Hi rthummer,
First of all, she needs to see an Internist or an endocrinologist. I can't imagine an ER ever starting anyone up on thyroid replacement, without a specialist keeping track of her. Plus, there are other tests she would need to really determine her exact problem. I think they just do a general thyroid test in the ER, and she would need several more. Plus, an Internist would figure out if there's something else going on that would cause her thyroid to be low.
And an Internist or a cardiologist would be the person to see about her heart. Good luck to her.

Thyroid meds come in many forms and strengths and it is the job of her regular doctor to prescribe them. She will need to see her general practitioner or an endocrinologist, like catherinet said, for further treatment. The blood test is certainly the start especially for low thyroid patients and I would imagine many doctors diagnose and prescribe meds on the blood test alone. Some will do further testing though - like detailed blood work on her T3 and T4 instead of just a standard TSH (thyroid stimulating hormone).

I had been through a similar thing and my thyroid problem was actually discovered in the ER not at a regular doctor's visit. Thyroid is a standard test in the ER when someone comes in with heart palpitations especially young women/patients. However like your daughter I was instructed to see my doctor the next day rather than have the ER treat me - once they confirmed I was not in immediate danger, their job was done. That is just how it is in the ER.

I just see my regular doctor (general practitioner) now, several years later, for my thyroid meds and annual checkups. I do suggest an endocrinologist at first though because they are (sometimes) more thorough in the initial diagnosing and testing phase.

Good luck to her, I know thyroid and heart issues are NO fun.

There is a condition called euthyroid sick syndrome. Any person who is sick, including those with serious heart diseases, can have a thyroid panel that looks like she has hypothroidism. But it is not a true hypothroidism, and when the underlying disease is corrected or treated, the thyroid testing returns to normal. If your daughter has euthyroid sick syndrome and she is placed on thyroid supplements, she could die due to the effects of thyroid hormone on the heart. That is why they did not want to place her on supplements yet.

It sounds like they do not know what is wrong with your daughter's heart yet; otherwise she would not have gone home on a monitor. Once they figure that out and get her treated, she should have another thyroid panel run. Then, and only then, should she be placed on thyroid supplements if she is truly hypothyroid.

My husband went through a similar incident lately, except they knew what was wrong with his heart at the ER- premature ventricular contractions. It's basically harmless although it annoyed Dave so muh he couldn't sleep and it made him very uncomfortable. But his regular Dr misinterpreted the ECG and thought he had escape beats and a slow heart rate. Then he ran a thyroid panel and the only abnormality was a SLIGHTLY high TSH, so he placed Dave on thyroid supplements. The PVCs got a bit worse over the next month. Dave had a full cardiac workup, checked out fine. During his followup with regular doctor, he mentioned the irregular beats were worse and the doctor doubled his thyroid dose. Now I had been telling Dave for the entire month that he wasn't hypothyroid and his dr was smoking crack or something (I'm a vet student and animals get the same heart diseases and thyroid diseases as people, and they are tested the same as well). Dave didn't believe me until the dose doubled without even having the results of the thyroid panel back. So he stopped taking the thyroid meds. Miraculously, the PVCs slowed down considerably. The thyroid panel turned out normal. 6 months later he had another follow up with a thyroid panel, and after having not been on supplements for 5 months the panel was completely normal. By this time, the PVCs stopped completely. So his thyroid supplement made his PVCs worse. Luckily for Dave, his only problem was the PVCs which are completely harmless and not indicative of any heart disease. Otherwise the mistake the doctor made by putting him on thyroid supplements and then doubling the dose may have seriously harmed or killed him.

I hope your daughter gets diagnosed and treated soon. Heart disease is scary...

Here is a link that might be useful: Euthyorid sick syndrome

meghane - I can sympathize with your dh as those thyroid meds are very sensitive and can really send a heart into a tizzy. If my dose is the slightest bit too high my palpitations go fierce. I get palpitations anyway, have for years, but too much thyroid hormone definitely makes it ten times worse.

I know some people get thyroid meds online and use them for diet pills because it speeds the metabolism. They don't know how they are playing with fire and could kill themselves.

I'm glad your dh is fine with the thyroid now, it's seriously a bummer to have thyroid disease (I know some are easily treated, but it's been a somewhat rocky road for me to get stabilized).

Thank you all. They had put her on blood pressure med. as her blood pressure was high, which made the palpations stop. She has to lock in to the machine everytime she has one of these palpations flutter, thump, stop of heart beats. Then record what she is doing. The blood pressure med. made them quit so they told her to cease the b/p med and then start recording the palpations. I do hope they find out what is wrong. I am so scared.

This is an update on my daughters condition.
They have put her on blood pressure medication. Toprol, I think that is what it is.
Then they are going to slowly, slowly adjust her on synthyroid. It is a synthytic thyroid med.

The palpations seem to have been there all along --- heredity but the high blood pressure made them where she could hear them. They are not life threatening.(don't know why they never heard them before, when she had a physical) Seems her grandmother on her father's side and one of her dad's sisters has the same thing.
Well, I am just glad it is not dangerous. It would have scared me too. Irregular heatbeats are wierd to me.... ya know?? I mean, like it is you heart!!! Anyway, her grandmother lived to the ripe ol' age of 84. She does inherit the thyroid problem from my side, so I guess she gets all our "good" stuff...NOT!!