Beta-Blockers & Hyperthyroidism: Should You Always Take Them?




Symptoms like:

  • Excessive sweating

  • Heat intolerance

  • Increased bowel movements

  • Tremor (usually fine shaking)

  • Nervousness, agitation, anxiety

  • Rapid heart rate, palpitations, irregular heart rate.

  • Weight loss

  • Fatigue, weakness

are all associated with Hyperthyroidism (when your thyroid gland works too much).



Rapid heart rate, palpitations, irregular heart rate are the ones that usually worry you more and can cause you to visit the ER.



When your thyroid works too much, you produce more epinephrine and norepinephrine. These two molecules are healthy when produced in the right amount. But, in hyperthyroid condition, epinephrine and norepinephrine are overproduced and bind to the beta receptors in your heart. This causes your palpitations.



That's why palpitations medications are called beta-blockers. Moreover, beta-blockers for hyperthyroid, decrease the conversion of T4 to T3.



Do you really need them or can you avoid them?


This depends on the severity of your symptoms.



Which beta-blockers drugs are better for hyperthyroidism?


  • Propranolol. Some people with hyperthyroidism experience “thyrotoxic hypercalcemia”, which means that they will have elevated serum calcium levels, and the mechanism isn’t completely understood. This is another reason why someone with hyperthyroidism who also has elevated serum calcium levels on a comprehensive metabolic panel might be told to take propranolol.


  • Atenolol. This probably is the second most common beta-blocker we see patients with hyperthyroidism and Graves’ disease take. Like most other beta-blockers, it can help to decrease the resting heart rate, high blood pressure, and can also help with angina (chest pain).


  • Metoprolol. Although metoprolol is sometimes recommended to those with hyperthyroidism and Graves’ disease, it is more commonly recommended to treat angina (chest pain) and high blood pressure.


  • Acebutolol. Acebutolol isn’t commonly recommended for hyperthyroid conditions, as it usually is used to treat high blood pressure and heart rhythm disorders.


  • Timolol. In addition to helping to decrease the resting heart rate and high blood pressure, timolol can also be used as eye drops to reduce pressure inside of the eye and is used to treat open-angle glaucoma (when there's high pressure in the eyes).



When should you take beta-blockers?


  • Option 1. With very high resting heart rate and/or high blood pressure. Some people with hyperthyroidism also have high blood pressure, and this is another scenario when a beta-blocker might be given in combination with antithyroid medication.


  • Option 2. When someone is unable to tolerate the antithyroid medication.


  • Option 3. When someone is planning on receiving radioactive iodine. It is recommended to discontinue antithyroid medication prior to receiving this treatment, although beta-blockers may be recommended to manage the symptoms.


  • Option 4. When someone has subacute thyroiditis.



What are the side effects?


Some of the common side effects of beta-blockers include drowsiness, fatigue, dizziness, and weakness. Other less common side effects include dry mouth and eyes, dry skin, diarrhea, nausea, vomiting, and cold hands and feet. Some people have also reported a decreased sex drive, shortness of breath, and sleep disturbances.



It’s also important to mention that certain beta-blockers (Propranolol and metoprolol) can inhibit the production of CoQ10. CoQ10 is important for cellular activity and detox.



Thus, if you are taking propranolol or metoprolol, you should consider taking 100mg to 200mg of CoQ10 in the form of ubiquinone, or another option is to take a lower dosage of ubiquinol.



What natural options do you have?


If your symptoms are severe, then natural remedies will NOT be enough to help you reduce palpitations.



Until hyperthyroidism is under control and put in the remission, and if your symptoms are severe, herbal remedies should not be what you opt for.



However, if your symptoms are low or mild, what are the herbs that can help you?


  • Motherwort. This is a natural beta-blocker, as some sources show that this herb has a blocking effect on beta-adrenergic receptors. But, it is not as potent as beta-blockers medications. Motherwort can also be as antibacterial, antioxidant, anti-inflammatory, and has analgesic properties.


  • Hawthorn. Usually well-tolerated.


  • Bugleweed. This herb has antithyroid activity. By reducing thyroid activity it can decrease the cardiovascular effects, without acting directly on the heart.




Let us know about you:



How are you managing heart palpitations?

Are you supplementing CoQ10?




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