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Heart rate
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Heart rate

I had radio active iodine in March.  On October 29th, I started taking 112 mcg of synthroid and having problems keeping my heart rate down.  It runs in the 90's to 105 even after taking propanol three times a day.   Am I taking too much synthroid?    My doctor is 80 miles away and hard to get in to see him.
16 Comments Post a Comment
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Avatar_m_tn
Do you have any other symptoms besides high pulse rate?  If so, what are they.  Also,cannot comment on Synthroid dosage without looking at your test results.  Please post your thyroid related test results and their reference ranges shown on the lab report.
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Avatar_f_tn
I know that my last reading was 8.4.    I did not see it but the nurse told me on the phone.   I don't see the doctor until January.
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Avatar_m_tn
So far with the limited info, I am not very optimistic that your doctor knows very much about proper testing and treatment of thyroid patients.  If you had the RAI in March, the end of Oct. is way too long before starting on replacement thyroid med.  Second, 112 is much too high for a starting dose.  That alone could account for your reaction.  Third, testing only TSH is totally inadequate.  

TSH is a pituitary hormone that doctors like to believe accurately reflects levels of the biologically active thyroid hormones, Free T3 and Free T4.  In reality TSH cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important consideration.  Your doctor should be testing for Free T3 and Free T4 (not the same as Total T3 and T4) every time you go in for tests.  In addition, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, those should be tested as well.

I have the name of a doctor in Little Rock, that is reported to be a good thyroid doctor.  By that I mean a doctor that will treat a hypo patient clinically, by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  I  recommend that you go ahead and make an appointment there, instead of waiting to see your current doctor in January.  If you are interested, I will send a PM with doctor's name.  
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Avatar_f_tn
Thank you.    I really have no idea what tests are done because I have never seen the results.    I am very concerned about my heart rate.   There are tmes that I feel just like I did before taking RAi.    My doctor said it takes 8 weeks to get the true results of my meds so that is why I haven't called him.
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Avatar_m_tn
How about calling and getting results and their reference ranges from your doctor's office and then posting here so can better assess the adequacy of your testing and treatment?

It doesn't take 8 weeks to get a good idea of the effect of changes in thyroid meds.  Over 90 % of the effect on blood levels will show up in 4 weeks, which is about now.  Is there a local doctor that you could at least get to do the tests, rather than having to travel 80 miles to your thyroid doctor?  

You did not respond to my mention of a good thyroid doctor in Little Rock.  Are you interested in that possibility or not?
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Avatar_f_tn
I will try to call tomorrow and find out more about my test.   My doctor is in Little a Rock but I am open to seeing someone else if I can't get some results soon.  I really don't like feeling this badly.   If I need to, I can get test done here locally from my Primary Care Doctor.  
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Avatar_f_tn
I may be paranoid about my heart rate because my mother had a heart attack at age 44 when she was given too much thyroid hormone.   I have no idea how much she was given at the time.  She is still living and is 87 now.   E Mail the doctor's name in a Little Rock and if I don't get some answers tomorrow,  I will contact the doctor you know.
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Avatar_m_tn
Please do go ahead and get the tests done for Free T3 and Free T4.  Make sure they all know it is to be Free T3 and Free T4, not Total T3 and Total T4.  Also request Vitamin D, B12 and ferritin.  When results are available please get a copy and post results and their reference ranges shown on the lab report so that we can better assess your status.  

I am sending a PM with doctor's name.  Just click on your name and go to your personal page.  Then click on messages.  
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6555161_tn?1382385462
To clarify, you weren't on any meds from March until October, correct? And they started you on 112? Now granted, that was my starting dose about a month after RAI, but only because that was my second one, and left me very hypo, and it did it very quick. I think 112mcg is way too high of a starting dose for you. Granted, TSH alone is not the best indicator, but looking at it: when you said yours was 8.4 and you're taking what I did when my TSH was 88? That just seems like way too much.
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Avatar_f_tn
I did not take any meds until October 29th after having the RAI in mid March.    I am not going to take any more meds until I speak with the doctor.   I won't be able to get through to him until Monday.
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Avatar_f_tn
I had test done Monday but have not heard from my doctor.  I went to the hospital today and got the results but afraid I do not know what they mean.  Please help me understand them.   Thyroxine - 9.4,  Triodothronine - 36, and TSH 0.13.
I still feel nervous and my heart rate gets high and I take beta blockers twice or three times a day.  I have not taken my 112 mcg of synthroid since last Saturday.
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Avatar_m_tn
Thyroid test results must always be compared to reference ranges from the same lab.  Please double check the Triodothyronine result and post range listed for it.  Also, same for Thyroxine.
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Avatar_f_tn
It says 4.7 - 13.3 (uh/dl) on the thyroxine   9.4
Triodothronine resin uptake (%). -  36
TSH. 0.34 - 4.82 (ulU/mL). - 0.13

I don't know what any of this means.  That is all that is on the results.
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Avatar_m_tn
You did not respond to my previous question about any symptoms you have other than heart rate.  Please tell us about thos if any.

Your doctor did a poor job of deciding which tests were to be done. Your T4 test is Total T4, which is not nearly as useful as a Free T4 test.  The other test is a T3 Uptake test, which is outdated and almost useless, compared to a Free T3 test.  That is why I suggested that you make sure you are always tested for Free T3 and Free T4 each time you go in for tests.  If a doctor resists, just insist and don't take no for an answer.

As for the results of the very limited test results, your Total T4 is right around the middle of the range.  If your Free T4 shows a similar pattern there is certainly nothing there to indicate a hyper problem.  Your TSH is suppressed below the range, which many doctors quickly interpret as being hyper; however, as I previously explained, that is not usually the case unless you do have hyper symptoms, due to excessive levels of Free T3 and Free T4.  The limited test data don't indicate excessive levels as a problem.  

So, I think you are wasting your time with that doctor.  You need to try a doctor that will test for Free T3, Free T4,Vitamin D, B12, and ferritin, and that will start you on the right dosage of thyroid med and increase dosage as slowly as you can tolerate without any reaction, until hypo symptoms are relieved.  
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Avatar_f_tn
I am jittery, fatigued, do not sleep well at all.   It is almost as bad as it was before I took RAI.   I am thinking of not going back to my Endroconogist and seeing someone that I can communicate with, especially if I don't hear from him soon on these test results.  It is hard to tell a doctor what test he should run but I am tired of feeling terrible.
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Avatar_m_tn
Unfortunately most times hypothyroid patients don't have the luxury of just depending on their doctors to decide which thyroid related tests should be done.  For regular doctors in med school, not a whole lot of time is spent on Endocrinology and within that study thyroid issues are covered in an even shorter time.  In general it seems they are taught the "Immaculate TSH Belief" and Reference Range Endocrinology", as the way to diagnose and medicate a thyroid patient, rather than the more time consuming evaluation of a patient for the signs and symptoms of hypothyrodism, and clinical treatment.

So it is vital for hypo patients like ourselves to know enough bout hypothyroidism that we can help direct the doctor toward proper testing and clinical treatment.  Therefore, you should always make sure the doctor agrees to test you for Free T3 and Free T4 each time you go in for tests.  If the doctor resists, just insist on it and don't take no for an answer.  I even make sure that the lab people confirm what tests are to be done, to avoid the discrepancy that occurs so frequently between what you really want to test and what they actually request to be done.  If you are unable to even get the doctor to run the right tests, then you have no chance of getting the right treatment.  And don't forget the importance of testing for Vitamin D, B12 and ferritin.
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