hypothyroid question

Good Morning,

I have been having more recent a fib- saw my gp who did a TSH with a result fo 9.85 ( I have been hypothyroid for years and am currently on 100 mcg of synthroid) she increased dose to 112 mcg. I am anxious about this as I initially went into afib because I became hyperthyroid when I went from a dose of 112 to 125 some years back. It appears that the hypothyroidism is symptomatic for me currently as I am quite tired all the time, somewhat depressed, gained some wt and the TSH is elevated.
I know hyper can induce a fib but wonder if the more hypo state could be inducing more a fib for me as well ?
Any rhoughts so much appreciated!

Lisa

Lisa - From my personal experience as well as that which is thoroughly disucssed in functional medicine circles, I'm offering the following considerations.

Definitely, your TSH is too high and you are hypothyroid as indicated by your many typical 'hypo' symptoms. The TSH is an indicator but not the only marker of consideration. There are other thyroid values that need to be measured so you can assess the whole picture... A typical thyroid profile panel includes not only TSH but also Free T4 and Free T3, T4, T3, reverse T3, and anti-TG antibodies, and anti-TPO antibodies. Read more [www.gdx.net].

Synthroid can be the problem. Quite often your body is unable to convert T4 to T3 which is the active thyroid hormone...and Synthroid only provides T4. I was in 'supervised neglect' for about 10 years taking Synthroid and continued to have all of the physical symptoms of hypothyroidism even though my TSH was in range... but at the higher range of what is now considered to be optimal.... because I was unable to convert the T4 in Synthroid to T3... and ended up with thyroid enlargement with nodules as a result. I had ultrasound and biopsy to rule out malignancy as that's typically the course of nodules.

Once I found a knowledgeable GP, I was prescribed Armour thyroid hormone which includes both T4 and T3 and I began to make some progress... or so I thought. The nodules remained in place for another 10+ years even though I consulted with several endocrinologists who were only interested in the TSH number and nothing more.

Getting back to basics and the classic book on thyroid by Broda Barnes, MD, (Hypothyroidism - The Unsuspected Illness) I monitored my first morning temperature (as described in the book) and recorded consistently that my basal body temperature was several degrees below normal. In time, I purchased the new Temporal Artery thermometer which gives quick and accurate forehead scans.

The research by physicians interested in thyroid dysfunction that focuses on Iodine repletion was suggested some years ago by my first holistic MD who started me on iodine repletion but it was so conservative dose-wise, it had only marginal impact. I read more here about the iodine connection, hypothyroid and the connection to Afib and delved deeply into the literature offered by the doctors I call the "Iodine Literate Doctors"... G E Abraham, J D Flechas, J C Hakala, and David Brownstein. Reference: [www.optimox.com]

I requested the Iodine Challenge test which indicated iodine deficiency and I began supplementing with low-dose iodine. I didn't want to overdo or rush the process because I was concerned about flaring up my heart so I just plodded along for years and didn't really seem to see much progress until I increased the dosing. In hindsight, had I increased sooner, my heart would have been much more calm.

As a result of the iodine repletion, I was able to reduce my need for the Armour thyroid hormone replacement from 15 mg once a day to only 15 mg three times a week. At one point, my heart became 'jittery' and my thyroid profile indicated I had become less hypo and trending toward hyper-thyroidism. It was easy to reverse that just by stopping the dosing for couple of weeks.

Since I have an annual ultrasound to monitor the nodules to be sure none are troublesome (malignant), the results indicated that I had eliminated several of the nodules and reduced the size of several. It's not totally normalized yet, but I'm gaining on it. The current endocrinologist is amazingly silent at my success with Iodine. Not surprising because none of the four endocrinologists with whom I treated for over 20 years, was ever curious about my iodine levels and didn't order testing. Amazing. An essential nutrient and they weren't interested..

Keep in mind that if you drink fluoridated water...either naturally-occurring or added to the municipal water supply, that fluoride binds the iodine receptor sites in the body... and of course, it affects thyroid function as well. While I haven't had fluoridated water for 30 years, I did work at locations that did and drank that water regularly so all the while I was struggling, that was running interference. That coupled with the fact that I was born and raised in "The Goiter Belt"... certainly didn't help my chances of maintaining an adequate iodine level.

I have no way of proving conclusively that my iodine deficiency and years of hypothyroidism contributed to the onset of my atrial fibrillation, but all the literature points to a definite association.

Best to you,
Jackie

Lisa:

In 1993 I was diagnosed with Graves disease (hyperthyroidism), I then had my thyroid nuked, I became hypo. I have been on Synthroid since 93, I don't have a problem with it, I am on 125 mcg./day. I have been stable for a very long time, feel fine, I see Dr. Brownstein twice a year, he is a holistic doctor and has written a book on the Thyroid. He knows I am on Synthroid, doesn't see that I have any problems with it.

A lot of doctors don't prescribe Armour because it is rather difficult to regulate, it is taken from Pigs Thyroid which has more T3 than humans. T3 is what can make you hyper, I have read that some cannot take Armour because of that reason. Some do well on it, however, I believe it is a little more tricky and needs more checking.

I agree with Jackie that Iodine (Iodoral) would be of benefit, only start slowly on it. I did take Iodoral for probably about 5 years, I took 12.5 mg. everyday which finally was just too much, I broke out in hives, so I quit taking it.

When people still have their thyroids, it is probably harder to control, as you are still producing the Thyroid hormone, so you may have more or less on some days. But don't rule out one drug over another, it depends on your body. When you increase your thyroid hormone, just do it a little at a time.

Liz

Hi Lisa Mac,

Its good you heard from both Jackie and Liz above as both approaches are fine for the right person. Liz is right too in that having had her Thyroid nuked for Graves disease,. it does make working with Synthroid easier and more reliable for many folks in her boat. My objection is to Endos who ONLY use Synthroid for all cases of Hypo regardless of the circumstance, and who only use TSH testing alone of with maybe Total T4 added in to determine dose adjustments. For many people such a rigid protocol is inadequate for long term thyroid maintenance. It does work fine for some for sure, so its part of the tool kit, just not the only, nor always the most effective way to skin the cat.

Synthroid is only active in helping your thyroid by its conversion to cellularly active T3 at each cell. So the bottom line is all thyroid meds work via the appropriate delivery of cellularly active T3 to the system. T4 itself is a storage form of thyroid hormone and itself has no real biologic action without prior enzymatic conversion to T3.

If you well functioning enzyme system for metabolizing T4 then Synthroid can work okay as Liz has experienced. Also made a bit simpler by the fact that her body no depends solely on Synthroid for her thyroid hormone supply.

My sense is that Liz has been blessed with an overall solid endocrine system, the Graves autoimmunity being an exception. I glean this from her description of her mothers robust long health and her own experiences she has shared her over the years its clear she has made good use of her gifts and has managed her self well.

Shannon

Hypo state can cause more afib. Just prior to afib I was prone to inappropriate sinus tachy. One of my drs. recommended increasing my T3 dose. I did so with great apprehension and it worked. I now know if my thyroid becomes too low or too high it will cause afib.

I am subclinically hypothyroidic, a few minor symptoms present themselves which can be controlled with non-drug means to raise metabolism.

About 15 years ago a doc put me on the lowest dose of synthroid, and after exactly 30 days I experienced 180 bpm tachy for about 3 hours. This was my first experience with heart rhythm problems.

Of course, I quit the stuff immediately.

Careful diet has reduced the TSH to around 5 with all other markers within spec -

Afib slowly developed over that 15 years - and is presently "cured" by way of ablation.

My take is that hypothyroid condition is not likely a cause of afib, but is one more issue that may facilitate it's progression. Afib is a product of stressed foci - I doubt that a lower metabolism stresses those foci...but a metabolic control system that is failing and overcompensates repeatedly with bursts of excessive stimulation certainly can be a cause of foci failure over time, IMO.

Sleuthing out why the thyroid gland is not functioning optimally is the challenge.

Thyroid hormone imbalances have a variety of causes. It can be an iodine deficiency, adrenals shutting down, toxicity from mercury, fluoride or other environmental toxins or auto-immune involvement… all of which affect the thyroid. Mercury is a big trigger of auto-immunity and is known as a thyroid disruptor. When the HPA or HPTA axis is involved it can take time to rule out various influences. Cortisol affects thyroid function.

Hypothyroidism slows the heart rate and weakens the heart's contractions, decreasing its overall function. For some, this can (along with other dysfunctions or core nutrient deficiencies) promote a tendency for developing arrhythmia. We've seen both hypo and hyper situations reported here as causal for afib.

Since thyroid function is intricately involved in the hypothalamic-pituitary-adrenal axis (HPA or HTPA) axis, it's not easy to sort out where the dysfunctions occur without the proper testing. It's clear that measuring TSH is not the only relevant number, yet oddly that seems to prevail as the main diagnostic marker. Even today, many clinicians still haven't adjusted to the 2002 guidelines that took the TSH range from 0.5 - 5.0 down to 0.3 - 3.0 as 'normal' functional range and that's really just a hint to look further with more testing. Consistently low body basal temperature is always a significant clue as well as sluggish metabolism.

Mentioned frequently in other posts on thyroid dysfunction is the iodine, bromide, fluoride connection to thyroid function interference. This offers a whole other diagnostic area of assessment to help determine the cause of thyroid dysfunction. Those who research and lecture on this topic always mention that hypothyroidism is now epidemic in the US.

There are non-autoimmune thyroid disorders and auto-immune disorders such as Hashimoto’s and Graves disease.

In Hashimoto’s, people may start out more hyper and eventually go to hypo-thyroid. With Graves, they are always hyper-thyroid with a revved up metabolism, weight loss, rapid heart rates, pounding hearts and various types of arrhythmias. It’s important with Graves to learn the underlying cause of the auto-immunity.

Hyper-thyroidism as in Graves disease is found to be connected to Epstein Barr Virus as the underlying cause; also, H.pylori infection in the case of Graves. These are relatively new findings and often not considered a contributing or causal factor for the auto-immunity but testing for the pathogens proves otherwise. Something is causing the body to attack its own tissue.

About 90% of people with hypo-thyroidism have Hashimoto’s thyroiditis which is the most common auto-immune disease in the world. It affects about 1 in 10 Americans with hypothyroidism or about 28 million here in the US and the rate is continually growing. The thyroid is making antibodies against the thyroid gland and that’s usually triggered by an infection such as the Epstein Barr Virus, H.pylori or another microbe, Yersinia enterolitica, a gut bug. Gluten sensitivity is found in Hashimoto’s patients as is selenium deficiency.

This serves to emphasize the importance of doing a complete thyroid assessment profile which includes antibody testing for both anti-thyroglobulin ( Anti-TG) antibodies, and anti-thyroid peroxidase antibodies (Anti-TPO).

It’s obvious that the TSH alone does not tell the whole story.

Jackie


Suggested Reading - new book well received in Functional Medicine circles
The Thyroid Alternative
Nikolas R. Hedberg, DC, DABCI
[drhedberg.com]

Genova Diagnostics
[www.gdx.net]

Lisa, I am also hypothyroid, and my afib episodes decreased in frequency when I started taking Synthroid about eight years ago. When my TSH test Is 5 or higher, I tell my doctor I want a higher dose, and that has always worked for me. Your TSH level definitely shows you need a higher dose. I would be worried if mine were that high. Thyroid affects almost every organ in the body, including heart and lungs. The heart is not getting enough oxygen when you have insufficient thyroid.
I would be afraid of NOT taking the higher dose, rather than afraid of taking it.