me whenever you like.  Just hover your cursor over my name, then click "Send Message" and you'll get a blank form to do so.

[Loganrg5]

Hi again-

Thank you very much for replying. I see a lot of anxiety reading through the messages on these boards, and it's nice to have people like you to help assuage some of it. A couple other people on my previous post were very sweet as well.

I actually went in to my university's urgent care clinic today after some palps that just felt awful. The doctor I saw looked over my labs again and said I should definitely not stop taking the meds, and that the symptoms will likely go away with time, or a dosage increase. Whereas my PCP didn't really even want to start treating me, saying that a 7.23TSH is only mildly elevated, this fellow thinks that I should definitely be treated. When I go in for labs in a couple weeks I will make sure that they are doing better tests.

(I teach at a U-California school, and am subject to their health plan, which doesn't leave me a lot of wiggle room regarding doctors or care. Seeing an endo was out of the question - they assured me that my current doc has a "special interest" in thyroids. I guess that's nice.)

So, thanks again, and I may write you in the future for more reassurance, if I can be so forward. Can We send private messages on this site? I haven't really looked into it...

[Barb135]

"I'm new to this stuff and it's no fun."  I agree -- I was once new it and it was no fun...

It's unfortunate that your doctor ordered some obsolete tests; those would be Total T3 and T3 Uptake.... They tell very little about what's going on with your thyroid, but we'll use them as far as we can. Many doctors don't do Free T3 and if yours refuses when you ask, you should think about finding a different one.

Were these labs before you were prescribed the 25 mcg levo or have they been done since? I'm guessing they were before, since the TSH is  so high.

I agree that your levels were low in the ranges and warranted med.  Even though your antibodies were negative last year, you should ask to have them done again.  Make sure they do, both, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb), since either/both can be the basis for a diagnosis for Hashimoto's.  If you have the reports for the antibody tests, please post them.  You might really have Hashimoto's, which can be a real game changer when it comes to thyroid hormone levels, medication dosages, etc.

Clarification:  the symptoms you're having (heart palps, shortness of breath with exertion, nervousness and flushing can be symptoms of too little medication... I had them when I was on too little medication.  Be aware though that they can also be symptoms of too much medication so if they don't go away within a few weeks of a dosage increase or if, at any time, you fee that you are in medical distress, you should go to the nearest ER got get checked out... Just remember that TSH is sometimes suppressed even when thyroid hormones are lower than we need them...

That's the worst thing about thyroid issues.. I thought I knew all the symptoms to look for with over medication, but when I had them I found out I was still under medicated... it takes time to learn it all, but you'll get it,  eventually...

[Loganrg5]

Hello, Barb135.

The latest tests look like this:

T3 total: 109   range: 84-172 ng/dl
T3 uptake: 33.4   range: 23-36 %
T4 free: 1.1   range: .8 - 1.8
TSH: 7.23 mIU/L

I do not have the results for free T3; I was also negative for antibodies one year ago when they did that test (they didn't do it this time).

So, clarification question: you say that being on too little medication can have the same effects, but is that due to the medication or to the hypothyroidism itself?

Thanks for replying, I'm new to this stuff and it's no fun.

[Barb135]

I'm sorry I must have missed your other thread.  Did you post your current thyroid lab results on it?  If so, can you copy/paste them onto this thread for me?  Be sure that the reference ranges are included, since ranges vary lab to lab and have to come from your own report.

Side effects of the levo are, typically, symptoms of hyperthyroidism; however, shortness of breath, with exertion, along with heart palps, nervousness and flushing can also be symptoms of too little medication.  I had them all when I was very hypo.  They went away when my levels became adequate.

If you're due to see your doctor in a couple weeks, you should also be due for new blood work; that will tell you whether your levels are getting too high, but I'd doubt that they are.  

It takes 4-6 weeks for the med to reach full potential in your blood and you should not stop taking it without your doctor's okay.  25 mcg is a very small dose and is almost never the final dose.  

Have you been tested for thyroid antibodies?