recently diagnosed hypothyroid (with lab results)

[tsr58]

I am looking for suggestions with regard to "lifestyle changes" (diet, etc.) for people with hypoactive thyroid. For several years I have had a practice of walking an average of two to three miles per day; sometimes more. I eat very little salt and eat more fish and chicken than red meat.

PMD recently prescribed Armour Thyroid 60 mg. in the AM due to TSH of 4.88. Selected lab results are below.

I read here on the "Armour Health Page" the suggestion that the medication be taken sublingually rather than swallowed. Neither my MD nor my pharmacist mentioned this. I take other meds in the morning (Lisinopril, Wellbutrin, Ritalin, baby aspirin (also inhale Advair and Nasonex); and in the PM, Sanctura, Colace, Xanax PRN, and Ambien PRN) all of which I swallow with obvious the exception of the sprays.

QUESTION: Is it important to dissolve the Armour Thyroid under my tongue rather than swallowing?

QUESTION: I read on the same page that it's good to divide the dose at least 2x per day, to spread the effect. Again, is this an important point? It's not the way my prescription was written. If it's important, I'll discuss it with my MD. Thyroid issue is new to me.

QUESTION: Are any of the OTHER meds listed above known to cause thyroid issues or interactions with Armour Thyroid, including possibly impairing systemic absorption?

QUESTION: Would grapefruit juice potentiate (increase) or block the effect of Armour Thyroid? Avoid it?

RECENT LAB RESULTS:

TSH 4.88 uIU/mL (Range = 0.450 - 4.500) - High
Thyroxine (T4) 7.9 ug/dL (Range = 4.5 - 12.0)
Triiodothyronine (T3) 135 ng/dL (Range = 85 - 205)

Sex Horm Binding Glob, Serum 24 nmol/L (Range = 13-71)
Free Testosterone (Direct) 9.0 pg/mL (Range = 7.2 - 24.0)
Estradiol 28 pg/mL (Range = 0 -53 / Adult Male 39) - Low
LDL 115 mg/dL (Range = 0-99) - High
LDL/HDL Radio 3.0 (Range = 0-3.6)

Calcium (Serum) 9.2 mmol/L | 9.3 on 1/2/2009 | (Range = 8.5-10.6)  
Sodium (Serum) 139 mmol/L on 2/1/2009 | 103 on 1/2/2009 | Range = 135-145)
Glucose (Serum) 71, fasting (Range = 65 - 99) fasting / 114 on 1/2/2009, not fasting

White Blood Count 9.8 on 2/1/2009 | 12.0 on 1/2/2009 - High | (Range = 4.5-11)
Red Blood Count 4.74 on 2/1/2009 | 5.08 on 1/2/2009 | (Range = 4.7-6)
Hemoglobin 14.3 on 2/1/2009 | 14.9 on 1/2/2009 | (Range = 13.5-17.5)
Platelets "Unable to perform adequate platelet count due to platelet clumps" on 2/1/2009 | "Clumped" on 1/2/2009 | (Range = 150-400)

"Hematology comments: Differential verified. Slight anisocytosis [red blood cells of unequal size] and poikilocytosis [presence in the blood of poikilocytes]. Few large platelets were observed... Unable to perform accurate platelet count due to platelet clumps. Platelets appear adequate on slide."
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I had prostate cancer; RRP in 11/2006. PSA 0 since; Depression since 2003; ADHD first dx 1982; and Hypertension since 2008.

My next scheduled MD appointment is next Monday, with a hematologist/oncologist, to assess the platelet clumping, as well as some unexplained bruising, followed by my PMD the following Monday. I was assessed for this once before, in 2005, with negative findings. Clumping at that point in time was attributed to an anticoagulant agent in the test tubes, rather than any medical condition in me.

Recent symptoms: In recent months I have gained about 10 lbs., despite daily walking and moderate diet. I have felt run down and unfocused, despite meds; anxiety, insomnia. Lipid profile (HDL and LDL) has been healthy from 2004 up to the most recent. LDL is now elevated, and HDL low.

It's unclear to me whether the platelet clumping and bruising could be related to high TSH, or if it is entirely unrelated. This issue seemed to concern my PMD more than the elevated TSH. Could they be related?

Childhood health history positive for mumps, chicken pox, and unconfirmed rheumatic fever.

Family history is positive for hyperthyroid (mother); leukemia (paternal grandmother); and heart disease (father and paternal grandfather); and diabetes (paternal grandmother, sister).
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NOT TESTED RECENTLY, BUT PLAN TO DISCUSS WITH MD:

Thyroid Antibodies (TPO and TgAb) -
Ferritin –
B12 -  
DHEA –
Cortisol –
VitD –
Phosphorus –
FSH -
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Any suggestions or advice would be most welcome, with thanks.

[laura1967]

Hypothyroidism can cause cholesterol level problems and depression, which may correct themselves once you find an optimal level. I use a pill splitter with my Armour even though there is not score. I split in half....too difficult to split 3 way. You might want to stick with your dr who prescribed the armour, as it is hard to find endo's to prescribe armour....unless your dr knows one to refer. Make sure you are doing thyroid lab work every 4-5 weeks until you reach optimum levels. Most important....you need to find out WHY you are hypo? Have her run those autoimmune tests. If you have Hashi's then you will need to have supressed levels to keep those antibodies in check and for your body to be able to heal.  
I also think your attention definately should be on the platelet clumping....glad to hear you are going to see a hemotologist.

[tsr58]

Laura,

I was only diagnosed this week and have been on the medication since Wednesday. You're the first person I've found, aside from my PCP (who didn't tell me very much about it aside from writing the scrip) who seems to know anything about hypothyroidism, treatment, etc.

The Armour Thyroid pills that I have (60 mg.) are relatively small and are not scored. I do have a pill-splitter though. They can be split without impairing their effectiveness? I think the pill is too small to split into three parts.

It seems like a stroke of luck that I was diagnosed at all. I went to my PCP with an appointment for an annual physical. She was not in the office, due to an emergency at the hospital. The nurse met with briefly and took fasting bloodwork. I asked her to include a hormone panel; specifically testosterone, due to feeling tired, run down, no libido, etc. She suggested adding thyroid to the work, which I had never had done before. If the doctor had been there, I'm not sure it would have occurred to her to order it, as she has not brought it up before.

When I saw the doctor last Monday, she noted the elevated TSH and recommended Armour Thyroid (specifically mentioning that she prefers this to Synthroid), but didn't comment on it much. She seemed more concerned about the platelet clumping, in part because of some unexplained bruises on my abdomen which I had not even noticed; and referred me to a hematologist/oncologist for a consult. Once I see her, I suppose an endocrinologist will be next.

The lipids levels, which also concern me, are actually improved from fall 2007, but worse than they were before that. I walk several miles a day and ea a healthy diet, so I could see no good reason for LDL to be increasing and HDL going down. Hypothyroidism, I suppose, may explain it. I've also started taking Niacin.

The lipid numbers in my initial post may have been a bit confusing. This will clarify:

Date/Time             LDL - HDL - Total
02/02/2009 09:00 - 115 - 38 - 166
09/17/2007 08:17 - 126 - 39 - 181
09/27/2006 08:18 -   84 - 51 - 181
10/19/2005 08:21 -   98 - 50 - 163
09/27/2004 08:11 - 110 - 30 - 156
06/29/2001 08:31 - 160 - 26 - 211
02/10/1995 14:00 -  ??? - ?? - 244

I wonder if the thyroid meds will also help with the depression for which I've been on Wellbutrin pretty much since 2003 (with brief tries on SSRIs)!  Maybe even contributing to attentional difficulties that I've had (though I was diagnosed wit ADHD in 1983 when I was in college, and retrospectively dating back to childhood).

In any case, I appreciate your reply and would welcome any additional thoughts you might have

Are you aware of any possible connection between hypothyroidism and low platelet count and/or platelet clumping, leading to unexplained bruising?

Thanks.
  

  

[laura1967]

Hi there and welcome!
You should never take meds with grapefruit juice...it interferes with absorption of many meds. Meds are best taken with full glass of water.
Armour should always be split into 2 dosages because T3 meds are short lived. First dosage taken early am 2-4 hrs before any other meds. 2nd dosage should be taken approx 5-6 hrs later. If you are going to try to take it sublingually, then break dosage into 3 times so you aren't absorbing so much at once....otherwise it may make you feel hyper with palps. I swallow mine, but there are many who do sublingual. My body was too sensitive to do sublingually. It is very common for pharmacist and dr to forget or not know to tell you to take in divided dosages. Sadly too common.
I don't think there are any drug interactions with thyroid meds, but always check with your pharmacist with everything you are taking...you are on a lot of meds.
It looks like you may have some other hormonal issues going on....your testosterone should be higher than just a low normal, could also be why your estriodal level is low as testosterone will convert to that.