Hello and thankyou for approaching DoctorSpring with your query.
I have gone through your case in detail and understand your concern.
Your symptoms could either be stress related or due to hyperthyroidism.
Since your free T4 levels are not very high, and TSH is slightly below normal it is advisable to get your Free T3 levels tested as well. This will give us a better picture on whether you are having hyperthyroidism related symptoms or no. Free T3 levels will also help us monitor your progress with treatment.
Have you had any major stress or anxiety recently?
Do the symptoms of chest pain and feeling of your heart beat or fast heart beat start only at night?
Are you having intolerance to heat? increased sweating?
What dose of metoprolol are you taking?
Please reply as a follow up. In addition if you could get your Free T3 levels tested and upload the results would be helpful.
I hope this has helped.
Thankyou
Patient replied :
My dosage of metoprolol is 25mg once every morning i have never had stress or anxiety before i have always been extremely sensitive to caffeine which seems to trigger these affects as well if i drink energy drinks coffee or any work out supplements although i use to be able to enjoy a soda like dr pepper coke ext no problems recently if i drink one of those the attacks are very severe i sometimes have chest pain through out the day there was a week where i had chest tightness and the feeling of sharp needles stabbing around my heart that lasted for a few days straight once of the medication lorazapam which is only .05 mg they seem to have went away or be minimal sometimes it flares up during the day at work or just relaxing trying to watch tv but at night it almost always happens around 7pm when i sit down to unwind and get ready for bed they are the worst chest pain shortness of breathe extremely dizzy sometimes nausea rapid heart rate once in a while i get a few heart palpitations i can feel in my throat my breathing also feels like i have to wheeze to get breaths i can't sleep I'm shaky cold then hot my hands and feet get sweaty sometimes its so bad i just stay up all night other nights i just lay there for a few hours take an ambien and finally pass out its hit and miss during the day i seem to get winded very easy its like i have no energy i don't feel like my self i get irritated very easy and i feel on edge its hard to focus and lately i find my self very forgetful its hard to crack a smile or play / hang out with my wife or son because I'm having trouble just feeling happy i always feel just groggy but i do get up every morning go to work ect. also how do i get my free t3 levels tested and are any other of the levels on my blood report that are off causing this as well like my chlorestoral ? i am always thinking Its my heart but every time i go get an ekg it is fine so I'm not sure if i need to look further into heart issues or its just in my head…. lately i really feel like I'm crazy
Hello and thankyou for your reply.
I have gone through your case. Your symptoms are likely to be anxiety related. I would advise you to stop consuming caffeinated drinks. I would advise you to continue Metoprolol 25 mg as it will give you symptomatic relief. After repeating your tests, if the thyroid tests are normal you will have to slowly stop metoprolol in consultation with your doctor. You will require to get a blood test done, to test serum free T3 levels. Regarding the rest of your blood tests, you Triglycerides are high, but not alarmingly high. And your HDL levels (good cholestrol levels) are low. This does not seem to be the cause of your symptoms as you have done EKG and blood tests and they have come normal. Hence this does not seem to be the problem. However I would advise you to exercise, ( a brisk walk) atleast 5 days a week and control your diet, in order to decrease your Triglyceride levels and increase your HDL levels. Use olive oil in your diet, increase your fish intake, have nuts and whole grain products. Increase you intake of leafy vegetable fruits. Cut down on carbohydrates, fried foods and fats. This should help improve your HDL and triglycerides.
In addition I would advise you to visit a psychiatrist to discuss your symptoms as they are likely to be anxiety or stress related. There is Cognitive behavioral therapy available where the therapist and patient work during session, to help you understand your thought process, monitor your day to day progress, have different activities to help you cope with your situation. You may require anxiolytics like SSRIs in consultation with your doctor.
As of now your symptoms are nothing to worry. Here is in short what I would advise you to do.
1) Continue metoprolol and get yourself tested in 2 months say about a week before the endocrinologist appointment.
2) Stop caffeinated drinks
3) Start exercising atleast 5 days a week and modify your diet
4) Consult a psychiatrist.
Patient replied :
So i have since received a called from my endocrinologist sayings they messed up on my appointment and had to push it and additional 30 days out may 1st I'm very frustrated with that i just went to my doctor on monday and talked to him told him that ambien wasn't working i was having trouble sleeping still and would go 2-3 days without sleep then finally sleep a day so he told me to completely stop ambien and we were going to take 3-4 lorazepam a day as needed .05 so i was already taking one in the morning i started taking one right about 5 o'clock and one right before bed i have done this all week and have no problems i felt great all day been doing good at work and sleeping although normally i'd go to bed around 9pm-10 now i can't go to sleep till about mid night is the only difference I'm also still taking the metoprolol every morning i have started eating better all week and since monday have went on a light jog / walk every evening after work today which is friday i had my first issue again i did everything as said woke up took my metoprolo and my 1 lorazepam then took another around 5pm now this is were i think i messed up i tried to have 1 beer with my wife while watching tv just 1 that was it and i drank it all feeling fine and sorta tired tried to go to bed woke up extremely sweaty all over my face about 15 mins into falling asleep feeling really anxious light chest pressure / squeezing on both sides it feels like my hearts racing but its not i checked my own pulse I'm at about 96 pbm but I'm not tired now and i feel like I'm shaky & or spaced out so it also made me scared and worried so i got up came down stairs and took only half a lorazepam because of fear that the 1 beer affected me 1 hour later still nothing I'm still feeling the same so i took the other half like i normally take a full one every night i'm so emotionally exhausted from not being able to be my self I'm at the point were i think that i make a lot of this up in my head but at the same time I'm so scared something is actually wrong with my i always fear its my heart i have had 4 ekgs now all normal chest X-rays only thing doctors say is possible thyroid which i mentioned earlier but its a long waiting game and i fear at 3 lorazepam a day i will be addicted by the time i see a specialist my body seems to not be able to function without them given that i don't feel normal or i have these attacks when I'm not on them i really just want to know whats wrong with my i have a family and a 3 year old son and I'm so worried about my health after my blood report i can't seem to have a normal life…i really need some solid answers / advice on what is wrong with me and why this is happening it always seems to flare up on weekends maybe because i have nothing to do also how do you distinguish the difference between a panic attack and a true heart problem??? i think this is my last question i can ask so i hope to get some good answers let me know how i can add more if needed thank you!
Hello, thankyou for your reply.
I can understand what you must be going through.
Lorazepam is a benzodiazepine and can cause physical dependence if taken for a few months. For that you will need to take care not to abruptly stop the drug. You will require to slowly taper your dose under the advise of your doctor and then stop it. As of now you can continue the medicine and need not worry. It can be taken 3 times a day and your dose is fine.
It is difficult to differentiate between a panic attack and a heart attack as patients with panic attack do present with similar cardiac symptoms. The only way to rule out a cardiac attack is investigations.
Since you have got your ECG done and you have got your blood tests done and they were normal you need not worry. Your
Continue metoprolol till you meet your endocrinologist.
In addition I would highly recommend that you visit a psychiatrist as he can evaluate your case completely and give you appropriate treatment for the same. There are highly effective drugs such as SSRIs that can be used as treatment for your condition. You will require a prescription for them and hence I would advise you to meet a psychiatrist.
Continue exercising.
I hope this has helped.
Wishing you good health.
Thankyou
Patient replied :
Hello, thankyou for your reply. I can understand what you must be going through. Your symptoms seem to be related to a panic attack and you will require to be evaluated for the same. Lorazepam is a benzodiazepine and can cause physical dependence if taken for a few months. For that you will need to take care not to abruptly stop the drug. You will require to slowly taper your dose under the advise of your doctor and then stop it. As of now you can continue the medicine and need not worry. It can be taken 3 times a day and your dose is fine. It is difficult to differentiate between a panic attack and a heart attack as patients with panic attack do present with similar cardiac symptoms. The only way to rule out a cardiac attack is investigations. Since you have got your ECG done and you have got your blood tests done and they were normal you need not worry. Your Continue metoprolol till you meet your endocrinologist. In addition I would highly recommend that you visit a psychiatrist as he can evaluate your case completely and give you appropriate treatment for the same. There are highly effective drugs such as SSRIs that can be used as treatment for your condition. You will require a prescription for them and hence I would advise you to meet a psychiatrist.Continue exercising. I hope this has helped. Wishing you good health.Thankyou
Hello, thankyou for your reply. I can understand what you must be going through. Your symptoms seem to be related to a panic attack and you will require to be evaluated for the same. Lorazepam is a benzodiazepine and can cause physical dependence if taken for a few months. For that you will need to take care not to abruptly stop the drug. You will require to slowly taper your dose under the advise of your doctor and then stop it. As of now you can continue the medicine and need not worry. It can be taken 3 times a day and your dose is fine. It is difficult to differentiate between a panic attack and a heart attack as patients with panic attack do present with similar cardiac symptoms. The only way to rule out a cardiac attack is investigations. Since you have got your ECG done and you have got your blood tests done and they were normal you need not worry. You continue metoprolol till you meet your endocrinologist. In addition I would highly recommend that you visit a psychiatrist as he can evaluate your case completely and give you appropriate treatment for the same. There are highly effective drugs such as SSRIs that can be used as treatment for your condition. You will require a prescription for them and hence I would advise you to meet a psychiatrist.Continue exercising. I hope this has helped. Wishing you good health.Thankyou