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How to tell is this is correct armour dose.
I'm new here, so here's a little history: I'm 48 years old. I was hypo years ago, but decided to go off Synthroid. Without treatment, I had no symptoms for ten years, and a 'normal' TSH (4.5.) which we tested every six months. However, a year ago I felt withdrawn and mildly hypo, so we tested TSH: 4.98. We did not do an antibody or T3 test.
I've been taking Synthroid ever since, but in the past 5 months, I've became very symptomatic. TSH was 46. We doubled Synthroid (100mcg) for two months, and now TSH is 2.5, but I feel exhausted, withdrawn, depressed, scattered, dull, voice is gravelly, strong cravings for carbs/sweets and hot/spicy, gained 20 lbs, fingers and face are puffy. I don't recall if I have any short term memory. :-) And now my hair is thinning.
So it's Hashimotos. My TPO antibodies are 6771.
Because Synthroid is clearly not relieving the symptoms, my Dr is supporting me to try Armour, but he knows little about it. Because my antibodies are so high I decided to start on one grain. I felt more energy after I took it, but not noticeably better, so after a week I decided to up to 1 and a 1/2 grains. No shakes or other issues and I'm sleeping better, so I think it's helping. After another week, I went up to 2 grains, which I split between 3 doses. I plan to stay on 2 grains for two or three weeks. My morning temp was averaging 97.3, but now hitting 97.8 almost every day.
How --or when-- can I tell if this is the correct dose? How will I know if it's too much or too little?
I would really appreciate advice.
I've been taking Synthroid ever since, but in the past 5 months, I've became very symptomatic. TSH was 46. We doubled Synthroid (100mcg) for two months, and now TSH is 2.5, but I feel exhausted, withdrawn, depressed, scattered, dull, voice is gravelly, strong cravings for carbs/sweets and hot/spicy, gained 20 lbs, fingers and face are puffy. I don't recall if I have any short term memory. :-) And now my hair is thinning.
So it's Hashimotos. My TPO antibodies are 6771.
Because Synthroid is clearly not relieving the symptoms, my Dr is supporting me to try Armour, but he knows little about it. Because my antibodies are so high I decided to start on one grain. I felt more energy after I took it, but not noticeably better, so after a week I decided to up to 1 and a 1/2 grains. No shakes or other issues and I'm sleeping better, so I think it's helping. After another week, I went up to 2 grains, which I split between 3 doses. I plan to stay on 2 grains for two or three weeks. My morning temp was averaging 97.3, but now hitting 97.8 almost every day.
How --or when-- can I tell if this is the correct dose? How will I know if it's too much or too little?
I would really appreciate advice.
Your comment about amphetamines seems tangential to me.
It sounds like you have been fortunate enough to find doctors who listen to your symptoms, test Free T4 and T3 and work with you on getting the proper dose. Even as your body has changed with time. I am glad for you. Perhaps you can share your story as to how you found your thyroid health.
For many others it has not been so easy. This forum is for sharing success and challenges. It has been invaluable for me in learning how to advocate for myself and find my way out of a dangerous hypo situation.
It sounds like you have been fortunate enough to find doctors who listen to your symptoms, test Free T4 and T3 and work with you on getting the proper dose. Even as your body has changed with time. I am glad for you. Perhaps you can share your story as to how you found your thyroid health.
For many others it has not been so easy. This forum is for sharing success and challenges. It has been invaluable for me in learning how to advocate for myself and find my way out of a dangerous hypo situation.
If only getting adequately tested and treated for possible hypothyroidism were as easy as seeing a doctor or two. Good thyroid doctors are very scarce because most have the "Immaculate TSH Belief" and use "Reference Range Endocrinology". That doesn't work for the majority of hypothyroid patients, That is why there are so many people on thyroid Forums like this. And why we spend so much of our personal time trying to help members understand what is really needed in the way of testing, diagnosis and treatment.
You are comparing taking too much Armour vs amphetamines... really... not even close....If you are ADHD or ADD, you do not get the rush that you are referring to. Every person is different when comes to the thyroid disease & reacts differently to meds. For one thing, nobody should taking the advice from anyone on the internet about how much meds a person should take.Tell the person to see a doctor or two doctors or three doctors and get a medical diagnosis. Tell them to write in a dairy about their daily activities and give it to their doctors.
I have Hashimoto onset 16 years ago, and my body does not react the same as it did when I was in my twenties. I only wrote this for anyone reads this article in the future. Go see a doctor instead of reading the what ifs on the internet because this disease varies from person to person even if your numbers are same, your symptoms are not exactly the same. It must be Rocket Science.Unfortunately, there is no cure or magical pill for it.
I have Hashimoto onset 16 years ago, and my body does not react the same as it did when I was in my twenties. I only wrote this for anyone reads this article in the future. Go see a doctor instead of reading the what ifs on the internet because this disease varies from person to person even if your numbers are same, your symptoms are not exactly the same. It must be Rocket Science.Unfortunately, there is no cure or magical pill for it.
Best answer yet..... Watch your symptoms and increase gradually. I had a thyroidectomy 20+ years ago. Was on Synthroid for most of those years. Found Armour 2 years ago. I am now at 3.5 grains, but feel like I may need more. What should I do? I have been at this level for over 6 months.
1 Comments
What symptoms do you have? What are your thyroid related test results and reference ranges shown on the lab report? If tested for Vitamin D, B12 and ferritin, please post those as well. Ever been tested for cortisol?
Best answer yet..... Watch your symptoms and increase gradually. I had a thyroidectomy 20+ years ago. Was on Synthroid for most of those years. Found Armour 2 years ago. I am now at 3.5 grains, but feel like I may need more. What should I do? I have been at this level for over 6 months.
If you take a look at this link to the 2012 issue of Clinical Practice Guidelines for Hypothyroidism, by the AACE and ATA associations, you will note on page one that, "The guidelines are not inclusive of all proper approaches or methods, or exclusive of others, The Guidelines do not establish a standard of care, and specific outcomes are not guaranteed. Treatment must be made based on the independent judgment of health care providers and each patient's individual circumstances. A guideline is not intended to take the place of physician judgment in diagnosing and treatment of particular patients."
http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2012.0205
All this is generally ignored by many doctors who lock in on TSH as the predominant diagnostic they need, and if it is above range, then they will also test for Free T4. If Free T4 is within its range, then many will not treat, regardless of symptoms. The guidelines do mention some of the symptoms that can be related to hypothyroidism, but then go on to say that, "While the exercise of calculating clinical scores has been largely superseded by sensitive thyroid function tests, it is useful to have objective clinical measures to gauge the severity of hypothyroidism."
Unfortunately most doctors have interpreted the Guidelines as rules to follow and use that as an excuse to deny treatment for many hypo patients. The only real value to TSH is to distinguish between primary (autoimmune system related ) and central ( hypothalamus/pituitary related) hypothyroidism. Suffice to say we could talk all day about why this situation exists, but TSH cannot be shown to even correlate well with the biologically active thyroid hormones, Free T4 or Free T3 much less correlate with symptoms. Yet, symptoms are why we go to the doctor, not our TSH levels.
Even when the doctor tests for Free T4, the range for it (and also Free T3) are faulty, because of the erroneous assumptions used to establish them. As a result a Free T4 or Free T3 in the lower half should be suspect for being hypo, and further evaluated.
As for something you can show your doctor, this might be a good talking paper. This link was written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Since you mention dosing, you might also be interested to know the following, taken from a study by Fraser, et al. " “It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement…The poor diagnostic sensitivity and high false positive rates associated with such measurements render them virtually useless in clinical practice…Further adjustments to the dose should be made according to the patient’s clinical response.”
Also from a study in the British Medical Journal. "In a study published in the British Medical Journal, Meir et al also investigated the correlation of TSH and tissue thyroid effect. It was shown that the TSH level had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose. The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.” They stated that signs and symptoms of thyroid effect and not the TSH should be used to determine the proper replacement dose."
http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2012.0205
All this is generally ignored by many doctors who lock in on TSH as the predominant diagnostic they need, and if it is above range, then they will also test for Free T4. If Free T4 is within its range, then many will not treat, regardless of symptoms. The guidelines do mention some of the symptoms that can be related to hypothyroidism, but then go on to say that, "While the exercise of calculating clinical scores has been largely superseded by sensitive thyroid function tests, it is useful to have objective clinical measures to gauge the severity of hypothyroidism."
Unfortunately most doctors have interpreted the Guidelines as rules to follow and use that as an excuse to deny treatment for many hypo patients. The only real value to TSH is to distinguish between primary (autoimmune system related ) and central ( hypothalamus/pituitary related) hypothyroidism. Suffice to say we could talk all day about why this situation exists, but TSH cannot be shown to even correlate well with the biologically active thyroid hormones, Free T4 or Free T3 much less correlate with symptoms. Yet, symptoms are why we go to the doctor, not our TSH levels.
Even when the doctor tests for Free T4, the range for it (and also Free T3) are faulty, because of the erroneous assumptions used to establish them. As a result a Free T4 or Free T3 in the lower half should be suspect for being hypo, and further evaluated.
As for something you can show your doctor, this might be a good talking paper. This link was written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Since you mention dosing, you might also be interested to know the following, taken from a study by Fraser, et al. " “It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement…The poor diagnostic sensitivity and high false positive rates associated with such measurements render them virtually useless in clinical practice…Further adjustments to the dose should be made according to the patient’s clinical response.”
Also from a study in the British Medical Journal. "In a study published in the British Medical Journal, Meir et al also investigated the correlation of TSH and tissue thyroid effect. It was shown that the TSH level had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose. The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.” They stated that signs and symptoms of thyroid effect and not the TSH should be used to determine the proper replacement dose."
I'm new to this "taking charge of my health" thing and I'm battling my doctor over dosing with Armour. I just went to the American Board of Endocrinologists website and I can't find where they state that TSH should be .2-3.0 or 3.5. Can you help me with something I can show my doctor?
Thanks for telling us your experience. Information like that is good for new members to read about.
I also was just curious about what your thyroid test results looked like from the time you were feeling so bad, and then when you were feeling good. It is always interesting to see what levels work best for members.
I also was just curious about what your thyroid test results looked like from the time you were feeling so bad, and then when you were feeling good. It is always interesting to see what levels work best for members.
Your advice is "right on!". I have just completed 2 1/2 years of a TSH/T4 doc who kept showing me that everything was within range - and yet I felt as if I was going to die!. It wasn't until I did my own private tests (through True Health Labs, via the Internet) of complete Thyroid panels that I was able to see that although I was within range, every one of the measurements was about one unit above the minimum range bar. I calculated the T3/T4, T3 to reverse T3 ratios and saw for myself that things were way out of whack and therefore why I was feeling so ill. With that knowledge I got very angry, I finally flipped and went to the insurance office of my HMO and demanded that I get a "sensible" Endo. She called another hospital, got me a different Endo and here I am with almost no symptoms, a clear head, no headache, no muscle pain, no joint pain, wide awake and back into life on Armour Thyroid. Why on earth we are up against this wall of obstinance from the medical profession I would truly like to know. Anyway, keep talking and keep this outrageous nonsense in the limelight.
Your advice is "right on!". I have just completed 2 1/2 years of a TSH/T4 doc who kept showing me that everything was within range - and yet I felt as if I was going to die!. It wasn't until I did my own private tests (through True Health Labs, via the Internet) of complete Thyroid panels that I was able to see that although I was within range, every one of the measurements was about one unit above the minimum range bar. I calculated the T3/T4, T3 to reverse T3 ratios and saw for myself that things were way out of whack and therefore why I was feeling so ill. With that knowledge I got very angry, I finally flipped and went to the insurance office of my HMO and demanded that I get a "sensible" Endo. She called another hospital, got me a different Endo and here I am with almost no symptoms, a clear head, no headache, no muscle pain, no joint pain, wide awake and back into life on Armour Thyroid. Why on earth we are up against this wall of obstinance from the medical profession I would truly like to know. Anyway, keep talking and keep this outrageous nonsense in the limelight.
I posted a new question called "Rt3 rears its ugly head! Please advise!" I think that's what I called it anyway. It has all my new labs listed. From the title you can see there is an RT3 problem. I do not feel hyper in any way, shape or form. I don't feel great either, but improving. Rt3 is daunting to me.
So you aren't feeling the drop in FT3? That's good! Hopefully the small increase will get it back up there before it takes any toll on your energy levels.
re: lab results: My Dr's office staff know I call for the results and they always give them to me over the phone, time permitting, until I can pick up the paper copy. I'm always matter-of-fact when I go to a new Dr so we just start out with that expectation, that I will get the labs and research them before my next visit. I catch things my Dr misses sometimes.
Well, if you get a chance to read my other post, please let me know what you think.
So you aren't feeling the drop in FT3? That's good! Hopefully the small increase will get it back up there before it takes any toll on your energy levels.
re: lab results: My Dr's office staff know I call for the results and they always give them to me over the phone, time permitting, until I can pick up the paper copy. I'm always matter-of-fact when I go to a new Dr so we just start out with that expectation, that I will get the labs and research them before my next visit. I catch things my Dr misses sometimes.
Well, if you get a chance to read my other post, please let me know what you think.
Well, suppressed TSH definitely has no ill effects. I know several people who have had undetectable TSH for years. Even high FT3 has no ill effects, IF you are not hyper. It's being hyper that's the problem.
My FT3 had tanked last time I had labs...I'm talking below range. The amazing part of that was that it totally blindsided me because I felt fine, so much so that I was sure the lab had made an error and had the test repeated. No error, but no symptoms, either. Anyway, I increased just slightly mostly to assuage my endo's conscience. So, I'm curious to see what FT3 is doing now.
Unfortunately, getting my labs out of the doctor's office is enough to raise anyone's BP. HE'S great about it, but the ladies in the office guard those results like junyyard dogs! Grrrrrr..... Got to start bothering them again this morning when the office opens.
My FT3 had tanked last time I had labs...I'm talking below range. The amazing part of that was that it totally blindsided me because I felt fine, so much so that I was sure the lab had made an error and had the test repeated. No error, but no symptoms, either. Anyway, I increased just slightly mostly to assuage my endo's conscience. So, I'm curious to see what FT3 is doing now.
Unfortunately, getting my labs out of the doctor's office is enough to raise anyone's BP. HE'S great about it, but the ladies in the office guard those results like junyyard dogs! Grrrrrr..... Got to start bothering them again this morning when the office opens.
I took 3 and a 1/2 grains yesterday and will try it for a few weeks. But today my basal temp was 97.5 where it had been 97.6 for three days before.
I was just getting up to 98.2 a week or so ago before my period. If my temp doesn't go up to around 98.2 for the second half of this cycle, then I will probably increase again. I'm in another thyroid group and several of the mods have had suppressed TSH for years now with no other problems.
But for me the Ft3 over range is a reason for reducing. I'm happy to get my Ft4 in mid range.
My next appt with my new doc is in Nov.
Hope all is well with your labs. Are you hoping for a certain result?
I am feeling happy and healthy, thanks. However, we seem to be going from spring right back into winter on alternating weeks. The warmth and the light definitely help the psyche.
I just had blood drawn this morning, so I will know tomorrow if my labs have caught up to my lack of symptoms or not.
Give it a try. You can always increase again if you have to.
I just had blood drawn this morning, so I will know tomorrow if my labs have caught up to my lack of symptoms or not.
Give it a try. You can always increase again if you have to.
Thanks so much! I was on 3 and 1/2 grains for four weeks without much improvement so I raised 1/4 grain. Now I am starting to see some improvement and if it's from 3 and 1/2 catching up, then I'm happy to drop a 1/2 grain.
I think I will try it and see if I continue to improve. I think I was hypo for years but didn't feel obvious symptoms. The inability to lose weight no matter how active I was, plus memory problems that never improved probably were pointing to hypo. But my TSH was "normal" at 4.5 so I didn't treat.
My employees are shocked lately that I've been remembering things in detail! That's a great sign. I have had memory issues for at least fifteen years. I thought it was permanent damage from being hypo years ago.
How are you doing? Are you feeling healthy and happy this Spring?
I think I will try it and see if I continue to improve. I think I was hypo for years but didn't feel obvious symptoms. The inability to lose weight no matter how active I was, plus memory problems that never improved probably were pointing to hypo. But my TSH was "normal" at 4.5 so I didn't treat.
My employees are shocked lately that I've been remembering things in detail! That's a great sign. I have had memory issues for at least fifteen years. I thought it was permanent damage from being hypo years ago.
How are you doing? Are you feeling healthy and happy this Spring?
Well, it all sounds positive. It will take a while to heal after being hypo, so you will most likely keep seeing imrpovement even after you stop increasing. The longer you were hypo, the longer that can take.
Since you hadn't taken your Armour before the draw, your doctor is right...there are definitely times during the day when your FT3 is even higher than it showed on your labs, which was already over the top.
You don't have hyper symptoms, and I always say that if you don't have them, you're not hyper. I don't know what to tell you about the decrease. It's very small. Were you ever on 3.5 before, or did you skip that dose and go from 3.25 to 3.75, for example?
Since you hadn't taken your Armour before the draw, your doctor is right...there are definitely times during the day when your FT3 is even higher than it showed on your labs, which was already over the top.
You don't have hyper symptoms, and I always say that if you don't have them, you're not hyper. I don't know what to tell you about the decrease. It's very small. Were you ever on 3.5 before, or did you skip that dose and go from 3.25 to 3.75, for example?
For clarification: My legs only ache after I sit down for a bit. And my voice has improved and I am peeing normally again. I still have puffy fingers and am withdrawn.
I do feel normal a lot, but wonder if I will ever become outgoing and vibrant again. I went through some severe trials a few years back which may have caused a change in my personality unrelated to thyroid disorder. But maybe it is thryoid.
Thanks for writing today.When I have the full results, I will post them. One thing I am thrilled about is that my liver enzymes have been rising for the past year and on this last lab, my ALT is still slightly high, but saw a 40 point drop and AST was normal again! I have been eating a TBSP coconut oil every morning in my coffee for two months and I think it helped!
I do feel normal a lot, but wonder if I will ever become outgoing and vibrant again. I went through some severe trials a few years back which may have caused a change in my personality unrelated to thyroid disorder. But maybe it is thryoid.
Thanks for writing today.When I have the full results, I will post them. One thing I am thrilled about is that my liver enzymes have been rising for the past year and on this last lab, my ALT is still slightly high, but saw a 40 point drop and AST was normal again! I have been eating a TBSP coconut oil every morning in my coffee for two months and I think it helped!
Yes, I do understand that is the RT3 ratio that will be revealing. I called again today and they they told me they won't have it until Friday or even next Monday.
I am sleeping straight through six hours a night. That is an improvement after years of frequent waking. I feel ok during the day and have noticed some improved memory in certain moments but super-tired after work. My feet and legs are still aching but I think that may be improving also. Muscle loss and fat are both factors in not having much energy or strength.
I rode my bike eight miles today and was so beat I had to stop a couple times. But I kept going. Even now, I want to get back out there and ride.
The Current lab showed Ft3 over the top of the range. I forgot the paper so I don't have the number or range in front of me. Still waiting on the others.
I don't have any hyper symptoms. No racing heart or racing thoughts. I was trembling when I was due for Armour but that has not been happening the past few days. I feel so normal, I forget to take the Armour and I end up taking them an hour or two late.
My DR said the fact that my Armour dose was so many hours before shows that it is in reality, my FT3 much higher when I am taking it.
I am sleeping straight through six hours a night. That is an improvement after years of frequent waking. I feel ok during the day and have noticed some improved memory in certain moments but super-tired after work. My feet and legs are still aching but I think that may be improving also. Muscle loss and fat are both factors in not having much energy or strength.
I rode my bike eight miles today and was so beat I had to stop a couple times. But I kept going. Even now, I want to get back out there and ride.
The Current lab showed Ft3 over the top of the range. I forgot the paper so I don't have the number or range in front of me. Still waiting on the others.
I don't have any hyper symptoms. No racing heart or racing thoughts. I was trembling when I was due for Armour but that has not been happening the past few days. I feel so normal, I forget to take the Armour and I end up taking them an hour or two late.
My DR said the fact that my Armour dose was so many hours before shows that it is in reality, my FT3 much higher when I am taking it.
Do I have this right: Your FT3 on this current lab is over the top, or it was back in February? Your FT4 is at 53% of range, which is right on target.
Fatigue can be caused by both hypo and hyper. Do you think you feel tired despite a good night's sleep or because you have insomnia or don't sleep well/too lightly? How are your other hypo symptoms doing?
It will be interesting to see what your RT3 is doing. Don't forget that it's the ratio of FT3 to RT3 that's important and not the raw numbers. With FT3 over the top, you can expect your RT3 to be quite high as well.
Fatigue can be caused by both hypo and hyper. Do you think you feel tired despite a good night's sleep or because you have insomnia or don't sleep well/too lightly? How are your other hypo symptoms doing?
It will be interesting to see what your RT3 is doing. Don't forget that it's the ratio of FT3 to RT3 that's important and not the raw numbers. With FT3 over the top, you can expect your RT3 to be quite high as well.
I left my labs at my specialist's office so I can't recall numbers, but what I have is this: The Feb lab showed my TSH is suppressed and my Ft3 on this lab is over the top of the range. My Ft4 is 1.53 with a range of .78 - 2.19 ng/dl (I have that one on paper)
My endo suggests I scale back to 3 and 1/2 grains for eight more weeks. He says I am hyper without outward symptoms. He said I may be feeling better from the last dose of 3 and 1/2 grains rather than the current dose of 3 and 3/4 grains, he also said fatigue can be caused from hyper as well as hypo. I actually liked him. He said we got all the tests he wanted and he also said if my cortisol test in a couple weeks shows a problem he will know how to treat.
His judgement that I scale back sounds reasonable, unless I become more symptomatic on the lower dose. Rt3 and Vitamin D won't be back for several days. I'm curious what you think, given this limited info? Thanks
My endo suggests I scale back to 3 and 1/2 grains for eight more weeks. He says I am hyper without outward symptoms. He said I may be feeling better from the last dose of 3 and 1/2 grains rather than the current dose of 3 and 3/4 grains, he also said fatigue can be caused from hyper as well as hypo. I actually liked him. He said we got all the tests he wanted and he also said if my cortisol test in a couple weeks shows a problem he will know how to treat.
His judgement that I scale back sounds reasonable, unless I become more symptomatic on the lower dose. Rt3 and Vitamin D won't be back for several days. I'm curious what you think, given this limited info? Thanks
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