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Suggest Treatment For Hypothyroidism And Insulin Resistance

Posted on Thu, 18 May 2017

Question: Hi Doctor,
Iam 37 year old female weighing 86 kg. since past 10-14 years Iam suffering from the follwing
1- Hypothyroid ( which is now at the extreme borderline of 0.3 tsh level and has a small 5.5mm nodule)
2- Insulin resistence (I have high level of insulin pp value is 211)
3- Panic disorder( started few years back when suddenly i went to emergency room since then i have been going in emergencies for so many times.)
Now, I had an attack few days back with chest pain. The pain wasnt going for 2-3 days. I had already done my stress echo which was fine. My lipids are under control.Still doc recommended to have a holter test monitoring of 24 hours. Iam attaching the report of the same with this.This report states some supraventricular ectopics. I want to know am I safe? do I have any heart issue? Neuro precribed it because i had palpitations he thought its related to arterial fibrilliation. Am I at risk of something?
Off late I have certain issues while I get up in the morning or whenever I get up from sleep. It feels that whole web network of my nerves is trembling inside. I can feel the tremor on my fingertips, arms, feet specially. Is it serious?
Since I have low BP (generally 110/70 but sometime 100/70 or 90/60 as well) embeta xr did not suit me to control my palpitations hence my doc had put me on ivabradine 5mg since XXXXXXX this year.
Please help and advise if Iam in some serious disease?
Thanks

Answered by Dr. Rishu Saxena (33 minutes later)

Brief Answer:
Panic attacks.

Detailed Answer:
Hi,
Thanks for choosing HealthcareMagic for your query.
As per your query answers are-

Supraventricular ectopics is an abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart.
As your stress echo is normal most likely cause of these ectopics in your case is increased levels of anxiety.
Grossly increased levels of anxiety are on of the most important documented cause of ectopics in patients with normal heart having high levels of stress and anxiety.
Heartbeats are normally initiated by a small group of cells at the top of the heart called the sinoatrial node, which acts as the heart's natural pacemaker.Over stress and anxiety stimulates the vagus nerve leading to excessive signal firing from pacemaker.

As stress echo is normal (highly sensitive) for cardiac disease i dont think you are at cardiac risk at all.However to be 99% sure a test called stress thallium can be done for your satisfaction.
Most likely all your symptoms are related to high level of stress and anxiety.Its not cardiac rather its panic attack.

Firstly get a stress thallium done for your mental satisfaction once it is normal consult a pyschiatrist for treatment of panic attack.
Embeta xr or ivabradine is bot required.
Ivabradine has no role in controlling ectopics its only used in patient with sinus tachycardia.
Follow ups are welcome.
Thanks.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Rishu Saxena (1 hour later)

thank you so much doctor,

so that tremors while getting up from the sleep every morning has nothing to do with the heart and its circulation?

Can overdose of vit B12 or high TSH cause it?

Regards

Answered by Dr. Rishu Saxena (9 hours later)

Brief Answer:
Panic attacks related tremors and symptoms.

Detailed Answer:
Hi again,

Tremors due to any thyroid problem or due to heart would be there through out the day and not specifically in the morning.

The problem seems to be related to panic attacks, therefore, they present only during a specific time.

Therapy with Paroxetine and Benzodiazepines should be started initially and response should be seen.

Thanks.

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee