Diabets, Graves disease and Pots

[dimitrios810]

Hello everyone.. i love the information on this site and wanted to tell you all about my situation and what you guys think.  I have had diabetes for 3 years and good glucose control.  This past january they found grave's disease as well.  Recently i have been suffering Pots like symptoms but don't know if its graves and pots or just graves.. How similar are they.  My heart races when i stand up,  I get weird pulse pressure throughout the day.  it has made me anxious alot.  I feel cold and hot at times and a hard time sleeping..   Strangely i was taking atenolol to help with the graves but i have a bad relationship with it because i normally have low blood pressure.  I had mild orthostatic hypotension before but now its bad.  I had Rai 6 weeks ago and my Pots symptoms started maybe 3 weeks ago.  i know i have to wait a few more weeks for my thyroid to stabilise.  my latest data was .234 tsh and a t4 of 1.69.  i still can't excercise alot.  i went for a walk around the block and was exhausted.  i get shortness of breath when i talk.  lets just say its not fun. my muscles are still extermly weak from the graves so i'm just in limbo.. i went to a neuro who told me he doesnt think its pots but low blood pressure and my cardiologist wants to do a stress test. i'm kind of confused.  

my meds are
lantus/humalog insulins
albuterol
xanax now klonopin
atenolol 25mg but i take 1/4

can i expect my pots to get better or is my thyroid normal and i have pots..  i have never fainted but get uncomfortable standing motionless and fidgety when not in motion.  i have alot of disgestive issues as well.. i hope this is my thyroid.  


any info would be great... lost in pots land

[tammyfrench]

I have POTs and just recently diagnosed with Graves and Hyperthyroidism. I had POtS diagnosis first. Have a tilt table test done. If your HR goes up 30 bpm or more upon standing or is atleast 120 bpm or more after 10 mins of standing that is POtS. I don't have hyper pots so my BP doesn't spike when I stand. That is different than normal pots. I as well have been on Atenolol for 14 yrs. if it is affecting your BP you can take a medications to raise your BP such as midodrine and fludrocortisone. Or you can try Ivabradine to lower your HR but not BP. I have IST as well. My resting HR got worse with the hyperthyroid. I am on Methimazole for that at the moment. I will not do RAI if it is recommended. Get a TTT done to diagnose POtS. A lot of times if you're diabetic it can cause dysautonomia. You can also get dysautonomia if your body experiences trauma such as RAI.  Find me on Facebook if you want to chat. Tammy French

[LivingInHope]

With P.O.T.S., symptoms are worst for me when I first get up from sleeping at night.  There are other times where my tachycardia acts up, but that is the worst time I think due to prolonged lying down and lack of hydrating myself while sleeping.  

What did the pulmonologist say?

[dimitrios810]

thank you so much for your reply.  its weird how many of the symptoms overlap.  i am trying to stop the atenolol day 3 and it has been hard.  i get the worst heart beats in the morning but they subsisde later in the day.  it may also be due to the synthroid for my hypothyroid situation.  i am going to a pulmonalagist tomorow and will see what they say.  i see my cardio later.  i hope my thyroid stabilizes and many things just normalise.  thank you for your help.
dimitrios

[LivingInHope]

Well, you've got a lot going on for sure.  

With P.O.T.S., typically the heart rate with standing makes up for standing up.  You can even get a spike in your blood pressure when the catecholamines go into hyperdrive and overcompensate.  There are, however, a certain percentage of patients with P.O.T.S. that pass out.  

You are taking blood pressure medication that I suspect is contributing to your drop in blood pressure with standing.  And both that and the Klonopin can have as side effects light-headedness and dizziness.  

The stress test your cardiologist wants to do might prove if your heart is over-reacting to the excercise in an upright position but is not to my knowledge one of the diagnostic tests by which P.O.T.S. is diagnosed.  Those tests are a tilt table test which is positive for the syndrome and a standing plasma norepinephrine level greater than a certain level.  But also, since you are having so much shortness of breath, he'll be checking out your heart for any problems that might be borne out while you excercise.

Grave's has in common with P.O.T.S. that with both, you can get a rapid heart beat.  Anxiety, while not typically considered a symptom of P.O.T.S., can be found in both Grave's and in some with P.O.T.S. & the rapid heartbeat and flow of catecholamines themselves I think can leave a person feeling wired.  

Grave's lists a sensitivity to heat on Mayo Clinic's site, but you also mention feeling cold at times, which can be a symptom of dysautonomia.  Some I think even get lower temperatures and resort to wearing a lot of clothing to try to keep warm.  Some with dysautonomia don't sweat like they should (lists Grave's sufferers perspire more), though not all.  Those who don't sweat like they should can get very hot.  I'm one with P.O.T.S. who does perspire and might be similar to someone with Grave's in that respect, perhaps.  

You also mention weird pulse pressure.  I've had some of those of late I've noticed myself!  

Just plain talking doesn't usually make me short of breath, though at times it does when I am walking at the same time.  I've had a hard time sleeping in the past from tachycardia, but that was not to do with P.O.T.S., but rather with my I.S.T. (inappropriate sinus tachycardia), which unlike P.O.T.S., can occur even when at rest.

Digestive issues can also be a part of dysautonomia, but of course, with Grave's, metabolism is too fast, so that could definitely cause problems.

May I suggest you see if you can get your thyroid situation well-managed and if you continue to have a rapid pulse rate with standing, etc., to ask your cardiologist for a tilt table test?  Or maybe just ask him/her for one sooner because you would like to rule out P.O.T.S.?  I do hope you find the answers you are seeking!