feeling hypo - labs say hyper. confused.

[obwat]

i feel worse than ever. DR says i'm over medicated.

lab says (armour, 3 grains):

TSH      .025 ref (0.3 - 5.7)
freeT3    4.2 ref(2.3 - 4.2)
freeT4    1.1 ref(.8-1.8)

how i feel:
tired tired tired!
much weight gain
bloat
still getting period few times/month (all GYN tests clear, nothing has helped this)
depressed (energy more so than mood)

good things:
constant chill has gone
brain fog has improved
hair not falling out

i've 'swung' hyper before bc of too much medication and i in NO way/shape/form feel like i did then - not even remotely hyper. this downward spiral into feeling BAD happened right after going from hypo -> hyper (in life & in labs). before that i felt really good. sounds dumb but -- is like something broke when that shifted occurred & it's still not fixed.

new doc has put me on synthetics + decreased meds.
armour 3 gr to 112mcg levoxyl + 10mcg cytomel (5mcg BID). been on it 2 weeks and feel WORSE.

is weird: no matter how much medication or what type we've tried, my T4 levels BARELY budge. 0.8 to 1.1 is pretty much my range. on 0.5 grains, on 5 whole grains. on natural, on synthetic. with a TSH of 1.0 or .008. T4 doesn't move.

for about 8 months my TSH was the same despite increase in meds. then it suddenly bottomed out and hasn't bounced back after repeated decreases in meds. my T3 has never been this high, but i know that part is from arour having a lot of T3 in it.

my ferritin is and has been low (16), TIBC high, iron normal.  iron supplements have not helped anything but the iron level rise.

so confused. help?

[Mark Lupo, M.D.]

You are iron deficient - most common cause in young women would be heavy menses - supplement with iron but take it 3-4 hours apart from thyroid meds.

From 3 grains armour to 112 t4 and 5 bid t3 is cutting the dose in half!  How about trying 90mg armour in am and 60mg about 2pm?  Your symptoms could be from over-treatment but some still sound like low thyroid.  I usually dose my armour pts bid.

I think a TSH of about 0.2 or greater is reasonable in an otherwise healthy person on thyroid hormone treatment.

[Ussie]

I would be hypo with a low Ft4 like yours.

[doodlebug1]

Hi obwat! You know, your FERRITIN says a LOT!! When mine was that low, I had the exact same symptoms as you! I had extreme fatigue, depression, achiness. I had to get on iron supplementation--in my case, I used Ferrous Sulfate because it's cheap in price. LOL. But if you use Ferrous Sulfate, there is literature out there that says you need to add Vit. E since it depletes it. I had to take 2-3 325 mg. per day with meals to even BEGIN to get my Ferritin up. When it got up to the 50's, I started having relief of symptoms. Now, I try to keep my Ferritin NO LESS than 70, at my docs suggestion.

On a side note, I have noticed that when a doc says someone is overmedicated, even with obvious continued hypo symptoms, they are too obsessed with numbers on a pieces of paper--namely the TSH. Before the TSH came into existence, docs were wise--looking at symptoms, and they treated symptoms.

I would bet that once you get you Ferritin corrected, you would do great on that Armour you were on. I have found Armour to be a FAR superior treatment to Levoxyl and any T4-only meds.

[obwat]

thanks for the info.

been taking iron supplements x 6 mos, even started eating meat after 17 years of being a vege. i was menstruating every 7 days! but now it's back to about every 12-14. really really heavy though. am guessing that's not helping iron any.

still really very confused about my meds. my new Dr is at one of 'the' progressive clinics here in San Francisco (attached to UCSF) and i followed up with 2nd Dr because i was getting conflicting info. kinda wanted a tie-breaker. i know, sounds awful, but  none of this makes sense to me. one dr says black, the other, white. no one has been able to explain anything clearly. anyway. both agreed that my supressed TSH means i'm on too much med & my fatigue, etc is related to hyper state.

Dr admitted the new dose of synthetic t3/t4 is lower than he'd expect me to need (am 5'10" and weigh 175) but says it will give us a lot of good information (?) at the 6 week lab test mark. am so tired of playing pharmaceutical roulette but what i've been doing for last 4 months hasn't been working either: 2 grains armour AM and 1 grain in PM. this was down from 4 grains in previous months.

the weight gain is killing me the most - have a whole closet full of clothes i can't go near. activity level normal aside from 3 weeks of limited activity during period of excercise intolerance in may/june when i definitely swung hyper (my jogging heart rate, normally >160 but was 185-190! i used an inhaler to help with breathlessness and WOW. don't ever do that. apparently it increases your heart rate. ended up in ER hooked up to an EKG, etc. ). normal week for me is 3 X 90 minute yoga classes, run 25 miles, weight train 3 days and am on my feet all day at work. and eat *really* obnoxiously healthy. still - am expanding and i'm not exaggerating. is worse than the 7 or so pounds when hypo crept up. more like 25 pounds! ugh. very frustrating.

no one has been able to explain why my t4 doesn't move. pages and pages of labs and a slew of different doses & meds. t3 changes. tsh changes. t4 remains stuck. shouldn't they all kind of influence each other?

maybe it doesn't matter but from what i do understand, it doesn't make any sense to me.

anyone have this problem? thank you so much.

frustrated.confused.

[doodlebug1]

Hi obwat. In my opinion, if your labs were mine, and on 3 grains, and when there were no hyper symptoms at all, the last thing I'd do is lower my meds (or add in that T4) especially when so many of the hypo symptoms have disappeared. I don't see a free T3 of 4.2 indicative of being over-medicated simply because a TSH is where it is!! I have noticed that the TSH means very little when a person is close to their optimal dose of Armour--the dose that rids them of symptoms!!

And...you even said you have felt worse with the med change!!

And, it is my understanding that T4 is a storage hormone. It's "main" contribution is to convert to T3--the latter being the active hormone which gives all the good benefits. So perhaps you maintain that T4 where it is because you are converting it....

And again, when my Ferritin was that low, I had monstrous symptoms...and only when I took enough to bring it up to the 50's did I rid myself of those symptoms. I had to take QUITE a lot to do that, so perhaps you are not taking enough? And funny thing, obwat, lots of us hypo folks have been noticing low Ferritin, EVEN without heavy periods. My DOC even has noticed it with herself--that her Ferritin was low--that she has to supplement to bring it up--and that it drops if she becomes lax with the iron supplementation---and her periods are not heavy....etc. She's also hypo....

We are allowed to express our opinions here, so in my opinion, your 3 grains was a great dose, and your Ferritin is WAY too low and is probably causing a lot of your problems!

[dedemc]

Hi Obwat... Iam about in the same boat as you.  I currently have low tsh (0.05) high t4, but low t3 and low t3 uptake.  Biggest problem is the weight gain despite being a very healthy person.  most resently my cortisol level was tested and is very low.  You might want to give that test a try.  It would suggest addrenial faliure and that might be the cause of the weight gain and other symptoms that go hand in hand with hypo.

[obwat]

doodle -

thanks for all the input. HELPS! what you're saying makes sense (almost more sense than my doctor) but something's not right.

*trying* to be brief, i've condensed a lot. if you can stand all the details, it basically went like this:

8/04 - 2/05 i took synthetic t3 20% + t4 80% combo. started at 1/2 grain and ended at FIVE grains. in this 6 month span nothing changed much on labs or in life: by the time we'd incremented up to 5 grains, t3 and t4 DECREASED slightly, as did TSH.

usual rules were followed: no iron, calcium, food, soy or fiber taken anywhere near meds. doc swore i must have some weird absorption thing caused by a lining of funk in my blood vessels...until test came back negative.

in 2/05 we switched to 2 grains armour. 2 weeks later, i started to feel better, but still not great. increased to 3 grains and i felt FANTASTIC!!! for about 2 months. my ferritin was 15 at that time too.

then i'm not sure what happened. there was a snafu with a Rx refill and i ended up taking 7.5 grains instead of 3. i didn't realize until i started getting heart palps, was unable to breathe, tremors, & experienced this bizarre anxiety freakout that lead me to seek emergency psychiaric treatment. i have been depressed before, but have NEVER had anxiety problems. is not my temperment at all.

the on-call psychiatrist prescribed valium but i told him, no - it's something physical. i'd read somewhere about hyperthyroid symptoms and asked him to check my levels. pretty sure he did it just to get rid of me (he REALLY didn't like me second guessing/rejecting his valium solution). when they came back my TSH was .008 ! (down from .744). T4 had jumped from 1.0 to 2.4.

ever since then, things have been awful. that was in may. we stopped meds for a bit then resumed 3 grains armour. have continued to feel awful on that dose x 3 months. tsh is still very low yet i'm gaining weight steadily, have menstrual woes, + fatigue(!!!)

does any of this sound familiar to anyone?

thanks for reading :)

[doodlebug1]

Hi. I definitely have lots of opinions/comments to make. LOL. First, are you multi-dosing? Since Armour has direct T3, and since it peaks about 2 hours after taking it, I found it wise to multi-dose. I, for example, am on 3 1/2 grains. I do 2 grains in the morning, one grain around noon, and the final 1/2 grain by 3 pm or so. And, I do the tablets sublingually--I place them between my inner cheek and gums (which is above the buccal gland). Doing it that way takes the hormones directly to your blood via the millions of capallaries that line your mouth, thus bypassing the acids in the stomach and the processing of the liver. (Also, sublingually doing Armour means you don't have to avoid the iron, calcium, etc at the same time!)

And...I STILL am of the opinion that you need to improve that Ferritin! Low Ferritin can cause the fatigue you mentioned! I certainly had it!

What is your pre-rising morning temp, and what is your mid-afternoon temp? I've learned that we are looking for the first one to be between 97.8 - 98.2, and the mid-afternoon to be 98.6.

But again...it really sounds like you need to find some major improvement in your Ferritin...even Dr.Mark mentioned iron. I had to take 2-3 325 mg. Ferrous Sulfate DAILY with food to even begin to budge my Ferritin up. I STILL have to take a maintenance dose to keep it up, and I don't have heavy periods at ALL.  

[obwat]

thanks doodle

when taking armour i did split the dose > 2 grains AM + 1 grain early afternoon. trying to make it three times would be pushing it - my workday is crazy and i know consistency would be tough. never tried sublingual though. yummy :)

for ferritin i'm taking 2 X 325mg ferrous sulfates twice daily, anything more than that & i'd encroach on thyroid meds. if i'm up realy late or early i'll sneak in extras whenever possible. also increased red meat eating to twice a week. not a huge fan but...

2 1/2 weeks on levoxly/cytomel and feeling low still. lower than before switch (energy, not mood). am back on the 7 day peroid cycle too - with spotting to fill in the gaps. fuN! ugh. get this - i left a msg with my Dr about it and he said i should increase the cytomel from 5 to 10 twice/day but not change levoxyl. said it's very important to reduce my meds to get my thyroid levels lower (raise my supressed TSH).

now, unless my math is bad - the 3 grains armour he took me off of =

t4 = 114
t3 = 27

new synthetic =

t4 = 112
t3 = 20

assuming (for sake of argument) my meds do need reducing, is this new&improved Rx REALLY different enough to do anything?? doesn't seem to add up to me....??

[doodlebug1]

I'm curious--earlier you mentioned that you had been taking iron for 6 months. Have you been taking the 1-2 325 mg. for six months?? (And by way, are you taking 1-2 tabs daily or 1-2 tabs twice a day, to equal 2-4 daily? When I was doing 2-3 325 mg. tabs a day, it took me a few months to raise my Ferritin.

Honestly, I think a doc switches meds like he did you because he thinks he has to do "something", and he didn't realize that your problem was probably the low ferritin!! LOW FERRITIN DOES CAUSE ISSUES WHEN ON ARMOUR!! I had it, and see others have those issues due to low Ferritin.

Also, I do want to tell you that though I went from T4-only meds to Armour, and never went on T4 plus Cytomel, I have read folks who DID do the T4 plus Cytomel state that they noticed better results when the got on Armour. Perhaps it's the T2, and T2--who knows.

[obwat]

hiya,

2 x 325mg capsules daily at bedtime + about 3 or 4 add'l capsules a week; snuck in between doses whenever possible. this has been since february so....8 months now. my periods are SO heavy and SO frequent though (this is relatively new - last few years, getting worse). not to be too gross but imagine having to change tampons every 45 minutes to an hour. super extra uber absorbant ones too. timing varies, but every 10 days is about average time between bloodlettings.

i've never just done t4. always some t3/t4 combo - either synthetic or piggy. it's clear on my last labs that i'm getting too much t3 - this much i know. i just wish i understood what my body is doing with it. to guess (and it is a guess - not proporting to have any clue what i'm talking about) i would say my pituitary/brain is seeing all the t3 and saying whoa! thyroid, quit it...which is why my tsh is so low & t3 so high. stuck in the middle is my poor t4, the long-distance/storage part of the equation. it's at the very bottom of normal. the pill i'm taking isn't enough to cover all my t4 needs & my thyroid is no longer adding a thing to the pot. since the t3 has a short half life, there's a weird deficit somewhere. hyperthyroid in one way, hypothyroid in another. that's my own made up theory though - please, no one take it as medical knowledge!!

you'd mentioned temps. i've never tracked it but have never had normal (as is not fevered) temp in the 98 range. always 97.something: 97.3, 97.6.

am thinking that my temp is different these days tho - i feel warm all the time now.