Dose tweak every week or so...is this common?

I went off meds (Armour) for while back in Feb., started back end of March at 60 mcg.  It took about five and a half weeks to feel fully replenished and then I felt an overload (specific symptoms of extreme fatigue, muscle tightness, anxiety, burning up feeling of being warm, loose stools, headache, etc., all too familiar when I got a bit high in the past).  It just so happened that my levels were scheduled to be checked about now; all came back good. TSH - 1.32 (.55-4.78), FT3 - 2.9 (2.3-4.2), FT4 - .09 (.89-1.76).  I then reduced to 45mcg based upon symptoms and in about 3-4 days the hypo symptoms kicked in.  So...I did the next day at 60 mcg and there I was back hyper again.  So now over the past week or so, I have been taking approx 52 mcg (yes, I am carving out the 30 mcg pill which is my second dose of the day, to be about 3/4 of the pill).  I have felt terrific for a week or so now, and yesterday there I was hyper symp again!  Today I reduced the second dose to almost half of the pill and we will see what happens.  What the heck here??  Thoughts??  I want to stabilize so bad, but it has been a serious challenge here lately.

[goolarra]

The key to stabilizing is CONSISTENCY.  You can't play with your meds day-to-day.  You have to stay on a dose long enough for it to stabilize (for the T4 element to stabilize).  That takes 4-6 weeks.  How you feel today has a lot more to do with the combined total of what you've taken over the last 4-6 weeks than it does with what you took today.

I'm assuming your FT4 should read "0.9".  It's not "good", it's still very low.  FT3 is also low.

How are your adrenals?

Perhaps a med with T3 in it isn't right for you???  It's T3 that's fast-acting and volatile and will affect you on a daily basis..

[grantj]

Consistency, makes complete sense.  I am sorry, yes, .9 for FT4, not .09.  T3 med has been great, except now that I am off another med, nothing is the same (and I am off another med rightfully so, Dr. advice).  I understand the fast acting and volatile nature of this, and I am almost thinking I am taking my doses too close together (7am and 11am), and the T3 is getting me.  Experience has it that when I took 30 mcg at 7am and waited until say 2pm or so to take the other 30, well, it just seemed like the second late dose does not "connect" to the first one like it would in taking it before lunch (even when I wait a couple of hours after lunch to take second dose).  

I am seeing a different doc in the morning who is supposed to be very experienced with Armour; have had other decent med professionals helping me, but really want to hear from this guy (friend referral).  With everything being low, as you say, I cannot understand why I would ever feel any hyper symptoms??  Adrenals are fine, per my doc, per my last test.  Thnx!

[goolarra]

Perhaps you would do better taking it at noon or 1:00 pm?  Unlike T4 meds, Armour and synthetic T3 meds can be taken not on an empty stomach...

I think the problem is that your FT4 is SO low (barely anything available for conversion) that you are running on T3-only.  You don't have any "emergency supply" available, so when the T3 in your meds is used up, you have nothing.  On the other hand, you get a "jolt" from the T3 in your meds, and T3 can make you feel hyper very quickly.  

Your FT3 is still on the low-ish side, but it looks good relative to your FT4.  

Are you on Armour due to a conversion problem, or was it personal preference?  It might be that adding a little synthetic T4 to the mix would get your FT4 up to a point where conversion would kick in during those times when the T3 in the Armour has been used up.  Your doctor might mention that.  

[grantj]

Goolarra, makes perfect sense.  I am on Armour since it was the first one I tried and seemed to work.  My T4 has never went up, even after being on meds for a few years now.  T3 has, but never T4.  When I had it all tested three weeks ago, T4 was lower than ever.  I get very scared to try a T4 (but am open to anything) because when the Armour went in short supply, I went to Synthroid with very yucky results.  I then added Cytomel, with even yuckier results.  Maybe the combo (Armour/T4) will do me fine??  Why do you think the meds are not raising my T4 at all?  I saw a different doctor today and he really feels like my adrenals are fatigued, which is the underlying issue, and really wants to address that first.  He put me on Adrenal support and I will see him again in two weeks; at that point, he may do saliva test.  What you said here, though, has crossed my mind more than once; looks like I need more T4 somehow if the Armour is not cutting it.  Thanks

[goolarra]

Armour contains a lot of T3 compared to what our thyroids would produce if they were healthy.  The ratio of T4 to T3 in Armour is between 4 and 5 to 1, and our thyroids produce 20 to 1.  The rest comes from conversion.  So, if you are not a slow converter, the T3 in Armour can overwhelm you before the T4 content is high enough.  We have several members who have had to add some T4 to the mix to get a good balance between FT4 and FT3.  I think that will be a different experience from your previous one with straight synthetics.

If your adrenals are off, you will have a very difficult time regulating thyroid hormones...glad to hear your doctor is addressing that issue.  

Keep us posted...

[grantj]

Thanks, yes, this was what I was thinking about ratio and all.  It seems like the T3 overwhelms, but with numbers in a fairly decent range (T3), it seems as though it should not be too much.  I am now taking my meds at 7am and 3pm, per new docs advice.  I was taking at 7am and 11am since I felt like the afternoon dose never "took".  All is different now with being off metformin, so heck, I will try the afternoon thing again.  Today is my first day, wicked headache from the change I am sure, T3 fine for now, tell tale will be in a week or so from now to see if I "overload" all over again.  If T3 does not build up, then why would I feel this build up over time?  Why not right now?  Once the build up starts, it won't stop until I reduce.  Then there I am again hypo as heck in a few days!  He is thinking spreading it out like this may be the answer.  He claims to know more about Armour than anyone in our city; ok, so I can hope I am in good hands.  He is a very wholistic guy, not much my style, but I am willing to give him a chance.  

[goolarra]

Sometimes what seem to be insignificant changes (like taking meds at a different time) can make all the difference.  

T3 does build to some extent...obviously, when we take T3 meds our FT3 levels go up.  However, T3 is very quickly neutralized by our bodies if not used, so the effects of too much T3 disappear much faster than does overmedication on T4.  That's why the timing of meds with T3 in them is much more important than timing T4.  It's tough to time that second dose so that you don't feel hyper for a while on the double shot of T3, but you also don't feel hypo if T3 level is allowed to go too low.  If your FT4 level were a little higher, your body's natural conversion might be able to "tide you over" more smoothly to the next dose.

If he knows his stuff with Armour, he doesn't have to be a charmer!

[grantj]

Well, so far so good today.  I took 30 at 7am and 30 at 3pm.  I felt that first dose start wearing off around 3pm or so, and even over the next few hours, it's as if the second dose does not take effect because it never overrides the first wear off??  I am going to see if he feels that a secondary pill of T4 would be of benefit; but just maybe, this will all smooth out over time once my body adjusts.  He did not act concerned when he saw that my T4 was very low; of course he barely looked at my recent thyroid labs since he was so concerned about addressing the adrenal issue.  He simply said that is typical with Armour since it is so heavy on the T3.  I imagine we will get more into the thyroid talk on our next visit in two weeks.  He is having a full blown hormone panel done next week.  I am going to make him put his money where his mouth is and see if he really knows all that.  I am concerned about him eventually loading me up with supplements of all sorts.  Not my thing; not opposed to a couple of key products, but I will not take handfuls of this stuff.  I got the adrenal stuff going, some drops to put under my tongue and a liquid vitamin.  Thanks!!

[grantj]

Well, here it comes; starting to overload again.  Same 'ol symptoms...vicious cycle continues.  I started spreading out the dose (7am and 3pm) and taking the 60 again (30 and 30) on Wed. and had two super excellent days, but today, well, I woke up with that severe exhaustion feeling, pressure around my eyes, muscle tightness/weakness, severe agitation and impatience again, feelings of burning up.  Now what, until I see him in a couple of weeks?  Yes, now I need to tweak until about two days later when I cannot function with the hypo symptoms all over again.  My fear is this;  will I ever truly stabilize?  I have way too much living to do for this kind of thing.  I fear not being able to enjoy my four year old as much as I could be.  Too many fears at this point; I need to maintain my faith and believe one way or another things will be great again.  Thanks!!

[goolarra]

You WILL stabilize...it takes time and patience (lots), but I've never heard of anyone who didn't eventually.  Hang in there...

Do you think you might be able to arrange to see your doctor sooner?  Unfortunately, I don't have any suggestions on how to get through the next couple of weeks without changing meds.

Here are my thoughts.  I know your doctor isn't concerned with your FT4, but "I" am!  FT3 is the test that correlates best with symptoms, true, but both FT3 and FT4 levels have to be adequate to feel well.  Your FT4 is SO low, that there's barely any available for conversion.  Your body is running on the T3 in your meds.  T3 levels vary depending on demand, etc.  You will have "peaks" and  "valleys" in FT3 levels throughout the day.  So, as you know, they have to be taken more frequently than T4 meds.  What often happens is that when cells are starved for T3, the adrenals jump in and try to "make up" for the deficit.

My theory is that your FT3 levels are variable through the day.  When FT3 gets too low, your adrenals kick in and try to "help out".  

Since dessicated is the only med you've tried, you really have no idea if you convert well or not.  If you do, either switching to a T4 med or adding some T4 to your dessicated would help to smooth out those peaks and valleys.  The adrenals then don't feel the need to kick in.  I think you'd feel a whole lot better with a higher F4.

If you can't get in to see your doctor sooner, can you split your does into more than two?  Meds with T3 can affect sleep, so the last dose can't be timed too late (although some people report that it doesn't bother their sleep).  The more frequently you take it, the less variablilty there will be in levels.  However, I think this is just an interim measure.

How do you plan to tweak your dose?

[grantj]

Thanks again, what you say once again makes total sense.  The reason I am seeing him in two weeks is that I am having blood drawn Tues morn to test estrogen, progesterone and testosterone.  It will take some turn around with that.  His big thing was that we have to work on the other areas (i.e.-adrenals, other hormones, etc) in order for thyroid to stabilize.  I don't think he got the urgency for me right now;  he even got frustrated when I told him I needed help NOW, not in two weeks.  I understand where he is at with that, but I was so desparate that day.  Hopefully, I am in the process of stabilizing and I won't need to tweak before then.  I don't know though, not sure what I will do from here except tweak every few days up and down.  Nice, huh?

If I split the doses up further, do you really feel like, for example, a 15 mcg taken at 7am, 15 at 11am, 15 at say 2pm and 15 maybe 5pm will be as effective as a whole as 30 and 30?  I believe I have tried this in the past, where I took the 30  7am and split the other 30 11am and 3pm.  It did not seem to do the trick or really work as a whole; of course, everything is so up and down, I really cannot say I gave anything a great shot nor have I received much in the way of guidance on this.  I was under the impression that my primary was very well educated on Armour, but he proved not to be the last time I was in.  The 30 at 7am and 30 at 11am was my best bet until all went haywire in 2/11 when I went off the other med.

TODAY, I feel fantastic.  Hmmm...do you think this adrenal stuff may be helping?  I seem to have take on a Dr. Jeckle and Mr. Hide profile!  lol, really not funny though.  I hope it makes a believer out of me.  I plan to take your info to him regarding T4.  If he has a problem with that or disputes it, I have another source I can go to that probably won't.  I am giving this guy a try based upon a referral from a good friend.  He is supposed to be the Armour guru.  We shall see.

[grantj]

Ok, so my daily report  here.  Well... no overload, BUT as mentioned and experience before, taking 30 7am and 30 2-3pm does not "take" the same as 30 7am and 30 11am, as a whole.  The 60 this way feels like less than the 60 the other way, and, I am waiting two hours after eating for the afternoon dose.  I don't get that at all, but it has happened before the same way.  Today I woke up with a depleted feeling of being low, felt very weak in the gym this morning, dull headache, but this is a good sign that spreading the dose out is the better way.  Now, I am guessing that I can work from here and just keep those doses far apart, and maybe do 45 at 7am and 30 2-3 pm, and see if that won't get me to optimal level and even get that T4 up. I cannot imagine that doing say 4 or 5 small doses throughout the day will work nearly as well as the two bigger ones and not overload at any point, BUT, if I can get the doses high enough, it may be key; way too many ifs, ands and buts with all of this!!  I plan to do nothing for the next two weeks until I follow up with this new doc IF it will hold here; I am functioning at an ok level at this point, much much better than if I overload, and know I need CONSISTENCY more than anything.  Thanks and you know I will keep you posted!

[grantj]

Whoa, last night about 7pm things went a major mess.  I began experiencing major anxiety, almost panic like reaction, inability to focus and concentrate on the conversation I was having with my dinner party guests, rapid thoughts that wouldn't quit.  This was all about the time the T3 was at full peak from taking the second dose at 3pm.  It sure feels like I am inputting too much T3 and it is coming to a head about the mid point of that second dose.  This does not occur with the morning dose, or hasn't yet so far and it is 11am.  I have felt a bit lightheaded all morning, but pretty darn good energy, positive mindset, sense of calm, etc.  Do you think my body is just trying to adjust to spreading out the dose and this will level out?  I do plan to address the T4 issue for sure, but just thinking again about what might also be going on.

[goolarra]

I haven't been ignoring you...company over the weekend.

I only suggested splitting into more than two doses as an interim measure that might make you feel better for the next couple of weeks until you see your doctor again.  I don't think it's a permanent solution.  

I really don't think (my gut feeling) that this is just your body trying to adjust to the time change on the second dose.  I suspect more is going on than just that, namely FT4 level and/or adrenals.  Four hours after taking is really not when T3 should be peaking.  It should peak almost immediately after you take it and be almost gone by four hours later.  I'm still thinking that the T3 had worn off last night by about 7:00, and I'm wondering if your adrenals hadn't kicked in, and that's what you were feeling, rather than T3.  

Well, at least you have a little more time before seeing the doctor to give the new schedule a chance to work if it's going to.  I hope today's going better...

[grantj]

Very interesting info.  No problem, you have been so helpful, didn't think you were ignoring me.  Thanks though.  I was under the impression that the half life of T3 is around 4 hr.; then thought that the duration of it was around 7-8.  I also thought that T3 took around an hour and a half to really kick in??  I read all this stuff in online literature along the way.  

Regarding adrenals; I am taking a product called Adrenal Essence from XYMOGEN.  Seriously speaking here; does this natural kind of stuff (saying this respectfully) really do the job OR, what is the "sure" way of fixing an adrenal issue, OR can you really ever truly fix something like this?  This is one area I know nothing about at all.  So...assuming this is all correct about adrenals kicking in, is this process further stressing and wreaking havoc on adrenals?  I am nervous about the idea of adding a T4.  You said I should have a different experience this time since it is not all synthetics.  My body seems so very sensitive to anything.  Is it accurate to say that if my adrenals are working better, this could raise T4 on it's own?  

Today I woke up with a bit of an overload feeling.  The new dose schedule has helped somewhat.  Instead of taking the second whole 30, I carved a small piece off (here we go again).  Things always seem worse after the second dose??  I am hoping and praying for this doc to help me.  I am thinking about getting one of my other reliable resources "in my back pocket" (set an appt now), in case he turns out to be less than helpful.  Thanks again!!  I so appreciate all the expertise and support!!

[goolarra]

I don't think I've ever googled it until just now, but I see the biological half life of T3 reported as anywhere from 4 hours to 2.5 days.  Given that most people have to take it more than once a day, I'm going with the 4 hours.  Biological half life is the amount of time it takes for your body to eliminate half of the meds you have taken.  So, if you take 5 mcg of T3, after 4 hours, we would expect only 2.5 to remain.  As soon as T3 is absorbed into your bloodstream, it is available to cells (this shouldn't take more than half an hour assuming a healthy gut).  So, the "peak" occurs very soon after you take it.

Adrenals are not my forte.  It might be worthwhile to post a question asking about the product you are taking.  I know some of our long-time members do take adrenal support products.  

When we're hypo for a period of time, the adrenals often kick in and work "overtime" to try to compensate for the slowdown in metabolism caused by the low thyroid hormones.  For a while, that results in high levels of adrenal hormones.  However, if this goes on for too long, it can result in adrenal fatigue, where the adrenals lose the ability to produce hormones, also.  So, yes, it could be stressing your adrenals.

I don't think that improving your adrenal function will raise your T4.  Actually, raising T4 should improve your adrenal function.  However, you often have to work on both at the same time...normalizing adrenal function will ALLOW you to adjust thyroid hormone intake with less of the bounce from hypo feeling to hyper feeling like you've been experiencing.

It's so hard to predict how our bodies are going to react.  So, each combination of T4 and T3, both synthetic and dessicated can really be a different experience.  I know lots of people on dessicated who had to go to synthetic during the shortage, and they were not happy...even when the dose was exactly the same as dessicated, it was not "the same".  Adding just a little synthetic often works for people when being on straight synthetics did not.  

Since it often takes quite a while to get an appointment, why not initiate Plan B?  You can always cancel if this guy works out.  

[grantj]

Yeah, I guess that really did not make sense for me to think T3 would peak at four hours or so.  It hits immediately and then tapers off along the way.  Today has been a good one.  I did not feel bad upon waking, no overload, no bad mood, no muscle aches or tightness, no excessive fatigue, etc.  I had a full day at the beach club with friends and almost forgot about all of this!  I am planning on feeling great tomorrow as well.  I am going to plan B just in case though.  Hopefully I am on my way now...

[goolarra]

Well, that sounds very positive.  Don't forget that, as you adjust to meds changes, etc., a few rocky days are expected.  Just because one day is a setback doesn't mean the next can't be the best ever.  The bad days get to be fewer and fewer.  Glad to hear it's going well...

[grantj]

Just an update following my dr. visit on Tues.:  Things are moving in the right direction with addressing the adrenal issues.  I did a lot of reading on this following my initial visit with this new doc.  Do you know that I have 20 adrenal fatigue symptoms and very few actual thyroid symptoms?  

Regarding thyroid, I do have low levels, but really my main symptoms include exhaustion and some depression at times. I do not have a lot of the other common symptoms at all (thankGod).  I am certain that he is onto something and am committed to getting my health in line.  I am taking what would amount to about 52mgs of Armour now, pretty consistent, no major overloads or underloads.  What I do know is that my body cannot handle the full 60mg for more than a few days to a week or so.  I realize now how overloaded I was now that I have come down for a time.  I am confident that as my adrenals strengthen, I will settle into a lower dose.  

I did not even go there about adding a T4; just want to see what happens over time with the adrenal products.  Following the birth of my son in 7/07, I had a string of health things that came up one after another.  I read where surgery can do a number on adrenals.  Long story short, I have had 6 full blown general anesthesia surgeries between 2/06 and 1/09!  Four knee surgeries, a c section (spinal anesthesia for this one) and an elective enhancement (if you know what I mean!)!  All of this, along with my husbands big job loss, numerous other issues, etc., it has been a rocky season of my life.  We are very much on the up swing now, so that is the main thing.

[goolarra]

Good for you!  I'm so glad things are looking so much better.  Adrenals and thyroid are very interdependent.  It sounds like both are now coming into line for you (along with your life!)   winning combination.  Keep it going and keep us posted...

[grantj]

Here I am going on four weeks now of adrenal support along with a liquid vitamin and I cannot believe the positive change I've experienced.  I was never a big advocate of supplements, but he sure is making a believer out of me about now.  I just added a supplement called Pantithene, which is also for adrenal support.  I am currently taking about 50mgs or so of Armour, and I am the same every day now, no overloads, severe energy loss, or hard crashes when the T3 starts to wear off (this is a huge accomplishment).  

I always thought that there was more too all my mood swings, energy shifts, etc. than just thyroid or perhaps low progesterone (they've even labeled me as bi-polar at one point).  I never really felt like the true underlying issue was addressed until now.  I will say, however, I have had really "good" seasons too since going on Armour in 3/09 thinking that all my issues were resolved for good.  I just hope that what I am feeling now is for real and permanant (realistically speaking).  Thanks again so very much for all your support and expertise; I truly appreciate it and am so thankful I found this forum.  Goolara, your time and interest in my case is so appreciated by me, really.

[goolarra]

Wonderful news!  So glad to hear it's working so well for you.  

There's another member who is having an issue similar to yours.  Can you buy your    supplement(s?) OTC?  If so, where do you get it/them?

I'm very happy to have been of some help...thanks, it's very nice to hear.

[tangerinelz3]

I am happy to read the end of this thread. It's so nice tO know there is light at the end of the tunnel. I hope you don't mind if I ask you some questions.
Goolarra is the absolute best, she has been so helpful to me.
Do you know exactly what your adrenals were doing? Mine are a little off, my cortisol drops low at lunch and is then high at bedtime. Can you tell me more about your supplements? Where can you buy them, what exactly you are taking etc...
I have Hashimoto's, diagnosed after having my first child. I am now 10 months postpartum. First hyper now hypo. I don't agree well with Synthroid, palps, anxiety, panic, sweating etc.... I am at the moment a very low dose and won't see my doctor again till August 5. I seem to either be exhausted or have too much energy ( not in a good way).
I am so happy that you are feeling better, and it sounds like you have your meds evened out.

[grantj]

I have my two adrenal supplements in front of me now and will read you what I have:  Xymogen, which is the first one he put me on and I bought it in his office, comes from Xymogen, exclusive professional formulas, 725 S. Kirkman Rd., Orlando, Fl, 32811.  ph #: 1800-647-6100  website is www.xymogen.com  

I am not sure where a person would buy this otherwise; I am sure there are other distributors, I plan to buy it from him from here on out.  This took about two or so weeks to really notice a difference and I will tell you that things got worse before they got better.  I thought they were making me worse at times, more anxiety around crash time, huge energy shifts as related to blood sugar, etc.  Finally, it started leveling out nicely and surpirsingly, and I was getting less and less crashes and thyroid ups and downs, which had went way out of hand.

The liquid vitamin he has me on is called Intramax, which he said is like rocket fuel.  Their info is:  Drucker Labs, Plano, TX, 75074.  ph# 1-888-881-2344  website www.druckerlabs.com
I also purchased this in his office (not cheap at all, but looking to be well worth it, $70.00 month supply.  I even have my husband hooked).  I also (this week) started Pantithene (for additional adrenal support) manufactured by NHG, P.O. Box 2203, Sparks, NV 89431 website is www.protocolforlife.com  This also was purchased in his office.

The thing I like about him, too, is that he does not sell everything.  He honestly seems to be cost conscious.  He told me straight up that he watches out for people's pocketbooks in addition to their health.  He said he would save me a few hundred dollars by listening to my symptoms and treating clinically vs. do an expensive test that he feels may not be all that accurate (he says the blood/cortisol thing is no good; even saliva may not be and he saw no need for it with clear symptoms).  I had twenty of the symtoms (symptoms) of adrenal insufficiency so he went accordingly instead of getting all hung up on lab numbers (our kind of guy).

I really don't know exactly what my adrenals were doing except that I would get this major crash thing around dinner hour that seemed to correlate to the T3 wear off in Armour.  I also had low energy, mood swings, fatigue, hypoglycemia type symptoms and many, many more.  The reason I never really explored adrenal fatigue further with anyone is that my cortisol level in a blood test was always normal.  That seemed to negate any such thing with all the other practitioners I have seen; I didn't know any better.  I almost argued with the man when he wanted to diagnose that rather than focus on thyroid!  Another thing, which may be TMI, is that ANY supplements in the past have always constipated me; not this stuff, thank God!

I sure hope this info helps...  

[grantj]

One more thing which I forgot to mention:  The original adrenal support product from Xymogen is called "Adrenal Essence".  They may have more than one, but this is the one I am taking.

[tangerinelz3]

Thanks for all the information. I found the Xymogen on a website and ordered the Adrenal Essence. I am willing to try anything that might help. Thanks again

[tangerinelz3]

Started the adrenal support 3 days ago. Did you have any side effects from the adrenal essence?

[grantj]

Sorry I am just seeing this post.  Regarding side effects with Adrenal Essence; yes.  It seemed to mess with my blood sugar a lot and sort of cause anxiety more than usual, even a bit of lightheadedness.  It leveled out after a week or so, BUT, as posted in another thread, it "worked" for about two weeks, then my thyroid situation acted up again.  Here it is almost a month later and it was determined that I do not have adrenal issues at all, I was simply on too high of a dose of Armour.  I am now in the process of lowering my dose, which has helped tremendously.  For whatever it is worth, though, I am seeing a different dr. now who also confirmed that this is an excellent product for those suffering from adrenal issues.  I do wish you well for sure; hoping it works for you!