HomeAnswersEndocrinologytsh levelAre TSH drops and fast heartbeats normal while on Levothyroxine?

What could cause drops in TSH and fast heartbeats in the mornings while on Levothyroxine?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Sneha Kannan

Published At August 25, 2020
Reviewed AtJune 8, 2023

Patient's Query

Hi doctor,

I am a 53-year-old peri-menopausal woman. My weight is 160 lbs. I had a thyroidectomy ten years before. Since then, I have been taking Levothyroxine 112 mcg daily and was maintaining a TSH level around 3.5 to 5 mU/L. (last good test was four months back with TSH- 4.0 mU/L). However, three months back, I had to change to a different Levothyroxine brand and used it for two months, then the next month woke up with a fast heartbeat in the morning and realized that my TSH level was suddenly down to 0.5 mU/L (also had a sudden drop in blood count of 8 g/dL). So I stopped taking it for three days and continued with the original brand. Every ten days or so, my TSH would go up by 1.0 point. So after ten days, it was 1.5 mU/L, then 20 days later, it was 2.5 mU/L (blood levels also rose to 9 g/dL). However, after another ten days (a full 30 days) from the initial problem, my heart again started to beat fast in the morning while waking up. The TSH levels had dropped again to 1 mU/L (blood levels still getting better- 10.4 g/dL, except for some exceptionally high white blood cells). So it is confusing because we thought the cause could be the switch in medicine, but now we cannot figure out what is causing these drops suddenly. Any thoughts on what could cause these drops in TSH value and cause hyperthyroid and fast heartbeats in the mornings?

Hi,

Welcome to icliniq.com.

Sudden drop of TSH (thyroid-stimulating hormone) level may be due to thyroiditis, inflammation, or leak of thyroid hormones. Other possibilities are mistakenly taken excessive levothyroxine dose, or the previous dose may not have absorbed well with immediate food intake. In the case of thyroiditis, you have to reduce the intake of Levothyroxine to 75 mcg. Infection, stress, certain drugs like radioactive iodine, etc., can cause thyroid storm. So repeat your thyroid profile after one month. If your heartbeat is still not under control, you can take a tablet of Propranolol 10 mg once daily for five days. Avoid caffeine drinks and alcohol. Review with reports or consult with your physician to examine and treat you accordingly. Take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Penchilaprasad Kandikattu
Dr. Penchilaprasad Kandikattu

Internal Medicine

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