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INR and Thyroid

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  • INR and Thyroid

    Hi, I had my aortic valve replacement 18 months ago and am doing OK on warfarin. My INR fluctuates a lot, ranging from 1.9 to 6 on the same doseage of warfarin. so it needs constant adjustment. I am also on Eltroxin for hypothyroid treatment and my cardio says that is what causes the fluctuations. When my thyroid is overactive the INR becomes high and when it is underactive the INR becomes low. My thyroid function is a bit erratic. I want to know if there is anybody in this site who has thryroid problems and is on anti coagulation therapy?

  • #2
    Hyperthyroidism (overactive thyroid) can increase the INR. Hypothyroidism can decrease it. At least that's the info given in Coumadin leaflets.
    Marsha (7-28-50), MVP 1990/MVR (St. Jude) & ASD repair 6/24/03 Baylor University Medical Center, Dallas Texas. Hometesting since 11/03, first with ProTime 3, now with INRatio.
    John (3-13-46), MV repair 5/10/07, Dallas Presbyterian, port-access incision, Dr. William Ryan. Chordae ruptured 12/05 in car crash.

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    • #3
      [The I'm not a physician disclaimer goes here]

      I'm taking Levoxyl for Hashimoto's Hypothyroidism - caused by my radiation treatments back in ancient times. My "underactive" thyroid has worsened gradually over the past 15 years, and in the past 2 years since my surgery, has necessitated 2 adjustments in Levoxyl dosage, but it was very easy to adjust my warfarin dosage (my thyroid function just goes down, not up as well).

      I can imagine that the "yo-yo" thyroid levels would make it more challenging to manage lots of things, not the least of which would be your INR :(
      25 mm Aortic & 29 mm Mitral St. Jude Master Series Mechanicals - UWMC 4/16/2002
      Guidant Insignia Pacemaker - Virginia Mason Medical Center 5/19/2005
      Cardioversion Tote Board: 3

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      • #4
        Hi Johnny, does'nt your thyroid level fluctuate with the medicine? My tsh comes down with avery minor increase in doseage of eltroxin.does this cause my INR to fluctuate amazingly with the same dose of warfarin? for ex. i was very stable with 5 mg of warfarin (INR 3). but suddenly with the same dose the inr dipped to below 2. The only change i made was a reduction (very mild) in Thyroxine.

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        • #5
          No, my thyroid functions have steadily decreased over the years...I'm currently taking 150 mcg of Levoxyl. Tests show that my thyroind levels are pretty steady, just decreasing over time.

          My desired INR range is 3.0 - 4.0, and I seem to have better luck than most staying in range. Last month I tested at 2.9, which was the first time I'd been "out of range" for a long time.

          I did take a ride on the INR roller coaster when I started an agressive diet and exercise program.
          25 mm Aortic & 29 mm Mitral St. Jude Master Series Mechanicals - UWMC 4/16/2002
          Guidant Insignia Pacemaker - Virginia Mason Medical Center 5/19/2005
          Cardioversion Tote Board: 3

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          • #6
            how often do you test for Thyroid and what are the tests you do. Do you only measure the TSH or complete thyroid profile. What brange do you keep yourself in? does it not cause palpitations?

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            • #7
              Please look at my website http://www.warfarinfo.com/levothyroxine.htm

              and http://www.warfarinfo.com/iodine.htm

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              • #8
                Originally posted by alok
                how often do you test for Thyroid and what are the tests you do. Do you only measure the TSH or complete thyroid profile. What brange do you keep yourself in? does it not cause palpitations?
                I've been taking synthroid for about 10 years - my tsh was 30 before I was on synthroid.

                The usual test is the TSH one though some today say the "Free T3" is a more accurate indicator (the free t3 not just the uptake one).

                Some people say to stay around 2.0 on the TSH - some say under 1.0 but we with heart issues can be a different story as going hyperthyroid can be a big strain on one's heart. Before my heart gave out I was also taking a little T3 (cytomel) - I sometimes I wonder if that contributed to my heart giving out. My tsh was runnning around .02 when my heart problems occurred. Now I'm real conservative about thyroid level as I can't afford any more strain on my heart.

                Now I just take synthroid t4 and my tsh is 2. something.

                The important thing to keep in mind that any change in thyroid status takes a month to be reflected in the TSH. That's what makes it so tricky to regulate.

                If somebody is hypothyroid on day 1 and takes a average dose of T4 thyroxine their TSH can remain high for a few weeks even though they're getting plenty of T4. After about a month the TSH level reflects what T4/T3 level one has.

                I can imagine that time delay of the TSH to stabilize can cause problems with INR too since one wouldn't be stabilized on a certain amount of thyroid supplement until one goes about a month on the same amount of thyroid if the amount of thryroid supplement is changed.

                A lot of factors can affect how effective the thyroid supplements are - like for example taking calcium supplements with synthroid can cause less synthroid to be absorbed. Some say soy for example tends to make one more hypothyroid.

                You might like Mary Shoman's thyroid info and free newsletter:


                Her website is:
                http://thyroid.about.com/

                here's a link about her book:
                http://www.thyroidfoundation.org/livingwell.htm

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                • #9
                  INR and TSH

                  Hi Jim, i think you have writtena lot of sense. My TSH generally remains at below .5 for the last 18 months after surgery. Every time i try to push it up, i become hypothyroid and feel very sluggish. So one can say i am more on the hyper side of thyroid. I do get occasional palpitations and ectopics if my TSH gets a bit low. My doctor has advised to raise the level to 1 at least but I dont know how that will be done.
                  Mybe my INR fluctuates because of the thyroid ups and down. Incidentally my sisiter who is also hypothyroid has difficulty in controlling the TSH to an optimum level. Like mine it fluctuates a lot.

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