Has or is anyone here experiencing PVCs (premature ventricular contractions)?

[Marco N Cognito]

I've been having a bad bout of PVCs this last week and cannot determine the cause. They seem to activate when either supine or standing. Sometime when standing up, I get near-syncope (lightheadedness). EKGs from urgent care visit definitely reveal PVCs. I do ok with moderate exertion (cardio), but the PVCs seem to spike post workout. Am already on a beta blocker (carvedilol) and ARB (telmisartan) for BP management. Beta blockers are prescribed as treatment for arrhythmias. I have had bouts of PVCs and near-syncope in the past that were self-limiting, usually by adjusting my BP med dosing. This time, it feels different. My last echo was 2 years ago and was normal.

Other issues that may be related:

- thyroid - had been slowly increasing my dose of NDT originally from 1 grain to 2 grains since the start of the year and still am subclinical hypothyroid.
- mild anemia (low serum iron, ferritin, RBCs, low HGB); adequate ferritin/iron levels are essential for thyroid function, so I am wondering if the latest increase in NDT is could be causing these symptoms due to increase in T3 and having low ferritin/iron even though labs still show high normal. Could be unrelated, but is still on my mind.
- low C02
- hsCRP has increased from baseline (was 1.5, now 2.9) which is a concern. Elevated hs-CRP is an independent predictor of PVCs (and CVD) in the general population, especially in men.
- I had just started a stack of pharma-grade healing peptides (BPC-157, TB-500) for chronic tennis elbow and then added pharma-grade GH. I have since stopped all these just to get back to baseline since the palpitations started a few weeks after starting.
- as I have obstructive sleep apnea and am using a CPAP, I notice that my AHI levels have increased slightly from an average of 2 to 4 (which is still considered low risk)

I'm due for an appt. with an EP doc (electrophysiologist) for a more thorough workup, starting with a 30-day event monitor to track ectopic beats over a longer time period than a Holter monitor.

I'm already taking every anti-inflammatory supplement available, eat all organic, low carb (75g or less), paleo-style diet. In the meantime, I don't know what else to do or not to do.

Suggestions & advice welcome.

 

[d-man]

I think I’ve narrowed mine down to low Iron. When my iron tested low last time my PACs/PVCs were at their worst.

 

[Sean Mosher]

Could be possible that you increased your NDT dose too much.
Maybe drop down slightly (by a 1/2grain or so) and titrate back up that way.
I think that many of us have experienced heart palps while dialing in thyroid.
I"m not 100% sure thats what's going on here but if so it's fairly common.

 

[Vince]

Could be possible that you increased your NDT dose too much.
Maybe drop down slightly (by a 1/2grain or so) and titrate back up that way.
I think that many of us have experienced heart palps while dialing in thyroid.
I"m not 100% sure thats what's going on here but if so it's fairly common.

I agree totally. It's not the first time I heard of people getting heart palpitations because of increasing their free T3 too much.

 

[Marco N Cognito]

I agree totally. It's not the first time I heard of people getting heart palpitations because of increasing their free T3 too much.

What I can't figure out though is why someone would present with symptoms of hyperthyroid (in this case, palps/PVCs) and have totally normal or even low normal TSH and FT3 levels. Then again, I hear from endocrinologists that symptoms like heart palpitations, tremors, sweating, anxiety, and insomnia may occur even if the TSH is within the normal range when taking too much T3 or NDT (even worse when iron/ferritin is low). I guess the only thing to do is drop my dose, wait and see...

 

[Vince]

What I can't figure out though is why someone would present with symptoms of hyperthyroid (in this case, palps/PVCs) and have totally normal or even low normal TSH and FT3 levels. Then again, I hear from endocrinologists that symptoms like heart palpitations, tremors, sweating, anxiety, and insomnia may occur even if the TSH is within the normal range when taking too much T3 or NDT (even worse when iron/ferritin is low). I guess the only thing to do is drop my dose, wait and see...

Having hypothyroidism and finding the right dose, can be a total pain. I've been on thyroid meds for over 7 years. To get my levels just right, is lot of work. My main focus is, how my free T3 levels helps improve my LDL cholesterol. That is my main reason for working on by thyroid levels. Many people that I have talked to, that take thyroid meds. Will have issues with palpitations, because other thyroid meds.

 

[Marco N Cognito]

Having hypothyroidism and finding the right dose, can be a total pain. I've been on thyroid meds for over 7 years. To get my levels just right, is lot of work. My main focus is, how my free T3 levels helps improve my LDL cholesterol. That is my main reason for working on by thyroid levels. Many people that I have talked to, that take thyroid meds. Will have issues with palpitations, because other thyroid meds.

Ditto for me on T3 and LDL reduction as it works directly on those receptors. Was hoping to keep increasing, but it's not a linear equation and there are many other issues that can complicate adjusting the dose. What's a right dose today may not be in 6 months as everything can and does change. I have been struggling with different thyroid combos and meds for the last 10 years and still not there! I think a lot has to do with genetic polymorphisms that reduce the ability of the deiodinase enzymes to convert T4 to T3 and that the rate of such conversion in those affected may vary widely over time, thus causing one to go from optimized to hyper or hypo. Then there's the problem with keeping ferritin/iron levels optimized in order for thyroid hormones to work, then there's cortisol, MTHFR, heavy metals, the list goes on. I envy the people that never seems to have a problem and stay at the same dose forever.

 

[Vince]

Ditto for me on T3 and LDL reduction as it works directly on those receptors. Was hoping to keep increasing, but it's not a linear equation and there are many other issues that can complicate adjusting the dose. What's a right dose today may not be in 6 months as everything can and does change. I have been struggling with different thyroid combos and meds for the last 10 years and still not there! I think a lot has to do with genetic polymorphisms that reduce the ability of the deiodinase enzymes to convert T4 to T3 and that the rate of such conversion in those affected may vary widely over time, thus causing one to go from optimized to hyper or hypo. Then there's the problem with keeping ferritin/iron levels optimized in order for thyroid hormones to work, then there's cortisol, MTHFR, heavy metals, the list goes on. I envy the people that never seems to have a problem and stay at the same dose forever.

I can super overdose T3 and have no issues. It doesn't even affect my sleep and it takes my LDL way down. The only problem I have is with my thyroid doctor. She gets very upset when I do that :-(. So I'm stuck working with her, which is fine with me. I just changed my dose about 10 weeks ago, I cheated with the first 6. Then went to my proper dose, for Labs on June 4th.

 

[Marco N Cognito]

I can super overdose T3 and have no issues. It doesn't even affect my sleep and it takes my LDL way down. The only problem I have is with my thyroid doctor. She gets very upset when I do that :-(. So I'm stuck working with her, which is fine with me. I just changed my dose about 10 weeks ago, I cheated with the first 6. Then went to my proper dose, for Labs on June 4th.

How are your selenium, Vit D, iron/ferritin and cortisol levels?

 

[Vince]

How are your selenium, Vit D, iron/ferritin and cortisol levels?

I do supplement with vitamin D and my levels are good. I don't have any issues with iron, I haven't donated blood for two and a half years. Never had my cortisol levels checked.

 

[Marco N Cognito]

I do supplement with vitamin D and my levels are good. I don't have any issues with iron, I haven't donated blood for two and a half years. Never had my cortisol levels checked.

Are taking straight T3 or NDT?

 

[Nelson Vergel]

You may be suffering from postural hypotension caused by the dosage of the ARB and beta blocker combo. Talk to your doctor about decreasing the dose of either one.

 

[Vince]

Are taking straight T3 or NDT?

Thyroid armour 90 mg and cytomel 12.5 mcg I'm also strict low-carb, over 7 years.

 

[JimGainz]

I had PVC episodes when I was dialing in my thyroid meds - first taking Armor and then T3. Seemed to occur right after I increased the dose. Once lowered, symptoms disappeared. Realize that your heart has many T3 receptors and is often the first to react to thyroid dose changes.

 

[Marco N Cognito]

Update: since lowering my dose of NP Thyroid from 2 grains (120mg) to 1.25 grains (75mg) a couple days back, my EKGs are mostly normal, the PVCs have reduced, and I feel much more myself and less stressed. What I don't understand is that my thyroid hormone levels were still not fully optimized even at 2 grains and I was ready to raise the dose again. When I reached 2 grains, however, my levels had at least improved somewhat, rT3 reduced, and lipids improved, so was on the right track. I took my time to raise my dose from 1 grain, slowly increasing by 1/4 grain every 30 days based on labs so not like I jumped up too quick. Then, I crashed. I had been underdosed at 1 grain and believe 2 grains is still not enough. Due to genetic conversion issues, I don't think adding more T4 and reducing T3 will be beneficial as I tried that before and it backfired, raising rT3. The only thing I can think of is that unless I supplement regularly and aggressively with bioavailable forms of iron, I will default to a low serum iron/ferritin. Iron/ferritin is necessary for T4-T3 conversion, so when I try to raise NDT, I get symptomatic because the T3 it isn't getting into the cells and causes hyperthyroid symptoms like palps/PVCs. Or it could be something else or a combination of issues blocking me from optimizing my dose.

Lowering the dose has helped with the symptoms for now, but I don't feel it is a fix and the underlying subclinical hypothyroidism remains at large. The only other thing I can think of is that perhaps I'm unique and fall outside of what considered optimal labs for the majority. Perhaps for me, I'm not meant to have a TSH of <2.0, T3 and T4 in the upper range of normal. Just a theory.

 

[Marco N Cognito]

I had PVC episodes when I was dialing in my thyroid meds - first taking Armor and then T3. Seemed to occur right after I increased the dose. Once lowered, symptoms disappeared. Realize that your heart has many T3 receptors and is often the first to react to thyroid dose changes.

It took a over a month from my last increase of NDT for these symptoms to present which still leaves me with the thought that it may have noting to do with NDT or thyroid.

 

[Marco N Cognito]

Update: 10 days at lower dose of NP Thyroid (1.25 grains) and still getting palpitatons/PVCs on/off. Even at 2.00 grains, my TSH was still in the mid 2's and my FT4 and FT3 were midrange. It seems thyroid is not a culprit. Still getting lightheaded on/off when standing up. I have no other symptoms.

 

[JimGainz]

Update: 10 days at lower dose of NP Thyroid (1.25 grains) and still getting palpitatons/PVCs on/off. Even at 2.00 grains, my TSH was still in the mid 2's and my FT4 and FT3 were midrange. It seems thyroid is not a culprit. Still getting lightheaded on/off when standing up. I have no other symptoms.

Some people are very sensitive to palpitations and any minor stimulant could set it off – you should also examine what is your intake of caffeine and also the timing of when you get the palpitations relative to when you take the thyroid medication – keep a log – if it’s consistent then it is probably the thyroid Meds. also you could try to eliminate caffeine and other type of stimulants if you take them to see if that is causing the issue – lastly even if you ruled everything out you may want to try a different thyroid med - or even further reduce or go off your existing thyroid med for about a week or so to see if that stops the seventh. I had palpitations and didn’t feel right on a relatively low dose of NDT and I was not converting the T4 – when I went to T3 and dialed in the dose, everything pretty much disappeared – although occasionally – like every couple of weeks I still get it

 

[Marco N Cognito]

Some people are very sensitive to palpitations and any minor stimulant could set it off – you should also examine what is your intake of caffeine and also the timing of when you get the palpitations relative to when you take the thyroid medication – keep a log – if it’s consistent then it is probably the thyroid Meds. also you could try to eliminate caffeine and other type of stimulants if you take them to see if that is causing the issue – lastly even if you ruled everything out you may want to try a different thyroid med - or even further reduce or go off your existing thyroid med for about a week or so to see if that stops the seventh. I had palpitations and didn’t feel right on a relatively low dose of NDT and I was not converting the T4 – when I went to T3 and dialed in the dose, everything pretty much disappeared – although occasionally – like every couple of weeks I still get it

I stopped anything with even the slightest amount of caffeine years ago due to withdrawal headaches and do not take anything that is a stimulant. I don't notice any increase in palps/PVCs following my NDT dosing. In fact, the ectopic beats and lightheadness now seems more pronounced again after decreasing the dose. My next guess is that it's related to the BP meds I've been on for some time (carvedilol and telmisartan), as these can cause lightheadedness and changes in potassium levels which can be a cause. Other than that, I don't think I'll know more until I get more diagnostic testing (Holter monitor, echo, etc.). I ran all these before and was negative for any CV abnormalities, made some small changes in my dosing, and the PVCs gradually dissipated.

 

[coltsblue1812]

I used to get them from time to time... a high quality magnesium supplement helps them stop very quickly, for me!