Thyroid-related Palpitations

Overview

Palpitations — a fast, forceful or irregular heartbeat — are a hallmark of thyroid overactivity, and can also occur when an underactive thyroid is over-treated with levothyroxine. Thyroid hormone directly affects heart rate and rhythm, so excess hormone drives the heart too hard, and over time this can trigger atrial fibrillation, especially in older adults. Because palpitations can also come from the heart itself, both the thyroid and the heart need assessment.

This page is about the palpitation symptom. For the overactive condition, see Hyperthyroidism and Graves’ Disease; for broader cardiac care, see Palpitations & Cardiovascular Symptoms.

How thyroid hormone affects the heart

• Excess T4/T3 raises heart rate and force of contraction — causing palpitations.
• Increases the risk of atrial fibrillation (irregular rhythm), especially in older adults.
• A suppressed TSH from over-replacement levothyroxine has the same effect.
• Beta-blockers relieve symptoms quickly while the underlying cause is treated.

When palpitations may be thyroid-related

• Palpitations with weight loss, heat intolerance or tremor.
• A suppressed TSH on testing.
• Palpitations that began after a levothyroxine dose increase.
• New atrial fibrillation with a thyroid abnormality.

Evaluation

• TSH, free T4 and free T3.
• ECG to check rhythm; further cardiac tests if indicated.
• Review of current thyroid medication dose.
• TSH receptor antibodies where Graves’ is suspected.

Management

If overactive, anti-thyroid treatment plus a beta-blocker for symptom relief. If over-treated, the levothyroxine dose is reduced. If a heart rhythm problem is found, it is treated alongside the thyroid. Once thyroid hormone normalises, palpitations usually resolve.

How we help

Dr. Nayak identifies whether palpitations are thyroid-driven, controls them quickly, and coordinates thyroid and cardiac care so both are addressed. Consultations are available in-clinic in Bhubaneswar and over teleconsultation.

Related conditions and patient concerns

• Hyperthyroidism
• Subclinical Hyperthyroidism
• Graves’ Disease
• Low TSH
• Levothyroxine Monitoring
• Palpitations & Cardiovascular Symptoms