Panic Attacks, Heart Palpitations And Your Thyroid

panic attacks, heart palpitations, thyroid disease, hyperthyroidism
Freedigitalphotos.net / Mary Shomon

You heart pounds quickly and loudly, Your hands shake with tremors. You feel dizzy. It's hard to catch your breath. You break out in a sweat. You think you're dying. You are gripped by a sense of fear. You could be having a panic attack.

Or, you feel your heart skipping beats, racing, fluttering, or pounding. You could be having heart palpitations.

Many people don't realize that panic attacks and palpitations can be a symptoms of hyperthyroidism – an overactive thyroid -- or autoimmune Graves' disease.

Some patients are even misdiagnosed as having panic disorder or heart problems when they are actually hyperthyroid. Once treated for their overactive thyroid, they go on to be free of these symptoms.

When you are hyperthyroid, your body produces too much thyroid hormone. This release of hormone can speed up your heart rate dramatically, increase blood pressure, and generally put your body into overdrive, and can kick in the body's fight-or-flee adrenaline response.

In Hashimoto’s disease, the up and down production of the thyroid can sometimes cause excess thyroid hormone to be is released erratically. A toxic multinodular goiter can also cause sporadic periods of hyperthyroidism. In turn, these episodes can be a trigger for panic attacks or cause heart palpitations.

Most people who have a thyroid dysfunction will find that once properly treated, panic attacks and palpitations become a thing of the past.

But what if you've been treated, but are still experiencing these episodes?

At that point, you will need to explore further diagnosis with your practitioner.

One key possibility to investigate is whether or not you have a mitral valve prolapse, a heart valve irregularity that is more common in thyroid patients, and can produce symptoms such as pounding, fast heartbeat, palpitations, panic attacks, dizziness, shortness of breath and other symptoms.

Mitral valve prolapse can be diagnosed by an echocardiogram, and there are treatments - including beta blockers - that can alleviate symptoms.

Another question to discuss with your doctor is your TSH level, and T3 levels. Once treated for hyperthyroidism, most patients become hypothyroid, due to radioactive iodine (RAI), antithyroid drugs, or surgery. At that point, you will be on thyroid hormone replacement. But if you are on too high a dosage of thyroid hormone replacement, and your TSH is in the lower end of the normal range, or your T3 is high or in the higher end of normal, you may be borderline hyperthyroid due to overmedication. It's worth discussing a slight reduction in your dosage with your doctor to see if that alleviates your symptoms.

If you are having periods of hyperthyroidism due to Hashimoto’s disease or toxic nodules, better treatment for your condition may resolve your panic and heart symptoms.

Finally, if you and your doctor cannot determine any condition-related reasons for your symptoms, you may in fact have a panic or anxiety disorder, or some sort of other heart irregularity, and you should be further evaluated by an expert.

PANIC ATTACKS

What are Panic Attacks?

A panic attack is a sudden feeling of overwhelming anxiety and fear. Your heart pounds uncontrollably. You may feel as if you are going crazy. You probably can’t even catch your breath. Panic attacks can lead to panic disorder if not treated. You could even start avoiding regular activities for fear that a panic attack will occur. Seek help immediately – the attacks can be treated. With the right treatment, the panic attacks can be reduced or even eliminated so you can once again enjoy your life.

Most of the time, panic attacks come on completely unexpectedly – with no warning at all. Typically, there is no clear reason for the attack. Sometimes the attack will even occur during sleep or when completely relaxed.

Sometimes, a panic attack is a one-time thing, however, many people experience recurrent episodes. Repeat episodes often occur and can be triggered by the same situation that caused an attack before.

You can be totally healthy and happy, yet still experience regular panic attacks. They could also morph into panic disorder, depression or social phobias. Panic attacks are treatable; regardless of what causes them. Don’t give up hope. There are lots of treatment plans and management strategies for dealing with panic attacks.

What are the Signs and Symptoms of Panic Attacks?

The following are symptoms that are common during panic attacks:

  • Breathing difficulty, shortness of breath, feeling of being smothered
  • Hyperventilation
  • Racing heart, pounding heart, accelerated heart rate (heart palpitations)
  • Chest pain or discomfort in the chest area
  • Shaking and or trembling
  • Feelings of being choked or actually choking
  • Feelings of unreality or of being detached from your surroundings
  • Uncontrollable sweating
  • Nausea or upset stomach, abdominal pain or distress
  • Feeling weak, dizzy, unsteady, light-headed, or faint
  • Paresthesia - numbness or tingling sensations
  • Hot or cold flashes/sensations
  • Fear of dying, losing control, or going crazy
  • Chills
  • Sense of impending doom or death, terror
  • Loss of control feelings
  • Feelings of ‘going crazy’
  • Fear of death

IMPORTANT NOTE: Any time you have symptoms that involve chest pain or discomfort, you should seek medical attention immediately!

What Causes Panic Attacks?

There is no exact cause of panic attacks, however, the propensity for panic attacks does seem to be run in families. It may not necessarily be an inherited gene, rather an inherited tendency. There also seems to be some common trigger points for panic attacks – such as major life transitions such as a new baby, graduation, marriage, death, divorce, job change, and physical moves.

Panic attacks can also be caused by various medical issues. As noted, a full thyroid workup should be performed in anyone with panic attacks, to rule out an underlying thyroid disorder. Anyone suffering from panic attacks should see a doctor immediately – as these other medical conditions can be possible causes:

  • Drug use (stimulants such as caffeine, cocaine or amphetamines)
  • Hypoglycemia (low blood sugar)
  • Medication withdrawal
  • Overuse of food additives (such as aspartame)
  • Adrenal issues, including pheochromocytoma

How are Panic Attacks Diagnosed?

Your doctor or healthcare provider can determine if you are having panic attacks. To help pinpoint a diagnosis, your doctor will review your entire health history, and perform a complete physical examination. In addition, you doctor might:

  • Conduct blood tests to check your thyroid and adrenal function
  • Perform cardiac function tests (including an EKG or ECG)
  • Conduct – or refer you for -- a psychological evaluation to discuss symptoms and issues which affect your day-to-day life (stressful situation, life changes, etc.)

How are Panic Attacks Treated?

Panic attacks are treated differently for each person. Each person may have a very different reason for the attacks, hence the difference in treatments. Medication is used for immediate support in alleviating symptoms, but frequently, cognitive behavior therapy is necessary in conjunction with the medication.

In some cases, antidepressants are prescribed for immediate release when you are in midst of panic attack. These include: Ativan, Klonopin, and Xanax.

The full range of antidepressants are sometimes prescribed regularly, to help reduce overall stress/anxiety as well as reduce severity and frequency of panic attacks. These include Celexa, Cymbalta, Effexor, Lexapro, Luvox, Paxil, Prozac, and Zoloft.

A few newer anticonvulsant drugs that seem to show promise in the treatment of panic attacks, including Lyrica and Neurontin.

A combination of psychotherapy and medication most often produces results in three months. Appropriate treatment is available and works for about 90% of people with this disorder.

In some cases, relaxation practices such as meditation and guided imagery can be effect adjuncts to the therapy and medication.

More Resources on Panic Attacks and Panic Disorders

To find out how panic attacks and disorders are diagnosed and treated, start your self-education process at About.com's excellent Panic/Anxiety Disorders site, led by expert Katharina Star.

Other helpful resources include:

HEART PALPITATIONS

What are Heart Palpitations?

Heart palpitations are feelings of a rapid heartbeat, pounding heart, fluttering heart, or the heart skipping a beat. You may become overly aware of your heartbeat, noticing your heartbeat in your chest, neck or throat. The actual heart rhythm may or may not be normal when this is going on. The palpitations can be frightening when they occur – but they are typically not harmful and usually go away on their own.

In some cases, palpitations can be a sign of something more serious. So, if you experience heart palpitations, please see your doctor immediately. Contact your doctor, or go to the emergency room if palpitations are accompanied by:

  • Feelings of dizziness/confusion
  • Fainting
  • Heavy sweating
  • Light headed feelings
  • Pain, pressure, tightness in chest, jaw or arms
  • Shortness of breath
  • Trouble breathing

What are the Signs and Symptoms of Heart Palpitations?

The signs and symptoms of heart palpitations include:

  • Extra heart beats
  • Fluttering heart
  • Overly aware of heartbeat
  • Pounding heart
  • Rapid heartbeat
  • Skipped heart beats

What Causes Heart Palpitations?

In addition to thyroid irregularities, common causes of heart palpitations include:

  • Various cardiac arrhythmias
  • Caffeine
  • A high fever
  • Hormonal changes associated with pregnancy, menopause or the menstrual cycle
  • Excess nicotine
  • Certain herbal supplements
  • Illegal street drugs
  • Excessive thyroid medications
  • Anemia
  • Severely low blood pressure
  • Dehydration
  • Strong reactions to stress or anxiety
  • Taking cold medications that contain pseudoephedrine
  • Vigorous exercise
  • Certain foods – especially very acidic foods

Palpitations can also be brought on by meals that are rich in carbohydrates, heavy in sugar or loaded with fat. High levels of MSG or sodium can also bring on heart palpitations.

Sometimes heart conditions, such as prior heart attack, coronary artery disease or congestive heart failure can cause heart palpitations as well.

How are Heart Palpitations Diagnosed and Evaluated?

Your doctor will conduct an examination, going over your medical history, discussing your medications, supplements, lifestyle and diet. The doctor will probably order blood work as well. The doctor will try to help figure out a pattern as to when the palpitations occur. Your doctor will likely ask you:

  • When did palpitations begin?
  • How long do palpitations last?
  • How often do palpitations occur?
  • Is there a pattern to the palpitations?
  • Do they start/stop suddenly?
  • Is your heartbeat steady or irregular during the palpitations?
  • Other symptoms that occur during the palpitations?

The typical tests to diagnose heart palpitations include:

  • Blood work - to check for anemia, thyroid disease and or electrolyte issues
  • Chest x-ray
  • Echocardiogram – an ultrasound of the heart structure
  • Electrocardiogram - to check for heart abnormalities
  • Holter monitoring – check for heart rhythm abnormalities

How are Heart Palpitations Treated?

If an underlying cause is found, appropriate treatment will be offered, which should reduce or eliminate the palpitations. If no underlying cause is found, then lifestyle changes will need to be made. The doctor will likely advise you to avoid things that are triggering the palpitations. Recommendations:

  • Avoid stimulants, including nicotine, caffeine, in herbal/nutritional supplements, and any illegal drugs
  • Reduce anxiety/stress, via therapy, relaxation practice, meditation, guided imagery or other methods that are effective for you

About.com's Stress Reduction site has articles and information about many effective ways to reduce anxiety and stress.

Sometimes, lifestyle changes do not reduce the palpitations. In that case, the doctor may prescribe certain medications. Beta blockers and calcium channel blockers have been useful in treating heart palpitations in some cases.

More Resources on Heart Palpitations

A good starting point is the Heart Disease site at About.com, guided by expert Richard Fogoros MD. In particular, he has an excellent article on heart palpitations.

Other recommended resources:

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