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909086 tn?1242660764

Hypothyroidism and Heart Palpitations

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!
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Avatar universal
I have hypothyroidism, I was put on the lowest dose of Levothyroxine. Recently switched to Synthroid due to binders that gave me hives. I’ve been suffering from heart palpitations as well. Saw the cardiologist, ran a bunch of test. I’ve been to the ER several times. I get dizzy, nausea, shaky, of course tightness in my chest. My blood pressure is always normal to low when I’m not having what I call and episode. But when I do have the palpitations they seem to at night mostly and huge blood pressure spikes 178/107.  So u are not alone. I seem to feel better and have less episodes when I have less stress, caffeine, healthy meals, less alcohol, earlier bedtime.
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Avatar universal
Thank goodness im not alone anymore.  Had 3/4 of thyroid removed in Oct 2019 since then my heart wont be still.  On Synthroid and now a beta blocker but my heart still races.  Have been treated like a complaining old woman and am fed up.  I hate this feeling I hate being so tired and I have having my thyroid removed.   Back to doc on fri am insisting on cardiologist and endocrinologist.....something has got to give!!!!!
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10 Comments
Since you are on T4 med it may be that your Free T3 is too low in the range.   Maybe even your Free T4 as well.  Please post all your thyroid related test results and reference ranges shown on the lab report.  Also please tell us about all symptoms you have.    What is your daily dosage of Synthroid?
Ok my last labs were 6/12/19 Tsh was 3.160 no T4 or T3 listed.  I take 50mcg's of Levothyroxin  I also have bad anxiety, indigestion, memory lapses and sleep is all screwed up, bloating.  I so appreciate this page.....thank you for your help!!!
Since your doctor only tested for TSH, I am quite confident in saying that I doubt seriously you will get what you need from that doctor.  TSH is a pituitary hormone that is affected by so many variables that it has only a weak correlation with either of the actual thyroid hormones, Free T4 and Free T3.   So you should always make sure they test for both Free T4 and Free T3 (not the same as Total T4 and Total t3) every time you go for tests.    Contrary to common belief hypothyroidism is not just due to thyroid gland disease or damage.  Instead it is correctly defined as "insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".    So it is suboptimal TISSUE T3 EFFECT that causes hypothyroid symptoms.    TSH has only a negligible correlation with TISSUE T3 EFFECT and related symptoms, so the only time TSH is useful as a diagnostic is when it is at extreme levels.  

A patient’s thyroid status is best determined with an integrated approach, including a full medical history,  clinical evaluation to identify signs/symptoms that occur more frequently with hypothyroidism, and expanded biochemical testing to support clinical findings.  Those tests include, Free T4 and Free T3, and initially  Reverse T3 and cortisol.  Vitamin D, B12 and ferritin should also be tested and optimized, due to their impact on TISSUE T3 EFFECT and symptoms.   Clinical evaluation that identifies multiple signs/symptoms typical of hypothyroidism best identifies the possibility, while FT4 and FT3 below mid-range, high levels of RT3, high levels of Thyroid Peroxidase or Thyroglobulin antibodies, or high cortisol levels provide supporting evidence and help identify cause.

Since you have already been diagnosed and had surgery to remove most of your thyroid gland, your concern of course becomes treatment with  thyroid medication.    You need increased thyroid medication that provides adequate TISSUE T3 EFFECT and relieves your many hypo symptoms.    Symptom relief should be the objective, not just test results, and especially not TSH levels.  TSH should never be used to determine a hypothyroid patients medication dosage.    Unfortunately many doctors don't understand this and would be happy with your TSH level and tell you that all is well.  Not so.    A very important recent study using data from thyroid cancer patients quantified for the first time the effect of FT3 on the incidence of hypothyroid symptoms and concluded that: “Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further in the upper half of its range.”  For patients on T4 therapy, achieving the TISSUE T3 EFFECT necessary for symptom relief frequently requires the addition of a source of T3 to their medication.

So you are going to have to convince your doctor to treat clinically, by adjusting your FT4 and FT3 levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels.   I am sending you a PM with info that you can use to try and persuade your current doctor to do the right things.  If that doesn't work you will need to find a good thyroid doctor that will do so.
To access the PM, click on your name and then from your personal page, click on messages.
Update after Dr appt. Friday Aug. 2.  Got referral for endocrinologist and cardiologist also they ran more blood work.  Results as follows....TSH 2.860 ulU/ml,  Free T4 1.22 ng/dL , T4 14.0 ug/dL, Free T3 2.8pg/ml.  There is no T3 noted.  no other labs run.  Heart rate in docs office was 104.  Was told no med changes but to wean myself off beta blocker since it wasn't working.  So its more waiting more misery and no answers.  Thank you each for your help
Please post the reference ranges for those test results as shown on the lab report.   Results and ranges vary from one lab to another so we need to know the ranges from that lab.  
Yes sir, these are the respective Standard Ranges listed ….TSH  0.340-4.020 ulU/ml,  Free T4 0.71-1.90 ng/dL, T4 4.8-13.9 ug/dL , Free T3 2.8-5.3 pg/mL...sorry and thanks
Your test results are about what I expected to see.   The average daily secretion of a euthyroid human is 94-110 mcg  of T4 and 10-22 mcg of T3.  You said 3/4 of your thyroid gland was removed, yet your thyroid med dose is only 50 mcg of T4.   This is clearly not enough since your FT4 of 1.22 is only 42% of its range, and even more importantly, your FT3 is at rock bottom of the range.    I also suspect that you probably took your T4 med the morning before the blood test, correct?  If so, that tends to give a false high reading for FT4.  So in the future you should always make sure to delay your med dose until after the blood draw.   A TSH test means very little when already taking thyroid med.  Your med dose should never be determined by your TSH level, as many doctors do.    

A hypothyroid patient should be treated clinically (as needed to relieve hypo symptoms like those you have).    To achieve symptom relief typically requires FT4 around mid-range, but more importantly, FT3 should be at least mid-range, and adjusted from there as needed to relieve symptoms.  Since your Ft4 was higher in range than FT3, that indicates inadequate conversion of T4 to T3.   So just increasing your T4 dose is not likely to achieve what you need.  You should try to get the doctor to add a source of T3 to your med and increase dosage as needed to relieve symptoms.

In addition, as mentioned above, there are several important variables that affect the response to thyroid hormone and symptoms.   Vitamin D, B12 and ferritin need to be tested and supplemented as needed to optimize.  D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.

Being referred to an Endo does ot assure a good thyroid doctor.  Many of those have the "Immaculate TSH Belief" and only pay attention to that, for diagnosis and treatment  That is very wrong.  If they go beyond TSH it is usually only to test for FT4 and then use "Reference Range Endocrinology", by which they will claim that a FT4 test result that is anywhere within the range is adequate.  That is also wrong.     You need a good thyroid doctor that will treat clinically, as described.   Personally I would hold off on the cardiac doctor until the thyroid issues were resolved, since hypothyroidism can cause the cardiac symptoms you mention.  

If you want to confirm what I have said, please click on my name and then scroll down to my Journal and read at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  You could give a copy of that to the Endo and see if he agrees and will treat you clinically, rather than just based on test results.   If not and you need a good thyroid doctor, let us know and perhaps a member can suggest one in your general area.  

I would love for someone from your organization to suggest a good doc.  I live in Hartwell, Ga about 1-1/2 hrs from Atlanta. so I can go to Atlanta, Athens, even Greenville, Sc.  So please please and thank you from everything in me (that still works, that is) You guys are a God send......WOW....how can I help you now?  
Please understand that MedHelp only provides the site for us.  Essentially everyone here is a thyroid patient like yourself.   We do have a lot of personal experience and have learned a lot over the years so we can try to provide good info to other members.  

I have sent you a PM with info.  To access, just click on your name and then from your personal page click on messages.  
Avatar universal
Did your endocrinologist who is treating your hypothyroidism test your calcium, phosphorus and PTH levels in your blood, and calcium levels in your urine?Did they run a full comprehensive metabolic panel on you? Was your magnesium level measured? Did the endocrinologist run a full lipid panel on you and order an ECG and/ or stress test or echocardiogram? Did they listen to your heart? Do you have a history of cardiac disease or heart murmur? Are you on medications that would interfere with metabolism of your thyroid meds -perhaps leading to increased levels?All of this should be done .%0mg of levothyroxine is pretty low for someone with a  TSH of 12.5 but  your dose cant be increased with such heart palpitations. Did they measure your freeT3 and free T4 levels? They might be too high even at the low dose of meds. Please please please go to a physician who knows what they are doing.I feel you deserve medical attention for these symptoms. I hope this helps.
Take care
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Avatar universal
That dosage seems  too low.  It is also synthetic.  I personally did not have relief of symptoms the entire 27 years I was on Synthroid.  I feel so much better on NDT.  I have tried several, ALL better than synthetic for me,  but am doing very well on WP thyroid.  WP is my favorite with the least excipients!   Blessings for good health!  BTW, I have palps when my dose is too low.  I do best with a TSH of  almost zero!
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Avatar universal
When you get results please post them here along with reference ranges and we will be happy to help interpret and advise further.  
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2 Comments
Will do. Thank you so much
I should have also mentioned that along with Free T4 and Free T3, it would be a good idea to ask the doctor to test for  Reverse T3, cortisol, Vitamin D, B12 and ferritin.   All can have an effect on your thyroid status.
Avatar universal
I have not had that particular problem my self but I have a friend that was showing many signs of it.  He was finally able to get in to see an Endo just recently and has started on Armour Thyroid.  Although the dose is still too small to really make a difference he says he is already doing better.  

There is a lot of scientific  evidence that hypothyroidism causes reduced cerebral blood flow, mainly to 4 specific areas.   One of those affect motor skills and another affects cognitive ability.  Also, while looking for information for my friend I ran across this: "Overt hypothyroidism is well-established as a reversible cause of cognitive impairment, which may sometimes be profound."
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1 Comments
I'm glad your friend is doing better. My heart and memory problems are the most bothersome symptoms I'm currently suffering from and they seem to be getting progressively worse. At this point my symptoms are simply intolerable. Those horrible heart related kicks in the chest have kept me up every single night over the past 5 days and my friends are really concerned about my memory. I'm a young adult and my memory is worse than the average 90 year old.

A few days ago I went to my doctor's office to get my thyroid checked. If the results come back subclinical (TSH 3+ FT3/FT4 below optimal) I will find a way to get on medication. I simply can't live with these symptoms anymore. If teh results come back completely normal and it's not my thyroid I don't know what could be causing this.
Avatar universal
My heart palpitations/PVCs started a year after I was hyper and a few months before I was diagnosed with Hashimoto's. They were relatively infrequent for the first few years (but still intolerable!). Now they come much more frequently :'(. Sometimes they're so bad that they keep me up at night because they won't stop. I'm currently unmedicated but I'm hoping to get on medication soon to see if it helps.
Anyone else also suffer from severe memory problems?
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1877796 tn?1320527991
I have hypothyroidism and am on Westhroid and I get the pvc's when my dosage is either too high or too low. It's frustrating, but also good to know that in 99% of the cases, per a doctor's website, these pvc's are normally harmless. They can also be caused by lack of sleep and lack of magnesium.
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1 Comments
How do you know if your dosage is too high or too low?  If it is based on TSH, that is totally inadequate to medicate a hypothyroid patient.  If tested for Free T4 and Free T3, please post typical results and their reference ranges shown on the lab report.  What, if any other symptoms do you have?
Avatar universal
I, too, have the same thing. I didn't know that my hypo was the cause of my palps until she reduced my Levo! Maybe you need a stronger dose. Go see your doc and let her know they subside with stronger medication.  Palps are not just linked to Hyper, I have proof of that with my symptoms.
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1 Comments
Thanks for the feedback.  It is a common misconception that palpitations automatically mean hyperthyroidism, yet there are some sources that correctly list it as a possible symptom of hypothyroidism.  
Avatar universal
Please create a new thread if anyone have a question. Followup is only useful for a single user. Clubbing all into one is just like adding several patients case history on a single prescription note.
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Avatar universal
I already responded to your other post on the same information.  
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Avatar universal
Get off the levothyroxine pills.  I switched to Tirosint, liquid capsule form, and am feeling so much better.  Fillers, dyes, cornstarch or sugar are in the generic forms, Synthroid contains iodine, as do some others.  Tirosint is NOTHING but pure levothyroxine.  
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Avatar universal
Just in case you don't hear from posters on this old thread, we will be glad to try and help if you will tell about any other symptoms you have and also list your thyroid test results and reference ranges shown on the lab report.  Also if tested for Vitamin D, B12 and ferritin, please post those as well.
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Avatar universal
What other do you have other than the palpitations?

If your doctor is dosing your thyroid meds based on TSH levels, it is unlikely your levels will ever stabilize.  TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms, and also levels of the biologically active thyroid hormones, Free T4 and Free T3.  

If you haven't been tested for Free T4 and Free T3 (not the same as Total T4 and Total T3), then you should get those done and make sure they are always tested when you go in for tests.  Members say that symptom relief frequently requires Free T4 at the middle of its range, and Free T3 in the upper part of its range, as needed to relieve symptoms.  

Further, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need to get those tested as well and then supplement as needed to optimize.  D should be about 55-60, B12 in the upper part of its range, and ferritin should be about 70 minimum.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results.  
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1 Comments
Hi at my suggestion I just had my doctor switch me from Synthroid 200mcg. to Naturethroid 195mg. because I was told by a friend that all around the Naturethroid is better. About a week ago I started having palpitations that have lasted on and off for over the entire week.  Sometimes hours on end.  I have mitral valve prolapse and left bundle branch block but I am on Toprol ( BB)50mg. for that. My latest labs after being on Naturethroid for about two weeks is T4, free direct 1.29ng/dl, Free Thyroxin Index 2.2, T3 uptake 30, Thyroxin (T4) 7.2 ug/dl, T3 141ng/dl and TSH .022 ulU/ml. Previous to this although I did not feel my best I had no palpitations.  The blood work on the Synthroid was TSH .048, T4 9.0, T3 uptake 30 and Free Thyroxin 2.7.  Thoughts?
Avatar universal
I too have been dealing with hypothyroidism for years and can tell when my TSH levels are off. Usually I get the Palpitations (feeling of heart flutters or sipping beats) when I am on too much Levothyroxin and more on the hyper side. Last month I started with the palpitations and thought my thyroid levels were on the "hyper" side again and I was taking too much medication. I went to get levels checked and my TSH was 64. Very Hypo so my doc increased y medication from 112 to 150. I am still getting the palpitations, very frightening sometimes it is so bad I am afraid to go to sleep. I am having another holter monitor done and a stress test just to be sure no other problem and if all is negative She is going to start me on a Beta Blocker. I was taking Inderal because I had Hyperthyroid first which gave me some fast heart beat and irregular heart beats.  I was given the radioactive Iodine which got rid of they Hyperthyroidsm but left me with Hypothyroidism. Yes my palpitations or flutters goes on throughout the day. I am praying that once my levels start to normalize they will go away.
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Avatar universal
T4,FREE(DIRECT) 1.38  
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Avatar universal
I realize I am making a lot of assumptions here, without any lab test results to review, but your story is a familiar one.  Palpitations can be related to low levels of thyroid hormone.  Just because you are taking a good dose of T4 med does not mean that your body is adequately converting the T4 to T3 which is the hormone used by all the cells of your body.  In order to find out if low Free T3 is the problem, you need to pressure your doctor to test for both Free T4 and Free T3 each time you go in for tests.  A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html

I expect that your doctor is reducing your med because of suppressed TSH, with the mistaken belief that low TSH automatically means hyperthyroidism.  That is wrong.  You are hyper only if having hyper symptoms, due to excessive levels of Free T4 and Free T3.  

I know how difficult it is in the UK to get tested and treated adequately.  We have had a number of members from the UK.  One who was finally successful in getting what she needed told us this.  

"What I have learned from my experience is that you have to go to the Dr's office and TELL THEM WHAT YOU WANT and to go backed up with knowledge.  You have to tell them that you have done your reading and looked into your condition and care about the long-term treatment of your health and thyroid.  If you fight for what you want, you will eventually find someone that is happy to go along with your wishes.  But we all have to take charge of our own health, right?"

So when you see your doctor I suggest that you should emphasize all the symptoms you have and the need to be tested for both Free T4 and Free T3.  Also mention that if your Free T3 is low in its range, then you will want to consider adding some T3 to your med.  Also, since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you should push to get those tested as well.  
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Avatar universal
Hi
I was diagnosed with Hypothyroidism in 1993 .
My diagnosis came about from having arrithmia and Palpatations which seemed a little odd at the time as  the Symptoms I was having indicated me being Hyper .
So I was put on Thyroxine and tests to see why I was getting these dreadful Palpatations .
But nothing was wrong so I was put on a Fleccanide which seemed to help with the fast heart beat but not with the Palpatations .
However I am still on it today !!
So over the years my dosage of Thyroxine went up and my Palpatations eased when I was on a dosage of 175mcg I felt much better however a couple of years ago it was lowered again to 150mcg where I have been having terrible Palpatations again .
Tests again proved nothing wrong but still these dam Palpatations persist.
Next week I am due my yearly blood test so small hoping that it will go back up to 175mcg as I am convinced it's what the problem is as I am tired my joints are painful I am breathless and Palpataions getting worse .
22 years of this crap and still feel no better than I did when first diagnosed and no one listens .
But I did have a few years when I felt good and that I am convinced was down to the higher dose .
Unfortunately in the UK we don't get a choice in what we are tested for you have to try and convince the GP .
Xx
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Avatar universal
Hello Kodifik,,

New to this but I have been placed on 50mcg and now 75mcg in last 6 months
by my GP was diagnosed with Hashi last June. I do now have these palps and it is scary, had to let you know I tried movement and it worked for me the other day and plan to continue. However, with all research I have done I feel
the Levo is the cause and have app with endo and will ask to go on Armour.
Do not want to risk these palps from throwing a clot into blood stream as this can certainly happen. Thanks for your input!
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Avatar universal
...almost forgot, also have irregular heartbeat...misses then hits several quickly.  
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Avatar universal
My HB's running about 105 regularly
and my tsh was tested at 3.84.   (age 60 male)

(on diltiazem 60mg slow release, which seems to be keeping my BP down)

other symptoms - out of breath quickly, dry skin on hands and heels, a few times I've had depression moods in early morning that go away quickly once I'm up and going.  

  Does this seem to be hypothyroid?  
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Avatar universal
Well said donny.  Thanks.
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Avatar universal
Throughout the internet, hypo people are asking the same questions. I've been hypo for almost two years. My VA doc doesn't seem too "on" about this and I have had to do my own research and implementation. The VA ONLY prescribes levo, not Armour/NDT, etc... The levo made me sicker and the lower the dose, the sicker I'd be. All of the classic stuff - weight, flu feelings, migraines, heart stuff...BAD heart stuff...terrible experience!!!
So I insisted on Armour - I have to pay for it. 2 days after being off levo my 24 hr migraines disappeared. Now, 8 months later and my weight is at 182 from 206... I'm only taking 1/2 grain per day but am bumping it to 3/4 today because of heart palpitations and upper valve issues probably from hypo...
I believe that we are not educated properly, do not know what questions to even ask, and are essentially relying on our dr's to be HELPING us. NOT!
They are too busy running us thru like cattle every 15 minutes all day so they can make pmts on the Jag and their country club dues.
YOU need to be your own lab rat!. I am 67 yr old male... male thyroid is not that common, comparatively. So my stuff may be different, but generally the same. Don't be afraid to bump up the doses to see if it makes an improvement in your condition. Generally the dr's will keep you on too low of a dose and then forget about you. Get a blood draw every 6 weeks. I usually have to remind them and they say "OH YEAH! You're right!" WTH are computers for??? Take your (hopefully) armour/NDT by dissolving it under your tongue. It's not bad - just kinda chalky. You'll get used to it and it goes to work better. You'll peak in about 4 hours, so break up your doses thru the day. My doc wants me to take mine all at once, once per day.... thats BS. Then I get a let down in the afternoon... TAKE CONTROL! It's YOUR body and YOU are the one feeling like crap! Some of the forum people have been sick for 20 years!!!!!
NO THANKS! If you can't get to feeling better, see another doc or a naturopathic person. And lastly... Treat yourself as if you were your own only child! It really helps to love ourselves! Honor your ill feelings if you're not feeling "right"... Listen to others (including your doctor) with a bit of skeptical acceptance. You WILL get better!
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1 Comments
You got it right! I have some sort of thyroid problem (I got most of the symptoms except weight gain), but I take kombu seaweed every other day. It helps with the total exhaustion I was feeling, though I still get heart palpitations and night sweats sometimes. But better than taking pills for me anyway! I hate pills, bleech! The seaweed also got rid of these nasty zit type things I would get (they weren't zits, but they would appear on my face or neck and were like zits but there would be a lump under the skin).
Avatar universal
Doctors like to think that TSH 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 correlate well with symptoms, which should be the priority.  

When already taking thyroid meds, TSH is basically useless as a test.  Many hypo patients taking adequate levels of meds to relieve symptoms, find that TSH becomes suppressed below range.  That does not mean hyperthyroidism, unless hyperthyroid symptoms are present due to excessive levels of Free T3 and Free T4.  

A good thyroid doctor 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.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

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