A T3 only question from alittleblues

[Alittleblues]

Hi! I have been on four grains Armour for a year or more now, plus adding 25 mcg Cytomel for a few months. Since I have worsening joint pain, continued thinning hair, Rt3 within the past year, drier skin and basically have no energy or desire to see people on my days off work, my Dr supports going off NDT for a short while and doing a trial of Cytomel only.

I have no current labs.

Which is better: to cut Armour out first and immediately take Cytomel equaling the T3 I was getting from NDT plus the current Cytomel dose, or weaning off Armour and taking only the amount of Cytomel that I have been taking? Or some other option?

I would appreciate any knowledgeable opinions. Thank you

[gimel]

Both Free T4 and Free T3 are much too low in the range.  As mentioned I see no need for the various supplements you are taking.  I would stop those and adjust thyroid dosage.  I would continue with D, B12 and iron supplements as needed to optimize D to about 55-60, B12 in the upper end of its range, and ferritin at about 70 minimum.  Have you ever had a diurnal saliva cortisol test, done at 4 times during the day?

[Alittleblues]

Here are Ft4, Ft3, and Rt3 results:
Ft4 is .51 my/dL range .78-2.19
Ft3 is 2.9 ph/mL range is 2.5-3.9
Rt3 is 11 my/dL range: 8-25
Ratio is 26.4

[Alittleblues]

OK, Thanks. I'll ask my Dr about the supplements. He suggested Tyrosine and 5-HTP  because I don't sleep well and the Adrenall before strenuous exercise. My sleep was interrupted repeatedly for months but that seems to doing better.  

I'm waiting for a call back from him.

[gimel]

This is just my opinion, but if it were me I would eliminate any supplements for which I did not have test results indicating a need, especially the Adrenall, iodine, selenium, and tyrosine.  You really can't be sure of whether the effects are what you want or not.  For example, cortisol is an antagonist of thyroid hormone.  High levels of cortisol from the adrenals or meds/supplements can offset the effect of thyroid hormones.  With you taking a large dose of thyroid med, I don't see the need to supplement with iodine.  I would continue with the D, B12 and iron supplements, just re-test to see where you are currently.  

Other than that it is clear that you need to increase your Free T4 level, and you need to see your Free T3 and Reverse T3 results, in order to make an informed decision about med dosages.  

[Alittleblues]

We halved my dose to clear some RT3 and now I'm low again. I'd like to add a third grain of Armour but will wait until I talk to him on Monday.

My dr recommended Adrenall and he feels the iodine is ok. My iodine excretion was around 70-75%. (Can't recall exactly.) I take about a teaspoon of sea salt four - five days a week now but was low salt for years.

I haven't tested for cortisol in a while.

[gimel]

With those symptoms and the limited test result of Free T4 being below range, it is apparent that your thyroid hormone levels are off; however you really need to know the Free T3 and Reverse T3 as well.  Why are you taking iodine and Adrenall?  Have you tested for cortisol?  

[Alittleblues]

Need help:  I have been on 2 grains Armour plus 65 mcg cytomel for a couple months now with worsening dry skin, air hunger, muscle weakness and continued hair loss. My average daily temp the last four days has been a consistent 97.8. I have two lab results but waiting for reverse T3 and freeT3.
My TSH is .02, and it has been that for a few years now.
My free T4 is below range: .51 / with a range of .78-2.19 ng/dll

I am on  daily vitamin D, B, selenium, iodine, and progesterone, and also taking  Adrenall, tyrosine, 5-http and Iron a few days a week.

I talk to my doc on Monday but will not have Free T 3 for or Rt3 ratio for a week or more. Would upping by a grain of Armour be helpful?  I can't believe my T4 is this low! It seems the higher the Free T4, the better I feel! I have a fitness event coming up in two weeks and I'm struggling with endurance when I bike. I have eaten gluten on a few occasions the last weeks after being off it for a year.

I take 2 grains Armour plus 25 mcg cytomel in morning and by 1:00 I'm trembling until I take another 25 mcgs. I take 10 at bedtime. At one point I took 80 mcgs daily and hair was still coming out but also growing in. I noticed new little spikes all over my head. got scared though and backed down the dose. Hair is slowed down again for sure since I reduced to 65 mcgs cytomel.

Any advice would be appreciated!

[Alittleblues]

Thanks. I expected to feel worse on the lower dose. Usually 2 grains of Armour feels horrible. I could add another grain of armour but not sure if that will help with reverse T3.  Honestly I don't know how much to take. Any thoughts? I never felt good at 3 grains.  It's hard to keep it all straight. My dr said to wean off armour but how fast?  

[gimel]

Since you are already on the revised meds, I just wanted to point out that I am not surprised that you would feel slowed down.  You went from 4 grains of Armour, equivalent to about 275 mcg of T4, to current dose of one grain plus 30 mcg of T3, which is the equivalent of about 168 mcg of T4.  That is a pretty severe change.  At that level I expect that you are going to feel even worse than you do currently, as the T4 level drops over the first few weeks.  Please let us know how you are feeling as you proceed.  

[Alittleblues]

Thanks! Yes, my vitamin d was at top of range a year ago so I was shocked to it so low. My ferritin in October was 97. I still maintain that with a supplement .( I hope it near that anyway.) Today I'm starting to feel a little  slowed down on this lower dose. My voice sounds a little gravelly.

[gimel]

You badly need the supplement for Vitamin D.  For best effect it should be 55-60.  You also need to know your B12 level.  It should be in the upper endof its range.  Ferritin is also very important for a hypo patient.  Low ferritin can cause symptoms, and also affect how thyroid hormone is metabolized.  Here is a quote from a reliable source.  

"Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (238-242). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. "

[Alittleblues]

I meant add T3 or Armour, not T2,  

[Alittleblues]

My last Vitamin D was below range but I have been treating that for a few months. 4000-2000 IUS daily.

From October 2014 after months on 4 grains.

TP antibodies were down to 626 from 6771 a few years ago.

Free T3 3.8 pg/ml    range 2.5-3.9
Rt3: 22.                  range 8-25 ng/dl       ratio: 17.3:
Free T4 1.22           range .78-2.19
TSH   .02 uIU/ml     range .465-4.68 (TSH hasn't moved for a year or more regardless of dose.)

I have currently reduced my dosage to 10 mcgs T3 morning
1 grain Armour plus 10 mcgs T3 noon
10 mcgs t3 around 3:00pm

This is much lower than what I have been on. Hopefully this will clear the T4 pretty quickly. If I feel worse I can add T2 or a grain of Armour.

I hope I'm not one of the people who need six grains a day and I haven't gotten up that high. That is what scares me.

[gimel]

What were your Free T4 and Free T3 levels when taking the 4 grains of Armour?  Have you been tested for Vitamin D and ferritin?

[Alittleblues]

*Height should be thought darn autocorrect

[Alittleblues]

Thanks gimel!  I have continued to have symptoms the whole time. There was still the height that I wasn't on enough which is why we stayed at 4 grains and added t3.  How much should I reduce the Armour? My dr said I would wean down but didn't tell me how quickly. Should I cut armour by half? And keep taking 25mcg Cytomel?

[gimel]

Stopping your Armour and going to Cytomel only is a drastic measure to me.  It has to be done very cautiously to avoid at some point somewhat unexpectedly flipping over into hyper, which is far worse than hypo.  

I would take the T3 only approach only as a last resort.  I was taking 3 grains of Armour myself and was having some hypo like symptoms, after a fairly long period of feeling very good.  Got some testing done and found my RT3 to be high, and my ratio of FT3 to RT3 lower than recommended by several sources.  I discussed with my doctor and got my Armour reduced, in order to reduce the amount of T4 available for conversion to RT3 and FT3.  At the same time Cytomel was added to my med.  That worked very well, and got my ratio well over the recommended level.  I have continued with that dosage of Armour and T3 med.  I also supplemented with iron to optimize my ferritin level. This approach might work fine for you and certainly it is a lot more conservative.