Newly diagnosed-need input

I had one bout of a-fib about three years ago when I have been prescribed too much thyroid glandular supplement by a Chiro. I have been without an episode until last month and had another this month.

My cardio. had perscribed verapamil (fast acting) on an as needed basis and now wants me on the sustained release every day. I am very reluctant to do this. Especially since right before the episode this month (2 weeks approx.) I had began taking synthroid under the supervision of an endo. My thyroid is not out of range, but perhaps it is on the high side for me (TSH 1.16).

Anyway, what has been your experience with meds? Other than the thyroid hormone I am med free and hate to start down that slippery slope.

Lynn,

The following doesn't address your question specifically but contains links that may be useful for new afibbers.

Dick put together info for new afibbers, much of which refers back to this site:
[af-ideas.com]

Adding to this, I would draw your attention to Hans first book which is great background:
[www.afibbers.org]

[www.afibbers.org]

[www.afibbers.org]

The (subscription) Afib Report - specifically reading the archives & the ongoing info.
[www.afibbers.org]

The Conference Room Archives:
[afibbers.org]

SESSION 61: Protocols for reducing/eliminating afib (November 5 -December 15, 2007)
[www.afibbers.org]

SESSION 63: No More Heartburn by Jackie Burgess
[www.afibbers.org]

SESSION 64: Exercise and Afib (May 21 - June 15, 2008)
[www.afibbers.org]

This search of the Conference Room Archives for "thyroid"
[www.google.com]

Good luck!

George

Lynn - a TSH of 1.16 (althought not extremely low) just might be in 'hyper' territory for your biochemistry.

Typically, they like to keep the TSH below 2.0 but you have to remember that the TSH is not the only measurement that is important. Have you had a complete Thyroid Profile which would include both free T3 and T4, T3 and T4, Reverse T3 and the thyroid antibodies? The complete profile is often very telling.

If my TSH gets around .40, I'll have some heart activity even though my endocrinologist swears it is not the thyroid hormone. My EP says that if I get too close to 'hyper'- thyroid numbers, then they tend to see afib.

I have a long history of hypothyroidism complete with resultant goiteroid tissue because the Synthroid I took for 10 years did not correct the problem. There are now nodules as well which becomes a concern because they can turn malignant so I monitor via ultrasound annually. I have been at this for 20 years. The endocrinologist wants to keep my TSH as low as possible in the hopes of discouraging further enlargement of the tissues or the nodules.

I have had physical symptoms of hypothyroidism as long as I can remember.... and still do. I use Armour Thyroid and since I've been supplementing with a thyroid support complex plus iodine, and cut back on the Armour dose, my TSH is up to around .80 and my heart seems stable. I stay away from non- Rx glandulars because the hormone levels are inconsistent.

What I've learned is that not all endocrinologists actually know much about fine-tuning the management of hypothyroidism and especially as related to arrhythmias. Some are very unfamiliar with Armour and don't have a clue about dosing; I recently saw a substitute endo while mine was on leave and she flat-out told me she knows nothing about Armour and so couldn't discuss dosing. Imagine! At least she was honest. Wasted $ on that appointment!

Not that your experience and mine are the same, but if you think possibly your afib is related to thyroid hormone replacement dosing, it would be smart to try lowering your dose first before you take another drug just to mask a problem that might be driven by your TSH being too low.

When I started experimenting with my dosing, I decided to take the 15 mg every other day instead of every day. In about 6 months' time I was able to raise the TSH just a bit and stabilize my heart. My other thyroid profile numbers are fine and I have my Functional Medicine MD check them every 2 - 3 months so I don't get too far astray.

You probably know your body better than anyone so it may pay to do some experimenting based on your 'gut intuition.'

Good luck, Jackie

Also, have them check your reverse T3. You might be storing T4 and your body may be "dumping" it as you take new meds - it seems too coincidental that you recently started synthroid. If that number is out of whack with the ratio to your T3 (have that tested at the same time), you could have a problem that for me, at least, is contributing to afib.

Your regular doc - and even your endo - might not agree to test it. But I'm glad I did because I don't think I would ever get anywhere in my afib treatment if I didn't fix that problem first.

Good luck.

Lynn:

I had Graves Disease (hyper thyroid) and had my thyroid ablated (that was a long time ago--I wouldn't go down that road now), I was started on synthroid when I became hypo. I too was over medicated and had my first episode of afib because of it, the first few years I only one of two episodes of afib a year, then they increased, I believe that was due to the docs giving me lanoxin, that is a bad drug, I wouldn't touch it.

As Jackie says, you need to get your free T4, free T3 etc. tested, I go mostly by my free t4 if that is too high, that will put me in afib. I wouldn't start a med. until you find out more.

Liz

Lynn
I echo Jackie, Darcy and Liz on thyroid panel and dosing. I carefully walk the tightrope between hypo and hyper. I have had afib episodes due to pushing too close to 2 on my TSH...pace of moving to a lower TSH may be an issue as well.
Hope you can get back on track.
Cyndie

Lynn,

Regarding the sustained relase Verapamil and your question about whether to go down that route....

I was prescribed daily sustained release Verapamil for my atrial flutter about 7 years ago. For me it was like having a huge brake on my heart all the time. Even walking up stairs was tiring. It was my desire to get off the sustained release form that led me to go for an ablation which I had about 6 months later. That stopped the flutter, though I still get afib episodes now and then.

I would not go back on the sustained release Verapamil unless there was no other choice.

Thanks so much for all your replies. I suspect that the recent episodes are thyroid related. I am thankful for my integrative MD and endo. for being astute enough to monitor T4 and T3 and use it in fine tuning.

My problem is my cardio. To begin, he doesn't think I should be on thyroid meds because in his records my TSH has only been as high as 5.05, so he has not had proof that it went above 5.50 (basically because I was smart enough to seek treatment when the symptoms became apparrent.).

Now since I have had two episodes within 30 days (probably due to thyroid tweeking) he (the cardio.) insists that I must go on extended release verapamil (rather than the pill in the pocket approach) because my a-fib could damage my heart (mind you my highest documented rate is 155) and it could turn into VF because I had some PVCs mixed in on my last EKG. My heart is otherwise healthy. Supposedly he conferred with my EP, but when I spoke to my EP he basicly said that my a-fib is not a threat to my health and taking a daily med. is a quality of life decision. I tend to believe my EP.

Is a-fib life threatening if you have a healthy heart. I realize there is the clotting risk, but I take a low dose asprin.

Also, I have noticed the a-fib when my thyroid was down (once when TSH was 5.05 and once at 3.46) as well as when it was up. Has anyone ever had the a-fib episodes when they had a drop in thyroid?

Lynn - the new, (2006) revised guidelines by the Endocrinologists group lowered the range down from 5.0 to 3.0... . Most Endos like to have it down below 2.0. Hyper territory comes in when it is less than .5 . It's been my experience that not all doctors are up on the new guidelines.... even now.

Either hypo or hyper can cause arrhythmia. It's also important to consider that if the individual also has adrenal insufficiencies or burnout, tweaking the thyroid first without treating the adrenals will make the patient worse. Adrenals should be always be addressed first. The Adrenal Stress Profile by Genova Diagnostics is a salivary collection that measures cortisol production and DHEA over a 24 hour period... it's reliable and easy to do.

Jackie

[thyroid.about.com]
[www.genovadiagnostics.com]

Jackie:

I am pretty sure that I have weak adrenals. I am taking desiccated adrenal supplement and taking lots of vitamin C. I've been thinking of asking my integrative dr. for dhea, but I know that people with heart rhythms problems are not generally advised to take dhea.

I've not had the test run, because according to my dr. we are doing everything that we would do if it came back positive.

You are right about pushing the thyroid when the adrenals are weak. I thought I was going slowly, but perhaps not slow enough.

Has anyone here taken dhea?

Lynn - I was supervised with DHEA years ago when I was treating for adrenal burnout but I was tested first. It's important to do the testing; assume nothing. The saying goes: Test, don't guess. If you don't need DHEA, then, it's not good to take it anyway. Jackie

The Life Extension foundation is now recommending DHEA for everyone over a certain age. Personally I am a bit cautious when it comes to hormones.

Just wondered if anyone with a-fib has been able to tolerate dhea. Were you experiencing episodes back when you used it or was that prior to a-fib. Just curious

Lynn - I was using it just prior to afib...now that I think about it. Supervised by a Board Certified Family Practice MD. I honestly don't think there was any causal relationship between afib and DHEA.... and what I know now compared to back then... indicates we never sufficiently addressed the magnesium/potassium issue. Jackie