# Propranolol & fatigue



## jani_3 (Nov 21, 2012)

Hi guys,

I have a question regarding propranolol and fatigue. Since starting the propranolol for symptoms of hyperthyroid I have noticed a massive decrease in energy and an intense fatigue that lasts most of the day for me. I take the propranolol 3X per day: morning, around 2pm and again in the evening.

I saw my Endo yesterday, she said that from my ultrasound she saw a hot nodule on my left lobe that she suspects is making too much hormone. I am scheduled in for an RAIU scan in 4-6 weeks from now and based on those results, she will get me to take RAI to kill off the nodule.

For the fatigue, she said that its most likely caused by the propranolol, as this is a common side effect. Her only suggestion was to try taking it less...which somedays I can but others I have to take a fourth pill because my heart rate gets too high and if left too long like before, I get chest pains as well as an array of other hyper symptoms. I feel like it's catch 22 - if I don't take the propranolol then I get all my original symptoms back, but if I do...then I have to suffer through this fatigue all day. If I was just at home and could lay down when tired I wouldnt mind as much, but I am starting a new job in a few weeks and worry about struggling through the fatigue while being productive.

My Endo doesn't want to start me on Tapazole until my Free T4 is out of normal range. Its high but not completely out, however, I am very symptomatic. Once I get my next set of blood tests back on the 11th Jan she says she will review it then and might consider starting me on a small dose of Tapazole so I can get off of the propranolol. Has anyone else experienced fatigue while on propranolol? Is there anything I can try that may help combat this fatigue?

Thanks,
J


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## StormFinch (Nov 16, 2012)

Has your doctor tested your Free T3 as well?

Since symptoms of both hyper and hypo are pretty interchangeable, it could be the Propranalol or it could be part of the hyper symptoms.

I didn't notice a whole lot of fatigue with the Propranalol but then I was exhausted from both the hyper and the resulting insomnia. I've been on several different beta blockers however, with various degrees of exhaustion problems. If it's the blocker it could be temporary until your body gets used to taking them.

You might also have your doctor run tests for ferritin, vit. D and B-12. All of these are effected by thyroid issues and deficiencies can be another cause of exhaustion.


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## jani_3 (Nov 21, 2012)

Thanks for your reply Stormfinch!

Yeah, FT3 was run too...both are on the high end but within range.

FT3 - 6.2 (4-7.2)
FT4 - 20 (11-22)

So they are both at the high end of normal but as the endo points out...still normal. I didn't notice fatigue until after I started taking the propranolol...before I had the common insomnia problems but also had some muscle weakness which I feel a lot more now, so it could be thyroid related.

I was thinking to check my ferritin, B12 and Vit. D levels at my next set of blood work. Did the other BB's you were on cause you to feel exhausted? It's so hard to seperate what is thyroid related symptoms and what could be from the meds. I have been on the propranolol for 6 weeks now...wouldn't my body be used to them by now?


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## StormFinch (Nov 16, 2012)

Oh good grief yes! I don't remember what it was, but one of the handful of beta blockers I was on made me soooooo exhausted. All I could do was sit on the couch and stare at walls in between naps. 

Yeah, at six weeks I'd say that if you were going to get past exhaustion caused by a blocker you probably would have.

I know that the docs give propranolol because at high doses (160mg and above) it somewhat lowers T3 levels, but that's at high doses, and no doc I've been to has ever given it to me above 20mg. Needless to say, if you're on a low dose, you might talk to your doc about changing to something else. I was on bystolic with a previous doc, and though more potent than propranolol, not only did I not have any side effects, it was better at controlling my heart palps and fine tremors. I did read somewhere later though that Bystolic can cause thyroid storm in Graves patients if stopped suddenly. Atenolol, alprenolol, and metoprolol, like propranolol, also can help lower T3 levels, so there are definitely other options out there.


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## jenny v (May 6, 2012)

Has she offered to look at other types of beta blockers for you? I was started on propranolol and it sucked the life out of me. I could barely get out of bed. I'm on Toprol XL now, which works great. It's an extended release of metoprolol so I only have to take it once a day.


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## CA-Lynn (Apr 29, 2010)

And let's not forget that it's the holiday season......that in and of ITSELF should make you exhausted. So I would just pace myself and see if the exhaustion doesn't relent after the 1st of January.


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## jani_3 (Nov 21, 2012)

Thanks everyone for your input, I really appreciate it!

Stormfinch- I'm definitely not on high doses of propranolol, just 20mg up to 4x daily but I try to only take it 2-3 times per day. Although, I have noticed that sometimes if my heart palps are extra bad that even the propranolol doesn't seem to help much with that.

I am finding that I have to really push myself through the day to do things...my eyes just want to close if I sit for any length of time.

CA-Lynn - I honestly haven't been doing anything extra during this holiday season haha. I haven't even bought presents yet, as I began having intense hyper symptoms (also had adrenal insufficiency) at the end of Sept. and have been spending most of my time going to doctors appointments and focusing on getting healthy again. This holiday season will come and go and I won't have done too much differently. So I definitely know it's either my thyroid or the propranolol. Althuogh, I can always hope that come January 1st I will be full of energy again! 

Jenny - I haven't asked about different beta blockers, I didn't think of that. I told my Endo about my fatigue since starting the propranolol and she just sorta looked at me like "yeah, that's a common side effect for a lot of people." and shrugged her shoulders as to say "just push through it, nothing I can do!" which was kinda annoying. I think she is planning to give me the RAI soon and hoping that will take care of my symptoms and I can get off the propranolol all together. Although I definitely like the sounsd of an extended release pill that would last all day!! I might ask her at my next appointment.

Did anyone with hyper symptoms find it impossible to drink caffeine before being treated? I know I would feel absolutely awful if I had coffee or anything with a decent amount of caffeine in it before I started the propranolol...I am just curious if now that I am on propranolol I could have a cup of coffee once in a while or do you think I should just avoid it until I treat the hyperthyroid?


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## jenny v (May 6, 2012)

Honestly, I would just avoid caffeine altogether right now until you get the thyroid and heart issues under control. The thyroid is causing the heart palps and the propranolol is trying to control those heart palps and caffeine would only make things worse at this point.


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## jani_3 (Nov 21, 2012)

Thanks for that Jenny! I figured as much but thought I would check to see if anyone else had those issues too. I find even having too much chocolate gets my heart rate up to scary high levels! No special coffee's for Christmas!:sad0049:


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## piggley (Sep 15, 2012)

Jani, just remembered -article re chocolate,fwiw. 
not good news

http://ithyroid.com/chocolate.htm


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## jani_3 (Nov 21, 2012)

Thanks for the article piggley!! It says that chocolate may be high in cadmium...but doesn't explain why this isn't good for hyper's. I tried googling it but only came up with cadmium poisoning articles! Hopefully I haven't eaten THAT much chocolate! haha.

Do you know of any articles, or if you could explain to me, why cadmium is bad for hypers?


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## CA-Lynn (Apr 29, 2010)

Cadmium is found in many foods and not limited to chocolate. You would have to consume an enormous amount of it to suffer toxicity. As I recall, the toxic level depletes zinc and some other naturally occurring elements in the body. But again, the amount of cadmium absorbed would have to be phenomenal.

As far as cadmium being bad for hyper's, I think this is just an exaggeration.


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## jani_3 (Nov 21, 2012)

Phew! Thanks for that Lynn. I couldn't find any articles or info on the net regarding cadmium + hyperthyroid so thought I would ask!

I suffered really bad heart palps again last night - woke me out of a deep sleep. Took me a while to figure out why I was having them...as I haven't had them since Ive been on the propranolol....but then I realised my fiance and I shared a drink earlier that night and it was diet coke!! Duh....I never realised how much caffeine I consumed in a day until it started adversely affecting me!! :S


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## piggley (Sep 15, 2012)

hi Jani,could have been the Diet Coke hey, perhaps the sweetener too. We can get sensitive to all sorts of thngs we ate and drank happily before the wheels fell off our Thyroids- its a giant pain in the behind!
Sorry you have the palps, they are horrible. Hope you are feeling better.


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## jani_3 (Nov 21, 2012)

Thanks Piggley,

Yes, it IS a giant pain in the behind. Normally I am pretty good with the caffeine but with all the Christmas buzz lately I guess I forgot and was thirsty from the shopping...haha. Won't make that mistake again!!

The palps are the worst. It's really hard to explain to people what they feel like/how unpleasant they are unless they have them. I am feeling better now thanks!!


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## StormFinch (Nov 16, 2012)

jani_3 said:


> The palps are the worst. It's really hard to explain to people what they feel like/how unpleasant they are unless they have them. I am feeling better now thanks!!


I told my doc I didn't know how to describe them. He looked at me over the tops of his glasses and said "Like something large is living inside your chest and occasionally rolls over?" My chin hit the floor before I realized that he'd probably heard it before, but that was exactly what mine felt like outside of the strong beats. lol


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## jani_3 (Nov 21, 2012)

Yes, stormfinch, definitely feels like something large is living inside me and occassionally rolls over!

I know that doctors and endos' all know the symptoms and signs of thyroid disorders...but I wonder how many of them have first hand experience with them?? It's a totally different thing to tell someone what something SHOULD feel like, as opposed to saying "I know exactly what that feels like and it's not nice!" I just say this because I am a mental health professional and have worked with a lot of clients who suffer from anxiety and panic attacks...however, aside from the occassional fear of public speaking or the like, I have never experienced anxiety or panic attacks first hand myself.....until my hyperthyroid set in! I KNEW all the symptoms of panic attacks before but until you have to live with it...it's hard to truly empathize with the person experiencing them. Although, I sorta feel like this is a cruel form of anxiety/panic attacks because no matter how much I rationalize my symptoms in my head or try to "take deep breaths to calm myself down" it doesn't stop my heart palps or shortness of breath.....it's origin is physical, not psychological.

Anyways, had to get some new propranolol before Christmas is here cos' I couldn't manage to go a day without out! Luckily I got the last 50 that the pharmacy had....phew! That was a close one! 

Hope you all have a Merry Christmas with your loved ones...and enjoy good health, even just for one day!!


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