Hyperthyroidism

[yankeeRN]

ONSET ? early August: hands shaky with fine motor  stuff in the morning (thought it was my morning coffee), resting heart rate 90-108 (had been exercising intensely should have been lower), heat intolerance and sweating worse, nervous energy (fidgety),had to decrease weights at the gym, had to decrease intensity levels on  aerobic equipment,  otherwise felt fine

Early September   h/a, dizziness, pounding heart--went to ER hr 120-160, bp 180/97, shaky to arms, hands , legs, and abd  ( felt awful )   ER result: dx hyperthyroidism per labs tsh not detectable, free t4 2&1/2 what the high should be

Since the day in the ER: shakiness intermittently all over (comes and goes suddenly), increased heart rate and pounding heart with walking slowly from one room to another (my heart rate jumped to 120-130 with just that little activity), felt panicky (stopped with betablocker), shaky legs going down stairs, chest pressure at times with walking but resolved with stopping activity (have had 2 EKGs and 2 chest xrays), muscle weakness (arm and legs), weight loss 18 pounds (? 10 lbs from exercise then the rest just came off and appetite increased), loss of muscle tone in arms and legs, swallowing different but ok (occ slight hoarseness after eating), hungry more often, shortness of breath at times with talking , increased frequency of stools but not loose




TREATMENT thus far:started  metoprolol ER 12.5mg increased gradually to 75mg daily (dose increase only good for 1-2 days then symptoms  intensifying)
After thyroid scan started PTU 50mg q8h  felt great for 2 days then shakiness and s/s returned (had also been decreasing the metoprolol by 12.5 mg per day per md order)  9/26 per md increased PTU to 100 mg  q8h with dose started   at 1330h and felt good by 1600h with no shakes and hr in 90's

When is this going to get better?.....have been out of work for 2+ weeks  I see the endocrinologist  in a little more than 2 weeks..not soon enough in my opinion.  Am I ever going to be normal again? From everything I have read this hyperthyroid is not an easy fix. I was healthy as a horse before all of this.

[Totie]

Sounds like you have graves. Please be careful on hitting "thyroid storms".

How is your weight?

[yankeeRN]

l  lost 18 pounds but I do think 10 of it was from exercise and eating less.  I lost the weight over about 3 months.  I know...I am fearful of a thyroid storm. This shakiness drives me bananas. And the heart pounding even with my rate being 90's . I have had to lay low...can't do much more than very short walks..getting discouraged.  --thanks for responding

[yankeeRN]

I have been trying to increase my protein as my muscle mass has shrunk..generally eating more but mostly healthy stuff..have not lost anymore weight nor am I trying to...when I exercised I was solid but now like I said my muscle has decreased.

[gimel]

It's too bad that you are having to wait around for the Endo.  I just wondered if you could call and make an appointment to at least get your blood testing done ahead of time, so that you could discuss results during the appointment.  Could save you up to a week if the doctor is agreeable to the early testing.  

I am sure that the doctor would feel more comfortable about which tests to run after talking with you during the appointment, but you could help guide things by telling them of your symptoms, and your need to get some help as soon as possible.  Also tell them that you have gained a lot of knowledge about your condition and as a start you need the TSI test for grave's and also TSH, Free T4 and Free T3.  

[Totie]

Is there anyway you can get your Primary dr. to try & get you in earlier. If the symptoms are bothersome go back to your doctor & he/she you can't handle the symptoms, maybe he can put a call in to the endo for you.

It will get better once your are treated properly. I eventually had to get mine out because of graves/hyper. The RAI just could not control it, nor could the medications. I hit a thyroid storm before the RAI, then I hit another storm after RAI, the only hope I had was surgery.

People are all different in how they react to medicines/disease.

If you have too call every morning to see if there is an opening or cancellation for your endo. I was lucky, I had a hospital that actually had caring technicans, doctors & staff.

If new symptoms persist call your primary or the endo office. Thyroid storms are very dangerous...

[Anniegoose]

thank you for all this lovely information.  i was on iodoral for almost 6 months and was doing fine until my dosage got moved up to 2 pills twice a day.  my TSH went into the ozone layer and now i have a few of the issues that yankeeRN is having.

the endocrinologist has me de-toxing from the iodoral, then getting my blood re-tested in 2 months.  i plan on getting re-tested a LOT sooner.  either this week, most definitely next week by my naturopath since i don't trust the lab that did the blood test a week ago.

[danie17075rm]

It sounds similar to everything I experienced in the last year.  I finally decided to remove my thyroid a month ago.  I was in your exact position and I don't have graves, just hashi's.  For some reason though, I transitioned to hyper and my body wouldn't get out of it.  I also was choking on my goiter.  At the time, I could not walk to the next room without heart rates as you described.   If the meds are not working they might recommend RAI or surgery.  I was hyper during my surgery, but took atenolol before it started.  My heart rate was great during surgery, but stayed around 150 during recovery.  I was in recovery for HOURS.  They finally moved me to a room when it reached 120 and it stayed there most of the night.  It went down by morning.  I was on toprol XL when I first went hyper and it did not help at all.  For some reason, the extended release does not work as well for this.  Atenolol or others similar that release everything at once make a WORLD of difference in how you feel.  Atenolol was a life saver for me and I read a few studies in which doctors prefer it in for those with hyperthyroidism.  Sometimes people take it twice a day during this time too.  I pray that you can get relief soon.  I do understand.  The last year was the worst of my life.

My thyroid is out now and I am adjusting to the meds.  I am VERY hypo still as am building up my dose slowly.  I feel better extremely hypo than I have in the last year.  I can finally walk up steps without going into cardiac arrest!  As others said, be very watchful for symptoms of a thyroid storm.  I was in the ER countless times when all of that was going on.  


If you can get some lemon balm tea, I strongly recommend it.  It is not a cure all, but it blocks thyroid hormone and helps calm down everything.  I carried it with me EVERYWHERE while I was hyper.

[yankeeRN]

I had my md  call to get an earlier appointment and the absoulte soonest is Oct 14th.  I will try to call the Endo this morning and beg to be seen sooner as I am desparate.  I will see if my primary md can get those labs too.  Yes I agree I need to get help asap. God forbid what does a thyroid storm feel like?  It has been bad enough with the pounding heart even when the rate is only 90----is much less  freq in occurence since the PTU started.  I have been trying to keep a log of how I feel  (symptoms) since the first week I was sick because the days seem to run together.  
On a good note my bp is good....had been weaning my betablocker (metoprolol ER) per md order by 12.5 mg and today I wasn't suppose to take any but after yesterday I didn't dare not to take it and I will call my md today as soon as the office opens.  My md is a nice compassionate guy and knows his stuff and I feel like I can call him at the office to get my questions answered....he happened to be sitting behind me and my husband in church and then he called me on Sunday to give me results of my scan and ask how I was feeling.  My md also knows how I don't like to take medicine and was never on any before all of this...I do realize that I need to take the stuff I am now on because I absolutely need to :(   I may need to ask him if I can go up on the metoprolol ER to feel better at least temporarily.
I have been to the ER twice already and almost once--I convinced my husband to just let me lay down in the car and see if the pounding and chest pressure would go away----it did after abut 10 minutes...I had had 2 ekgs while having pressure and 2 chest xrays, and heart labs ..they were all "fine" except for  the high high heart rate.  I know this is serious stuff and it is so scarey to me being a nurse...I have seen too much other stuff.  We rarely see a hyperthyroid patient since most of the time they are  treated as outpatient.
Thanks for the help everyone..having been there yourselves you know how desparate you feel to just feel better.  At the end of the day I will check into the Lemon balm tea.not sure I would be able to walk through the grocery store .. I may have to have my husband or mother pick it up. Does it have caffeine in it? I had to cut out my coffee (I usually has 1 cup in the am)--gave me a splitting headache first day without but little stuff compaired to the other symptoms.  Once again thank you all  for the info and for the prayers.  One other thing......just because I a shaky ...like in the ER they thought I was nervous.  I told them that the shakiness has gotten worse as has the symptoms but I was not nervous....just concerned...I tought just give me the damn beta blocker iv  and the shaking will stop.  Thanks for letting me vent.

[Ericamegan]

Hi, I have Graves and was hyperthyroid.   I had ALL of the symptoms you mentioned. The rapid heart rate, shakiness, difficulty exercising, muscle loss, anxiety and the list goes on.  I think I had it for years until the symptoms got too bad to ignore.  I had RAI in Feb 2010 and am now feeling great, but it has been a long ride.  Until you can see a dr, I would avoid exercise, gluten, caffeine, and iodine.  You can also increase your calorie intake.  When I was hyper I ate around 3000-4000 calories a day and didn't gain or lose any weight.  If it is Graves', it means your immune system is attacking your thyroid.  SO, there's nothing wrong with the thyroid.  There's something wrong with your immune system. This can be caused by stress, family history or gluten sensitivity. When I was diagnosed my symptoms where so bad I did RAI right away.  I wish I would have researched my options and tried a few other things before zapping my precious thyroid.  After RAI I felt better, but not great until I found the proper medicine combo of synthroid and Cytomel and changed my diet.  I rarely eat gluten or junk food and this has made a huge difference in how I feel and how my eyes look.( My eyes were also being attacked from thyroid eye disease).  I can say I feel better than I have in years, so I don't regret RAI.  I am know able to exercise and feel strong again. When I was hyper I weight around 125lbs.  After RAI I became hypo and gained 10 lbs.  I am now around 128lb. and have much more muscle and much healthier. Good luck to you!

[yankeeRN]

I cannot do any exercise and haven't  for almost 3 weeks when everything hit the fan with my heart rate and bp---I was very healthy before--right now I can walk in the house  from room to room  and feel not great but ok.  I miss my exercise but there is no way that I could even attempt it---going up and down the stairs and walking room to room and rare walk inside to get a few groceries on a good day is about all I can manage.  I am 48 years old and told I look 10 years younger...not sure about now.  My eyes seem to be ok .
I work on a very  busy med surg telemetry unit and we are on screech most of the 12 hour day...I get a 30 minute lunch which I make myself take...otherwise I drink a quick milked down oatmeal in the morning and afternoon....takes about less than 5 minutes to drink and those are my breaks (it's the same way for the other nurses).  I do love my job though  and I like to be busy....not always that busy though.  I haven't been able to go back to work I am on a FEMLA for the past 2+ weeks. Maybe if I had a desk job I could work like this.
The meds for me work for a couple of days but never relieve all the symptoms and then my md ups them. Sounds like the RAI has worked for you...I wasn't given an option as of yet.  
I quit caffeine the day after my heart rate soared..I have always been sensitive to caffeine and a little went a long ways.  How did you know about the gluten? I will have to ask my md about immunology testing.  This past March I awoken feeling sickish and when I went to jump in the shower I could see a huge reddened and raised area on  my back--it went from my under arm level  across one side to the other and went just below my bra level in the back--I had tried topical stuff and the had to get a prednisone taper from the md and after that it was gone.  It had looked like a huge hive but felt like a sunburn--I hadn't been in the sun..it was March in the northeast. Could my body had been fighting something then I have thought.
How was the process for the RAI and avoiding people ?  

I called my md this morning and he re upped my betablocker so I can get some relief from my symptoms.  I called the Endo office and asked for an earlier appointment...none available yet...will keep the oct 14 appt but the office gal said she would keep her ears out for any cancellation and call me..thank you God:)..someone has a heart:) Thanks for all the info..I really do appreciate it:)

[Totie]

I was young & a new mother when I hit my first thyroid storm, SO doctors attributed my symptoms as post part depression, so I beleived them.

I had cramps in the muscles, leg pains, aches, headaches, HR 140 sitting down, dropped from 130 lbs to 88 lbs even though Iate like a horse. I had insomnia & was so hyper. I had head intolerance. People just kept asking me what I was on at work, I was just non stop.

It was not until I developed a toxic goiter (that became so noticeable in my 88 lb body frame) that doctors could not MISS it. I freaked out when I noticed one morning my neck looked like a football players lineman neck. I went in different doctor & it took him 30 seconds to diagnose me with ITS YOUR THYROID.  The only test he did before shipping me to the Endo immediately was " stick your hands out", I did they were trembling uncontrolably.

Even then it was not until I had the thyroid up take scan that they saw how bad I really was (but I can say being hyper did not bother me, I had energy& was young) & the technican refused to release me & they admitted me right then & there.

They told me it was a thyroid storm caused by graves that when they ran all the blood work everything came out ABNORMAL. My organs started getting attacked. I was hospitalized for two weeks to bring my body back to normal, then I had the RAI, but a month later, still hit another storm, addmitted when I went in for a follow up, the next day had surgery.

I am good now,but I can still remember the shots in my abdomen, thighs, the burning medication which was potassium. Man was I REALLY messed up.

But all history now...Thank god...That was 18 yrs ago....but I remember the hospitalzation well..

[yankeeRN]

Wow  Totie you went through an ordeal but are better that is encouraging. I should knock on wood before I say this--I sleep like the dead..out for the count.  Prior to the first ER visit I was boundless in energy at work and believe me when I say on an average day on my unit a nurse walks about 5 miles....( I know because I have worn a pedometer in the past and tried to see on average how far I walked in an 8 hour day.we now do 12 hour days. )
I have always been full of energy at work.... .I love my job on most days.  In the few months preceeding all of this present health crisis of mine I was more tired after a  12 hour day of work..after work I would drive the 10 mins to home, jump in the shower , and eat my bowl of  Special K cereal ...after that I was reclined in my recliner and snoring so my husband says.  I remember just prior to this mess one of our cnas made a comment jokingly  that she was going to put a tranquilizer in my morning coffee--I blew her off thinking she was menopausal and needed her cigarette...I guess I should have listened.   At first the increased heart rate I didn't seem to notice but I sure do now and I gotta be nice to my heart because I don't want to go into atrial fib.  
Wow you realy lost weight--that's scarey.  What was wrong with your doctor that you lost that much weight....that's a  crime it got that bad.
For all those people who ignorantly say ..."Gee I 'd love to have that and lose weight."  One day with the shakes and rapid heart rate  and all the other stuff that goes with this and they would regret it.  If it were fat weight that went that wouldn't be bad--I could lose another 10 pounds safely but this is muscle and I don't want to lose any more of that--trying to eat more  protein. I was almost rock solid from the gym and now jiggly but that is the least of my worries. Any way....thanks for sharing Totie.

[Totie]

For six months my doctor at the time (female) attributed it to just being depressed & not eating. She would not belive I eat like a pig. I would go in about once a month with a different symptom & it was always changing the headache medication or anti-depressant. She just knew it was post partum depression, I had given birth recently, I did have a nurse tell me my graves was trigged by my pregnancy, only thing wrong during my pregnancy was toxemia so had to have an emergencey induced labor. Funny I went in for my monthly pregnancy visit, & ended up delivering my child 12 hrs later. Let's just say WE WERE ALL CAUGHT OFF GUARD to a baby that was not supposed to be born until well over a month later. ..

That I can say was the first health issue I went through, after the birth I guess it is when I started the symptoms, but I just attributed them to giving birth, and working full time so always non-stop at that young age with a new born.

If it was not for the comment my dad made about my neck looking swollen I would have continued to ignore the symptoms & belived it was all post partum depression. ...The heart beat at night I did not even notice because I assumed it was normal to hear your heart beating when you are trying to sleep. The muscle cramps was my  thought of being out of shape for I hate to work out....I lost all my pregnancy weight 35lbs a week after delivery, BUT then it did not stop. I think they thought I was not eating because I was always on the go.

Lucky when I went in after 5pm to my clinic my reg. dr. was gone so I saw someone else...Thank God.

Let's just say SHE is no longer my doctor.....

I do have other medical issues, BUT not related to thyroid. My dosage has remained the same for the last 5yrs.

[danie17075rm]

I have not had caffeine in a year.  When I was hyper I cut out ANYTHING stimulating to the body (no chocolate, sugar, spicy food etc).  Lemonbalm is mildly sedating (but safe).  It really helped me make it through, but you are still going to have to do something long term.  I lost 40 pounds.  Not only was my metabolism on the fast track, I could not eat because my heart was racing so much I felt like I couldn't breathe all the time.  The beta blockers are ABSOLUTELY ESSENTIAL until you get past this.  Then you can wean off of them.  I HATE taking medicine.  I took one pain pill through my whole c-section!  I had to do it though.  I am still on the beta blocker, but in a tiny 1/4 dose.  I will try to wean off of it when I get stable.  I couldn't even go up stairs at the heart racing all of the time point.  I was lucky to walk to the bathroom.  

[yankeeRN]

Geesh new mother and all with this going on..I just can't imagine...in the past few weeks I have done nothing--I can't imagine having a newborn in the middle of this all.
Totie....some doctors need to listen.  Luckily mine does  listen because I really need his help. When you said that your father noticed that your neck looked swollen..that was fortunate that you payed attention to it.  When I had lost about 10 pounds after all the exercise I was doing one of the female doctors commented on the fact that I had lost weight and she asked if I was sick...I thought that odd at them time especially since I was exercisinfg intensely. I will have to ask her why she questioned if I was sick...kinda late but I would like to know.  The came the comment from the cna about slowing me down.  Then we actually had a young patient with hyperthyroidism with thyroid storm...I had thought to myself  geesh that might be me but dismissed it because he was much shakier than I was....but sadly I am as shaky now as I remember him.  Denial is not a good thing.  
Yes luckily there was a different doctor  there for you to actually listen to you and see you without any preconceived diagnosis.  
I hear ya when you say you eat a lot..I am too..trying for the higher protein and eating lots more of fruit and veggies.  

Danie....  I have also experienced the shortness of breath from the rapid heart beat..it hasn't affected my appetite though...running out of groceries much faster....oh well. I will check with my doctor on the lemon balm tea as I don't need any other issues at present..it does sound like a good idea though..thanks.  Yes I know the beta blocker is essential..my doctor had me weaning slowly off the betablocker with the starting of the PTU because he said that once the PTU kicked in to suppress the thryoid I would need less of the beta blocker.  I NEED the beta blocker and got the md to ok increasing some  as I felt shaky and my rate increased AGAIN with washing 3 dishes...had to call in sick for the next 2 days because I would not be much help at work...I am sicker than some of the patients there. Thank you Danie for stressing the essential of the beta blocker..I can't belief the first ER visit I declined it....was the stupidest thing I did as my symptoms from that day on escalated.  I don't like pills but I am thankful someone invented the betablocker. I guess I will have to be more strict with the sugar and chocolate ..there have been a few days I just wanted something sweet but no more.  The caffeine has been stopped  day after the first ER visit.   Thanks Danie and Totie...

[danie17075rm]

I got to a point where to my my beta blocker was like a crack addict looking for a fix lol.  I depended on it THAT much.  Usually right before it was time for my next dose I could feel it losing effect, so I would wait for the next one.  It was TERRIBLE!  I finally broke it up and took 1/2 in the morning and 1/2 at night so I was always covered.  I'm glad your doc is so helpful. Ask him about the lemonbalm.  I only drank it when my heart rate shot up to 150 or something while I was at rest.  It's a safe herb that people drink all of the time (they even give it to kids).  There are no interactions other than if you were severely sedated with beta blockers and drugs such as xanax, it might increase those effects.  I don't think you'll have to worry about that in your "hyper" times though.  It's mild.  You won't even notice much, but it takes that adrenaline rush away a bit.  Good luck.

[danie17075rm]

You don't have to give up chocolate and sugar, I just did because my body was such a mess that I didn't want anything stimulating in it.  I was always looking to relax.  I really feel for you.  I hope this goes away soon!

[yankeeRN]

Yeah I hear ya about the beta blocker it seems to be the only way to decrease the shakes and keep the heart rate below 100 most of the time at rest...I was so hoping to wean myself off and I was one pill away from being off from it..but now I am going in the other direction.  I guess I gotta do what I gotta do to keep my heart rate reasonable.  The next 2 weeks till I see the endo could be long.  I am not on any antianxiety specific drug...I don't seem to feel anxious with the beta blocker so no sense in adding another pill and side effects to the picture..my only pills are the PTU and the beta blocker. Yes all this stuff an stop anytime and I am ready to get back to normal wishful thinking. Thanks Danie.

[danie17075rm]

I didn't take the xanax either.  They gave me some in the hospital and it didn't help at all (maybe because it wasn't in my head).  The beta blockers were the only thing that worked with the hyperthyroid anxiety.  I could actually feel it blocking the adrenaline.  It was a weird feeling.  It was like it was suppressed, yet I knew it was still there.  Hopefully the ptu will kick in for you.  I bounced back and forth between hyper and hypo so I couldn't take anything without my numbers shooting drastically in the opposite direction. When my heart rate was really high I would do the vagal maneuver.  You can google it, but basically you just bare down and it slows things down.  They had me do it in the hospital.

After I had my thyroid removed and my heart rate was stuck at 150, they just kept injecting beta blocker after beta blocker into me.  Nothing would work at that point.  I was so drugged up from surgery that I couldn't be nervous about it luckily.  It's just a horrible feeling when your heart rate is rapid. I literally had no life during the last year.  I'll pray for your speedy recovery.

[Ericamegan]

Here are a few articles about the thyroid-gluten connection and other possible triggers of auto immune diseases.   I'd never heard anything about this connection until after RAI.  Before RAI I ate mostly gluten.  I couldn't imagine being able to be gluten free until my brother said he wasn't tolerating gluten.  When he was researching he saw a lot of info on the possible thyroid connection.  At that point most of my hyper symptom were gone, but my eyes were still being attacked.  I decided to give it a try.  My eyes have improved greatly and I when I cheat my eyes flare up & my body swells up.  I really think for some people there is connection and it's worth getting tested or just trying eliminating it from you diet.  I also try to avoid aspartame and any other possible triggers.  Other research shows many people with graves' disease have low Selenium levels.  I now take 200 mg of Selenium a day.  I really think more research should be done on the triggers of auto immune diseases.

The RAI process was not too bad.  I had to avoid people and pets for 2 weeks. They said to keep at arms distance, use different toilets, and not to sleep in the same bed.  I became even more hyper after RAI for a few weeks as my thyroid leaked out hormone.  I did lose about 5 lbs during these 2 weeks.   I'm a hairstylist and had to take that time off work which was a financial strain but worth it.  When I was hyper I thought I was going to have to quit doing hair because I would shake so badly, had extreme muscle fatigue, had anxiety attacks and was so exhausted at the end of the day.  I did receive a large dose of RAI (32 mCi) because my dr said I had prob had Graves' for years and was very bad. He didn't want to take a chance at it coming back and said if you completely destroy your thyroid there is less chance of thyroid cancer.  I'm not sure if that's true or not.  Graves' does run in my family...my mom has it too.  I hope some of this info helps you.  I remember how overwhelmed I felt when I was hyper.  I wish you luck!


http://thyroid.about.com/cs/latestresearch/a/celiac.htm

http://chriskresser.com/the-gluten-thyroid-connection

http://www.elaine-moore.com/Articles/GravesDisease/ThyroidDiseaseTriggers/tabid/183/Default.aspx

http://paleozonenutrition.wordpress.com/2010/08/26/hashimotos-auto-immune-thyroid-disease-avoid-gluten-like-the-plague/

http://www.elaine-moore.com/Articles/GravesDisease/AllergicTriggersinGravesDisease/tabid/135/Default.aspx

http://www.adventuresofaglutenfreemom.com/2010/05/celia-disease-autoimmune-disease-and-a-little-piece-of-my-journey/

[danie17075rm]

I went gluten free when I became hyperthyroid and it didn't do a thing for me (in fact I got worse throughout the year and developed a second autoimmune disease in the mean time).  I am still gluten free (and very strict about following it), but now it is just because I am afraid to add it back in.  It didn't help me at all.  I think everyone is different.  If you are not intolerant or have celiac disease, I'm not so sure it is necessary or even beneficial to take out gluten.  I think sometimes we can end up causing ourselves more problem.  I'm sure it has worked for some people, but speaking from experience, it just made my situation worse.

[yankeeRN]

First of all thank you all for all the info..coming from people who have been there I know you understand and I can relate..it helps me be hopeful to hear that things will get better.  I am not sure if I clarified this but I have a multinodular thyroid..per my doctor he said it was not cancerous...thank God . I agree that the beta blocker is the only thing that helps the shaking and though when all this mess started and before the beta blocker I had felt almost panic which I had no clue where it came from.  The intermittent panic feeling stopped with the initial low dose beta blocker.  @Ericamegan:  I will check out those articles.  I am not sure if mine in from autoimmune.I  think it might be a different class..I am still sketchy on this though.   @Danie ...  thanks for the word of caution.  I am going to get started on those article that Ericamegan suggested.  Thanks again:)

[yankeeRN]

I had wanted to comment on the vagal maneuver...glad you reminded me of that  (I have used it on patients on my unit..I guess when it is me with the rapid heart rate my brain is not in gear)...I guess I didn't think it would work because of the cause being hyperthyroid---if you say it worked for you the I will try it if my rate goes up beyond 120...so far today has been good for rate.  My doctor also has said I can increase my metoprolol another 12.5mg  if I need to..he just wants me to be careful once the PTU kicks in. I still have to check with the doctor about the lemon balm tea.  Today has been much better than yesterday morning.  

[danie17075rm]

I'm so glad you had some relief!  The vagal maneuver does help it go down.  I still do it when my heart races actually.  Maybe the PTU is starting to kick in and make you feel better.  I pray it all goes away.