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Dr Basu
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Experience:  MD
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Could my hypothyroidism cause similiar symptoms as atrial

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Could my hypothyroidism cause similiar symptoms as atrial flutter? I had a mitral valve replaced last year and take a small dose of levothyroxine for low thyroid, and metoprolol (to maintain heart rate and AF). I feel better after I take the Metoprolol but the cardiologist says I can come off it as I had a heart ablation last fall which lowered the heart rate from 124 to 66-78 BPM, but I am still having fluttering sensations in the middle of my chest, a feeling of weakness, shortness of breath, and nausea. He said my EKG was great, no sign of AF, and to see a thyroid expert. I do not see how a brief EKG can detect AF when it does not occur on a steady basis.


Thanks for your question.

Hypothyroidism does not cause atrial flutter.

But, levothyroxine can precipitate palpitation & atrial flutter even at a low dose.

You mentioned about normal TSH.

Your free T4 & total T3 level should also be checked.

If these levels are high, then levothyroxine dose needs to be reduced or discontinued.

To detect the heart rhythm abnormality ( arrhythmia), you need a holter monitoring for atleast 24 hours or longer.

You are right that a brief EKG may not be able to capture the atrial flutter.

Customer: replied 7 years ago.

Should I continue to take the metoprolol? TSH came back I needed the low dose Levothyroxine. Also blood test showed high cholesterol which open heart surgery showed great clean heart with no sign of damage-all doctors involved said I did not need to take simvastatin which I stopped. I had blood test for Hashimoto disease but that came back ok even though I haved 80% of the symptoms!

Cardio doc keeps saying no AF-you make sense about the holter-why didn't he suggest it? He also said I could take twice the level of thyroid on a weekend and see if I felt better. What do you think, about that?

You should continue with metoprolol as this minimizes the palpitation episodes.

But, you can hold metoprolol for 48 hours before the holter monitoring so that the test can detect the palpitations if present ( metoprolol reduces the sensitivity of the test).

Since the thyroid work up came back normal, there is no point increasing the dose of levothyroxine as this can worsen your heart symptoms.

Customer: replied 7 years ago.

I have talked to many women who have had thyroid trouble that went undetected by blood tests or they came back requiring a low dosage of meds.

Please be honest with me-should I get a new cardio doctor based on what I have told you. I have some other issues with things he has said. He is a very nice man, but the PT's in my cardio classes sort of snicker when I mention who I see. He is out of a major hospital here in Mi and was just assigned to me by my heart surgeon. They are all part of a huge heart facility. I am fairly knowledgable about medical things and read online all the time and something just seems wrong. I know as a doctor you are unable to go out on a limb and tell me more than you have. Should I see an endo doctor? Thanks for your advice so far.

Thanks again for all the information.

There is no harm seeking a second opinion about your heart condition.

Regarding thyroid issues, please do not forget the lab errors, which sometimes occurs.

Hence, you should see an endocrinologist & repeat the labs in 3 months.

Customer: replied 7 years ago.

Thanks for your advice. I will find an endo doctor asap as I am tired of feeling tired. lol. I really thought after nearly dying (the mitral valve actually went during a heart cath to check the arteries before I was to have the open heart that week.) they told me I had about ten minutes. They also said I would feel so much better-lungs, heart, energy and all, but I do not as most of the symptoms are back nearly a year later-weight gain, shortness of breath, constant fatigue, upper chest soreness, hair loss, etc.

I am usually a very healthy person which is why this whole thing ticks me off as people keep saying I should feel so great! What do I say to my cardio doctor as he is part of the big medical group? Would I be labeled 'difficult'?

Thanks you again for providing additional information.

Mitral valve surgery does improve quality of life if the symptoms were related to the valve disorder.

Since, cardiac problems have been taken care of, the problem needs to be addressed elsewhere.

Besides thyroid, you need other endocrinological work up as well to rule out pheochromocytoma, adrenal gland dysfunction & pituitary disorders.

Also it may be late, menopausal symptoms due to estrogen deficiency can also 'hit' anytime.

Hence, this should not be a problem if you want to see an endocrinologist.

Asking a second opinion in medical field is encouraged in complex cases like yours when common tests do not diagnose your symptoms.

Dr Basu and other Medical Specialists are ready to help you
Customer: replied 7 years ago.
Thank you very much for your prompt and courteous manner.I shall consult an endo doctor asap and get this handled. If problems still occur, then I will get another cardio doctor.
good luck with everything.