Aa
low tsh on armour dr wants to reduce armour dose
I am 54 and have had Graves Disease for 9 yrs now and have been on armour thyroid (90 gr) for almost 2 yrs now and every time I see my dr to get labs done, she wants to dose me according to the TSH. Today she called and said it had gone down again since January and wants me to reduce my dose to 60.. I am starting to gain (5 lbs since Jan) and I don't want to gain anymore and afraid if I decrease my dose I will gain another 5 lbs... When I started on Armour I lost 5 lbs and again later another 5 lbs and had maintined till this past Jan. I am very short and cannot gain any more weight.. I have also been riding my excercise bike for 1/2 hour, at least 5 days a week and also take a 30 min walk at least 3 times a week and still no loss or even inches in a month now....
Is it wrong to dose according to TSH levels and what dr is more familiar with armour dosing? I am seeing a regular dr in an internal medicine office.. they do have a part time endocrinologist and she will ask him for advice but he is old school and doesn't believe in armour......so not much help there...
I do need to say that I have felt more energy and better than I ever did on synthroid but want to get dose right so that it helps me as much as possible........rather than just be in normal range, would like to be in higher end of normal..how do I get the dr to believe me or understand what it is like living with this???
Thanks for any advice you may have.
Is it wrong to dose according to TSH levels and what dr is more familiar with armour dosing? I am seeing a regular dr in an internal medicine office.. they do have a part time endocrinologist and she will ask him for advice but he is old school and doesn't believe in armour......so not much help there...
I do need to say that I have felt more energy and better than I ever did on synthroid but want to get dose right so that it helps me as much as possible........rather than just be in normal range, would like to be in higher end of normal..how do I get the dr to believe me or understand what it is like living with this???
Thanks for any advice you may have.
Thats why I had to take care of myself. Could not find a doc that would not watch that TSH. It just got so frustrating, and thought I would have a nervous breakdown.
Hypothyroidism at 36 years old (now 55) Graves disease 2002 PTU, Radioactive iodine 2004.
Hypothyroidism at 36 years old (now 55) Graves disease 2002 PTU, Radioactive iodine 2004.
Mainly what I was trying to provide you with the above article was more info that showed the fallacy of using TSH to dose hypothyroidism. You might also find it interesting as another indicator of your thyroid state, to check your basal temperature, which is done in the armpit before getting out of bed in the morning. The normal range is reported as 97.6-98.2. If using a digital thermometer, turn it off and place in the armpit and let stay for 10 min., then turn it on and take reading. I'm told this gives a better reading with a digital.
Thanks for info.. I used to take my thyroid med at night and then when I went on Armour, went back to morning. I also take it sublingually under the tongue..a nurse on Weight Watchers had suggested so doesn't interfere with other drugs. I did have my results faxed today and my NP only did the Free T4 which is mid range for the values from my lab. That makes me more convinced to stay on the dose I am comfortable with.. And I also had taken my Armour the morn I had my labs drawn and wa always told not to take it before labs were drawn.. I have always had to be pro active in my care as it seems most endocrinologists I have run across are more caring for diabetes patients rather than thyroid patients... Frustrating situation to say the least. Tried an alternative clinic also and she was more into hormone replacement therapy that when I went on Bioidentical estrogen and progestrone.. I almost went WILD!!! I was a basket case and just stopped it and finally got back to somewhat normal I will say I do get hot flashes more often than I had been having them more recently and maybe it is too much thyroid in my system, but I gain weight so easily and am only 5 ft tall that I will have to stop eating to control it. I am so jealous of people I see eat anything and are still small. I still am under 185 but that is my top weight and am getting close to it right now and scared to death it will go higher......
Maybe this might provide some additional info for your discussion with doctors. following is an excerpt from this link.
http://www.endfatigue.com/health_articles_t-z/Thyroid-taking_thyroid_hormone_at_night.html
Should Thyroid Hormone Be Taken at Night?
A new study shows that TSH and Free T3 and Free T4 levels fluctuate during the day . Surprisingly, TSH levels start to rise around 9 pm, hitting bottom again around 9 am. T3 levels follow a similar pattern following TSH levels by around 90 minutes (as would be expected if the TSH stimulates T3 release from the thyroid). T4 variability was not associated with TSH variability. So what does this all mean?
Key interesting take home points:
1. Thyroid hormone levels are highest at night while we sleep—NOT while we're awake.
2. Even though TSH regulates T4 over the long term (days to weeks), TSH variability during the day mostly seems to play a role in fine tuning T3 levels during the day, having little to no effect on T4 hormone variations during the day. This suggests that fine tuning the timing of giving T3 is more important than T4.
Implications:
1. With TSH varying so widely during the day (increasing by 72% from its daily low to its daily high—almost 1 mU on average and sometimes over 2 units in some people in the study), strictly interpreting a TSH level as the sole determinant of whether someone needs thyroid hormone becomes an even more ridiculous approach than it has been in the past (unless they want to define the normal range based on a set time of day the test was done—even if one does, TSH is still horribly unreliable).
2. Earlier research has suggested that people do better taking their thyroid hormone at bedtime instead of in the morning, and clinical experience has shown this is also often the case. This study further suggests that thyroid (especially if it also contains T3) may best be taken at night instead of in the morning. I have often had patients take part of their thyroid later in the day. Years from now, we may find this to be the preferred approach (perhaps even giving the entire dose at bedtime). Even now, for those not doing well on thyroid, it is worth a try of taking all or part of the thyroid dose at bedtime for a few weeks to see which way feels best.
3. Giving T3 may be important as well as T4. It is interesting watching the authors tiptoe around this issue. One can almost feel the politics as they say "Following the first publication that a combination replacement therapy of T4 and T3 may improve quality of life for hypothyroid patients,13 there has been considerable debate as to actual benefits. Despite a large number of studies there is no conclusive evidence that combination therapy with T4 and T3 improves efficacy of therapy or health related quality of life."14 This statement, of course, ignores that there is no conclusive evidence that using only T4 (e.g., Synthroid) does so either. This simple observation is irrelevant to the politics of treating an underactive thyroid though, and I suspect the authors were simply spouting the current dogma so they could avoid being attacked for proposing that perhaps T3 may be worth adding to treatment (as they hint at).
http://www.endfatigue.com/health_articles_t-z/Thyroid-taking_thyroid_hormone_at_night.html
Should Thyroid Hormone Be Taken at Night?
A new study shows that TSH and Free T3 and Free T4 levels fluctuate during the day . Surprisingly, TSH levels start to rise around 9 pm, hitting bottom again around 9 am. T3 levels follow a similar pattern following TSH levels by around 90 minutes (as would be expected if the TSH stimulates T3 release from the thyroid). T4 variability was not associated with TSH variability. So what does this all mean?
Key interesting take home points:
1. Thyroid hormone levels are highest at night while we sleep—NOT while we're awake.
2. Even though TSH regulates T4 over the long term (days to weeks), TSH variability during the day mostly seems to play a role in fine tuning T3 levels during the day, having little to no effect on T4 hormone variations during the day. This suggests that fine tuning the timing of giving T3 is more important than T4.
Implications:
1. With TSH varying so widely during the day (increasing by 72% from its daily low to its daily high—almost 1 mU on average and sometimes over 2 units in some people in the study), strictly interpreting a TSH level as the sole determinant of whether someone needs thyroid hormone becomes an even more ridiculous approach than it has been in the past (unless they want to define the normal range based on a set time of day the test was done—even if one does, TSH is still horribly unreliable).
2. Earlier research has suggested that people do better taking their thyroid hormone at bedtime instead of in the morning, and clinical experience has shown this is also often the case. This study further suggests that thyroid (especially if it also contains T3) may best be taken at night instead of in the morning. I have often had patients take part of their thyroid later in the day. Years from now, we may find this to be the preferred approach (perhaps even giving the entire dose at bedtime). Even now, for those not doing well on thyroid, it is worth a try of taking all or part of the thyroid dose at bedtime for a few weeks to see which way feels best.
3. Giving T3 may be important as well as T4. It is interesting watching the authors tiptoe around this issue. One can almost feel the politics as they say "Following the first publication that a combination replacement therapy of T4 and T3 may improve quality of life for hypothyroid patients,13 there has been considerable debate as to actual benefits. Despite a large number of studies there is no conclusive evidence that combination therapy with T4 and T3 improves efficacy of therapy or health related quality of life."14 This statement, of course, ignores that there is no conclusive evidence that using only T4 (e.g., Synthroid) does so either. This simple observation is irrelevant to the politics of treating an underactive thyroid though, and I suspect the authors were simply spouting the current dogma so they could avoid being attacked for proposing that perhaps T3 may be worth adding to treatment (as they hint at).
Just suggest to her to look into T3 studies and see how the TSH is correlated.
The TSH is naturally suppressed - even with normal thyroid function if all is working correctly due to the Free T3 circulating within the body.
The TSH is the pitutiary telling the thyroid to produce hormone - so if you were a Graves patient - with no thyroid left - Your meds are now controlling most of that conversation and the T3 in Armour is controlling your symptoms and metabolic stability.
Take a look at this reading I just got this morning. It may help you understand more on the T3 information to share with your doctor.
http://www.thyroidscience.us/info/06%20Chapter.2.Metabolic.Rehab.pdf
The TSH is naturally suppressed - even with normal thyroid function if all is working correctly due to the Free T3 circulating within the body.
The TSH is the pitutiary telling the thyroid to produce hormone - so if you were a Graves patient - with no thyroid left - Your meds are now controlling most of that conversation and the T3 in Armour is controlling your symptoms and metabolic stability.
Take a look at this reading I just got this morning. It may help you understand more on the T3 information to share with your doctor.
http://www.thyroidscience.us/info/06%20Chapter.2.Metabolic.Rehab.pdf
Thanks, This is the same NP that started me on this medicine and I have tried to educate herbut she just doesn't remember. I did get her to up the dose once (from 60-90) but I think she forgets. I did go see a dr in the same office and she had to ask an endocrinologist about the armour and kept me on the same dose in Jan... but I don't feel comfortable with her dosing either. We don't have alot of endo's where I live and I have been thru a few of them. I don't particularly feel bad right now and I am not going to drop my dose down.....I just dont feel I want to gain any more weight and I know I will...
You might also tell the doctor that scientific studies show that alleviation of patient symptoms does not correlate with TSH levels. The test that best correlates is free T3, with free T4 a distant second. I think that Doctors get hung up on keeping TSH within its reference range because of the mistaken belief that below the range automatically classifies you as hyperthyroid and maybe they want to maintain TSH within the range to prevent any possible criticism. In the absence of hyper symptoms, you are not hyper, just because of a low TSH. Another concern they will sometimes mention is potential bone loss. Bone loss cannot be caused by the absence of TSH (low TSH test result). The only possible association would have to be from excessive T3 and T4, but as I understand it, this possibility only exists with levels that far exceed their reference range.
You are correct that she should not be dosaging armour according to TSH. The T3 will supress the tsh down and make you look hyper when on optimal dosage. She should be looking at the free t3 and free t4 levels. T3 should mid high normal range, T4 level should be mid normal range.
This is a common mistake that drs make, and the sad thing is that it makes it look like armour doesn't work for people, when in actuality it is because these drs don't know how to dosage properly.
Stand your ground and gently try to educate her....
This is a common mistake that drs make, and the sad thing is that it makes it look like armour doesn't work for people, when in actuality it is because these drs don't know how to dosage properly.
Stand your ground and gently try to educate her....
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
