Panic Attacks, Heart Palpitations, and Your Thyroid

Taking a Beta Blocker Usually Does the Trick

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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.

Panic Attacks and Heart Palpitations From Hyperthyroidism

Many people don't realize that panic attacks and palpitations can be 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 hormones can speed up your heart rate dramatically, increase blood pressure, and generally put your body into overdrive. In other words, excess thyroid hormone may kick in your body's fight-or-flee adrenaline response.

In addition to autoimmune Graves' disease, in Hashimoto’s disease, the up and down activity 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 disorder will find that once properly treated (for example, with antithyroid medications, radioactive iodine, or surgery), their panic attacks and palpitations become a thing of the past.

That said, often times in addition to treating the actual thyroid disorder, a beta blocker (a type of blood pressure medication) is also prescribed to ease symptoms like a fast heart rate and nervousness.

Treatment of Panic Attacks and Heart Palpitations

But what if you've been treated and 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 a 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 thing to consider with your doctor is your TSH level. Once treated for hyperthyroidism, most people 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 at the lower end of the normal range, you may be borderline hyperthyroid due to overmedication. In this case, it's worth discussing a slight reduction in your dosage with your doctor to see if that alleviates your symptoms.

Similarly, 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.

Lastly, 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. In these instances, you should be further evaluated by a heart specialist and/or a psychiatrist.

Besides heart problems or a true anxiety, other causes of panic attacks include:

  • Drug use (stimulants such as caffeine, cocaine or amphetamines)
  • Hypoglycemia (low blood sugar)
  • Medication withdrawal
  • Adrenal gland issues, including pheochromocytoma

A Word From Verywell

Be reassured that with proper treatment of your hyperthyroidism and a beta blocker, your heart palpitations and panic attacks should be alleviated.

If not, though, please inform your thyroid doctor. You may need to be evaluated for other causes.

Remain resilient through this process—with close follow-up and a thoroughly devised treatment plan, you can feel well. 

View Article Sources
  • Grais IM, Sowers JR. Thyroid and the heart. Am J Med. 2014 Aug;127(8):691-98.
  • Ross DS. (2016). Graves' hyperthyroidism in nonpregnant adults: Overview of treatment. Cooper DS, ed. UpToDate. Waltham, MA: UpToDate Inc.