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Dr. Andrew Rynne

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What causes fluctuating blood pressure levels and blurred vision while treating thyroid disease?

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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 6076 Questions

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Posted on Mon, 6 Mar 2017 in Hypertension and Heart Disease
Question: Question to Cardiologist only please. What test should be run to distinquish a high blood pressure problem that comes and goes or is not a steady program. 77 year old female. Sometimes blood pressure zooms high up to the 200 level/90s. Taking a thyroid medication (synthroid) taking amlodipine 2.5 morn and night and it is not controlling. The bottom goes real low with blurry vision. Upper does not go down to normal and bottom goes lower. Does not work properly. Pulse rate varies accordingly.
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Answered by Dr. Ilir Sharka 26 minutes later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!


Regarding your concern, I would explain that your symptoms could be related to thyroid hormone imbalance or synthroid.

I recommend consulting with your doctor for a physical exam, a resting ECG and some blood lab tests ( to investigate for the possible underlying causes):

- thyroid hormone levels
- complete blood count for anemia
- blood electrolytes for possible imbalance
- kidney and liver function tests.

You may need to make changes to the dose of synthroid.

Adding a betablocker could also help reduce tachycardia.

If all the above tests result normal, you should discuss with your doctor on the possibility of adding another antihypertensive drug to your therapy or increase the dose of amlodipine to 10mg daily.

Hope to have been helpful!

Feel free to ask me again whenever you need!

Kind regards,

Dr.Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka 1 hour later
Recent bloodwork, TSH was 4.06 near top of reference range. Did not address this problem. says it is within normal (I don't agree).
MCHC was low at 31 and RDW was high at 15.3 (out of range). This was a CBC, and TSH bloodwork. The PT with INR -10.1 - within normal is all says. PT -ref range 9.0-11.5. (that's the anemia right?) That would be ok?
I'm taking the amlodipine at 2.5 mg twice a day. When I have tried highr dosage it makes the dystolic into the 70s, but not the systolic which goes above normal. Causes balance or eye problems.
Would you suggest a heart scan to see about blockages? I know I have small arteries. Tryglerides last time were in the 80s my doctor told me. He did not seem to want to spend any time with me. I went in for blood pressure check. He was a substitute doctor.
doctor
Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

I would recommend checking again your thyroid hormone levels after a month, in order to closely monitor them for possible changes.

Regarding the complete blood count changes, they seem to be indicative of anemia.

I recommend performing some other tests to investigate for the possible causes underlying anemia:

- iron plasma levels, ferritin and transferrin levels for possible iron deficiency anemia
- vitamin B12 plasma levels and folic acid plasma levels.

Considering the fact that amlodipine has such effects on your diastolic blood pressure, I would recommend taking a betablocker (like nebivolol), which do not have such influence on diastolic blood pressure.

I don't think that there is any need of heart scan, because you have no symptoms of coronary artery disease (like chest pain during physial exertion, shortness of breath, etc.).

But, you can perform a cardiac stress test, just to be sure that there is no presence of coronary artery disease.

I recommend performing regular physical activity (walking, aerobics, etc.) and avoid salt and caffeine intake, in order to help you manage better your blood pressure values.

Hope to have been helpful!

Wishing good health,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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