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Armour Thyroid or Cytomel
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This patient support community is for discussions relating to thyroid issues, goiter, Graves disease, Hashimoto's Thyroiditis, Human Growth Hormone (HGH), hyperthyroid, hypothyroid, metabolism, parathyroid, pituitary gland, thyroiditis, and thyroid Stimulating Hormone (TSH).

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Armour Thyroid or Cytomel

I have been seeing a endocrinologist for about a year after my primary doctor had trouble with the symptoms that I was experiencing. The latest lab work dated 6/6/2013 showed once again that the TSH level is BELOW desired range. The numbers are 0.036. I am prescribed 60 mg of Armour daily. I had a physical and the blood work showed those numbers. She encouraged me to follow up with my Endocrinologist. Should I talk to him about something else? I use to be on Synthroid before Armour.
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649848_tn?1357751184
Is TSH the only test being done?  You should also be getting tested for Free T3 and Free T4, which are the actual thyroid hormones.

TSH is a pituitary hormone and should not be used alone, to diagnose/treat a thyroid condition.  Many of us on replacement hormones, particularly, those on medication containing a T3 component, such as Armour or cytomel, have low or suppressed TSH. You're only hyper if you have hyper symptoms.

If you have labs for the Free T3 and Free T4, please post them, so we can better assess your situation.  Be sure to include reference ranges, as those vary lab to lab and have to come from your own report.

If you haven't been tested for FT3 and FT4, you should ask your endo to order them, EVERY time you have a TSH test.

What, if any, symptoms do you have?  Do you know whether or not you have Hashimoto's?  

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180255_tn?1371414263
Thanks Barb,I am waiting for the endocrinologist to call me back and I will request that. I am just learning about all of this and appreciate your suggestions.Yes I am diagnosed with Hashimoto. I don't feel as tired as i use to be since he increased it from 30 mg to 60 but there are days when i still struggle with fatigue. Starting to have trouble staying asleep, sometimes i wonder if its my thyroid or menopause which I am going through.
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Avatar_m_tn
Do you take all your medication at once or do you take half in the morning and half in the afternoon?

Many people find they need to split the dose as the natural thyroid you are taking has both a T3 and T4 component. T3 is used up in a short (read hours) and T4 takes up to 6 weeks to stablilize.  So in order to get through the day without running out of T3 many people find they need to have a 2nd dose in the early afternoon.  Be aware that taking it too late will cause many people problems getting to sleep.

Hyper and Hyp symptoms can cross over so it is not always difinitive. But it is not uncommon for  Hypo (low thyroid) to be tired all the time and fall asleep quickly BUT they are unable to stay a sleep or get a restful sleep and they wake up as tired as they went to bed.  Hyper patients on the other hand are "wired" and cannot easily fall asleep.

Since you state above you have trouble "staying asleep" that would be more consistent with Hypo.  And also the fact that upping your dosage seemed to help would indicate that you are less hypo now than before.  You just havenot yet hit the dosage for optimization yet.  The trick is to go slow and small increases and ALWAYS get both your FT4 and FT3 levels checked EVERY time.  To be treated with a T3 medicine and not testing FT3 borders on malpractice in my opinion.

As a man I have no clue about what menopause does to sleeping.  But I have a feeling in the not too distant future, my wife will cause me to learn plenty about menopause...LOL
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649848_tn?1357751184
While many people who are hyper, do have a "wired" feeling, they can also be fatigued because they aren't sleeping well/enough.  Fatigue can apply to both hyper and hypo, as well as other conditions.

Unfortunately, the sleep issues can also apply to more than one condition, including both hyper and hypo, as well as menopause.  

Reproductive hormones need to be tested, along with thyroid, FT3 and FT4.
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180255_tn?1371414263
Thanks Barb135 and flyingfool. The last two days I am soooo tired so much so that when I come home I go straight to bed for a nap. I take both 2 30 mg each first thing in the morning but now believe I SHOULD take the other in the late afternoon. I spoke to the endo nurse and ask her if she received the doctor's note about my blood test being on the low side, TSH=0.036.

She says the doc now wants me to only take 1 30 mg twice a week and the other days 2.  She said the Free t4 was 1.01 and as far as the Free T3 she said the doc does not run that one because the number is too small for him to make a recommendation based on it.  
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1202943_tn?1347844252
I always take my armour twice a day.  Once at 8am and then again at 3pm, but it just depends on what time you wake up.
My TSH is always below range without ever having a hyper symptom.  My old dr used to only test FT4 and TSH.  It took some searching to find a dr who knows how important Free T3 testing is.  I've found that Free T3 correlates most with symptoms. I would insist on having this test done.
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649848_tn?1357751184
At 1.01, your Free T4 was too low, indicating that FT3 would be, also.  My TSH has been at < 0.01 for the past 5 years and I've never been hyper with that.  Instead of decreasing your dose, based on the TSH, your doctor should have increased it, based on the FT4....

Most people taking a med with a T3 component find that splitting the total dosage into multiples works best, because it keeps FT3 levels more stable throughout the day. Typically, 1/2 the dose in the morning, then the other 1/2 around noon or early afternoon, depending on your schedule.

Looks like you need to find a different doctor.  Doctors who refuse to test FT3 and who dose, based on TSH, will keep you ill for a very long time.
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180255_tn?1371414263
I was thinking the very same thing...find a new doctor who test T3. Reducing the dosage did not make any sense to me so I am now doctor shopping. I took a dosage this morning and will take the 2nd dosage at 3.
Thanks again everyone!
Sharon
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649848_tn?1357751184
Be careful taking a second dosage too late in the day, as it could affect your sleep.

I take my second dosage at around noon - 1:00....... you can experiment with it and see what works best for you.

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Avatar_m_tn
Also any thryoid medication can supress (produce a very low TSH result).  However it is even more common when a person is taking T3.  And you are taking Armour which has plenty of T3 in it.

The Dr is asking you to lower your dosage because of a low TSH and on no other information.  And the low TSH as I just pointed out can easily be suppressed by the T3 component. Rendering the TSH which is almost worthless to begin with to completely irrelevant when taking T3 medication.

Again any Dr who is prescribing a patient with a T3 component and not testing for Free T3 is bordering on malpractice in my opinion.
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180255_tn?1371414263
Thank you! I took my first dosage at 7 and the next at 2 and my energy level was the same...tired, sleepy, depressed.
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Avatar_m_tn
While T3 acts "fast", it still takes a while for your body to adjust to a new protocol.  So one day is not going to really tell you everything.

That is not to say however that you may still be under medicated.

Also you want to try to have your blood labs drawn under the same cirtcmstances as best you can.  Usually if possible when on a medicine with T3 you don't want to take your medicne before the blood is drawn.

T3 is fast acting and thus is ramps up and is used up entirely in a few hours. I think T3 usually peaks about 2 to 3 hours after taking it. And because of this if you take your T3 before taking the blood labs it will appear that your T3 is high or higher than what it "nominally" is at.

all that being said. Consistency is the best policy.  If you take your morning dose and then get blood labs drawn, you may want to wait until just before you take your 2nd dose of the day to have the blood drawn.

If the Dr is actually ajusting the dose based upon your symptoms and only looking at the blood labs as a reference. And uses symptoms are primary, then again consistency is important.  Even if you take your meds prior to the blood being drawn, if it is the same each time you are then comparing apples to apples.  So even if the ranges especially the FT3 seem like they "should" be high enough, yet you are still symptomatic, it could be an indication of the timeing of when you took your medication and when the lab was drawn.  The Dr SHOULD be able to realize this. But don't count on it.

Also remember to separate taking your meds with food or supplements by a fair amount of time.  Calcium in particular significantly reduces the amount of thyroid that is absorbed when they are together.  
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180255_tn?1371414263
Thanks I never take my med prior to Bloodwork. I have called several endocrinologist asking if they test T3. Some can;t see me until August. I would hate to have to deal with these symptoms that long.
The HUNT continues......
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Avatar_m_tn
I have tried to help another member find a good thyroid doctor in the Charlotte area.  I came up with two prospects.  I am sending a PM with some info for you.  To access, just click on your name and then go to messages.  
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180255_tn?1371414263
Thank you so much!
sharon
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180255_tn?1371414263
Dr.Hester is in the same Group that Dr.Robland is in(my endocrinologist)  and will call tomorrow and ask questions. He was rated the Top Endo doctor in Charlotte but he will not Test T3,
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180255_tn?1371414263
love the reviews of Dr.Belgrave
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