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Splitting Armour Dose
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Splitting Armour Dose

To: Stella
Stella,

You seem very knowledgable and I was hoping you could help me though adjusting my armour.  I have Grave's disease and no thyroid (RAI).  I took 1.5 grains of armour 1X day for a year with no problems. Almost overnight, my TSH raised to 5.8 and my FT3 dropped to 2.3, FT4 .61 so I needed to raise my armour.  Ever since this time, I have struggled.  I had a doctor put me on IsoCort who never tested me first (mistake #1) and I have been taking the higher dose of Armour in 1x day (mistake #2).  

My ACTH test is good, AM Cortisol Test good, Vitamin D levels normal (now after supplementing), take Vitamin B Complex and Vitamin C (500 only), progesterone and estradiol.  My current Armour dose is 1.75 with TSH of .069, FT3 3.0, FT4 .96,  I have dry skin, acne, mood swings, irritability, light sensitivity, weight gain, irregular bowels, etc.  When I tried to lower my dose (per my doc), they got worse!  I feel better on 2.0 grains but after a week, I start to backslide with feel overmedicated.

I don't like to take Armour subligually...it gives me the jitters.  How can I dose it best?  It seems I do good on 1.5 grains in the AM.  If I add the .5 grains before lunch, how will this affect my levels or should I go back to the lower dose and add only .25?  Does splltting the dose affect how much you actually need to take?

Debbie
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393685_tn?1325870933
Hi Debbie - I looked up your profile information and had to giggle a bit first. You show your gender as male  and as I was reading your post I sat back and was freaking out about your estradiol and progesterone comments on your question. :)

It may be best to view your profile over and switch that - I assume you are female right?

OK - going on the female lines  with hypothyroidism. May I ask a few things first?

When was your thyroid taken out by RAI? Are you comfortable sharing your age? Are you still supplementing with Isocort?

Depending on how you answer those could open up a few more thoughts.

As for the basic labs  - can you share the reference ranges? Labs have different ranges on that. Not sure where you are falling in those ranges.  

Keys things I am picking up on with adrenals is you are light sensitive - gaining weight. This could indicate problems with sluggish adrenals and your Armour could be setting you off with the jitters regardless of dosages. You had serum labs - and they were normal. They may have not picked up issues.

When you take the 1.5 grains all in the morning - are you fatigued in the mid afternoon? When you increased to the 2 grains - did you do the whole dosage in the AM too?

I'll be happy to suggest something I think may work for you but as you can see - I got alot of questions above. Let's look at these first OK?

One question I think I can answer here is : Does splltting the dose affect how much you actually need to take?

No - I don't think so. You see, it all about finding a pattern of release with splitting Armour. It needs to work as your body intended prior to you needing the medication. And basing most information on conversion from the liver and stomach absorption with the acids, you may be having swings with that process too. Your stomach does not have the same acids in it daily, sometimes it is up more and more potent at times too. That's where sometimes subligually is more of a steady release for Armour patients - the dosages are sometimes easier to figure out this way too and helps you manage the meds better daily.

Let me also add above that the Vit C of 500 is just a tease for your system when trying to build your immunity back up - RAI knocks out your immunity too.  More like 1500 is better for you since you have no thyroid left. Adding some zinc is best too - around 30 mg. That might alone kick your adrenals back into gear.

Irr bowel is so common - along with acid reflex for us "no thyroid" patients. It's very hard to get someone to listen to us and put that together - but it is a problem for most. "NO" thyroid patients need to add probiotics and digestive enzymes to our daily regimen - this should not effect any thyroid hormone levels - but it does kick the system back into gear to move the waste out of our bodies. Two great things for me is Pearls acidophillus and Peppermint Oil gel tablets. Both have rid me of Irrat bowel and heartburn/acid reflex entirely. Keep up the B vit - that help with your metobolism cells.

Your dry skin is still a condition I have a bit too. Internal moisterizing is better than outside- Fish oil (Omega 3-6-9) should be added daily to your supplement package. I found when I did that it helps so much - but I get lazy on taking it. Maybe when the weather breaks here I will worry more about my dry skin. Right now I just feel it is something I am not over concerned about for me.

Now your threw in the progest- and estrog stuff too. What are you taking? OTC? - bio identical?

IF you have to much progesterone in the body, it spills off into testosterone and that causes acne really bad. I take bio identical progesterone and found that a HUGE issue for me. I am still trying to find my sweet spot with the cream and so far find an every OTHER day application is best for me for only two weeks during ovulation.

Looking forward to you posting back!
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Avatar_f_tn
Hi Stella,

I have corrected my profile and added a little more back ground.  Let me see if I can answer all of your questions...

Yes, I am female, I had RAI in 2004 and was on synthroid and cytomel until late 2006,  I found 1.5 grains of armour to work for one full year (taking once a day though I can't remember if I was tired in the afternoon--too long ago).  I began upping my Armour in January 2007 to 2.0 grains six times a week (my doctor's suggestion) and felt horrible every Sunday (my skip day).

I went to a homepath who put me on digestive enzymes and probiotics, IsoCort (six a day right off the get go!) and told me to up my armour.  I have been on a roller coaster since.

My current labs at TSH .069 (.45-4.5), FT3 3.0 (2.3-4.2) and FT4 .96 (.60-1.76). FSH 97 (it keeps going up), Vitamins D 47 (32-100), AM Cortisol 18.4 (4-22). I take 1mg estradiol and 150mg progesterone (down from 200) in a pill form (bioidentical).  I lowered my progesterone because I was so dehydrated and to be honest, I do think my acne improved in the last week and I just lowered it two weeks ago so you may be right about the testosterone.  I take 500mg fish oil and 2000mg flax seed daily.

On the bowels, I used to have the most completely normal cycle and only when I began playing with the higher dose of armour and started on probiotics, digestive enzymes, etc., I began going up and down, from normal ro diarhea (diarrhea) and somewhere in between.

I am due for labs at the end of March and hope I can find my optimum dose before then.  At that time, my doctor will retetst my estradiol, progesterone, VItamin D, Metabolic panel, TSH and Free Ts.  

I really appreciate any suggestions you have.  I am willing to try anything right now.  I am not on IsoCort and thought I would try 1.875 grains?  1.375 in the AM and .5 in the early afternoon?  How do I get trhough the adjustment?  

Thanks for all of your help!

Debbie (a female!) :)
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Avatar_f_tn
Correction, I began taking Armour in late 2005 not 2006.  Sorry!
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393685_tn?1325870933
OK - much better Debbie :)))

Here's my thought on it - and personally you are following a great regimen of things for thyroid support- ( since "we" have no thyroids to support us anymore.) Were you / Are you Graves when they did the RAI?

I think you are A symptomatically still hypOthyroid. I do not think your adrenals are in need of HC ( maybe support) and taking that HC - shot you through the roof. How long did you take it?

Upping your Armour and introducing HC is a double whammy on your body - I would bet your system was running full steam but not sure what the heck it was suppose to do. Those are confusing doctors orders to me.

I think also you need to tweek down the progesterone too. You may be on a tad to much and if it is getting mixed off your labs they can adjust. I think it is spilling off -

Armour thoughts : - Your doctor told you to take 2 grains 6 days a week then dry out on Sunday? never heard of that one either -  and the T3 would be gone by Sunday night. It's like starting all over on Monday again -  then by Thursday you are back in a pattern at full steam and by Sunday again you crash - Are you sure no meds on Sunday was the order?

Then IF you were to test on Mondays with labs - nothing would be "real time" results. Do you get what I mean there?

Here is what I think based off your dosage and TSH - FT3- FT4. I think at this time you should stay on the 2 grains your doctor said right now but change things up a bit. Your Free t3 looks low - and your TSH may need just a bit more tweeking down to - maybe a .5 would be your sweet spot for you - especially if you are autoimmune thyroid.

guessing only???

Swallowing - your Armour :

One hour after waking take 1 grain - empty stomach no supps - no eating for 1 hour. Then go about your usual regimen of things in the morning

after 2/1/2 - 3 hrs have past -  take additional 30mg (1/2 grain) . You should be approaching a light snack or lunch soon - eat something 1/2 hr to an hour after that last dosage - perferrably high protein. At lunch eat  - and take a Vit B supplement with that meal along with some digestive enzyme tablet. Again 3 hrs later take the last 30 mgs of Armour and repeat snack.

At bedtime you can try a zinc/selenium/magnesium and peppermint( digestive) supplement. Also adding Vit C at night is good too.  One thing I learned is taking in Vit C is helpful with everything - I try to consume about 2000mg every other day.

You may have to simulize your adrenals some throughout the day and sea salt can help you with that process. If you can handle it - sipping it throughout the day ( 2 glasses 8oz with teasp salt) Honey added in is good too.

Make sure you mix regular plain water in between the sea salt ones. 6 min glasses of water a day to flush is best.

( I can "talk the talk" on that - but I find it "hard to walk" for me to drink that much too) I do try.

Your adjustment period may be a burst of alertness in the afternoon and then start of calm a bit around dinnertime - but that should even out some as a few weeks go by.  

Then retest in March -



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Avatar_f_tn
Hi Stella,

Thank you so much for taking the time to write me with your suggestions.  Just to clarify a few of points you asked about:

I had Grave's when I had RAI and I had a very low WBC so this is what my doctor recommended.  I continue to have elevated TBI, TPO and TRab antibodies.  This is probably because my adrenals are working overtime?

Yes, my doctor said 2 grains six days a week which comes to 1.75 daily if I even it out.  That of course still bothered me because I took it all at once AND I still had hypo symptoms.  That's why I thought I would try 1.875 (1.0 + .5 +.375?).   Or were you thinking I needed to stay on the amount the doctor told me (12 grains a week?)

I agree with you on the progesterone and hopefully when I get my next labs, my doctor will agree as well.  Incidentally, after I began bioidentical hormones, my potassium took a nosedive and I now take 20meq a day.  Progesterone is a natural diuretic and I think that is the problem.  That's why I had her reduce it to 150 from 200.  I wish I could adjust it myself, but I can't because I take one pill with everything together.  Actually, two pills .5 est/.75 prog,  I need the estrogen for hot flashes so if I cut it back to one pill, they will return...I tried it!

You mentioned my TSH may need more tweekling to .5?  You realize I am at .069 (much lower)?  Would splitting the Armour cause this to finally change?

I don't think I can go two hours without food in the AM so I will try sublingually again.  When would I take my first dose if I get up at 8am?  Are you wanting it to "kick in" later in the morning?  Is that why I am waiting until one hour after waking?

I have never thought of taking my B complex at lunch time but I can try it.  I bought a timed release one so it is supposed to take 8 hours to fully absorb.  Do you think taking it in the morning with everything else would still be okay?  I want to simplify my life...not make it so complicated :(  

I hope I answered all your questions and please let me know what you were thinking on the Armour dosage and TSH.  

Debbie
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499534_tn?1328707778
There is a little room for improvement with your T4 level, but there is quite a bit of room for improvement with your T3 level. You levels look a lot like mine....I can't seem to get my T3 level where it should be (high normal). I am thinking about discussing with my doctor if she would be willing to trial a run of Cytomel (T3) with my Armour just to see what happens. I may have quite more difficulty converting T4 to T3 than we thought.
Just thought I would add my 2 cents. Low T3 can make you feel miserable!
Also are you taking B50 or B100 complex? Take the higher dose one....liquid form is actually best because you will absorb more than you will pee out.
Don't be afraid of your TSH number....it is always very low and looking hyper when on Armour. My dr tells me we have to treat by symptoms and the Frees not the TSH.
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Avatar_f_tn
I appreciate your input very much.  I do think that I have a problem with T4/T3 conversion.  When I was on Synthroid (.112) and Cytomel (5mcg), my TSH was around 2.4 with a FT3 of 2.9 (low) and FT4 of 1.34 (above mid range).  It seems to me that I wasn't very good at making T3 according to these numbers?

I do take the B-100,  I didn't know there was a 50 so I will be sure not to take it.  Mine is timed release which just makes it easier.  I feel like I am tied to a bag of supplements when I go out so I am not sure how I would do with liquid...you have to take it more often, right?

I have Cytomel so I guess I could try what you are saying but first I will try the route of splitting my doses.  I would be very curious to hear if it works for you.  Let me know if you are interested in staying in touch.

Debbie :)
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393685_tn?1325870933
Oh Goodness - when I read the TSH I read .69 not the zero - sorry.

I still don't feel any difference in what I thought could help you. Regardless - dividing those dosages more throughout the day - may even keel you out better with the T3 levels. You should be higher there regardless.

I agree with Laura and she sure has been a tough case to crack on her T4 and T3 levels. We can talk for hours on "thoughts" - she has more issues than I did - with raising t3 levels and she still has a thyroid working in her :)

I think as we talked - her throught of adding Cytomel may be helpful for her with her doctor.  I believe there are alot of us NO THYROID patients with conversion issues - more than what is talked about or released.

Probably a good idea for you to try splitting first instead of looking directly at another med.  You still will have no meds available on Sunday right taking the 2 grains? I don't like that idea at all either. Will your doctor consider adding to the script so you can take it 7 days a week? If not I would accommadate the weekly dosage so you can take it 7 days and not skip Sundays - but I would split the meds up to taking them 3 x's a day at least in smaller dosages.

I have tried it both ways taking Armour and I really find taking it sublingually is most effective. You may find taking it in smaller dosages through the day helps control the swing up and down better off swollowing the med. It also is a steady release of meds and you actually are getting the full dosage through out the day every day. I decided to take it sublingually because I had such horrible burning in my stomach and bypassing that process helped get my belly back on track again. Plus I can eat when I want then.

I like taking my B's later in the day - I feel better and sleep good too. It works good for me. I take a liquid form of it as Laura suggested too. It made a huge difference.

Go ahead and change things up the way they work for you - as long as you are getting it all in - that's key. I like to take the B's later for the thought that they burn more fat in the body and increase energy - so I use it to get through that afternoon hump and I don't have any sugar or carb or caffine cravings doing it later too.
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Avatar_f_tn
Thanks for clarifying a few things.  I will splt my dose up to last over seven days (I have 60, 90 and 120 mg so I can do it myself.  I don't think my doctor is stuck on me doing a skip day, this was just her suggestion so I didn't have to cut pills.  Obviously she isn't on hormone replacement or she would know this doesn't work!

You think because I still had hypo symptoms it was more related to how I spread out the T3 and not that I need a little more, right?

I will try the sublingual again but this time with food in mystomache and see if I do better.  I think you are right that smaller amounts will be more tolerable.

I'll try the B at lunch.  If it helps, why not.  I did add more C (1000mg in AM and 500mg at dinner is the total now).  Let's see how I do for a couple of weeks.  Thanks again!



Debbie :)
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Avatar_f_tn
First day at new dose...after taking 1 grain sublingually, I had chest pain, snowy vision and became irritable within 40 minutes.  This tells me my adrenals are weak.  I will try tomorrow with a lower AM dose (.75 + .75 + .50).  Incidentally, I felt good this morning when I got up!  Yeah! :)

Debbie
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393685_tn?1325870933
If those seem to still be to high you can go with 30mg 4x's a day too.

Keep us posted
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Avatar_f_tn
It's been five weeks since I began splliting my armour dosage.  I now take 1 grain in the AM and .75 grains at 2pm (both sublingually).  I just had my blood drawn on Monday and received my results today:  TSH 2.25 (.45-4.5), FT3 2.4 (2.3-4.2) and FT4 .76 (.61-1.76).  Huge drop from before!  I have been feeling tired and my muscles a little achy.  Now I know why.  Why would my levels adjust so much?  Of course now, my doc is happy with my numbers and I don't feel any better.  

Any suggestions?  I am at wits end with all of this :(

Debbie
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393685_tn?1325870933
Clearly the Free T3 is bottoming out on your lab. You are very low on that test. This a FT3 in that range - hypo symptoms most likely will rear up.

I am thinking either an increase now is needed to raise the FT3 (and in turn lower the TSH) and also you may need to try supplementing with selenium.

Selenium can provide some assistance with conversion with some thyroid patients. Some have found huge differences - some struggle with it.

How are the adrenals right now - Did you retest? If they are still slow - that can pull off the Armour and cause hypo symptoms too.

Are you still not taking Armour on Sunday? What time and day did you test and did you test with having Armour in you that day?
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Avatar_f_tn
Thanks for taking the time to get back to me.  I am taking armour everyday including Sundays.  As far as my adrenals, no she has not retested.  I did start taking resveratrol three weeks ago which is supposed to help your adrenals.  It seemed that a week into it, I started getting tired.  My nails are starting to break easier and I can't lose weight for anything...I feel like I am now retaining water.  It's actually supposed to be very good for your body (made from red wine grapes), and maybe my body is becoming more efficient and is finally using the armour better?

I definately think I need to raise it as I am on a downward slope right now and by the time I see her, I could be very hypo.  Not changing my dosage and just when I take it has caused a big difference in my levels.  If the resveratrol is affecting it, I probably do need to go up.  I can try selemium but won't that lower my FT4?  It's already almost at the bottom of the range.

I was so tired last night that I forgot to mention my FSH and LH.  FSH is 105.4 and LH is 85.4.  Both of these numbers are high for a woman on bioidentical hormones.  My estradiol is very low 41 (19-528) but she is dosing my symptoms (hot flashes) not numbers.  This could be taking its toll as well?  If the resveratrol is supposed to help adrenals, wouldn't this help my sex hormones too?  I am a real mess! :(

Debbie

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Avatar_f_tn
Sorry, I left out that I had my blood test in the morning before eating or taking my armour.  My last dose would have been at 2pm the day before (approx).  
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393685_tn?1325870933
The whole thing sounds like a tweeking of meds and creams are needed to get you stable.

It does sound like the doctor is approaching the estrodiol and progesterone correctly - but why IF you are on Armour are they not dosing by symptoms and following the TSH?

Usually increases with Armour are two weeks apart until the patient is symptom free.

It doesn't sound like this is you - or I am missing something in your responses.

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Avatar_f_tn
No, you are correct. She is dosing by symptoms for estradiol and progesterone and not for thyroid meds.  I agree, I need tweeking!  My first thought is that I am still getting too much progesterone which can make me tired, gain weight, some acne (less than before), etc.  Since I cannot have her rewrite the prescription until I see her in Mid-April, I will try cutting back on my own which means less estradiol as well.  I take two pills a day with a combination of both...I will try one a day for a week and if my hot flashes don't return, I may be okay. .

If all goes well but I still feel as if I am going hypo (no hot flashes though), I can slowly raise my armour 1/8 a grain and see how it goes.  I have plenty of time before my appointment to do this and so I can tell the doctor how I feel.  She is open to my input but unfortunately almost impossible to get in to see and so I find I am left on my own to figure this out.  

Another option would be do raise armour first but I still feel like I am getting to much progesterone.  My levels are 4.8 and I don't really understand all the different ranges,  I do know that I started at .5 and so it has gone up 4.3,  I am taking 150mg per day with 1.0 estradiol.  

If you can think of anything else, please let me know.  You are a great sounding board. :)

Debbie
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