Questions about Armour

[hashi2healthy]

I recently read that some people have had much better results using Armour when they chew or dissolve the tablets completely before swallowing & dose twice daily instead of just once. If you have any experience with this, I would love to hear your thoughts & opinions. Also... How long does it actually take for the T3 in Armour to begin working in the body & how long does it last? I haven't yet come across this information while researching.

[Barb135]

Any doctor who says a patient asks too many questions is not a good doctor.  You have a right to have all your questions answered.  You don't need an endo, anyway, just a doctor who is willing order the right tests and work with you to achieve symptom relief.  

Fatigue can apply to either/both hypo or hyper.  It's possible that your dose is too high, but with the tests you had done and no reference ranges, there's no way I can tell for sure.  If that's and FT3 and it's high, then possibly you're over medicated - even labs can make mistakes on reports.  You might want to contact your doctor's office or the lab to make sure, but since it's time for new labs, I'd just get new ones with the tests I mentioned above, specifying Free T3 and Free T4.  

Yes, it's definitely worth getting the ferritin tested, since iron is needed for thyroid hormone metabolism.  While you're at it, you might as well go ahead and ask for vitamin B-12, since deficiency can cause horribly fatigue as well.

[Madmax1952]

Thank you sooo much.  My physician is my primary doctor....not an Endocrinologist....I didn't have good rapport with my Endo......he said I asked too many questions....I reminded him it was MY thyroid....anyway, I will get those tests done.

So, is fatigue a symptom of over medication?  Should my dosage be lower?

Also, my father had Hemochromatosis and I requested a ferritin test also....thanks again, Barb.....when I get the new results, I will get back with you..thanks again....

[Barb135]

Those are really odd.  I don't even know what TS 3 is, unless it's a serum T3.  At any rate, it appears that your doctor doesn't know much about ordering labs, because s/he's ordering Total T3 and Total T4, which are obsolete and not very useful.

Also, I've never seen a TSH of 0.82 being too low, as ranges for TSH, typically run from 0.45 - 4.5.  Many people would give their eye teeth to have a TSH of 0.82... lol

If your T3 is high, you're, most likely, over medicated.  Do you have symptoms of over medication, other than lack of energy?  That can apply to either hypo or hyper.  Other symptoms of over medication could include sudden, unexplained weight loss, diarrhea, rapid heart rate, heart palpitations, hand tremors, etc.  

Since your labs were done in November, it's about time to do them again.  Do you think you can get your doctor to order new ones and order Free T3 and Free T4, with the TSH, this time?  And make sure you ask for a copy of the full lab report.

[Madmax1952]

The TS Free is TS 3.... Result says High
TSH Serum.....Low
No numerical ranges

[Barb135]

Is the TS you have listed, supposed to be T4, Free?  Or is it T3, Free?  What are the reference ranges?  Ranges vary lab to lab and have to come from your own report.

[Madmax1952]

I have had no energy since August, 2014...
I am on Armour..90 mg

My lab results as of 11/12/14 are:

TS Free.  4.6
T4 Total, Serum.  6.7
TSH Serum.    0.82
How can I get more energy.....had RAI 2006 due to hyperthyroidism.  I changed to Armour about a year ago....felt fine then in August I noticed a big drop in my energy level.  I was in 60 mg. of Armour so I changed it to 90 mg and haven't felt any more energetic....any suggestions?

[hashi2healthy]

I just want to say thank you to everyone here, whether you've commented on my threads or not, for the knowledge & support you offer complete strangers. This community is definitely comforting when you're desperately seeking answers, guidance & support. I wouldn't wish any kind of thyroid disorder on anyone at all, but it's somehow comforting to know that others out there understand.

With all of my heart, I thank you. <3

[hashi2healthy]

Thank you for your support, goolarra. It really means a lot, as I'm sure you know, to talk to people who understand, who "get it" - especially when struggling & looking for a glimmer of hope that it will all be okay somehow, someday.

Honestly, right now, that's all I want, just progress & to feel okay. I don't have to feel great, or better than I've ever felt in my entire life. I just want to feel okay, not constantly unwell, struggling to do one of the effortless things most people take for granted & hopeless. I can work at it from okay.

I'm sorry your first year was very rough for you. I'm glad you found someone who listened & helped you & that you've felt well ever since. I can only imagine how good that must feel. Thank you for telling me it gets better. I think sometimes we just need that reassurance from someone else who's been there & knows.

I think you're right, I probably just needed a little tweaking on synthetic instead of completely changing meds & ruining the progress I'd made, even if it wasn't much, it was something. I really need to get my meds right & soon. I'm praying that the new endo I'll see in a couple weeks will be the one to finally help me do that.

I'm not sure how quickly my thyroid is being destroyed, I've had two ultrasounds & only received the results of the first one a year ago. With the second one, the endo did it in his office & just said it was Hashimoto's (already knew that) & he wouldn't worry about it. I never used to be able to feel it when I touched my neck, but I can now on the right side, so I know it's more swollen than it used to be & it hurts to touch it. Is there any way (tests or something) to know how fast it's progressing or how much longer this will go on before it's dead & I'm totally dependent on meds? It's been an awful nightmare of a roller coaster ride so far & I'm just ready to get off.

[goolarra]

My endo has said that for some people, it takes decades for the gland to be destroyed completely, for others, it goes like gangbusters.  Furthermore, the thyroid isn't destroyed on a nice even slope, either gentle or steep.  Rather, you can go along for a period of time with little change and then fall off the cliff to the next level.

You can make your goal to get back to where you felt best; that's an excellent starting point.  You might just have needed a small tweak at that point to get rid of the lingering symptoms.  

It does get better.  I had a very rough first year on meds, but I finally found an endo who listened, and I've felt well ever since.  My last U/S confirmed that my thyroid is dead and atrophied.  I think it gets a lot easier when the thyroid dies and you're totally dependent on meds...fewer surprises.  They seldom remove the thyroid due to Hashi's unless there are extenuating circumstances.  I think you just need to get your meds right.

[hashi2healthy]

After looking over my labs & notes of how I felt when, on what meds at what lab levels, etc, that was my conclusion as well. When I tried to talk to the endo I was seeing about destruction of the gland & needing a dosage increase, he told me "no no no, it doesn't happen that fast". My response was that it obviously can & that I know that Hashimoto's is the continuous destruction of the gland, requiring more & more replacement, so not to try to BS me, I'm not an ignorant, uninformed patient, I educate myself. He didn't like that... I think the worst part of all of it was that even when I felt my best, I still felt bad with all of the symptoms, just to a slightly lesser severity.

Through all of this, I've lost so much already... I've lost jobs, I've lost relationships, I've lost myself (the woman I was prior to Nov 2012), sometimes I feel as if I'm losing my mind & even my faith has suffered.

Does this ever get better? Do people ever get their lives back? When the gland is finally completely destroyed, is it over? If I have it removed, does it stop?

[goolarra]

I understand your frustration.  

You felt your best when your FT3 was quite high in the range, 79%.  By 7/2, your FT3 had dropped considerably, but it was still 58% of range.  Since there was no meds change between those two labs, we have to assume that the antibodies were at work destroying more of your thyroid function.  

You can order the adrenal saliva test online, without a doctor's order.  Perhaps that would be worth doing.  It's harder for the doctor to ignore your concerns if you have something concrete, like lab results, to show him.

[hashi2healthy]

Thank you for your response. I don't think his neglecting my FT4 just because my FT3 has risen over time is acceptable at all, which was my first indication that I needed to find a new Endo (and did, the appointment was scheduled the same day). I felt the best I have ever during all of this when my levels were briefly here:

5/21/14 brand Synthroid 75mcg & generic Cytomel 10mcg
TSH 0.412 (0.450-4.500)
FT4 1.07 (0.82-1.77)
FT3 3.9 (2.0-4.4)
Vit D 55.0 (30.0-100.0)
Folate 5.7 (>3.0)
Iron 55 (35-155)
% Sat 16 (15-55)
TIBC 339 (250-450)
Ferritin 74 (15-150)

At this point, I believe I was on a good path, just needed another T4 dosage adjustment. However, one was not made at that time, as these were tests done by my PCP, not the Endo. I didn't see the Endo until 7/2/14, 3 months after my initial appointment with him (4/2/14) where all he did was increase my Cytomel from 5mcg to 10mcg. Here are the results of testing done at the 7/2 appointment:

7/2/14 brand Synthroid 75mcg & generic Cytomel 10mcg
Endo said levels were "stable" & switched to Armour 60mg.
TSH 1.64 (0.270-4.200)
FT4 1.00 (0.93-1.70)
FT3 3.4 (2.0-4.4)

By this time, I was feeling worse again. Even though this Endo said my levels were "stable", my TSH had risen, while both FT4 & FT3 decreased. I had asked him about other thyroid replacement options previously, he said I could try Armour & that's when he started me at 60mg. From there, I declined rapidly & despite me telling him at my 10/8 appointment that I felt absolutely horrible, worse by the day, he told me I needed some relaxation in my life, to take up gardening (implying I was just stressed) & his solution was simply to increase the Armour to 75mg, still far less T4 than I was taking with the 75mcg of Synthroid.

I wish I had known then what the actual amounts of T4 & T3 are in Armour, but I thought he'd know the proper dosage for me. Even after learning & bringing it up with both my PCP & the Endo, no change has been made except to decrease the dosage of Armour back to the original 60mg he started me at in attempt to get rid of the palpitations I began having.

Confusing, I know, I'm sorry. I'm still trying to make sense of it all myself. Maybe this is why I have frequent headaches, I research too much. Sounds like a doctor's explanation lol...

I've suspected adrenal dysfunction of some type for quite a while since it's been a very slow going process that has yet to remove any of my symptoms, even when I felt slightly 'better' in May. I've also had some mild, dull pain across the area of my kidneys at times, but no one has addressed that at all. This is why I've asked numerous times for a cortisol test. I asked 2 different PCPs & the Endo specifically for a saliva cortisol test. The PCPs said there was no reason for that test. The Endo said there was no reason for saliva, that a 24hr urine collection would show if there's a problem. The problem there (as we know) is that it could be very high at one point during that 24hrs & very low at another time, but balance out because it's all mixed together & an average is given. This Endo just seems to be incompetent when it comes to testing & treating thyroid patients. This is why he's been fired.

After almost 2 years now of thyroid hormone replacement, I guess I kind of expected to be feeling better instead of lying in bed again, exhausted & still struggling to take deep breaths after all this time... It really makes me wonder why they can't (won't) further educate themselves to better help their patients. If we're able to learn all that we do through research & talking to other people who KNOW, why can't they? Don't they still have to take an oath to "do no harm"?

I'm sorry for the public display of my "mood problem" (as noted in my medical records), I'm just really frustrated by all of this.

[goolarra]

I firmly believe that while FT3 is the more active of the thyroid hormones, you can't ignore FT4, either.  Both have to be right FOR YOU.

Cortisol testing is important.  When adrenals are off, it's almost impossible to regulate thyroid hormones.

[hashi2healthy]

Goolarra... Yes, IIRC, this is the lowest my FT4 has ever been. I asked my new PCP & he said I have to talk to my endo about changes to my thyroid meds. My next appointment with an endo isn't until 2/2 & it will be the first time seeing a new one. I'm going to ask about either adding more T4 or going back to synthetic T4 & T3 & just work my way back up from where I am to where I was when I felt my best (not good & not optimal, but a little better), then go from there. Just to see how I'd feel, I took 90mg of Armour split into 2 doses & chewed. It's too much T3 with my T4 so low. I had more palpitations,  more difficulty taking deep breaths & panic attacks. I do believe the T3:T4 ratio in Armour is not right for me... My current plan is to ask again for a 4 point saliva cortisol test instead of the 24hr urine collection the first endo ordered which doesn't show fluctuations of course & appeared "normal". And I will request a medication change. Right now, I guess it's just a matter of trying to ride this out until I get to see the new endo. Even with my FT3 as high as it is now compared to where it was (below range) when all of this began, I feel as bad now as I did then. I'm more confused than ever about all of this. The current endo I won't be returning to actually said in October that FT4 levels aren't important if FT3 is 'good'. Clearly, he's wrong, because I feel like crap!

[goolarra]

Looking at your 11/3/14 labs, your FT4 is very low, but your FT3 is just about where it should be.  In the switch from 75 mcg levo and 10 mcg Cytomel to 60 mg Armour, you decreased your T4 intake by about half, but T3 intake remained about the same.

Have you considered asking your doctor to add a little synthetic T4 to your Armour to get a better balance of FT3:FT4?

[gimel]

No problem.  I just mentioned it because a lot of the information goolarra was looking for had already been posted elsewhere.  Having all information in one thread helps us in putting it all together and assessing a member's status.  

[hashi2healthy]

I have started 3 threads & I didn't know there's anything wrong with having different threads for different questions here. I actually thought different questions were supposed to have different threads on forums, at least that's been my experience everywhere else. My apologies if that's not the case here...

To answer some questions, I was taking 75mcg of brand name Synthroid & 10mcg of generic Cytomel before switching to 60mg of Armour in July 2014. I was feeling the best I had, but still not well up until around June, then started to decline, figuring I needed another dosage increase. I asked about other medications because it had been on synthetic replacement for almost a year with little to no symptom improvement. The endocrinologist I was seeing recommended trying Armour & I now know that he actually cut my T4 back a lot with that dosage. Since starting Armour, I've had a steady decline in how I feel & my symptoms have again worsened to the point they were when this all started for me.

I do know that it takes 4-6 weeks for T4 to balance in the blood. This is not something that happened suddenly & there has been ample time to clearly see that Armour at the current dosage of 75mg is not working for me. I asked the questions I did here about splitting the dose & crushing the pills to find out how others have done with that. That's all.

If anyone is actually interested in lab results, etc.. I actually posted a journal entry including my symptoms, dated lab results with dosages & notes about treatment that I've kept along the way.

[gimel]

Unfortunately hashi2healthy has started a number of different threads, so info is scattered all over.  Here is a link to some of the info you requested.

http://www.medhelp.org/posts/Thyroid-Disorders/Losing-hope-Help/show/2433488#post_11843533

[goolarra]

Well, if that's what your bottle says, you might ask your pharmacist to verify that it's okay to crush it.  There are many variations of desiccated, many referred to as "Armour", so it's worth the question.  

What dose of Synthroid/Cytomel were you on, and how much Armour are you taking now?  How were you feeling before the switch, and why did you switch?  How long ago was that?

Do you have current labs to post and labs before the switch?  Please include reference ranges if you do.

It's very hard to tell from one dose what difference a change in dosage or delivery is going to make.  It takes 4-6 weeks for the T4 portion to reach its potential.  So, until everything rebalances, it's not unusual to feel a bit worse.    

[Red_Star]

I felt worse on Armour myself. I was taking 3 grains of Armour (prescription for 1 grain) and I was having serious breathing issues (you know what's that's like!) and had to go back to synthetic T4. I thought there was a potency issue but my pharmacist said there wasn't (she almost had a heart attack hearing I was taking 3 grains lol).

I decided to try mixing the Armour powder in water for better absorption (I live in Australia so Armour is made up in compounding pharmacies) but this still wasn't working well. I had to go back to T4 stat! It took a couple of weeks to breath better. I also find if my breathing worsens I can breath better in about an hour or two after taking thyroxine.

I have no problems absorbing synthetic T4 regardless of stomach acid and pancreatic enzyme levels. Stomach acid signals the pancreas to produce digestive enzymes to further break down food; proteolytic enzymes are secreted by the pancreas. When I was taking Armour my stomach acid was severely depleted (in my case due to a year of hyperthyroidism) which looks to be the reason why I wasn't doing well on Armour.

Excerpts from the book: Thyroid Diseases: Clinical Fundamentals and Therapy by Fabrizio Monaco, Maria A. Satta, Brahm Shapiro, Luigi Troncone...

"There is some differences in the rate of absorption between animal and synthetic preparations. After a single oral dose of synthetic L-T4, the absorption is approximately 70 - 80%, 20 - 30% being recovered in the stool.  It is absorbed rapidly, mainly in the distal small bowel, reaching maximum plasma levels in 2 to 4 hours."

"Variability of absorption also occurs with desiccated thyroid, dependent on proteolytic enzymes of the gastrointestinal tract. Since desiccated thyroid and thyroglobulin preparations contains T4 and T3 incorporated into thyroglobulin, to release thyroid hormone the crude preparations must be hydrolyzed by gastrointestinal proteolytic enzymes, which indirectly influence the absorption of T4 and T3."

[hashi2healthy]

Thank you for your response. I've just gone by the stickers placed on my prescription bottles, which say "Swallow whole. Do not crush." & the directions, which say to take it once daily. I'm still learning all of this & appreciate hearing what others who've been through all of this before me have to say.

All I know for sure is that since switching to Armour from Synthroid & Cytomel, I've felt worse & worse. I guess I'm searching for any & everything at this point that could possibly help me feel better. I feel absolutely dreadful & hopeless right now, like I did when this all began with my very first symptoms.

I split my dose today & chewed it before swallowing, but didn't notice any difference at all.

[goolarra]

Most people taking meds with T3 in them split them into two half doses, half first thing in the morning and half late morning to early afternoon.  You can experiment with exact timing so it meshes with your schedule.  Most people avoid it after mid-afternoon so it doesn't disturb sleep.

You can chew, dissolve or take the tablets sublingually.  If you take them sublingually, they kind of avoid the digestion process and some of the med is absorbed directly into the large blood vessels under the tongue.  

T3 is very fast acting and should kick in fairly soon.  If T3 isn't used promptly, your body neutralizes it.  That's why it's best to split the dose since that helps to keep FT3 level more even.  However, do keep in mind that although FT3 is the most active form of the thyroid hormones, FT4 can't be ignored, either.  So, before you know how a dose is going to effect you, you have to wait for the slow acting and slow building T4 component to reach it's potential, too.  That takes 4-6 weeks.