Hi - I would love your opinions on how my results are looking please. To give a brief background - I'm in the UK and was diagnosed with sub-clinical hypothyroidism in July 2011 with the following results:
FT4 13.2 (12-22)
FT3 4.0 (3.1-6.8)
My initial symptoms were anxiety, panic attacks, headaches, tingling in head, hands and feet, vertigo, dizziness and a weak neck.
I started on 50mcg of thyroxine and 6 weeks later at the end of August my results were:
FT4 18 (12-22)
FT3 3.8 (3.1-6.8)
After initally feeling worse I felt slightly better.
Endo suggested upping to 50/75mcg but I didn't in fact increase to this as I suspected a conversion problem, so stayed at 50mcg and added in 2 Nutri Thyroid (which is a bovine "hormone free" OTC glandular available in the UK). I strongly suspect it isn't hormone free. I felt much better but than gradually started to feel worse and then much worse. Three months later at the end of November my results were:
FT4 22.7 (12-22)
FT3 5.8 (3.1-6.8)
I wasn't feeling at all well at this point and was feeeling spaced out and that I was looking at everything through a dirty window as well as all of the original tingling and vertigo coming back. I showed the endo a Mayo clinic report which showed that these over the counter thyroid glanduars usually do contain fairly hefty doses of thyroid hormones and managed to persuade him to give me a trial of Armour, which surprisingly he agreed to, although he has never prescribed it before. He said this would take a few weeks to organise as Christmas was coming up.
Foolishly I stopped all thyroid medication for about 10 days. I felt increasingly bad with very, very bad tingling and vertigo. I restarted 50mcg of thyroxine and 1 Nutri Thyroid and gradually improved over the next few weeks, whilst waiting for the Armour.
I finally started the Armour on 15th January at 1/2 a grain split into two doses. Initally I felt better but could feel it wearing off before the next dose was due. I alternated between feeling Ok and dreadful. This carried on for 3.5 weeks at which point I had a blood test showing:
FT4 7.0 (12-22)
FT3 2.9 (3.1-6.8)
I rang the endo and he agreed to double the dose to 1 grain a day and he wanted me to stay on this dose for 7 weeks before the next blood test. I felt better to start with and then gradually got worse with episodes of anxiety and rapid hearbeat of up to 88 bpm. Other times my bpm was as low as 53.0. Last week I was feeling really anxious that I might have gone hyper so went to see my GP to ask for an earlier blood test. He did it there and then even though I had already taken my morning dose of 1/2 a grain of armour 9 hours previously. The results were as follows:
FT4 12 (12-22)
FT3 5.0 (3.1-6.8)
I currently feeling a bit better but its very variable. Some days I feel extremely anxious and some days not so. The tingling/vertigo come and go.
I'm due to have the proper scheduled blood tests at the end of next week which will be after being on this 1 grain dose for 6 weeks. I just wondered how this looks and what the impact will have been of taking half of my armour on the day of the test please?
I have been tested for TPO ab and Tg ab and they have both come back negative. Sorry I hoped to keep this brief but haven't managed to. Thanks very much.
If you took the Armour before the blood test, it would show a falsely high FT3, though FT4 result wouldn't change because of the long 1/2 life of the T4 in the Armour.
Your latest blood work shows TSH too high, but some people are okay with higher than normal TSH. Your FT4 is at the very bottom of the range, which is not good, and FT3 is only slightly above mid range. Looks like you might need a slight increase in dosage.
Not sure how well the OTC thyroid meds are regulated in UK, but in the U.S, it's illegal for OTC supplements to have any measurable hormones in them.
One site (I'll try to find the link an attach it) I think it was the stop the thyroid madness site.
The article stated that when starting natural dissected thyroid you need to up the dosage about at week two. Or some sort of bio feedback loop would occur and mess things up. I do not know if this is true and the article didn't go into what the heck this feedback loop was about or why etc.
But your description of what is happening sounds coincidental to the 2 week or so time frame which made me think of that article.
Here is the quote: "Those who start on natural desiccated thyroid have discovered that it can be wise to RAISE within two weeks or less to prevent hypothyroid symptoms from returning due to the internal feedback loop in your body, which can happen if you stay on a low dose too long before raising. "
Here is the link. It is under How do patients dose with natural desiccated thyroid? section.
If the link does not work simply go to: "stop the Thyroid madness" (all one word) *******. Then on the article headings on left side it is under "why natural Thyroid" heading and the "natural thyroid 101" link
Thanks very much for your comments. Yes I think OTC thyroid supplements are supposed to be hormone free in the UK too, but I know of other people who have had similar effects (going a bit hyper) as me whilst taking them.
This is the Mayo clinic study I showed my endo:
"Use of Over-the-Counter Thyroid Support Pills is Risky, Mayo Clinic Researcher Finds
Thursday, October 27, 2011
JACKSONVILLE, Fla. — People who use over-the-counter "thyroid support'' supplements may be putting their health at risk, according to a study being presented at the annual meeting of the American Thyroid Association. The supplements contain varying amounts of two different kinds of thyroid hormones apparently derived in large part from chopped up animal thyroid glands, says the study's senior investigator, Victor Bernet, M.D., an endocrinologist at Mayo Clinic in Florida.
The hormones are known as T3, or triiodothyronine, and T4, or thyroxine. They are regulated by the U.S. Food and Drug Administration and intended for use only in prescription medication because they can cause significant health issues, such as an increase in heart rate, heart irregularities and palpitations, nervousness, and diarrhea, Dr. Bernet says.
"These hormones have effects throughout the body, which is why they are controlled," he says.
Not only did nine of the 10 supplements studied have animal hormone, the amount of hormones in the products varied significantly, sometimes exceeding doses used for individual patients and comparable to levels found in prescription thyroid medication, Dr. Bernet says.
The supplements likely do not give most people the results they are seeking, such as weight loss or less fatigue, he says.
"The amount of thyroid hormone a normal person would have to take to lose weight would be dangerously high and there is no evidence that use of thyroid hormone effectively treats fatigue when used in people without actual hypothyroidism," he says.
Because physicians have seen a number of abnormal thyroid tests from patients using over-the-counter supplements, Dr. Bernet became interested in this issue when he heard reports of such cases as chairman of the American Thyroid Association's public health committee. He worked with researchers including endocrinologists at Walter Reed Army Medical Center, where he practiced at the time.
The researchers bought 10 commercially available thyroid supplements from stores or websites and used high-pressure liquid chromatography to separate and identify the chemical components of T3 and T4. Nine of the 10 contained T3 and five of them would deliver as much, or more, than 50 percent of the total amount of T3 produced by the body daily.
Four of the 10 supplements contained T4, and some of those contained a dose that could be twice as much as what an adult needs each day. Only one supplement had no detectable T3 or T4.
The results show there is a need for more effective monitoring of the contents of over-the-counter thyroid support products and more patient education about the products' potential health risks, Dr. Bernet says."
I am hoping my endo will agree to a small increase in my dosage but I don't know whether it would be best to try an extra 1/4 of a grain or 1/2 a grain. As my endo has never prescribed it before I don't know if he will have any idea either! Thanks again for your help.
Thanks very much for your comment. I feel as though I am getting there and a lot of that is down to the advice that you and "gimmel" gave me back in August, regarding low T3/conversion problems.
I have read the STTM book re the feedback loop and I think Dr Lowe (RIP)mentions something similar about being on a low dose causing problems on his website. I wondered if it was that with me though, as I think Dr Lowe said that the small dose could suppress the TSH and therefore stop the body making its own thyroid hormones. My TSH was 59.0 back in Feb so was high rather than suppressed. I am really confused as to why my TSH has been fluctuating so much, but I suppose I need to be patient and wait to see what happens when I am on a stable dose. Any ideas gratefully recieved!
Hi Clare. Congrats on getting a UK doctor to prescribe Armour. You are one of a very select few. LOL
A half grain of Armour contains about 19 mcg of T4 and 4 1/2 mcg of T3, so in view of you having taken your Armour prior to the last test result, I would think that another half grain would be best. Then you can start slowly, by only taking 1/4 grain for a couple of weeks and then add the additional 1/4 grain.
Keep in mind that a good thyroid doctor will treat 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, not just test results. You and your doctor could get some good insight from this letter written by a good thyroid doctor that I highly respect for his knowledge and experience. The doctor frequently consults with patients from a distance and then sends this letter to their Primary doctor to help guide treatment.
Your doctor is already doing much more than most of the doctors in the UK that we hear about. Perhaps if you give him info like the letter you can keep him from reverting to the standard thyroid treatment protocol of the NHS.
Hi gimel - thanks for your comment and advice re an increase of half a grain - I will suggest this to my endo next week.
This endo is the same one who told me I was euthyroid back in July 2011 when I first saw him. He wrote to my GP that I had no symptoms of an underactive thyroid in spite of my long list of them, and it was only when I pointed out that my TSH had been 15 and then 18 that he reluctantly agreed to give me a trial of thyroxine.
I almost didn't go back to see him but am so glad I did now. He seems to have mellowed a bit and when he wasn't cross with me for trying an OTC thyroid glandular and in fact suggested carrying on with it but at a lower dose, I decided to take the plunge and ask for armour as the dose is standardised!
He said he couldn't prescribe it but I said he could and then he agreed! But he said he had no experience with it. Well apparently he now has another patient on a trial too. I'm seeing him privately (due to health insurance), although he does practice within the NHS as well. I'm hoping that if my treatment is a success then he will be a bit more openminded in the future with his NHS patients. I'm also hoping that my NHS GP may end up prescribing it for me as then it would be free of charge (hypothyroid patients are entiteld to all NHS prescriptions free of charge). I do realise how lucky I am to have got this far - just hope the progress continues. Thanks again for your advice.
This is a considerable improvement than when I was on 1/2 a grain (see results above). I am seeing the endo tomorrow so any advice on what dose increase to ask for would be gratefully received, as the endo has no experience with dosing it. Thanks very much in anticipation!
All three of your tests indicate the need for more thyroid med. Recall from the link I gave you above, that the doctor stated, "the ultimate criterion for dose adjustment must always be the clinical response of the patient. I have prescribed natural dessicated thyroid for your patient (Armour, Nature-Throid) because it contains both T4 and T3 (40mcg and 9mcg respectively per 60mg). This assures sufficient T3 levels and thyroid
effects in the body. Since NDT has more T3 than the human thyroid gland produces, the well-replaced patient’s FT4 will be below the middle of its range, and the FT3 will be high “normal” or slightly high before the next AM dose."
So perhaps giving a copy of the letter to your doctor might make him feel more comfortable with your treatment. Then, if it were me, I would ask for an increase of one grain, with a plan to increase by 1/4 grain every two weeks, to a total of two grains. Carefully monitor how you are feeling along the way, and plan to go back for re-test in about 10-12 weeks. Also, I suggest that whatever dose you are taking, as best you can, split it into two doses - for morning and early afternoon.
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