Why more medication is making levels flip

[Jamielin86]

So I have been on Armour Thyroid for 13 years. My levels have always been in the normal range and we have never messed with my dosage. Well I started not feeling good a few years back and have just started seeing a new doctor who thinks it has to do with the re formulation of Armour. So he added cytomel 5mcg to my daily Armour medication and I started to feel better. We retested my levels and they were still In middle of the range and the doctor decided to add 5 mcg more of the cytomel. Well now my blood work is showing a .5 tsh (lab normal is .350-4.500) but my t4 free is .64 (.80-1.80)and my free t3 is 2.9(2.3-4.2). So from last time my tsh has came down some more but my other levels have went lower too when they were higher. Any explanations of why my free t4 is now showing hypo when I'm on more medication and my free t3 has dropped as well?

[Barb135]

Yes, I understand that you've been on Armour for 13 years, but our bodies can change over time and we react differently, especially if you have Hashimoto's.  Hashimoto's is constantly destroying thyroid function and as it's declining or gone, you may need medication adjustments.  

If you want to increase FT4, you should add T4 med, not something that contains more T3...

You should ask for the TgAb test to help confirm/rule out Hashimoto's.

Do you remember if you had taken your Armour prior to the blood test in which your FT3 was at 3.5?

[Jamielin86]

Appreciate your help. I've been on Armour for 13 years. The only change we've made is adding the cytomel. I don't think I've ever had a TgAb test. I will ask the doctor about it. I hope my body is just trying to figure out what's going on. Yesterday My Doctor upped my Armour from 60 to 90mg and reduced my cytomel from 10 to 5 mcg to see if we could get my ft4 up.

[Barb135]

What are the reference ranges for the Free T3 and Free T4? Reference ranges vary lab to lab and have to come from your own report...

I take a T4/T3 combo and my FT4 went down for a while after I added more T3, but then after a few months (probably about 6) things leveled out and it came back up... Sometimes it takes the body time to adjust to dosage changes - everything has to rebalance and it often doesn't go as fast as we want it to.

Had you taken your Armour prior to the blood test when FT3 was 3.5, but maybe not, when it was 2.9?  Taking medications with a T3 component prior to a blood draw will give a false high result.  You should always have the blood draw prior to taking any med that contains T3...

Perhaps you had the blood draw after your Armour dosage when you had the 3.5 FT3 but did not take any thyroid hormones when you had the 2.9 FT3?  

TPOab is not the only antibody test to diagnose Hashimoto's... Have you ever had a Thyroglobobulin Antibodies (TgAb) test? That's another marker for Hash's... If you haven't had that test, you should ask for it...

[Jamielin86]

T4 free before cytomel was 1.12,  t3 free was 3.5. I understand my t4 wouldn't necessarily go up but I don't see why it would go lower by adding cytomel. My Armour dosage is 60 mg a day.  Been on added cytomel since April. Not sure if I have Hashimotos or not. My TPO is only 13 the last time it was checked if that tells you anything.

[Barb135]

What dosage of Armour are you on?  Since you've only added cytomel to the Armour, there's no reason to think your FT4 would come up... in order to bring FT4 up, you have to add T4 med, not cytomel, which is T3 med.

What were your FT3 and FT4 levels before adding the cytomel?  TSH is pretty much irrelevant... How long have been on the added cytomel?  Did you try increasing the Armour dosage before adding the cytomel?

Do you know if you have Hashimoto's?

Sorry to ask so many questions, but knowing the answers to these questions could help us figure out what's going on...