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General Thyroid/Hashi's Question
I have diagnosed Hashi's. I'm a male 44 years old. Have had this condition about 4 years. Have taking Synthroid or the generic brand since. I'm on 112mcg dosage. Today got my lab results.
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
I've been to Mayo several times. My head is in a fog. My ears ring and I'm a bit dizzy. They tell me it has nothing to do with my thyroid. Seems back around Thanksgiving I started feeling this way. Some days are better than others. I take my meds at 9:00PM each night on empty stomach. I used to take in the morning but researched that it might be better to switch to evenings so I did. 5 weeks ago my TSH was 5.62 at Mayo Clinic. I'm comptemplating on switching to Armour. Any thoughts? I know in my mind and heart, the way I am feeling is because of my thyroid.
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
I've been to Mayo several times. My head is in a fog. My ears ring and I'm a bit dizzy. They tell me it has nothing to do with my thyroid. Seems back around Thanksgiving I started feeling this way. Some days are better than others. I take my meds at 9:00PM each night on empty stomach. I used to take in the morning but researched that it might be better to switch to evenings so I did. 5 weeks ago my TSH was 5.62 at Mayo Clinic. I'm comptemplating on switching to Armour. Any thoughts? I know in my mind and heart, the way I am feeling is because of my thyroid.
When a patient is hypothyroid for extended periods they sometimes end up with what is called adrenal fatigue, due to the adrenals being overworked so much trying to make up for lack of thyroid hormone. These are some of the symptoms of adrenal problems.
Fatigue/Weakness
Poor Appetite
Weight Loss
Nausea, Diarrhea
Muscle, joint, abdominal pain
Light-headedness upon standing
Low blood sodium level
Skin darkening
Low blood potassium level
anxiety or nervousness
shakiness
dizziness
racing heart
feeling hot,
Another problem that occurs frequently in hypothyroid patients is low iron, identified by having low ferritin. Low ferritin can cause the following symptoms. Also note the effect of low ferritin when raising dosage of thyroid med.
Minor aches
Fatigue
Weakness
Heart palpitations
Increased pulse
Loss of energy
Loss of libido
Confusion
Irritability
Shortness of breath
So low ferritin symptoms can mimic hypothyroidism. Shortness of breath is also a symptom of low ferritin levels. 93% of patients with ferritin under 50 ng/ml were iron deficient. Excessively low ferritin as well as low iron can resulting in hyper symptoms when raising desiccated thyroid (armour). Severely low ferritin or iron can be improved quickly with iron injections or IV iron infusion - a few weeks as compared to a few months from iron supplementation.
It is generally recommended to hypo patients that they should address low cortisol, and low ferritin issues before even starting thyroid meds. So I think you need to find out your levels by doing a 4 test 24 hour saliva (or urine) cortisol test, and also a test for ferritin, and a full iron test panel. Then you will need to adjust as necessary to get your cortisol and ferritin to adequate levels.
Your Free T3 and Free T4 are in the lower half of their ranges, which is frequently associated with having hypothyroid symptoms. So, I'd say that you need to increase your free T3 into the upper part of its range, as necessary to relieve hypo symptoms, and also raise your Free T4 to around the middle of its range. You may have to wait until resolving any cortisol or ferritin issues before resuming your thyroid med increase.
Also, if you haven't been tested for Vitamin D, and B12, you should make sure to do so and look to get those well up into their ranges.
Fatigue/Weakness
Poor Appetite
Weight Loss
Nausea, Diarrhea
Muscle, joint, abdominal pain
Light-headedness upon standing
Low blood sodium level
Skin darkening
Low blood potassium level
anxiety or nervousness
shakiness
dizziness
racing heart
feeling hot,
Another problem that occurs frequently in hypothyroid patients is low iron, identified by having low ferritin. Low ferritin can cause the following symptoms. Also note the effect of low ferritin when raising dosage of thyroid med.
Minor aches
Fatigue
Weakness
Heart palpitations
Increased pulse
Loss of energy
Loss of libido
Confusion
Irritability
Shortness of breath
So low ferritin symptoms can mimic hypothyroidism. Shortness of breath is also a symptom of low ferritin levels. 93% of patients with ferritin under 50 ng/ml were iron deficient. Excessively low ferritin as well as low iron can resulting in hyper symptoms when raising desiccated thyroid (armour). Severely low ferritin or iron can be improved quickly with iron injections or IV iron infusion - a few weeks as compared to a few months from iron supplementation.
It is generally recommended to hypo patients that they should address low cortisol, and low ferritin issues before even starting thyroid meds. So I think you need to find out your levels by doing a 4 test 24 hour saliva (or urine) cortisol test, and also a test for ferritin, and a full iron test panel. Then you will need to adjust as necessary to get your cortisol and ferritin to adequate levels.
Your Free T3 and Free T4 are in the lower half of their ranges, which is frequently associated with having hypothyroid symptoms. So, I'd say that you need to increase your free T3 into the upper part of its range, as necessary to relieve hypo symptoms, and also raise your Free T4 to around the middle of its range. You may have to wait until resolving any cortisol or ferritin issues before resuming your thyroid med increase.
Also, if you haven't been tested for Vitamin D, and B12, you should make sure to do so and look to get those well up into their ranges.
Well, today is Jan. 18, 2013. I'm still the same and have been all over the place. I've had some good days but most of them suck. On 12-19-12 I did labs. They are below. Any thoughts? I was bumped up to .150 of Synthroid on 12-27 after seeing endo down in Phoenix. He gave me six week supply and wants me to take for six weeks. I've got say that after two weeks on it, I had about 4 days where I felt everything was normal. Then I went right back into the tank! What happened? Did I overshoot somehow? I know my labs would be lower right now than they were on 12-19. Much lower. I'm guessing around the 1.5 TSH and higher T3 but that is only a guess.
And as for the Armour which I talked about back this past summer, I took one pill and was literally jacked up for over 24 hours. It just greatly intensified the symptoms I had......really dizzy, fast heart rate, nauseated, etc. I stopped after one day. It was 90mcg of Armour I believe.
TSH = 2.34 (.40 - 4.5)
FT4 = 1.1 (0.8 - 1.8)
FT3 = 3.0 (2.3 - 4.2)
And as for the Armour which I talked about back this past summer, I took one pill and was literally jacked up for over 24 hours. It just greatly intensified the symptoms I had......really dizzy, fast heart rate, nauseated, etc. I stopped after one day. It was 90mcg of Armour I believe.
TSH = 2.34 (.40 - 4.5)
FT4 = 1.1 (0.8 - 1.8)
FT3 = 3.0 (2.3 - 4.2)
First I want to provide this info,
"A stable dose of L-T4 in treatment of thyroid diseases is achieved when the amount of hormone entering the bloodstream equals the proportion that is metabolized, allowing constant serum concentrations of fT4, fT3, and TSH. When administered in the fasting state, about 80% of L-T4 contained in modern tablets is absorbed. After ingestion, serum T4 values peak at 2–4 h and return toward basal levels after about 6 h. The serum half-life of T4 approximates 7 d in the euthyroid state, and its clearance depends mainly on deiodination and to a lesser extent on other pathways, such as sulfation and glucuronidation"
As I would interpret your situation, when you skip a dose, that amount of T4 is obviously not in your blood to be metabolized. Since the half life is about 7 days, that means that half of that dosage amount has not been available to be metabolized over that 7 days. With your dosage of 112 mcg of T4 med, then by the end of the week you would have lost the effects of metabolizing approx. 45 mcg of T4 (112 mcg x 80% absorption x 50%). However, with the skipped dose, there is less T4 available to metabolize each day and the cumulative effect for you would be approx. 45 mcg, for the week.
I can understand why you might eventually feel some effect of skipping the dose, but I see no reason why you would not notice any effect until exactly 7 days have passed. And then, of course, we have only discussed T4, and have not tried to evaluate the effect on Free T3, which is the biologically active thyroid hormone that largely regulates metabolism and many other body functions, and correlates best with hypo symptoms, while Free T4 and TSH do not correlate.
So just take your med every day as prescribed, and don't worry about the half-life of T4. LOL If you should miss a dose, just make up for it over the next couple of days. Since T4 does have the slow half-life compared to T3, you shouldn't notice any effect of a make-up dose.
"A stable dose of L-T4 in treatment of thyroid diseases is achieved when the amount of hormone entering the bloodstream equals the proportion that is metabolized, allowing constant serum concentrations of fT4, fT3, and TSH. When administered in the fasting state, about 80% of L-T4 contained in modern tablets is absorbed. After ingestion, serum T4 values peak at 2–4 h and return toward basal levels after about 6 h. The serum half-life of T4 approximates 7 d in the euthyroid state, and its clearance depends mainly on deiodination and to a lesser extent on other pathways, such as sulfation and glucuronidation"
As I would interpret your situation, when you skip a dose, that amount of T4 is obviously not in your blood to be metabolized. Since the half life is about 7 days, that means that half of that dosage amount has not been available to be metabolized over that 7 days. With your dosage of 112 mcg of T4 med, then by the end of the week you would have lost the effects of metabolizing approx. 45 mcg of T4 (112 mcg x 80% absorption x 50%). However, with the skipped dose, there is less T4 available to metabolize each day and the cumulative effect for you would be approx. 45 mcg, for the week.
I can understand why you might eventually feel some effect of skipping the dose, but I see no reason why you would not notice any effect until exactly 7 days have passed. And then, of course, we have only discussed T4, and have not tried to evaluate the effect on Free T3, which is the biologically active thyroid hormone that largely regulates metabolism and many other body functions, and correlates best with hypo symptoms, while Free T4 and TSH do not correlate.
So just take your med every day as prescribed, and don't worry about the half-life of T4. LOL If you should miss a dose, just make up for it over the next couple of days. Since T4 does have the slow half-life compared to T3, you shouldn't notice any effect of a make-up dose.
This is really to anyone but thought I was ask. I've picked up a pattern which may be all in my head, but here goes. At times, because I really don't know, I feel like the Synthroid is making me feel this way. Its hard to believe it is not. But, I've read that Synthroid has a half life of 7 seven days. So, for example, if I took my regular dosage on a Sunday morning and throughout the week up until the following Sunday, and SKIPPED that does, would I see the results of skipping that does 7 days later? Or would I see it much earlier? I ask this because I have skipped a dose on more than one occassion, and I've got to tell you, I seem to notice the effects of this 7 days later...not the next day or two. Could this really be the case? If so, I think I know what my problem is. I don't routinely skip doses. But I will admit I've done some experimenting. And each time that I can recall, I get these very awful hypo symtoms beginning exactly 7 days after I skipped the dose. Yesterday, Sunday was a great example. I felt horrible...absolutely horrible....just waiting to drop....any minute. However, the Sunday before I skipped.
anthony,
what armour did you get. Did you get the generic? You seem to be doing better. You asked a question today and i thought it was interesting and i responded with my theory on it. you said
" I dont understand why i was taking synthoid for so long and then all of a sudden i just started getting all these weird symptoms and everything changed".
My personal theory is that your thyroid became more degenerated and lost its power. I had 4 sonograms. My surgeon compared all four of them. I saw her look at them. She showed me. The most recent was 3 months before my surgery, and then of course right around surgery time. The results of each were different. Just in 3 months the thyroid because more diseased, harder to see and in the final sonogram, part of it was starting to cover my lymph node *which was removed*. So my guess is, your thyroid has been getting worse, but you have not been keeping up with the increases possibly that surround it.
Also above you state that you feel like you are all alone in this. Remember one thing - Albert Einstein once said "i am glad that no one decided to help me, that way i was able to figure it out on my own"
I totally believe this. I am proud of the fact that I started with doctors giving me the BS run around and I am able to now use my experience to teach others starting out to ween through all the weirdness and BS that is out there on some of those ridiculous sites.
what armour did you get. Did you get the generic? You seem to be doing better. You asked a question today and i thought it was interesting and i responded with my theory on it. you said
" I dont understand why i was taking synthoid for so long and then all of a sudden i just started getting all these weird symptoms and everything changed".
My personal theory is that your thyroid became more degenerated and lost its power. I had 4 sonograms. My surgeon compared all four of them. I saw her look at them. She showed me. The most recent was 3 months before my surgery, and then of course right around surgery time. The results of each were different. Just in 3 months the thyroid because more diseased, harder to see and in the final sonogram, part of it was starting to cover my lymph node *which was removed*. So my guess is, your thyroid has been getting worse, but you have not been keeping up with the increases possibly that surround it.
Also above you state that you feel like you are all alone in this. Remember one thing - Albert Einstein once said "i am glad that no one decided to help me, that way i was able to figure it out on my own"
I totally believe this. I am proud of the fact that I started with doctors giving me the BS run around and I am able to now use my experience to teach others starting out to ween through all the weirdness and BS that is out there on some of those ridiculous sites.
Yes, sorry, but I do not have them. I live in Alaska, and we just don't have the greatest docs up here. Meaning, they only tested TSH, nothing else. So, over my own learning, anytime I get labs, I get Ft3, FT4, and TSH. If I didn't mention it in an earlier post, I do have diagnosed known Hashi's. Never knew I had it. But apparently I do. I have the antibodies. Don't know if that is the cause of a lot of my symptoms. I truly feel I'm a bit undermedicated too. I have the Armour now, but am going to hold off on taking it for a while...if ever. I'd rather not change my meds if I don't have too.
"But I don't want to go to far." Absolutely, move very slowly. When I was increasing when first on meds, I think I hit every split and/or combination of tablets I could come up with to get very small increases.
What you really have to start looking at is your FT3 and FT4 rather than your TSH. What were those last summer when you had the hyper symptoms? That might be a real clue to what's going on now. If you were on 175 then, it could be really interesting to see how your FT3 and FT4 balanced out on that.
The key to adjusting thyroid meds is to do it slowly. Cutting from 175 to 88 is way too big a cut. 25 mcg at a time at most...less if you tend to be very sensitive to meds in general.
There's a big difference between depression caused by chemical imbalance in the brain and depression for a reason. We all get depressed, and certainly not feeling well for a long time will do that to you. Not long ago, I was sitting in my doctor.s exam room waiting for him to come in. There was a poster on the wall, but I'd hung my jacket over the title of the poster and couldn't see that. The symptoms were thyroid symptoms, pure and simple, and I got really excited about the fact that they were publicizing thyroid symptoms...until I moved my jacket...the poster was for depression.
If you have labs from last summer, please post them.
What you really have to start looking at is your FT3 and FT4 rather than your TSH. What were those last summer when you had the hyper symptoms? That might be a real clue to what's going on now. If you were on 175 then, it could be really interesting to see how your FT3 and FT4 balanced out on that.
The key to adjusting thyroid meds is to do it slowly. Cutting from 175 to 88 is way too big a cut. 25 mcg at a time at most...less if you tend to be very sensitive to meds in general.
There's a big difference between depression caused by chemical imbalance in the brain and depression for a reason. We all get depressed, and certainly not feeling well for a long time will do that to you. Not long ago, I was sitting in my doctor.s exam room waiting for him to come in. There was a poster on the wall, but I'd hung my jacket over the title of the poster and couldn't see that. The symptoms were thyroid symptoms, pure and simple, and I got really excited about the fact that they were publicizing thyroid symptoms...until I moved my jacket...the poster was for depression.
If you have labs from last summer, please post them.
Yeah, I'm beginning to feel that way. I know I haven't felt normal for like a full year. I'm doing better it seems each day. But back around Halloween, maybe just before Thanksgiving, I got really sick. My head was rocking, ears blaring, massive headaches, fast heartrate, shaky, insomnia, no appetite, rapid weight loss. I thought something was really wrong with me, like cancer or something. I felt like a hypochondriac. I've had to battle through this entirely on my own. I mean I have support at home but when you don't feel well, and you feel it daily, and your doctors tell you nothing is wrong, you go bananas. I did. I had some low times there for about two months. I am increasing my T4, Synthorid. I'm on 112s now and I've been taking one half of one of those pills extra, once a week. I have to say, it is making a difference. But I don't want to go to far. This time last summer, I had a lot of these very same symptoms and turned out my TSH was at .03! I was on 175's at that time. I started cutting that dosage in half to 88's. And I took that dosage up until Halloween. I think must have become very hypo. But I sure didn't feel tired....I was complete opposite. Had doctors prescribing me Ambien, Xanax, Ativan! Crazy....I knew I didn't have aniexity, was depressed, etc. If anything I was depressed about my condition.
I'd still just increase T4 before either adding T3 or switching to Armour. With an FT4 level of 9% of range, there's absolutely no indication yet that conversion is even a problem. T4-meds haven't been given a fighting chance. Get that FT4 up and see what happens...
The endo told him that the ear ringing has nothing to do with his medication or thyroid. Funny, i was told the same thing as well as 4 other people i know. Id still add t3 before switching to armour.
Doctors get some wild ideas.
Why in the world would someone have noticed the problem.? Thyroid testing is seldom part of regular screening. When it is, TSH is usually the only thing tested. The only way to determine conversion is the compare FT4 and FT3 levels.
But, just for the sake of argument, suppose that's true. Is the implication that you should continue to feel like crap just because you've had the problem all your life?
Sorry, but your endos are both full of baloney.
Why in the world would someone have noticed the problem.? Thyroid testing is seldom part of regular screening. When it is, TSH is usually the only thing tested. The only way to determine conversion is the compare FT4 and FT3 levels.
But, just for the sake of argument, suppose that's true. Is the implication that you should continue to feel like crap just because you've had the problem all your life?
Sorry, but your endos are both full of baloney.
I've had to endo docs tell me that if you have issues converting T4 to T3, it didn't just start. You are born with the problem and someone would have noticed that problem along the way, typically within the first two years of life.
@ GIMEL = I love you man. That was a funny comment. I am feeling better i have to admit. Now I'm getting greedy. I want to feel 100% or at least 90%.
@ coldthyroid. If you had to ask me my opinion (for whatever its worth) why don't you try adding some t3 in (cytomel) for a couple weeks and see how you do before switching to armour? That way you can at least test it out before doing a complete 360 change.
also coldthyroid - my suggestion to you is to not just "get on armour". You need to pick a brand - If you want to just go to walgreens or whatever you guys have there, I would suggest NP THYROID that way you get the same thing every time. Or if you want to go with something else pretty consistent pick Erfa from canada. Chances are your insurance won't cover the erfa, but its relatively cheap (around $20 a month including shipping) and you can easily order it online and in most cases have it on your door in 4-7 days.
@ coldthyroid. If you had to ask me my opinion (for whatever its worth) why don't you try adding some t3 in (cytomel) for a couple weeks and see how you do before switching to armour? That way you can at least test it out before doing a complete 360 change.
also coldthyroid - my suggestion to you is to not just "get on armour". You need to pick a brand - If you want to just go to walgreens or whatever you guys have there, I would suggest NP THYROID that way you get the same thing every time. Or if you want to go with something else pretty consistent pick Erfa from canada. Chances are your insurance won't cover the erfa, but its relatively cheap (around $20 a month including shipping) and you can easily order it online and in most cases have it on your door in 4-7 days.
COMMUNITY LEADER
gimel pretty much said everything I would have said, so I'll only comment on a couple items.
"I have been told that TSH changes all the time, throughout the day. It could be 1.5 on (sic) minute and then two hours later at 4.5. Thats how it works....and it makes sense." Absolutely - TSH can change for a large number of reasons, even within the same day, which is why we "always" recommend getting the FT3 and FT4 tests before being put on medication or changing doses.
"I see so many people out here changing stuff up on an every other day basis. That seems ludicris.(sic)" You're absolutely right. It takes approximately 4-6 weeks for a T4 med to reach full potential in your system, so changing med after only one day, IS totally ludicrous. There are a few that are super sensitive to medications and there are those who have a reaction to fillers/binders in the pills, but I think both of those are relatively rare.
T3 only medication (cytomel or generic) is an exception, because it's much faster working and doesn't stay in your system very long, so most people can tell relatively quickly, whether their dose will be adequate or not.
Not sure exactly how desiccated works; gimel could tell you that, but I'd think the T4 would have to have time to build in your system, just like synthetic, while the T3 would kick in pretty quickly.
Symptoms often get worse once a person starts on medication. That's because the body has been without the hormones and it takes time for it to readjust. If you don't give it adequate time, you end up on the hypo roller coaster.
Keep in mind that many symptoms can apply to both hyper and hypo - "strong" and rapid heart rate, is one of those. I had them pretty bad, after I started on med, even though I was severely hypo. Before dx, my heart rate would go SO low (low 30's when I slept), that when I got on med and my hr came up close to normal, it felt horrible. I still get a feeling of my heart "pounding"; it's like being "overly aware", but that's due mostly to anxiety because of a situation I have no control over.
I agree with gimel that simply being "in range" isn't good enough for many of us, but doctors (yes, even endos from Mayo) only look to see if you are in the range, and if so, they say you're fine. They tend to keep a lot of people very ill, because being "in range" and being optimal are not the same thing. If you still have symptoms, your levels aren't optimal.
Are you making sure you eat a good breakfast? If you don't and your blood sugar levels fall, you could get the ringing ears/dizzy feeling.
"I have been told that TSH changes all the time, throughout the day. It could be 1.5 on (sic) minute and then two hours later at 4.5. Thats how it works....and it makes sense." Absolutely - TSH can change for a large number of reasons, even within the same day, which is why we "always" recommend getting the FT3 and FT4 tests before being put on medication or changing doses.
"I see so many people out here changing stuff up on an every other day basis. That seems ludicris.(sic)" You're absolutely right. It takes approximately 4-6 weeks for a T4 med to reach full potential in your system, so changing med after only one day, IS totally ludicrous. There are a few that are super sensitive to medications and there are those who have a reaction to fillers/binders in the pills, but I think both of those are relatively rare.
T3 only medication (cytomel or generic) is an exception, because it's much faster working and doesn't stay in your system very long, so most people can tell relatively quickly, whether their dose will be adequate or not.
Not sure exactly how desiccated works; gimel could tell you that, but I'd think the T4 would have to have time to build in your system, just like synthetic, while the T3 would kick in pretty quickly.
Symptoms often get worse once a person starts on medication. That's because the body has been without the hormones and it takes time for it to readjust. If you don't give it adequate time, you end up on the hypo roller coaster.
Keep in mind that many symptoms can apply to both hyper and hypo - "strong" and rapid heart rate, is one of those. I had them pretty bad, after I started on med, even though I was severely hypo. Before dx, my heart rate would go SO low (low 30's when I slept), that when I got on med and my hr came up close to normal, it felt horrible. I still get a feeling of my heart "pounding"; it's like being "overly aware", but that's due mostly to anxiety because of a situation I have no control over.
I agree with gimel that simply being "in range" isn't good enough for many of us, but doctors (yes, even endos from Mayo) only look to see if you are in the range, and if so, they say you're fine. They tend to keep a lot of people very ill, because being "in range" and being optimal are not the same thing. If you still have symptoms, your levels aren't optimal.
Are you making sure you eat a good breakfast? If you don't and your blood sugar levels fall, you could get the ringing ears/dizzy feeling.
After the following paragraph, I meant to add a comment.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
If the FT3 and FT4 data bases were similarly purged of the suspect hypo and hyper patient data, from my background in statistical analysis, I have previously estimated that the range for FT3 would increase from 2.3 - 4.2 up to approximately 3.2 - 4.3 and for FT4 increase from .60 - 1.50 to approx. 1.0 - 1.55. I think this is why we hear from so many members with FT3 and FT4 in the lower end of their ranges, yet they still have hypo symptoms.
I have run across thyroid info that called these higher levels "functional levels", as contrasted with the so-called "normal" ranges.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
If the FT3 and FT4 data bases were similarly purged of the suspect hypo and hyper patient data, from my background in statistical analysis, I have previously estimated that the range for FT3 would increase from 2.3 - 4.2 up to approximately 3.2 - 4.3 and for FT4 increase from .60 - 1.50 to approx. 1.0 - 1.55. I think this is why we hear from so many members with FT3 and FT4 in the lower end of their ranges, yet they still have hypo symptoms.
I have run across thyroid info that called these higher levels "functional levels", as contrasted with the so-called "normal" ranges.
Just thought I'd join the party here and throw out some info that might be of further interest to you. Many of our members, myself included, report that relief from hypo symptoms required that FT3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range. Scientific studies have shown that FT3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.
As has already been mentioned above, just being within the low end of the range is frequently inadequate for hypo patients. My explanation for this is that the ranges for thyroid tests are established on data from the total population of patients. Then the assumption was made that about 2.5% of of people are hypo and 2.5% were hyper, so reference range limits were drawn based on those assumptions.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
This would not be such a huge problem if doctors used the ranges as guidelines within which to adjust levels as necessary to relieve symptoms. Instead, as your doctor did, they use the ranges as pass/fail. This is totally wrong.
As long as you have hypo symptoms, with your levels of Free T3 and Free T4, it is an indication that your meds need to be increased until your biologically active thyroid hormones (Free T3 and Free T4 ) are adequate to relieve symptoms. It may be that you need more T3 in your meds; however, since your Free T4 and Free T3 are both low in their ranges, you may be able to increase both by just increasing your current med. If your Free T3 level starts to lag behind your Free T4 level, then that would be an indication that you are not converting the T4 to T3 adequately,and you could add a source of T3 to your meds.
As has already been mentioned above, just being within the low end of the range is frequently inadequate for hypo patients. My explanation for this is that the ranges for thyroid tests are established on data from the total population of patients. Then the assumption was made that about 2.5% of of people are hypo and 2.5% were hyper, so reference range limits were drawn based on those assumptions.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
This would not be such a huge problem if doctors used the ranges as guidelines within which to adjust levels as necessary to relieve symptoms. Instead, as your doctor did, they use the ranges as pass/fail. This is totally wrong.
As long as you have hypo symptoms, with your levels of Free T3 and Free T4, it is an indication that your meds need to be increased until your biologically active thyroid hormones (Free T3 and Free T4 ) are adequate to relieve symptoms. It may be that you need more T3 in your meds; however, since your Free T4 and Free T3 are both low in their ranges, you may be able to increase both by just increasing your current med. If your Free T3 level starts to lag behind your Free T4 level, then that would be an indication that you are not converting the T4 to T3 adequately,and you could add a source of T3 to your meds.
Oh, and one more thing. I've spoken to at least two different endo's on the ever changing TSH. I have been told that TSH changes all the time, throughout the day. It could be 1.5 on minute and then two hours later at 4.5. Thats how it works....and it makes sense. TSH is what is says....when you body needs more thyroid hormone, you would expect your TSH to be higher. And vice versa. Not one person out here can tell me when their body needs more thyroid hormone. If you could, then you would be a billionaire becuase you could easily cure hypothyroidsim or hyperthyroidism by coming up with a way to medicate based on when you body needs hormone.
My doctor looks at all of it...TSH, FT3, and FT4. They are within the range so he says all is good. I'm the one who pushed for Armour. I have yet to take any. I feel my symptoms are either hyper or from the Synthroid. I can say, that I take my Synthorid at 9:00PM. I get these symptoms around 10:00AM the next morning. Ringing in ears, dizzy a bit...not horrible. Shaky hands. Also, I have an extreme amount of energy. Meaning, I don't exhibit hypo symptoms if you ask me. I wake up at 4:45AM on a normal work day, hit the gym, ride 10 miles, and then do some really solid circuit training. Then work 7:00AM to 3:00PM. I then come home, make dinner (yes, I'm the cook in the house), work out in the yard, mowing, raking, etc. until 10:00 probably. Then I go to sleep. I don't feel exhausted. I notice at times, my heart rate is very strong, and more rapid than normal. Other times, heart rate is completely normal. By the way, the Mayo endo said its complete myth about taking Synthroid with food. You obviously get a better absorption rate on a completely empty stomach but he said a lot of people actually do better taking it on a full stomach. No one at Mayo clinic has given even the remote possibility that I may be a bit hypo or hyper. They too looked at all the FT3, FT4, and TSH. I now demand it...not just TSH. Not one doctor has said your FT4 and FT3 are in range, but a bit low. They just say they are in range. For me, from my neck up (my head) is where I have the problems. As I write this, it is 10:30, and my ears ring, I've got a groggy headachy feeling, and some tingling in mainly my left ear. Also, just to note, I did ask about Armour and other natural thyroid medications. He said people typically start having all kinds of different troubles when they start self medicating, breaking pills in half, adding different natural thyroid medications, cytomel, etc. The body gets confused. I see so many people out here changing stuff up on an every other day basis. That seems ludicris. It takes a while for any of this medication to work. I maybe a bit under medicated for sure so I'm going to continue taking that extra half pill once a week, like the endo doc said, for now. He said it would bring my TSH down, and you know what, it did....dramatically. Over four weeks, it went from 5.62 to 2.93. In RANGE! And since it seems no one out here, no one, can properly provide a true conversion chart, I won't take the Armour unless my symptoms get much worse. I've had morning cortisol checked, testosterone checked, adrenals checked. All check out folks!~
COMMUNITY LEADER
Hey Bruce -- can't you see that I tripped up earlier in this thread, with the T3/NDT issue? Obviously, I'm not a math wiz either, so, not walking down that road with you tonight....
Personally, I prefer the synthetics because I can control them individually, which I've had to do in the past couple of days, due to hyper symptoms; so you're right, with NDT, you get what you get. See, I'm agreeing with you again.... horror of horrors....lol
We have to keep in mind that not everyone can use the same meds, so synthetics might work best for me, but not for someone else; just like NDT might work best for some, but not for me......when it's all said and done, we all have to make our own choices.
Personally, I prefer the synthetics because I can control them individually, which I've had to do in the past couple of days, due to hyper symptoms; so you're right, with NDT, you get what you get. See, I'm agreeing with you again.... horror of horrors....lol
We have to keep in mind that not everyone can use the same meds, so synthetics might work best for me, but not for someone else; just like NDT might work best for some, but not for me......when it's all said and done, we all have to make our own choices.
I don't know about others here, but after being a part of your saga of many years, now that you have made some progress, I refuse to give you any information that might enable you to change your meds again. LOL
hey Barb, Looks like you changed your photo. Nice. Anyways, great thread. So anthony is looking to switch to armour, but i really think he should try just the cytomel first. That way he can add a little in at a time and at least with the t3, he can control how much he wants. He can take 112 of t4 and add 5mg of cytomel and see how he does. If after a week or so he adjusts he can add more. However with armour, it is what it is. And frankly I hate the way the t3 makes me feel. I would MUCH rather have a nice high ft4 and be able to raise my t3 as needed, rather than having a high ft3 and a low ft4 as seen in a lot of the NDT people.
I am very tempted to switch to t4, but still worried. Maybe ill try a compound or something.
With all this being said and all these discussions and math, if i am on 2.75 grains of erfa and wanted to switch to a t4 (leslie bloomberg told me the same thing you guys did by the way) what would be the proper about of t4 for me to start with? isn't it 20% less than the equivalent?
I am very tempted to switch to t4, but still worried. Maybe ill try a compound or something.
With all this being said and all these discussions and math, if i am on 2.75 grains of erfa and wanted to switch to a t4 (leslie bloomberg told me the same thing you guys did by the way) what would be the proper about of t4 for me to start with? isn't it 20% less than the equivalent?
COMMUNITY LEADER
Sorry; I read it again; don't know what I was thinking - bit of brain fog, there. I meant to say Armour has more T3 than the human body produces and going by the conversion chart that I was looking at, 37.5 mcg would be a pretty hefty starting dose. .
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