Hypothyroidism and Heart Palpitations

[MelinDel]

Hello Everyone - I am a 34 year old female who was diagnosed about 8 months ago with hypothyroidism.  Additional testing then diagnosed me with Hashimoto's Thyroiditis.  My initial TSH level was 12.7, so I was I placed on 50 mcg of Levothyroxine.  My TSH level is now 4.8.

I have had all of the normal hypothyroid symptoms - weight gain, muscle pain, tiredness, etc., but my biggest complaint (that doesn't fit symptoms of hypo) is heart palpitations.  At their worst, I was having them for sometimes 5 - 6 hours a day.  I did see a cardiologist, who did an EKG, echocardiogram, and also had me a wear an 24-hour heart monitor. After reviewing all of the tests, the cardiologist said that I had a perfectly healthy heart, and that the palpitations were most likely a result of hypothyroidism.

For the first few months after being on the Levothyroxine, I can honestly say that I did NOT feel any better.  However, over the past 6 - 8 weeks, I have begun to feel more like my old self again.  FINALLY, the palpitations started to subside - occurring for only 3 - 4 hours a day, then about 1 hour a day, then only a few flutters here and there.  I was absolutely elated to have them gone!

Within the past week however, as soon as I woke up in the morning, I could tell I just didn't feel right.  I've been having more palpitations again (an episode last night lasted for about 2 hours).  It's only been a few days since the  palpitations have returned, but I am scared to death that I am going to have to start dealing with them again.  They make me feel awful!

I promised myself I was going to keep this as concise as possible, and looking at the above I appear to have failed.  Has anyone else been diagnosed with Hashimoto's or hypothyroidism and suffering from long episodes of heart palpitations?  Any help or advice would be greatly appreciated!

[dani2776]

I too have Hashimoto's and have heart palpitations.  I would get what I describe as a flutter.  Now however I have tachycardia and just went through an EKG and holter monitor.  I am still awaiting the results to those.  Has your medicine been increased because based on your current TSH of 4.8, that is still too high and can be the cause of your problems.  Are you having any other symptoms? What about other tests that were checked for your thyroid?

[MelinDel]

My endo does want to increase the dose of the Levothyroxine, however did NOT want to until the palpitations subsided.  That's one of the reasons why I was so excited when they finally did, and now they seem to be on their way back again.  Like I said, it's only been a few days, but I am already worried that I am going to have these marathon episodes again. :-(

Other tests were done for my thyroid, with all levels coming back in the normal range.  As to what those tests were, I do not know.  I just remember my TSH level.

Other than the palpitations, my only other symptom that seems to have returned so far is a slightly elevated joint/muscle achiness.

How does the tachycardia make you feel?  Can you describe your symptoms?

Thank you SO much for your reply!  It's so nice to know that there's other people out there who feel the same way.

[MelinDel]

My endo does want to increase the dose of the Levothyroxine, however did NOT want to until the palpitations subsided.  That's one of the reasons why I was so excited when they finally did, and now they seem to be on their way back again.  Like I said, it's only been a few days, but I am already worried that I am going to have these marathon episodes again. :-(

Other tests were done for my thyroid, with all levels coming back in the normal range.  As to what those tests were, I do not know.  I just remember my TSH level.

Other than the palpitations, my only other symptom that seems to have returned so far is a slightly elevated joint/muscle achiness.

How does the tachycardia make you feel?  Can you describe your symptoms?

Thank you SO much for your response!  It's nice to know that there's other people out there like me.

[dani2776]

Did you ever think that the palpitations returned because you need an increase?  Just a thought.  I know my palpitations actually subsided after I started on Synthroid.  As far as my tachycardia, I am short of breath, lightheaded and very scared.  I don't know what is wrong.  Thyroid related?  Hopefully I will get some answers soon.  This is too much to deal with on top of trying to get my thyroid under control!

[goolarra]

You should really find out if your doctor did free T3 and free T4.  If so, you can post them with the reference ranges your lab uses.  The free's correlate with symptoms much better than TSH does.  TSH is a pituitary hormone.  It does not affect how you feel.  Your levels of FT3 and FT4 are what eliminate or increase symptoms.

I have a congenital heart defect that predisposes me to tachycardia/palpitations.  I find that the minute my FT3 goes up even slightly, my tachy increases.

[MelinDel]

I've never thought of that - I guess I need to see if my endo would be willing to increase my dose to see what happens.  I know how scared you must feel.  I wouldn't be surprised if a lot of your symproms are thyroid related.  I never had any palpitations prior to the past year.  Then I started feeling tired, achey (achy), and depressed, so I went to the doc and was diagnosed with hypothyroidism.  When I was having the palpitations all the time, I went to sleep every night scared to death I wouldn't wake up in the morning.  I would tell my husband to make sure I was still breathing in the morning before he left for work.

To:goolarra  That's really interesting about the T3 and free T4. I did not know that! I am definitely going to find out what they are.  Thank you for the info!  Is there anything that can be done to control the T3 and T4, or do you just have to deal with it?

[goolarra]

Thyroid meds (levothyroxine, Synthroid, Levoxyl, Armour, etc.) are what control the FT3 and FT4.  They only change TSH by virtue of the fact that they are changing T3 and T4.

Here's how it works:

Your pituitary gland (master gland, which is tucked into your brain) puts out TSH.  TSH is the messenger that tells your thyroid to produce more thyroid hormones (T3 and T4).  In turn, the pituitary receives the T3 and T4 from your thyroid (I'm simplifying the process here quite a bit), and adjusts how much TSH it puts out to keep your levels correct.

T3 is the active thyroid hormone.  It is about four times more powerful than T4.  However, it is very fast-acting and is removed from your body if not used promptly.

T4 is the storage thyroid hormone.  It floats around in your bloodstream until it is needed, and is then converted to T3, which can be used by your cells to regulate your metabolism..

So, when you take thyroid meds you are directly affecting the levels of T4 in your body.  If you are taking a thyroid med with T3 in it, you are also directly affecting the T3 level.

TSH is just a messenger...it has absolutely no influence on how you feel, except that it can reflect what your FT3 and FT4 are doing.  As I said - can.  However, it is so far removed from the actual production of thyroid hormones, that any number of other things can get in the way and make it inaccurate. TSH is fine as a confirmation tool, when backed up by FT3 and FT4.  However, it is becomming increasingly controversial as a stand-alone diagnostic tool and very controversial as the basis for adjusting meds.

When requesting T3 and T4 tests, be sure to request FREE T3 and FREE T4.  The other T3 and T4 tests are for TOTAL.  These are considered archaic tests, since they don't reveal as much info as to what's going on in your body.  Also, be sure to get the reference range your own lab uses...different labs use different ranges, units, etc.  So. it's very important to interpretation.

[MelinDel]

I cannot thank you enough for all of the information.  I am so tired of not knowing what's going on or why I'm feeling the way I feel.  I really like my endocrinologist - she's the first doc that's listened to me since all of this started happening.  However, I also feel like she dismisses "unrelated" symptoms too quickly.

Maybe someday, I won't wake up every morning wondering what kind of day it's going to be - a good one or a bad one.

Again, thanks for taking the time to post your response.  You have been very helpful!

[goolarra]

If you have a doctor who listens, you're more than half way there.  I spent almost a year with a PCP who kept saying my tachycardia wasn't related to the levo.  Now I have an endo I really like, too...listens, takes notes, works with me when I disagree with him...such a relief.

Your Hashi's may be contributing to the palps, also.  As your thyroid is attacked by your antibodies, it starts to malfunction and produce peaks and valleys of hormones.  Perhaps your palps occur when your thyroid is producing a bit more on its own.  If the palps persist, check into a beta-blocker.  BBs control the palps and tachy really well and do it almost immediately...very inexpensive, very few side effects (been around for decades).

[MelinDel]

My cardiologist offered to put me on a beta blocker, but I was a bit hesitant as several people said they didn't like the side effects - one of which was dizziness when standing up too fast.  I am a very active Mom of a two year old.  I walk 3 miles a day (in addition to chasing my son around), and now that the weather has warmed, I am busy with my flower and vegetable gardens.  I was worried that the beta-blockers would hinder me, so I opted not to take them.

Do you currently take a beta blocker for your tachycardia?  If so, what kind of side effects have you experienced?

[goolarra]

I've been on atenolol (BB) for over a year now...I didn't have any choice...no matter how little levo I was on, it increased my tachy.

They probably get dizzy when standing up too fast because BBs also lower your blood pressure.  If your BP is low to begin with, it could cause a problem.

The only side effect I have (and I don't know if it's the BB, or the Hashi's, or that I'm not 20 anymore!)  is that sometimes I feel a kind of "lag" in getting going (such as when I've been sitting at my computer for a long time and then get up), like something's holding me back or weighing me down.  It doesn't last more than a few seconds...just something I feel I have to "work through".  Anyway, it's nothing compared to having the tachy 10-20 times a day.  It was a life-saver for me.  I started on 25 mg, then had to increase to 50 as I increased my Levoxyl.  Seems to be pretty stable at the moment (knocking on wood).

[azqtpies]

I just wanted to chime in and say I too had BAD heart palps when I was hypo! I finally found a endo that confirmed that though it is not a common symptom of hypo it IS a symptom for some as the heart beats harder to pump blood , and when hyper it beat really fast to pump and therefore she says it can happen either way, until the thyroid levels are right for you!

I too went to a cardio and had all the heart test when they got real bad, had her do a tsh and I was very hypo for me! bingo that was it got my meds more stable and they disappeared then I went hyper and they were noticably coming back.

They are VERY scary and I know your fear all too well as i suffered for years with them, prior to my partial thyroidectomy I was very hper and never knew as no doctors ever did a thyroid test on  me! so I suffered all  that time. I was on a beta blocker for 5 years which did not help them, but did help  the panic attacks! which come from being hyper to.

Hang in there, they will get better when you get the right amount of meds.. I had  really bad breathless feeling last month when I switched and went hyper so have your levels checked and try and right down  your symptoms daily as they creep up on you very gradual usually. this will help not  to crash or soar overboard with the meds. I am still on my rollercoaster rideof getting stable! but at least my palps have gotten better as yours well too!

Just wanted you to know  they are very real! and yes they are linked to thyriod issues! Good luck

[rad44]

I have hashi and also have heart palpitations.  I just called the doctor today to request to have labs done.  Mine occur mostly in the evening when I lay down to go to sleep.  Sometimes I stay awake for hours because I am afraid to sleep.  It is also very bad if I wake up in the night and first thing in the morning.  It is very scarey.  It seems for me any dose of levothyroxine does it.  I am now down to 50 mcg and it is getting really bad again.  

[MelinDel]

Goolarra - Should the palpitations continue, I will have to keep the beta blockers in mind.  I was really reluctant to try them, but after reading your post, if I finally get to the point where I cannot deal with the palpitations, I will try them.

azqtpies and rad44 - Thank you both for your posts.  I would not wish the heart palpitations on anyone, but I am so grateful to hear that I'm not the only one suffering from them.  I wish you both the best and hope that someday everything will even out for all of us.

As for me, I too felt as though the levothyroxine made my palpitations worse initially.  I actually was on 50mcg at first, then backed off to 25mcg for 4 weeks, then back up to 50mcg.  Slowly but surely, as my TSH level lowered, the palpitations seemed to lessen.  That is until the last few days, but hopefully this is just a short phase.

rad44, I found it difficult to sleep even after my cardiologist told me everything was fine.  I feel your pain and know your fears.  Try not to worry though - it sounds like you're going through the same thing that I did.  And while I am still having them, it has gotten better!  Have you seen a cardiologist?  It may make you feel better.

Maybe a positive side to having Hashi's was that when I felt my worst, I made a decision to try and be as healthy as I possibly could be.  So I have cut out ALL caffeine, which seems to have helped, and changed my diet.  I also quit smoking (a pack a day) as I figured at the very least, it certainly couldn't have been helping with the palpitations. ;-)

[Broken3995]

Hello I am fairly new to the forum and was recently well about a month and half ago diagnosed and can not seem to get any help though I can not even get my Dr.s office to forward my results to anyone since I need a referral to get HELP I am at the end of my rope,I just want to get better. I too have heart palpitations,tired to the point I do not even want to move just an awful feeling and etc. I also suffer from anxiety so this sometimes just makes that worse as well. I just do not know what to do or where to turn. I am 35 years old and want to enjoy my life not wonder if today is going to be another bad day. It is a scary thing feelings and I am glad I found this forum. Next though I just have to figure out what in the world to do. If people at the front at these offices just knew what they put the patients through.

[goolarra]

Unfortunately, we often have to really beat up our doctors to let them know how bad we feel.  Call them and let them know how miserable you are and that you need a referral TODAY.  Sometimes you just have to squeak a bit louder than the next wheel to get any attention.  Can you refer yourself to an endo?  Some health plans allow that.    

[MelinDel]

I wholeheartedly agree with Goolarra.  If they're not helping you over the phone, I would make an appointment with your Doc and request a referral in person.

You need to be your own advocate when it comes to your health because no one is going to do it for you.  At the very least, get your Doc's office to make copies of your medical records and give them to you.  They HAVE to release your records to you - don't let them tell you that they don't.

My brother had the same issue with his Doc this year - he would not give him a referral.  So he switched PCPs and found one who would give him the referral he was requesting.

[Broken3995]

Thanks to you both for the advice. What I did manage was to gather some strength and call the place I had the lab work done and went myself to pick up a copy so at least this way I have the results in hand if I just have to go to a general practice Dr. It is wearing me down even more with all of this and today I call another GP and guess what THEY too are not taking new patients. I just seem to be running into a wall in every way. It is so hard when you have no energy in the first place then what little you muster is a let down. Thank you to both for the advice and concern.

[Broken3995]

FINALLY found a GP and I have an appointment this Friday.I hope all goes well. I am really getting down about all this.

[goolarra]

Well, I'm glad to hear things are progressing.  Hang in there...things WILL get better.  Do you want to post the results of your labs?  We might be able to suggest questions for your doctor or further testing to be done. If so, post reference ranges also.  Best of luck on Friday.