Need help interpreting thyroid labs on Armour

[l_fitz]

Recent labs are confusing to me & need input.  

I switched from Synthroid to Armour 8 mn ago.  Never felt good on synthroid & finally convinced doctor to switch to Armour but she wasn’t willing to work w/ me on reaching optimal levels vs HMO range.  Switched to a DO & she has been very open to information, but admits she’s not an expert on thyroid meds and has limited experience with Armour.  

We increased my dosage, trying to get my T4 up – but it seems the opposite is happening to my T3.  We decided to back down a bit to 1 ¼ tablets and I’m feeling terrible.  Totally drained of energy & my hair is like straw (something I’ve never experienced).

Can anybody offer any suggestions about what is happening. Thank you!

Have always split Armour dosage (half in early am & half early to mid afternoon)

Test Date Medicine               Dosage         TSH   Free T3 Free T4
5/2013       Synthroid        125 mcg                 3.34           2.92   1.00
11/2013 Armour          60 mcg (1 tablet) 1.67   3.26          0.70
6/2014 Armour          90 mcg (1 ½ tablet) 0.03   2.96   1.00
currently Armour          75 mcg (1 ¼  tablet) due for blood work in 2-3 weeks

[flyingfool]

Also it is VERY common for TSh to become suppressed when the patitent is taking T3.  

So it seems pretty clear to me the only reason for the decrease was the Dr was ONLY looking at the TSH being suppressed and the belief on that basis ALONE that you were overmedicated.  Thus the reduction.

The fact that your Free T4 and Free T3 remained low in the range and you were showing symptoms of being Hypo made no difference.

So think about this.  You have two blood tests and clinical response of the patient telling you that are all consitten with remainng Hypo.  And only one test showing that you could be hyper.  And the Dr went with the one result versus the three.    And consider that the Dr apparently is unaware that taking T3 could or would likely cause TSH to become suppressed.

All those signs tell me that your Dr may not be to "up" on how to treat thyroid.  The Dr is showing signs of "immaculate TSH belief"  and "reference range endocrinology'.    This is a warning sign.

You owe it to yourself to get as much education as possible and you can try to teach or work with your Dr. But always keep in mind that you may have to find another Dr.  As treating you with TSH alone is a recipie for disaster and keeping you feeling crappy.

[gimel]

A suppressed TSH in your case should not be a concern.  TSH causes no symptoms.  My TSH has been about .01 - .05 for around 30 years with no associated hyper symptoms.  Doctors' concern for low TSH with patients taking thyroid meds is misguided.  Most of them haven't bothered to really research the subject and confirm/deny the validity of the little info they were given in med school on the subject of hypothyroidism.  So many of them only use TSH to diagnose and treat a hypo patient, which is wrong.  If they go beyond TSH they usually only test for Total T4, or Free T4, and then want you to believe that a test result that falls anywhere within the huge  reference range is "notral", and that any symptoms you are suffering must be due to something else.  

Those practices are the main reason for the huge number of people suffering with hypothyroid symptoms.  I was one of those myself  for many years until I found this Forum and learned about the importance of Free T3 and got mine tested and confirmed as low in the range.  After changing my med to include a source of T3  and doing some tweaking of levels, based on symptoms, I now feel best I can even remember.

Optimum levels for Free T3 and Free T4 vary from one person to another.  Whatever levels are required to relieve symptoms are optimum for you.  Many of our members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range, or slightly higher.  Just keep in mind the quote above, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

[l_fitz]

Thanks for your input.  Part of the reason for the dosage adjustment was that I had misread the RX label and had actually increased to 1.5 tabs vs 1.25 tabs.  Doctor had wanted to do slow adjustments.  Think there was a slight bit of concern at how low the TSH was,  Will email their office and relay symptoms. Am curious how the next labs will be because I really don't feel well at all.

What are the optimum levels for my T3 & T4?

How low is too low for TSH?  Seems the last labs showed a fairly major drop.

[gimel]

I fail to understand the logic of reducing your Armour because your Free T3 went down from prior test.  Most likely you were not adequately converting T4 to T3, for several possible reasons.  Regardless, the right move would have been to increase your Armour, since your Free T3 was much too low in the range and your Free T4 was also a bit low.  So, I would suggest that you take that into consideration and get your doctor's agreement.  

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."

http://hormonerestoration.com/files/ThyroidPMD.pdf

One thing further, hypothyroid patients typically don't produce adequate stomach acid, so they don't absorb nutrients adequately.  Since Vitamin D is important to adequately metabolize thyroid hormone,  your D is way too low.  Good idea to start supplementing with 2000 I.U. daily.

[l_fitz]

Sorry, I meant to add that info and forgot.

I did not take my armour the morning of the test.

The ranges are as follows:
TSH   (0.320 - 5.500 uIU/mL)
Free T3   (2.30 - 4.20pg/mL)
Free T4   (0.70 - 1.8 ng/dL)


Other tests I had done:

Ferritin;   64 (13 - 150 ng/mL)

Iron;   58 (30 - 150 ug/dL)
Total iron binding capacity;   348 (250 - 450 ug/dL)
Iron/total iron binding capacity;   17 (16 - 50 %)

Vitamin D, 25-HYDROXY;   28 (20 - 96 ng/mL)

[gimel]

Before going further, two questions for you.  Did you take your Armour Thyroid med the morning before blood draw for those tests?  Second, what are the ranges for those Free T3 and Free T4 tests?  Since lab results and their calculated ranges vary somewhat from one lab to another, you should always compare results against ranges from that specific lab.