ARRYTHMIA, HIGH BLOOD PRESSURE and LUMP in THYROID.

Hello.
Thank you for your query at DoctorSpring.com

Thanks for your response Doctor.
I do not have any hot flashes or any other symptoms of menopause. I have been taking HRT since about 8 years old patientwhen I had a hysterectomy (I kept my ovaries.)
I agree that the estrogen cessation could have a hand in all of this. I was stable on the 100/25 mg dose of levo/T3 for 10 months. Then when I stopped taking the estrogen, I began to feel over medicated. Higher heart beat all the time (82-85 BPM resting. I used to have about a 72), heart beat increases just walking across the room, hot flashes while drinking any alcohol, feeling warm and clammy all the time, slight anxiety. So I started to decrease the dose. I have read that estrogen inhibits thyroid and maybe even the absorption of Levothyroxine. So perhaps stopping the estrogen made the Levo dose too strong since the absorption increased.
The sudden blood pressure surges and feelings of uneasiness are too extreme to point to the estrogen cessation. I have been taking estrogen on and off for the last 8 years. When I have stopped it in the past, I would get hot flashes at 3 am. But never anxiety or fear to the degree I was experiencing. The fear and anxiety and uneasiness I was feeling a few days ago was extreme over stimulation maybe caused by adrenaline. I could not even bear watching TV or hearing music. I had to wear earplugs because the sound of someone talking would startle me.
Please note that the EKG report said I am experiencing "occasional premature ventricular contractions and possible premature atrial contractions"
I have had these arrhythmias only since yesterday. I find when I am totally relaxed, I can stop them or minimize them. But I must be lying down resting and thinking calm thoughts. The doctor said it is not "serious". The cardio said he believed they are responding to blood pressure rises. I believe that because they come when I am doing things or thinking about things.
The pressure in my neck, around by thyroid gland may not have been inflammation but I could feel it pulsing, almost buzzing. So something was going on. I could not wear a seatbelt or a scarve when I felt it acting up because of the discomfort. That symptom has subsided.
The arrhythmia has emerged while the other symptoms I mentioned have all stopped. So the heart irregularity and blood pressure surges are the only two symptoms that remain at this point.
The timing of all of my recent symptoms coinsides with the over dosing of the Levo. So perhaps that fact needs to be considered first and foremost.
I began taking Levothyroxine one year ago. My symptoms were cold feet and hands, very light hair loss, very slow pulse, low blood pressure (100/70) skin rashes, numbness in limbs when asleep, hot flashes at night when I didn't take estrogen. The levothyroxine elminated all of those symptoms and I felt really healthy. But please note that I had none of the classic symptoms like weight gain, eyebrow thinning, etc.
1. Can you tell me how long it will take for my body to adjust and calm down?
2. Should I perhaps resume taking a little bit of the estrogen (estradiol) cream on my arm to see if I can get some relief? Or would this make matters worse?
3. Is the medication he prescribed sufficient? (Micardis Plus) Or would you recommend another?
Any other feedback you could offer would be appreciated.

Hello
The body typically takes 2 to 3 months for thyroxine effects to disappear and hypothyroid symptoms to reappear.
I still feel that a part of your symptom complex may be because of estrogen deficiency. However a gynecologist or endocrinologist would be the best person to consult to clarify that.
As far as the arrhythmia is concerned kindly get a 24 hour holter examination done. It would help to define if there is indeed any arrhythmia which is going on.
After a month of thyroid cessation kindly get a thyroid profile done.
Micardis plus is a good antihypertensive for you. You need to check bp at home to ensure smooth control. An ambulatory bp monitor may help check the bp continuously.
Kindly get a endocrinologist opinion in addition to the holter test.
Regards
Dr Vivek Mahajan

Thanks for your opinion Doctor.
I went to see the cardiologist. He put a blood pressure machine and holter monitor on me for 24 hours.
The next day, August 29th, he read the holter. He said I had 2500 cardiac events (2.5%), some tachycardia and all sorts of other types of events. The diagnosis was extrasystolic arrhythmia. He prescribed 45 mg Metopolol extended release once a day and propafenone 75 mg every 12 hours. He said the blood pressure was fine, stayed below 120 throughout the 24 period he monitored it.
My symptoms have subsided about 90% with the medication. I feel a few events in the middle of the night or when I exert myself in the daytime.
He said it was not dangerous but it was delicate, whatever that means. (He said in Spanish so I may be missing the nuance.)
I received my thyroid tests from the lab for a test I took on the 27th, two days after the irregular heart beats began. The Free T3 is exactly in the middle of the range (2.73 pg/ml with range of 1.71 - 3.71). Perhaps tht is too high in my case. I seem to feel better when my Free T3 is at the lowest end of the range (previous labs had me lower in the range.) The TSH was 8.77 with a range of .35 - 4.94. The Free T4 was 1.07 ng/dl with a range of .70 - 1.48. The endocrinologist said that the test indicates sub-clinical hypothyroidism at this point in time. (I have not taken any medication for 17 days.) She does not seem to know where to go from here other than to wait and restart the medication in a month.
Do you still think that the low estrogen is part of the symptom complex?
Do you think that I may be slightly hyperthyroid because my Free T3 is too far near the middle of the range, rather than the bottom, where I am the least symptomatic?
Do you think it is a combination of both of the above?
Do you have any other suggestions?
Thank you so much!

Hello.
Thank you for your response.
The arrhythmia is now clear. It is multiple PVCs as you said. The medications are appropriate and they will help in the long run. Your symptoms could be because of the arrhythmia itself. If you have a normal 2D ECHO and left ventricular ejection fraction, then you need not do much for the arrhythmia other than take those medications.
Your thyroid profile is showing subclinical hypothyroidism. This means you have some amount of thyroid deficiency.
You should wait for some time and get the thyroid rechecked after 5 to 6 weeks and restart Thyroxine.
I think, contrary to what you say about T3, your body probably needs more T3 than it has. So, I wouldn't say you have more T3 than necessary.
Estrogen deficiency would present as hot flashes, suffocation, warm feeling, need for cool air, irritability, mood swings. The symptoms of sudden adrenaline rush, I am not sure how exactly you feel, that but if you have a warm feeling, mood swings and irritability, then estrogen deficiency may play a part.
The arrhythmia that is documented will cause palpitations and unpleasant feeling in chest. So if you feel something other than that, it could be a mixed picture.
Regards, Dr Vivek Mahajan.