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Medicine or Hashimotos causing Skip Heart Beats

I hope someone could give me an idea of what is going on... I've been dealing with this well over a year.

I was tested by PCP in 2016 to confirm Hashimotos ( around 35 on TPO) and nodules on thyroid. I went to a Endo later that year. Started Tirosint 75 mcg (I had tried Synthroid prior and it made me sick). I started feeling better and my TSH was in the low 1.00. I started feeling run down again after 1 1/2 years on Tirosint and noticed when my PCP did my blood work the TSH was in the 2.00s. My Endo does not test Free T3 and the increase in TSH showed up when using their inside lab instead of outside lab like Quest.

I got an appointment with the Endo and he said he wasn't against increasing my medicine to 88 mcg even though my TSH was within range but to be aware of hyper symptoms. Well to me that is nervous and jittery did not know about heart problems.

After 2 days diarrhea started then after 5 days my heart started skipping and hasn't stopped for over an year. It has actually gotten worse. Endo said to go back to 75 mcg. The heart skips continued and the Endo told me it had nothing to do with the medicine go to cardiologist.

Well I have been to two cardiologist. Had all the heart tests and was told my heart is fine. One told me "I don't mess with the thyroid and your Endo just wanted to make sure your heart is okay". Went back to Endo "it is not the medicine and you TSH is good". Cardiologist number two would not directly say the medicine caused it or could still be causing it. Did say I was over-medicated and it should have left my system and the heart stopped skipping.

I got a beta blocker but was hard to take. My blood pressure is already low and it just made me feel off. Did not stop the heart skips.

So saw Endo again and he seemed aggravated with me. He told me it isn't my thyroid and isn't my medicine. Last TSH was 3.02 and Free T4 1.44 keep in mind that I started taking my thyroid medicine with food because at one time it did seem to stop the heart skips.

So I asked to try a lower dose to see if it would help my heart to stop and now I am on 50 mcg..... every other day. Endo did not tell me to do this I made the decision.

It hasn't gotten better.... has been about 2 1/2 weeks. I am actually feeling worse extreme fatigue, I already had anxiety it is not better, just not feeling well at all. PCP isn't any help and says the heart skips are anxiety.

I was thinking of slowly stopping the thyroid medicine completely. I know I never had any problems with my heart skipping until this happened. I know I have the hashimotos and the nodules but.... I just want to feel better. I have family that needs me.

Would appreciate any input.
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649848 tn?1534633700
COMMUNITY LEADER
Hypothyroidism can also cause heart-related issues and with your TSH at 3.02, it's a possibility that's your problem.  

You don't give us the reference range for the one Free T4 of 1.44, so we don't know where that falls within the range.  If you'll post that range, we'll be able to see where in falls within the range.

Reducing your thyroid medication dosage or stopping it altogether will only make matters worse.  If there's nothing wrong with your heart, I'd say your issues are related to your thyroid (hypothyroidism), not to the medication, itself.

I can't imagine how the one cardiologist could say you're over medicated with a TSH of 3.02, when there's no Free T4 or Free T3... Unless you have high thyroid hormone levels, you aren't over medicated.

Sometimes when changing medications/dosages symptoms worsen or new ones appear until the body adjusts to the new dose, which could explain the 2 days of diarrhea.  

Hypothyroidism can also cause low heart rate, since the thyroid is partially responsible for controlling heart rate.

You need to find a doctor that will test the Free T4 and Free T3 consistently so you know what your levels are each time you have testing done.  You also don't mention whether you took your medication on the days prior to having your blood work done.  

Have you had any vitamin/mineral tests done?  Vitamin B-12, D and ferritin are all necessary for the proper metabolism of thyroid hormones.  Ferritin is the iron storage hormone and iron is necessary for the conversion of the Free T4 storage hormone to Free T3 which is used by nearly every cell in your body.  
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I forgot to mention that there are sites from which you can order your own Free T4 and Free T3 tests if you can't get your doctor to order them.  They won't be covered by insurance, but sometimes if done on your own and taken to your doctor, s/he will see that levels are not what they should be and will prescribe medication accordingly.  

One thing to keep in mind is that it takes 4-6 weeks for a dosage of T4 medication to reach its full potential and as I noted, symptoms can sometimes get worse or new ones appear while the body adjusts to having hormones it isn't used to having.
Avatar universal
Ectopics can be caused by hyper and hypo. I was getting lots of PVCs before I got on medication. They were so bad that they would wake me up at night, a lot. My PVCs mostly gone now that my FT3 is closer to the middle of the reference range.

Knowing your FT3 and FT4 levels can definitely help you figure out whether this is thyroid related or not. I was getting more PVCs when my FT3 was borderline low. If your PCP thinks it's anxiety and is refusing to run additional tests, maybe it's time to look for a new PCP and explain the situation to them. Doctors often refuse to accept this but thyroid issues can definitely cause ectopics.

Another way to determine whether this is caused by hyper or hypo is to wear a loop monitor (a cardiologist can order this test for you) and check how fast your heart is beating when you get those horrible ectopics. This may not be 100% accurate but at least it may give you a sense of what's causing this. If you mainly get them when your heart beats under 55-60 bpm, it's probably hypo. If they often come when your heartbeat is 100+ bpm at rest it's probably hyper. I was getting lots of PVCs when my heart rate was under 55 bpm around the same week every month (clearly hormone related, zero correlation with anxiety).
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Avatar universal
Thank you both for responding. I hate to write such a long post....

Below is my TSH and Free T4. Endo does not test Free T3 said there was no need. So I will have to do it on my own. I had also mentioned adrenal issues previously but I didn't really get a answer to that.

Vitamin D was low on prior tests, 23 I believe, so I was taking 6,000 mcg a day it went up to 92. Was told to cut down to 2,000 mcg a day. Ferritin... well is that the same as blood count? I do take iron pills because my blood count was low years ago. No test for B-12 in several years. I was taking 1,000 mcg but stopped it and the Vit D3 because I thought maybe they were contributing to heart skipping.

When I went up to 88 mcg the diarrhea started on day two and continued until I stopped the medicine completely for a few days. The heart skipping started on day 5 of the increased dose. It was so bad I had to stop and go back to my other dosage.

The cardiologist I believe he put it that I had too much thyroid medicine in my bloodstream and so it caused hyper type symptoms but never got to the thyroid. So when I stopped then went to my regular dosage my heart should have stopped skipping.

I've had anxiety for awhile and feel like it is a fall back for the doctor.

Is a loop monitor a holter monitor? I wore one during my heart tests. Actually had it twice.

The skip beats come during high and slow heart rates. So slow for me is 78 I've never had it lower than that. High heart rates are 105. Today I've only had a few skip heart beats.

Note that in March 2019 I tried to switch to Synthyroid because I just thought it was something with Tirosint. When I switched for three weeks no heart skips then suddenly it started again and much much worse. (Sorry men) I even skipped a menstrual cycle. I was told that had nothing to do with the thyroid medication as well.

I will go back to taking 50 mcg every day for a few days then more than likely back to the 75 mcg. I felt awful yesterday.
It is just so confusing. I've read so much online but need some people to guide me in the right direction.

Jan 2017 (after 2 months on tirosint)
TSH 1.430 uIU/ml   ref 0.450-4.500
Free T4 1.30 ng/dl   ref 0.82-1.77

Apr 2017
TSH 1.740
Free T4 1.50

Oct 2017
TSH 1.760
Free T4 1.51

(next is when my TSH started going the other direction
, also using their inside lab)

May 2018
TSH 2.9
NO Free T4

(follow up with Endo in June. Went from 75 mcg to 88 mcg for 7 days, then stopped for a few days due to reaction, started back to taking 75 mcg with food as at the time it seemed to stop the skipping beats but they would start later in the day)

From this point taking medication with food

Nov 2018
TSH 2.1 Ref 0.5-4.5
Free T4 1.53 Ref 0.75-1.54

Apr 2019
TSH 2.4
Free T4 1.36

Nov 2019
TSH 3.02
Free T4 1.44
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6 Comments
I did take my thyroid medication on the days of  lab work. Was I not suppose to? The doctor never told me not to take them.
First off, you should refrain from taking your medication on the day you have thyroid labs until "after" the blood draw.  Taking medication prior to the blood draw can increase your Free T4 results by as much as 20%, giving you a false high.  It might also lower your TSH from what it would be if you hadn't taken your medication.  Most doctors won't tell you this and some say it doesn't matter when taking a T4 medication, but it can.

Your thyroid labs show your Free T4 levels to be in the upper range, but they wouldn't be valid since you took your medication prior to having the blood draws.

Ferritin is the iron storage hormone.  If you have a blood count done and your red blood count is low, you're considered anemic.  This is probably what you're referring to, is that right?  Anemia can be caused by low iron or low Vitamin B-12.  You should have them both checked.  Even if you have adequate iron in your blood, ferritin will tell you if you have iron in "storage", meaning a reserve.   If you haven't had iron tested for a while, you should try to get an iron panel as well as Vitamin B-12.  

The vitamin D at 23 was definitely too low, but 92 is a bit too high.  You should be able to maintain a good level with 2000 IU/day but should check periodically to make sure.

I'm not sure what the cardiologist was referring to by saying the thyroid medication was in your blood but not getting to your thyroid... the medication doesn't go to your thyroid; the blood carries it to individual cells throughout the body.  He might have meant that the cells weren't absorbing it, but there's no way he could know that without the Free T3 test.

I'd be more inclined to think you aren't converting the Free T4 to Free T3.  Free T4 is considered a storage hormone and must be converted to Free T3 before it can be used.  Not all of us are able to convert adequately, though most doctors assume we can.  If we can't convert adequately, we don't have enough Free T3 to get into the cells we continue to have hypo-like symptoms, but can still have a higher Free T4 level.

I'd suggest that you try to find a different doctor who's willing to test Free T4 and Free T3 every time you have blood work.  
Thank you for the information. I've went back on my Vit D and going to take the Tirosint 50 mcg daily until I see a new doctor.

So if a person can not convert the Free T4 to Free T3 what can be done? Is that when you start looking at natural thyroid medicine (amour,etc) or synthetic T3?
If one doesn't convert Free T4 to Free T3, you can either try taking a desiccated thyroid hormone or since you're already on Tirosint, you could try synthetic T3, such as Cytomel or its generic counterpart, Liothyronine.  

An alternative to taking a T3 medication is trying to increase iron and selenium levels (both of which contribute to conversion) to see if you can boost conversion adequately.  It helps, but usually isn't enough.

What medication/dosage did you originally start out on?  Sometimes, doctors start patients on too high a dosage to begin with and it causes problems from the very beginning.  We've had members who have had to go back and start all over on a very low dosage and work their way up to a therapeutic dose very slowly in order to alleviate symptoms such as you're having.
Thank you for explanation on the T3 medication. I never really understood about why some people had to add it.

I was originally started on 75 mcg Tirosint. Took it from around Nov/Dec 2016 to May 2018. I was feeling so much better during this time.
Then around March 2018 I started feeling very run down, anxious, dizziness. I had just been to the PCP (Re my May Labs) and noticed my TSH was going into the 2's. So I thought that might be the reason for my symptoms. Met with Endo with increase to 88 mcg and after a week that is when the heart problems started and never stopped even though I went back to 75 mcg.
Okay, so you felt good for a while, then started having the symptoms of being run down, anxious and dizziness...  That's when  Free T3 test would have been really good so we could see what your level was as low Free T3 could cause symptoms like that, but wouldn't necessarily mean you need more T4 medication.

It would also be good it you had Ferritin, B-12 and vitamin D tests because Vitamin B-12 deficiency can cause horrible tiredness.  When my B-12 is too low, the fatigue is actually as bad or worse than hypo tiredness.  B-12 is necessary for production of red blood cells which carry oxygen throughout the body.  It's also necessary for proper metabolism of thyroid hormones.  Iron is necessary for conversion of Free T4 to Free T3 and deficiency also causes anemia, which causes fatigue/tiredness.

Many people are also deficient in magnesium, which can cause anxiety/fatigue.

There are a number of things that could have caused your symptoms, including the heart-related ones.  

It's definitely time for a new doctor and new lab tests.  If you can't get your doctor to order the labs, I can link you to a site from which you can order labs yourself, without a doctor's order, if you like.  They won't be covered by insurance, but the price is reasonable.
Avatar universal
A holter monitor is usually worn for 24-72 hours and only a doctor/nurse can take it off. A loop monitor is a 30 day holter (but you can take it off yourself when you need to, e.g. to shower). I think a holter should be more than enough in your case. Do you have your holter test results? If not, you can get a detailed report that lists every single skip from your cardiologist by calling their office. Go through the report and check what your heart rate was when you had the skips (in my case it was under 55 bpm 90%+ of the time I was having getting skips and my heart rhythm was completely normal over 60 bpm. Most of my skips happened at late night right before and during sleep when my heart rate was around 40-50 bpm).

You mentioned that your heart stopped skipping for a few weeks when you switched brands and that it also affected your period. This is further proof that your heart skips are related to your thyroid. I think you just need to find a doctor who would be willing to look past your TSH levels and also listen to your symptoms and history and check your FT3.

Based on your FT4 it seems like you're leaning towards hyper and that's causing your heart skips. But it's hard to tell without knowing when the skips started and stopped in relation to your labs. Could you re-post your test results with the dose you were taking and symptoms you had at the time?

I agree with Barb135. Taking your medication on the day of your labs tends to affect your test results. I always make sure to stop taking them 26-27 hours before.
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I will post the results of my last holter monitor. I have a worksheet showing the heart rate and when the skips occurred. If I remember correctly it was at higher heart rates but I will have to review again.

The April 2019 labs were taking after the switch to Synthyroid. As I said the heart skips came back within three weeks and were so bad I had to make an appt with the nurse practitioner. I had stopped taking the Synthyroid for four days before going. So the labs were taken about four days after stopping Synthryoid. I also had the holter test that day.

Again I was told there was no correlation and reprimanded for stopping the medication. I mean it doesn't take much to see that a stop to the heart skips and missed period when switching medication.... that there is a connection. No way I was PG either and I've always had regular menstrual cycles.

I saw the PCP about a week or so later. The nurses were more concerned than he was about my heart. I had three nurses come in to take my blood pressure and listen to my heart. They were having a hard time hearing my heart to take my blood pressure and wasn't sure if it was correct. Plus they were concerned with my heart skipping.

Talked to PCP, he said anxiety and offered depression medicine. I told him I am not depressed sure there are things going on but I am not depressed. I was really desperate to find out what was going on. I told him I had been through more stressful times in my life and my heart never skipped. Would it really start doing it now? He proceeded to tell me "you are just going to have to get a hold of yourself" and left the room.

I am going to a new PCP and hope for the best.
What about the other tests (e.g. Jan 2017, Oct 2017)? Can you list the symptoms you had and the dose you were on at the time? When did you start getting heart skipsWas it before or after April 2017?

Thyroid issues can cause anxiety too, especially hyper. You really need a new PCP.
I was on Tirosint 75 mcg. I felt much better, had energy, and was doing so well. Then in March 2018 is when I started not feeling well. In May 2018 I noticed the results on the TSH were going up/hypo. Endo increased in June/July 2018 to 88 mcg. That is when the heart problems started and I went back to 75 mcg  but they never went away. So labs in 2017 is when I was feeling well the labs after May is when I started the heart problems.
If you find a way to get your FT3 checked it could be very helpful. It's also hard to tell if it's hyper or not since you took your medication on the day the tests were done. But your holter results can still help with that.

You mentioned that your heart skips tend to start in afternoon. As far as I know the medication takes a few hours to get into your blood stream, so it could be related. You may want to ask your doctor to split the dose into multiple doses (I take 45 mg in the morning and 30 mg 4-5 hours later). This way the medication won't all kick in at the same time and it will be less likely to cause hyper symptoms.
Avatar universal
Just want to thank you all for posting it really does mean a lot to me.
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649848 tn?1534633700
COMMUNITY LEADER
I had anxiety and heart palpitations/skipped beats horribly bad when I was hypo.  At that time, I also had a family situation going on that I couldn't control that caused a lot of stress.  I also worked full time and had little time off so that made the stress/anxiety a lot worse, which exacerbated the heart issues.  

I've had a holter monitor 3 times and definitely have bradychardia (slow heart rate), which I believe to be caused, at least, partially, by my hypothyroidism.

It's important to remember that a lot of thyroid symptoms can cross over and apply to either/both hyper and hypo.
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3 Comments
I had horrible anxiety when I was hyper, no skipped beats. I had horrible skipped beats when I was hypo, no anxiety.
The difference between us is a good example of how different we can be from each other and how symptoms can apply to either hyper or hypo.   It also shows how important it is to have the proper testing so we know what's going on.  :-)
Agreed :).
1756321 tn?1547095325
I cannot feel my heart beating so I have to check my heart moniter to see what is going on. My body temp and heart rate increase with hyperthyroidism and decrease with hypothyroidism.
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My heart rate is always low (bradycardia) but often "feels" like it's racing.  I do feel it most of the time.  

My body temp is low, too - when I went to have my recent surgery, my temperature was only 97,2 when I arrived at the hospital that morning.  It's typically, low (closer to 97 than 98) when they test it in the doctor's office, but they tell me anything between 97 and 99 is "normal"...  You'd think someone would eventually pick up on that, since I consistently tell them I have other hypo symptoms, but medical personnel pay no attention.

I've never been "hyper" as in too high levels of thyroid hormones, so have no idea how my body reacts to it but have had many of the same symptoms when I've had too low levels of thyroid hormones.   :-)  The one time my thyroid hormones levels came close to the top of the range, I felt awesome but my doctor panicked and decreased my dosage.  :-(
My heart rate is till pretty low. But it's not as low as it was when I was getting the heart skips. My body temperature also tends to be pretty low, especially when I take it at home. 96.5-97 ish.. It was always around 98 before I had Hashimotos.
Avatar universal
I have Hashimoto's as well and the skipped beats and palpitations can be brutal. I went through a few cardiologists and endocrinologist because each one kept blaming my issues on the other. I finally went to a holistic doctor that did muscle response testing. Honestly I was skeptical but I was so desperate and I felt I had nothing to lose at this point. He told me to eliminate wheat gluten soy oats and corn from my diet and although I was skeptical I did. Lo and behold two weeks later my palpitations went from everyday all day to about once or twice every few days. I feel so much better. I know you said your skipped beats started when you took your medication however maybe your hashimotos progressed around the time you started taking medicine. It must have that is why you started needing meds anyway. Sometimes people cannot tolerate the thyroid medication. It's worth eliminating the foods just to see how you feel. You have nothing to lose. I actually ended up being a vegan afterwards because once I eliminated the foods my holistic doctor suggested it made me more in tune with my body and other things that were aggravating my immune system. I never would have thought those foods were bothering me because I didn't have any type of allergic reaction to them but having Hashimoto's our immune system is already out of whack anyway.  I suffered with Hashimoto's  for years and I paid a lot of money to funtional medicine doctors that didnt help. But I found this holistic doctor he was so cheap it was only $50 to see him which is another reason I was skeptical because it was so cheap. But he change my life. He had me  do a heavy metal detox and he gave me these tinctures for a virus and something else I forgot sorry. And then he told me to eliminate certain foods......let food be thy medicine and medicine be thy food...sorry so long
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There are times it can be beneficial to eliminate certain foods... the main ones to eliminate primarily are gluten, soy, dairy and sugar.   Gluten is found is wheat, rye and barley.  Oats is, typically, okay for those with gluten intolerance/sensitivity to eat.  

Many people are lactose intolerant, so it's advisable to eliminate dairy, and of course, it's always advised to avoid soy when one has a thyroid issues as soy is one of the goitrogens that inhibits thyroid hormones.  Like soy, sugar is best avoided by everyone, because none of us needs extra sugar.

It's not necessarily advisable to become vegan since animal products are the only way we get our vitamin B-12 and one of the best ways to get iron, without supplementing.  

FYI, Faith, for anyone who can't tolerate ingredients in replacement thyroid medications, there's Tirosint, which is hypoallergenic and which the original poster is already taking.  I, personally, took Tirosint for about 5 yrs, until the price became so exorbitant I could no longer justify it.  Although I did well on it, I did still have some palpitations while on it.
Avatar universal
Believe it or not. I read and article recently that stated many heart palpitations and skipped beats etc can happen if a person has too little salt.  

We hear harping  to avoid st so much that many people go too far and cause heart anomaly’s from lack of salt and corresponding loss of electrolytes.  

Not saying this is the case here. But if you have happened to be actively avoiding or eliminating  salt, may want to consider it as a possibility.

In my case I had PVC’s with heart skipping feeling when I was hypo.

Heart skipping and pvc etc and anxiety also related to too much caffeine. So may want to think about the coffee and soda intake if they contain caffeine and you drink several a day.

Most all your symptoms and specifically the low body temp would most correlate to hypo. And as many stated above, heart rate issues are common with hypo.

I personally am not convinced, although possible. That a relatively small 13 mcg increase would send you hyper.

T4 medication takes several weeks to stabilize in blood. Splitting T4 medication is useless. Besides, Tirosint is a liquid gel cap, making it impossible to cut in half like a pressed powdered pill can be cut with a common pill splitter or knife.

T3 medication on the other hand acts in HOURS and therefore splitting the dose to twice a day is effective and makes sense for most people to do and I would recommend. T4 splitting dose that takes weeks to really stabilize is totally insignificant. At least in my opinion.
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