Aa
what are normal lab values on Armour?
OK, I realize there is no general rule, but that you need to go by symptoms. But I would like to ask something:
I've been on Armour Thyroid for the past year (I don't find AT nearly as bad as many say; it's actually worked quite well for me and I'm happy with it). Until recently, I was on 5 grains daily, and then my doctor suggested I decrease my dosage to 4.5 grains daily. These labs were taken two months apart:
on 5 grains of Armour:
TSH <0.001
FT3 4.1 (ref 1.7-3.7)
FT4 1.1 (0.8-1.8)
On 4.5 grains of Armour:
TSH <0.001
FT3 3.3 (ref 1.7-3.7)
FT4 0.9 (0.8-1.8)
My doctor - who, BTW, does not care about the TSH - said that since my FT3 levels were slightly elevated 24 hours after the latest dose, on 5 grains of Armour, I most likely needed a decrease. She also said that, since my FT3 levels on 4.5 grains were high in the range but not above range 24 h after latest dose, this means that my FT3 levels were "optimal" the day before.
But I have felt slightly more tired since my dose was lowered. I am also a bit worried that my FT4 levels are very low on 4.5 grains of Armour, but maybe I don't have to worry about that when I take direct T3? Aren't FT4 levels more important to people on thyroxine only, who need to make sure they have enough raw material to convert?
I understand that 5 grains of NDT is considered a hugh dose, and something most doctors would hesitate to prescribe?
FYI, I also tried Erfa Thyroid for a brief period, but did not like it. I had to go up to 360 mg to get the same effect as I do on Armour, but I still feel better on Armour. It feels like Armour is longer-lasting, while the effects of Erfa wear off pretty fast...but that's just me, of course.
Any thoughts on this would be greatly appreciated, thanks!
Kate
I've been on Armour Thyroid for the past year (I don't find AT nearly as bad as many say; it's actually worked quite well for me and I'm happy with it). Until recently, I was on 5 grains daily, and then my doctor suggested I decrease my dosage to 4.5 grains daily. These labs were taken two months apart:
on 5 grains of Armour:
TSH <0.001
FT3 4.1 (ref 1.7-3.7)
FT4 1.1 (0.8-1.8)
On 4.5 grains of Armour:
TSH <0.001
FT3 3.3 (ref 1.7-3.7)
FT4 0.9 (0.8-1.8)
My doctor - who, BTW, does not care about the TSH - said that since my FT3 levels were slightly elevated 24 hours after the latest dose, on 5 grains of Armour, I most likely needed a decrease. She also said that, since my FT3 levels on 4.5 grains were high in the range but not above range 24 h after latest dose, this means that my FT3 levels were "optimal" the day before.
But I have felt slightly more tired since my dose was lowered. I am also a bit worried that my FT4 levels are very low on 4.5 grains of Armour, but maybe I don't have to worry about that when I take direct T3? Aren't FT4 levels more important to people on thyroxine only, who need to make sure they have enough raw material to convert?
I understand that 5 grains of NDT is considered a hugh dose, and something most doctors would hesitate to prescribe?
FYI, I also tried Erfa Thyroid for a brief period, but did not like it. I had to go up to 360 mg to get the same effect as I do on Armour, but I still feel better on Armour. It feels like Armour is longer-lasting, while the effects of Erfa wear off pretty fast...but that's just me, of course.
Any thoughts on this would be greatly appreciated, thanks!
Kate
A quick answer to one of your questions is that in the words of a good thyroid doctor, "Dosage is irrelevant. Clinical response is all important." This is because patients are all different in their absorption rate of the meds, and how they are affected by thyroid meds.
Then, I think you will find this link to be interesting. It gives some history of how hypo patients were treated in the past, before the advent of TSH testing.
http://www.thyroid-info.com/articles/david-derry.htm
More later.
Then, I think you will find this link to be interesting. It gives some history of how hypo patients were treated in the past, before the advent of TSH testing.
http://www.thyroid-info.com/articles/david-derry.htm
More later.
Selenium: 134 ug/l (ref 75-140)
Vit B12: 724 pg/mL (ref 189-883)
Vit D: 31 ng/mL (>30)
Iron 76 ug/dL (ref 25-156)
ferritine 66 ng/mL (ref 10-205)
iron saturation: 19.4 % (15-45)
Thanks for the tip about a good iron product!
Vit B12: 724 pg/mL (ref 189-883)
Vit D: 31 ng/mL (>30)
Iron 76 ug/dL (ref 25-156)
ferritine 66 ng/mL (ref 10-205)
iron saturation: 19.4 % (15-45)
Thanks for the tip about a good iron product!
I wanted to ask you one more thing, as you seem very knowledgeable:-) Hope you don't mind.
Before being put on NDT, I was on 200 mcg of thyroxine for years. Blood tests ordered by my doctor (the one who prescribed NDT) showed a midrange T4 in the blood, but the 24h urine test showed T4 levels of 1100 pmol/24 h (ref 550-3160; should be >2500 according to my doctor). T3 levels were 824 pmol/24h (ref 800-2500; should be at least 2000 according to doctor).
So my question is: should I interpret this to mean that 200 mcg of thyroxine (a dose considered the highest "safe" dose by many doctors) was not enough for me and that, even with the extra T3 in NDT, I still need more than 200 mcg of T4 daily?
I did consider at one point to try and raise the NDT to 360 mg or 6 grains daily, but I decided against it as my FT3 levels were high already on 5 grains and would only rise on more NDT. So I guess you're right, and the answer is to add T4. The only question is: how much???
Before being put on NDT, I was on 200 mcg of thyroxine for years. Blood tests ordered by my doctor (the one who prescribed NDT) showed a midrange T4 in the blood, but the 24h urine test showed T4 levels of 1100 pmol/24 h (ref 550-3160; should be >2500 according to my doctor). T3 levels were 824 pmol/24h (ref 800-2500; should be at least 2000 according to doctor).
So my question is: should I interpret this to mean that 200 mcg of thyroxine (a dose considered the highest "safe" dose by many doctors) was not enough for me and that, even with the extra T3 in NDT, I still need more than 200 mcg of T4 daily?
I did consider at one point to try and raise the NDT to 360 mg or 6 grains daily, but I decided against it as my FT3 levels were high already on 5 grains and would only rise on more NDT. So I guess you're right, and the answer is to add T4. The only question is: how much???
Thanks for your very detailed reply! I have been tested for all those and put on supplements. Vit D and B12 and selenium are all optimal with supplements. The only thing I have a hard time getting up is ferritin and iron. I have tried several supplements, both OTC and prescription, so far unsuccessfully.
With FT3 in the high end of its range and rT3 in the low end of its range, you clearly don't have an rT3 dominance problem. I think you should consider guarding against that possibility occurring in the future by switching some of your desiccated to T4 meds. Then I would continue to adjust med dosages, with a target of reaching the middle of the range for Free T4 and the upper part of the range for Free T3, as necessary to relieve hypo symptoms. This should be done very slowly and carefully to avoid the usual pitfalls related to switching meds and dosages. The whole purpose of this is to avoid the problems patients taking large doses of desiccated sometimes run into, which is that too much of the T4 eventually gets converted into rT3, reportedly as a reaction to high levels of Free T3.
One additional consideration is that we don't know anything about some areas that can have symptoms that mimic being hypo. Before starting any program to switch meds and dosages, I really think you should be tested for Vitamin D, B12, ferritin and selenium.
One additional consideration is that we don't know anything about some areas that can have symptoms that mimic being hypo. Before starting any program to switch meds and dosages, I really think you should be tested for Vitamin D, B12, ferritin and selenium.
I have a copy of the lab results in front of me. My regular lab doesn't offer this test, so it was outsourced to a specialized lab.
You're not slow, my apologies! I forget to include the reference ranges.
My results, with reference ranges within brackets:
RT3: 0.15 ng/ml (0.09-0.35)
RT3: 0.23 nmol/l (0.14-0.54)
FT3: 3.3 pg/mL (1.7-3.7)
So they used two different measurements for RT3, but they are both on the low side.
You're not slow, my apologies! I forget to include the reference ranges.
My results, with reference ranges within brackets:
RT3: 0.15 ng/ml (0.09-0.35)
RT3: 0.23 nmol/l (0.14-0.54)
FT3: 3.3 pg/mL (1.7-3.7)
So they used two different measurements for RT3, but they are both on the low side.
Sorry if I'm slow, but you show two numbers for the Reverse T3 result (and reference range ???). I would expect one for the result and two for the range (low and high levels).
Plus the measurement units are strange looking. RT3 of 0.15 ng/ml//0.23 nmol/l. There shouldn't be two different units used.
Did you get those numbers directly from the lab report, or by phone?
Anyway, I think something is definitely wrong with those, and that is why you get a strange number when you calculate a ratio.
Plus the measurement units are strange looking. RT3 of 0.15 ng/ml//0.23 nmol/l. There shouldn't be two different units used.
Did you get those numbers directly from the lab report, or by phone?
Anyway, I think something is definitely wrong with those, and that is why you get a strange number when you calculate a ratio.
I have double checked the RT3 results, and those figures are correct. I know it's strange, I don't understand it myself.
I was wondering if raising my dosage to 5 grains daily would do the trick, but then I risk my FT3 levels getting too high in the process. So maybe it would be better to add some thyroxine instead?
I was wondering if raising my dosage to 5 grains daily would do the trick, but then I risk my FT3 levels getting too high in the process. So maybe it would be better to add some thyroxine instead?
"My doctor is on Armour herself and says it's impossible to get a normal TSH on NDT, so she's very relaxed about the TSH. She has even stopped ordering the TSH test when she sends me to the lab, but instead goes by the FTs"
- Your Dr could be a dream come true. A Dr who actualy takes Armour is one in a million.
- Your Dr could be a dream come true. A Dr who actualy takes Armour is one in a million.
Please double check the RT3 result and reference range on the lab report. It does look to be unusual.
AS for your question about T4, here is a quote. "Many on desiccated thyroid have lab results that show a low in range Total and Free T4 when their Free T3 gets into the optimal range (upper half). This is because desiccated thyroid (pig thyroid) is approximately 80% T4, and 20% T3, while a normal human’s thyroid output is closer to 94% T4 and 6% T3. [4] The simple remedy for people who test low on T4 is to just add some synthetic T4 to their desiccated thyroid. Studies show that both T4 and T3 need to be optimal for mental and physical well-being. The brain and body are in two different compartments, and they require both hormones."
For myself I have taken that to mean that I should target the middle of the range for FT4, so I am taking 25 mcg of T4 along with my desiccated med.
AS for your question about T4, here is a quote. "Many on desiccated thyroid have lab results that show a low in range Total and Free T4 when their Free T3 gets into the optimal range (upper half). This is because desiccated thyroid (pig thyroid) is approximately 80% T4, and 20% T3, while a normal human’s thyroid output is closer to 94% T4 and 6% T3. [4] The simple remedy for people who test low on T4 is to just add some synthetic T4 to their desiccated thyroid. Studies show that both T4 and T3 need to be optimal for mental and physical well-being. The brain and body are in two different compartments, and they require both hormones."
For myself I have taken that to mean that I should target the middle of the range for FT4, so I am taking 25 mcg of T4 along with my desiccated med.
Thank you both for your comments! I have been having a hard time getting my T4 levels up on Armour/Erfa, but I did not want to add T4 to the mix before ruling an RT3 problem out. I just got the results back, and they showed an FT3 of 3.3 pg/mL, and RT3 of 0.15 ng/ml//0.23 nmol/l. Although I cannot calculate the ratio (I get a ratio of 220 which is hardly realistic), I take it my RT3 levels are very low so I don't have an RT3 problem.
The reason I thought I might have an RT3 problem was that, before being put on NDT, I was on 200 mcg of thyroxine but my T4 levels were only mid-range.
My doctor is on Armour herself and says it's impossible to get a normal TSH on NDT, so she's very relaxed about the TSH. She has even stopped ordering the TSH test when she sends me to the lab, but instead goes by the FTs.
Interesting about T4 being more than a storage hormone; could you please tell me more about that?
The reason I thought I might have an RT3 problem was that, before being put on NDT, I was on 200 mcg of thyroxine but my T4 levels were only mid-range.
My doctor is on Armour herself and says it's impossible to get a normal TSH on NDT, so she's very relaxed about the TSH. She has even stopped ordering the TSH test when she sends me to the lab, but instead goes by the FTs.
Interesting about T4 being more than a storage hormone; could you please tell me more about that?
"By the way, I am impressed that he doesn't get all excited with a low TSH, for a hypo patient taking thyroid meds adequate to relieve symptoms. Please ask that he spread that idea around to his peers."
- Ya, that too!
- Ya, that too!
Good info from LM. Just wanted to add that before making another change, I would suggest that you give it a bit more time. You might also check to make sure that other factors are not having some effect. I would test for Vitamin D, B12 and ferritin to be sure they are well up in their ranges.
One other thing is that I have read that T4 is more than just a "storage" hormone and that it is best to have FT4 around the middle of its range. To achieve that for yourself, it would be best to add a small amount of T4 med, say 25 mcg, to your dosage. Good idea to discuss all this with your doctor. By the way, I am impressed that he doesn't get all excited with a low TSH, for a hypo patient taking thyroid meds adequate to relieve symptoms. Please ask that he spread that idea around to his peers. LOL
One other thing is that I have read that T4 is more than just a "storage" hormone and that it is best to have FT4 around the middle of its range. To achieve that for yourself, it would be best to add a small amount of T4 med, say 25 mcg, to your dosage. Good idea to discuss all this with your doctor. By the way, I am impressed that he doesn't get all excited with a low TSH, for a hypo patient taking thyroid meds adequate to relieve symptoms. Please ask that he spread that idea around to his peers. LOL
There is no normal.
However on most pig thyroid your T3 levels will be near the top with T4 near the bottom. Because pig thyroid ratio has more T3 per T4 than human thyroid.
If high T3 freaks out your Dr, then get labs in the AM before your morning dose.
When ever changing brands it takes time for the body to recognize and fully use the new brand (like a couple months sometimes).
Most feel Erfa is stronger and the T4 absorbs better because of the fillers used.......we are all different. Use what works best for you.
T4 of any brand can have absorbancy issues from food proteins, T3 never will. This can seem to make the T3/T4 ratio even worse in some people. Chewing dessicated with clean teeth can have better results in some people than swallowing. Erfa dissolves, Armour and Nature Throid need to be chewed to start the sublingual dissolving process.
However on most pig thyroid your T3 levels will be near the top with T4 near the bottom. Because pig thyroid ratio has more T3 per T4 than human thyroid.
If high T3 freaks out your Dr, then get labs in the AM before your morning dose.
When ever changing brands it takes time for the body to recognize and fully use the new brand (like a couple months sometimes).
Most feel Erfa is stronger and the T4 absorbs better because of the fillers used.......we are all different. Use what works best for you.
T4 of any brand can have absorbancy issues from food proteins, T3 never will. This can seem to make the T3/T4 ratio even worse in some people. Chewing dessicated with clean teeth can have better results in some people than swallowing. Erfa dissolves, Armour and Nature Throid need to be chewed to start the sublingual dissolving process.
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"FERRITIN test: Measures your levels of storage iron, which can be chronically low in hypothyroid patients. If your Ferritin result is less than 50, your levels are too low and can be causing problems…as well as leading you into anemia as you fall lower, which will give you symptoms similar to hypo, such as depression, achiness, fatigue. If you are in the 50′s, you are scooting by. Optimally, females shoot for 70-90 at the minimum; men tend to be above 100. If your ferritin is much higher, you could have hemochromatosis, a genetic disease in which too much iron is absorbed. Or, higher levels of storage iron can be caused by an on-going inflammation (which thrusts iron into storage, and is COMMON with many thyroid patients), liver disease, alcoholism, diabetes, asthma, or some types of cancer. Or it may be normal for YOU. Men are generally higher than women without having the above problems.
Note that you should be off all iron for at least 12 hours before testing to see what your body is hanging onto.
For supplementation, there are a number of options.
"But most patients and their doctors have found it necessary to supplement with iron tablets, which includes Ferrous Sulfate, Ferrous Glutamate, Ferrous Fumerate, etc. Supplementation needs to be spread out during the day, with food, for better absorption. Bluebonnet’s Ferrous Bisglycinate is a favorite among patients, but there are other good brands."
I have also read elsewhere that ferrous bisglycinate is a good supplement. There is also one called Slow Fe that is reported to be good.