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follow up labs and switching medication

I am new to the hypothyroid world and am trying to figure out my next best step.  

Initially my test results were:

TSH: 1.21 (range is 0.20-4)
Free T4 is 11.3.  (10.0-25.0 pmol/L)
Free T3 is 3.03.  (3.5 - 6.5)
Thyroid Peroxidase antibody is 13 (0-34)

My doc put me on synthroid, starting dose of 25 mcg.  I know this is basically a placebo dose.  I moved up to 50 mcg after two weeks and had a pretty bad reaction: feeling exceptionally tired, bad headaches, dizziness, overheated, heavy limbs.  The reaction felt like a combination of hyper and hypo thyroid.  I tried to stick it out for at least a few weeks on the higher dosage but ended up going back to 25 after a week and a half.  I had blood work done after 4 weeks of being on the meds (and a week and a half of being on 50 mcg).  These are the results:
After four weeks:

- TSH 0.72 (0.20 - 4.00 mIU/L)
- FREE T4 17.2 (10.0 - 25.0 pmol/L)
- FREE T3 3.8 (3.5 - 6.5 pmol/L)

I do know that this was not enough time for the dosage to be fully in my system but I needed to test then because I was going out of town and wanted to get off the 50 mcg dosage because it was making me feel awful.  I have since stuck with 25mcg.  Like I said, I know this dose is very low but my system has always been extremely sensitive to supplements of any kind.  

My jump in T4 leads me to believe that the synthroid was actually doing something though the lack of jump in T3 also leads me to believe I might have a conversion issue.  

My questions are:

1. what do you make of these results?
2. treatment possibilities:  if I am this sensitive, should I try 37.5 mcg of synthroid?  I also have a rx for Armour and would like to try it so am wondering what anyone thinks of this as an option given that it has both T4 and T3.

Other things: I did not get any other tests done but am taking iron, D, and B supplements as I know this is a factor.

I thank you in advance for your help.
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Avatar universal
I tend to think that those of us who are very sensitive to meds should probably give T4-only therapy a fighting chance.  If it works for you (and it does for me), the natural conversion process remains intact, and T3 to cells remains more "on demand".  

The numbers:  We're looking for an FT4 of about 50% of range.  When FT4 is there, FT3 should be 50+% of range.  Of course, we're all different, and those guidelines were meant to be broken by real humans. My FT3 tends to run very low, but I'm asymptomatic.  If your FT4 is where it should be (and for a while, not just a blip on the screen), your FT3 is still lagging and you still have symptoms, then a conversion issue is suspected.  In my experience, FT3 continued to go up for a while after my FT4 was stable.  

My FT3 and FT4 run considerably lower than the guidelines.  I often wonder if sensitivity to meds translates to sensitivity to all substances, including thyroid hormones.    
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Avatar universal
Thank you so much for the response. I really appreciate it.  

In your experience, do you think it would be better for me to stick with the synthroid and wait it out a bit longer instead of switching over?  I don't want to mess with synthroid if it might ultimately be the answer.  I just don't have a sense of what the conversion numbers should look like.  I am pretty pleased that my numbers went up so nicely.  I wonder if people like us who are so sensitive would feel overwhelmed on the combination of T3 and T4.  

I would love any more suggestions if you have a moment.

Thanks.
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Avatar universal
Your FT4 certainly came up nicely.  FT3 did as well.  It's still low, but it took quite a jump (from below range to 10% of range).  Many of us found that it took some time once FT4 levels were good for conversion to ramp up and FT3 to follow.  

I am very sensitive to meds/supplements as well, and my philosophy is to increase very slowly.  You could try increasing to 37.5 mcg.  You could also alternate 25/37.5 for a slower increase if you feel you need that.

Armour does have both T3 and T4.  However, the pig's thyroid produces a lot more T3 than human thyroids do.  For some people, that's a bonus, for others, it's too much.  T3 is also very fast acting and apt to take a little more getting used to than T4.  

Since your FT4 has been where it is for such a short time (and will probably go down some after you've cut back to 25 mcg), I think the jury is still out on whether you convert well or not.    
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