What You Need To Know About Heart Palpitations and Thyroid Health

When I was dealing with Graves’ disease, one of the most prominent symptoms I experienced was heart palpitations.  The same is true with many of my patients with hyperthyroidism and Graves’ disease, although occasionally I’ll also have people with hypothyroidism and Hashimoto’s tell me that they’re experiencing palpitations.  While thyroid hormone imbalances can cause heart palpitations, there can be numerous other causes.  In this blog post I’ll discuss many of these causes, when you should be concerned about heart palpitations, and towards the end I’ll discuss some natural treatment solutions.

It makes sense to begin by discussing what palpitations are.  Here are some common descriptions of heart palpitations (1):

• An abnormally rapid or irregular beating of the heart
• A skipped beat and/or rapid fluttering in the chest
• A pounding sensation in the chest or neck
• A flip-flopping sensation in the chest

The good news is that the cause of palpitations is usually benign, although sometimes they can be a sign of a life-threatening condition.  Many people get diagnosed with hyperthyroidism because of the heart palpitations they’re experiencing.  In other words, prior to getting diagnosed with hyperthyroidism, many people will decide to get checked by a medical doctor mainly because they’re experiencing heart palpitations, and will then find out that they have hyperthyroidism.

My situation was different, as prior to being diagnosed with hyperthyroidism I was losing a lot of weight and had an increased appetite, but it was an elevated resting heart rate that led me to schedule an appointment with a medical doctor who ended up diagnosing me with hyperthyroidism (and referred me to the endocrinologist who diagnosed me with Graves’ disease).  In the opening paragraph I mentioned how my heart palpitations were prominent, but I really didn’t start noticing them until after I was diagnosed.

What Can Cause Heart Palpitations?

Let’s take a look at some of the different factors that can cause heart palpitations.  You’ll notice that some of these are actual conditions (i.e. hyperthyroidism), but I’ve listed other factors as well, such as consuming too much caffeine.  It’s worth mentioning that these aren’t listed based on the frequency of occurrence.  For example, hyperthyroidism is listed first not because it’s the most common cause of heart palpitations, but because I work with a lot of people with hyperthyroidism.

• Hyperthyroidism.  This is what caused my heart palpitations in the past, and it is the most common cause of palpitations in my practice.
• Hypothyroidism. When someone with hypothyroidism experiences heart palpitations it usually isn’t due to the low thyroid hormone levels, but other factors, such as sex hormone imbalances and/or high cortisol levels.
• Taking too much thyroid hormone replacement.  I could have discussed this under “hyperthyroidism”, but I figured that some people with hypothyroidism and Hashimoto’s who are overdosing would miss it if I didn’t list it separately.  Although overdosing with thyroid hormone replacement isn’t something I commonly see in my practice, it does happen from time to time.  Some practitioners prefer to see the TSH of their hypothyroid patients who are taking thyroid hormone replacement on the low side, but if the person’s thyroid hormone levels are on the high side and/or the person is experiencing heart palpitations and other hyperthyroid symptoms, then the dosage should be reduced.
• Weaning off of beta blockers.  Sometimes weaning off of beta blockers such as Propanolol and Atenolol can cause heart palpitations.  This is especially true when they are abruptly stopped.
• Stress and anxiety.  We all know that stress can cause a lot of symptoms, and heart palpitations are one of these symptoms.  Anxiety can also cause palpitations, and it’s quite common for my patients to experience anxiety, especially those with hyperthyroidism and Graves’ disease.
• Excess caffeine.  Coffee of course is the most common culprit, although other sources of caffeine can also cause heart palpitations, including black tea, green tea, and chocolate.
• Anemia.  This can be confirmed through a complete blood count (CBC) with differential.  Many people associate anemia with an iron deficiency, although it’s important to remember that there can be other causes.
• Hypoglycemia.  This is yet another potential cause of heart palpitations, and sometimes it can be difficult to diagnose.  Having low fasting blood glucose and insulin levels is a sign of hypoglycemia, along with symptoms such as shakiness and/or irritability when skipping meals, dizziness, and fatigue that is relieved by eating.
• Electrolyte imbalances.  Low calcium, high or low potassium, and/or low magnesium levels can cause palpitations.  A comprehensive metabolic panel (CMP) measures the electrolytes, and is something I recommend for everyone to get.
• Certain medications.  I mentioned that too much thyroid hormone replacement can cause heart palpitations, but other medications that can cause them include amphetamines, anticholinergic drugs, and vasodilators.
• Sex hormone fluctuations.  Due to fluctuations in estrogen and progesterone, heart palpitations can occur in women of all ages, including cycling women (i.e.  the luteal phase of the menstrual cycle), during pregnancy, and the perimenopausal period.
• Structural abnormalities.  Examples include cardiomegaly associated with congenital heart disease, aortic aneurysm, and acute left ventricular failure.

When Are Palpitations a Concern?

I mentioned earlier how most heart palpitations are benign.  Many of my patients with hyperthyroidism and Graves’ disease experience heart palpitations, and while I can’t say that there isn’t a concern in these situations, correcting the hyperthyroidism will almost always resolve the heart palpitations.  It’s also worth mentioning that anxiety is very common in people with hyperthyroidism, and so this can also be a factor.  There are times when heart palpitations are related to an underlying cardiac condition, including an arrhythmia.  One should especially be concerned when someone has symptoms such as perspiration, fainting, alternating headaches, and vertigo or chest pain, as these can be indications of weak or irregular heart function which must be seriously examined (2).

Regarding my patients with hyperthyroidism and Graves’ disease, I’m more concerned with the elevated resting heart rate.  After all, it’s the elevated heart rate that is a risk factor for the development of an arrhythmia/atrial fibrillation.  Fortunately, upon decreasing the thyroid hormone levels there usually is a reduction of both the resting heart rate and palpitations.

Evaluation of Heart Palpitations

As I mentioned earlier, I commonly encounter patients with heart palpitations, which isn’t surprising since many of my patients have hyperthyroidism and Graves’ disease.  If someone didn’t experience heart palpitations until they developed hyperthyroidism, then one can usually assume that the heart palpitations were related to the elevated thyroid hormone levels.  However, it still is important to conduct a comprehensive health history and physical examination to rule out other causes or contributing factors.

For example, I mentioned how anemia and electrolyte imbalances can cause heart palpitations.  As a result, in addition to getting a thyroid panel, it is wise for everyone with any health condition to get a complete blood count (with differential) and comprehensive metabolic panel.  It’s also important to find out what medications the person is taking, if they consume caffeine on a regular basis, find out if they’re consuming alcohol, etc.  Adrenal testing can determine if they have elevated cortisol levels that are causing or contributing to the heart palpitations.

There of course are times when further evaluation of the heart is required.  For example, if someone is considered to be a high risk for an arrhythmia then an ambulatory EKG monitoring device might be indicated, such as a Holter monitor.  This is a 24-hour monitoring device worn by the patient.  Echocardiograms are commonly recommended for patients in whom structural heart disease is a concern.

Conventional Treatments for Heart Palpitations

Conventional treatments for heart palpitations depend on the cause.  For example, if someone has hyperthyroidism then the person will usually be told to take antithyroid medication and/or beta blockers, although many endocrinologists will recommend for their hyperthyroid patients to permanently ablate the thyroid gland through radioactive iodine.  If the heart palpitations are caused by something other than hyperthyroidism then this may be addressed by the medical doctor.

Natural Treatment Solutions for Heart Palpitations

While conventional treatment methods are sometimes necessary, of course the goal of a natural treatment approach is to address the underlying cause of the problem.  However, while doing this the person might need to take medication and/or herbs to help manage the symptoms.  For example, when I was dealing with Graves’ disease I took the herb bugleweed to help lower the thyroid hormone levels, and because I still experienced heart palpitations I ended up adding motherwort.  Both of these herbs don’t do anything to address the underlying cause of the condition, but instead manage the symptoms.

What I’d like to do is first list some things you can do to address the cause of heart palpitations, and then I’ll discuss some specific herbs which can help with the symptoms while one is addressing the cause.

• Lower the thyroid hormone levels.  If someone has heart palpitations due to hyperthyroidism, then it makes sense that lowering the thyroid hormone levels will usually help to resolve the heart palpitations.
• Be aware of medications that cause heart palpitations.  I already mentioned some of the medications that can cause heart palpitations, including amphetamines, anticholinergic drugs, and vasodilators.
• Decrease stress and anxiety.  Although I group these two together because there is some overlap, sometimes stress and anxiety need to be dealt with separately.  For example, someone might have a lot of chronic stress in their life which leads to anxiety, and in this situation addressing the stress should help with the anxiety.  Hyperthyroidism itself can cause anxiety, and in this situation, normalizing the thyroid hormone levels should resolve the anxiety.
• Reduce consumption of stimulants.  If you’re consuming caffeine on a regular basis then it makes sense to reduce your consumption, or better yet, take a break from the coffee, chocolate, etc.
• Address anemia.  Many people with anemia don’t take it seriously, but being anemic can lead to numerous health consequences.  In fact, when I see someone with anemia who has heart palpitations, the palpitations are frequently the least of my concerns.
• Balance blood sugar levels.  If someone has hypoglycemia this needs to be addressed.  Sometimes changing one’s diet and eating regularly can make a big difference, although some cases of hypoglycemia can be complex.
• Correct electrolyte imbalances.  If someone has low levels of calcium, potassium, and/or magnesium, then it makes sense to correct these imbalances.

Herbs That Can Help With Heart Palpitations

I just want to let you know that the list of herbs below isn’t all inclusive, as there can be other herbs, as well as nutrients that can potentially help to reduce heart palpitations.

• Hawthorn (Crataegus oxyacantha).  Many healthcare practitioners recommend hawthorn for overall cardiovascular support.  Not only can hawthorn help with heart palpitations, but it exerts a wide range of cardiovascular pharmacological properties, including antioxidant activity, anti-inflammatory effect, anticardiac remodeling effect, antiplatelet aggregation effect, vasodilating effect, endothelial protective effect, reduction of smooth muscle cell migration and proliferation, protective effect against ischemia/reperfusion injury, antiarrhythmic effect, lipid-lowering effect and decrease of arterial blood pressure effect (3).
• Motherwort (Leonurus cardiaca).  As I mentioned earlier, I took motherwort to help with my heart palpitations when I was dealing with Graves’ disease, and I’ve had many others with hyperthyroidism take this herb over the years.  Pharmacological studies have confirmed its effects on the heart and circulatory system, but motherwort also has antibacterial, antioxidant, anti-inflammatory and analgesic activity (4).
• Bugleweed.  This herb doesn’t specifically support the cardiovascular system, but by lowering thyroid hormone levels in those with hyperthyroidism it can help with heart palpitations.  In my situation taking bugleweed alone didn’t completely eliminate my palpitations, as I mentioned a few times in this post that I ended up adding motherwort.  However, some people do fine with bugleweed alone and don’t need to add motherwort.
• Lemon Balm (Melissa officinalis).  This herb has a calming effect and can help with heart palpitations, but also can benefit people with menstrual problems, hypertension, migraines, vertigo, depression, asthma, eczema, and advanced studies have demonstrated neuroprotective, anxiolytic, antispasmodic, antihyperlipidemic, and hepatoprotective effects (5).
• Valerian (Valeriana officinalis).  Since anxiety is a potential cause of heart palpitations, it makes sense that certain herbs that can help to reduce anxiety can also reduce heart palpitation.  These include valerian root (6), St. John’s Wort (7), and passionflower (8).  Just keep in mind that if hyperthyroidism is the cause of the person’s anxiety then the primary goal should be to reduce the thyroid hormone levels.
• Cortisol-lowering herbs.  High cortisol can also cause heart palpitations.  While taking herbs isn’t a substitute for lowering stress levels and improving stress management skills, certain herbs can aid in lowering cortisol levels by helping us to better adapt to the stress.  This includes herbs such as ashwagandha (which is a member of the nightshade family), rhodiola, and relora.

What’s Your Experience With Heart Palpitations?

If you have dealt with heart palpitations (or currently deal with them) please share your experience in the comments section below.  Were your palpitations caused by hyperthyroidism, hypothyroidism, or something else?  What helped to reduce your heart palpitations?  Thank you for sharing your experience!