There is one source that lists the conversion factor for T4 to T3 as 100 mcg of T4 being equivalent to 1 grain of Armour (60 mg). Another source says 75 mcg of T4 is equivalent to 1 grain of Armour. The difference being the assumption about the relative effect of T3 versus T4.
Apparently your doctor used the 75 mcg to 1grain factor. So the first possibility for your reaction is that the substitute dose is too high, even in the longer term. In the shorter term, the dose is too high to substitute all at once because T3 is so much faster acting than T4. Substitution needs to be done in stages.
So in my opinion, I would reduce approx. 1/3 of the T4 and replace with 1/2 grain of Armour each week for two weeks. Then I wait for a couple of weeks to see how you are feeling before making the last substitution. The delay is to make sure of how you are feeling with the new med and dosage, in order to make sure it is right for you. Symptom relief is all important. The second reason is that symptoms tend to lag a bit behind changes in blood levels of thyroid hormone. Slow and sure is the byword for changes, in order to avoid any unwanted reactions.
And of course you should always discuss changes with your doctor to get concurrence.
I'm on armour, was on Levoxyl, and couldn't handle it, at first on Armour I felt a bit hyper, and I would run out of energy by 5:00. I was informed I could split it up during the day, and that made a wonderful difference. I have energy during the early hours, and energy all the way to bed time. That might be something you could try.
Thanks for the input.
I will share this with my md.
In my reading, I found that T4 is not always converted to T3 by Synthroid users, and I am looking for some way to deal with symptoms of fatigue and mood.
Initially, I thought I was just intolerant to change, as I was once changed to a generic of Synthroid and felt ill.
I was wondering now if perhaps it was too drastic to change suddenly to Armour, and that may have been the problem.
It is amazing to me that there is such a lack of knowledge among the health care community about thyroid issues, and symptoms that are present that are not seen as a result of something lacking in treatment.
Thank you again for your response, it makes great sense.
It is true that many hypothyroid patients taking T4 meds find that their body does not adequately convert the T4 to T3. For that reason you should always make sure they test for Free T3 and Free T4 (not the same as Total T3 and T4) each time you go in for tests. Free T3 is the most important to know because it largely regulates metabolism and many other body functions. Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.
Since Hashi's is the most common cause for diagnosed hypothyroidism, it would be good to test for that possibility at least once. The tests for thyroid antibodies of Hashi's are TPO ab and TG ab. By confirming Hashi's is the cause, you can then know that your thyroid hormone levels will diminish over time as the antibodies destroy your thyroid gland, thus requiring increasing amounts of thyroid meds.
Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you should also test for those. It is always a good idea to get a copy of your lab reports and write on there how you were feeling at the time and what meds/supplements you were taking. These then become very valuable references. When new labs ae available, if you will post results and their ranges shown on the alb report members will be glad to help interpret and advise further.
One thing further to keep in mind is that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important for you, not just test results, and especially not TSH results. If your current doctor is not willing to treat clinically, as described, then you will ultimately need one that will do so.
Thank you so much. You seem to have great knowledge relating to these issues.
I realize now how important it is to be proactive regarding my symptoms; I will request these labs at my drs visit tomorrow and see how my request is responded to.
No, the range is far too broad, because of the way it is determined, based on large numbers of test results from basically anyone that gets tested, including patients with thyroid problems. Then they made an assumption that about 2.5% of the population is hypothyroid, and 2.5% hyperthyroid, and drew the range limits at those points. Since the real number is more like 15 - 18% (I have read), you can see just how screwy their ranges are for Free T3 and Free T4.
This is further explained in the following quote from a scientific study.
"Our data indicate that each individual had a unique thyroid function. The individual reference ranges for test results were narrow, compared with group reference ranges used to develop laboratory reference ranges. Accordingly, a test result within laboratory reference limits is not necessarily normal for an individual."
Andersen S, Pedersen KM, Bruun NH, Laurberg P. Narrow individual variations in serum T(4) and T(3) in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.
So for these reasons, a test result that falls in the so-called "normal" range does not mean that it is adequate for you. The group reference ranges are far too broad to be functional for an individual. That is why I always say that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels. You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation. The letter is then sent to the participating doctor of the patient to help guide treatment. In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."
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