Aa
Considering Armour again.
Hopefully, this will be the last lab post for awhile. My current medication is 75 mcg of Levoxyl 7x weekly, and 5 mg cytomel, 2 x daily/7 x weekly. I recently requested to try Armour because I am feeling bone pain, and heart stress. Dr. prescribed 60 mg. Armour.
Anyway, here are the lab results (before the Armour, which I have yet to start):
Range:
TSH: 0.24 (0.40-4.50)
T4, Free: 0.9 (0.8-1.8)
T3, Free: 3.3 (2.3-4.2)
T3, Total: 82 (76-181)
T3, Reverse: 17 (11-32)
Iron: 86 (40-160)
component D: 37 (30-100)
Vit D, D3,: 64
Calcium: 9.9 (8.6-10.4)
I can see I am on the hyper-side, and feel it, too. Is the 60 mg of Armour a good starting range? And of more importance, will it be an easier medication on my bones? lol.
Anyway, here are the lab results (before the Armour, which I have yet to start):
Range:
TSH: 0.24 (0.40-4.50)
T4, Free: 0.9 (0.8-1.8)
T3, Free: 3.3 (2.3-4.2)
T3, Total: 82 (76-181)
T3, Reverse: 17 (11-32)
Iron: 86 (40-160)
component D: 37 (30-100)
Vit D, D3,: 64
Calcium: 9.9 (8.6-10.4)
I can see I am on the hyper-side, and feel it, too. Is the 60 mg of Armour a good starting range? And of more importance, will it be an easier medication on my bones? lol.
I'm so sorry, I'm afraid I've confused you with all the math. Let's just talk in general terms for a while.
Armour contains BOTH T3 and T4. So, your doctor is suggesting 60 mg Armour plus 15 mcg Cytomel, and you will be getting about half as much T4 as you are taking now and 24 mcg of T3 (you are taking 10 now, so that's a big increase).
With the drop in T4 meds, your FT4, which is already low in the range is likely to go even lower. The big increase in Cytomel might raise your FT4 since less will have to be converted to T3 because of the high dose of T3 you will be taking. It's impossible to predict exactly what this new combination will do to your numbers.
"...the increase in t4 med (Levoxyl) dropped the numbers." Did it drop TSH only, or FT3 and FT4 as well? In theory, when TSH gets very low, it can indicate that you are taking too much meds (you are hyper). However, in practice, many things affect TSH. Many people find that once on meds (especially meds with T3 in them), their TSH goes very low and never goes back up. So, it is no longer a reliable indicator of if you are hypo or hyper. When that happens, TSH has to be ignored, and you have to look at FT3 and FT4 instead.
Has the doctor who prescribed this seen your most recent labs or is he going on last year's labs??? "I have no idea how he is going to react to my questioning of his decision." This is a VERY unconventional treatment. You deserve to know what made your doctor decide on this approach and what he expects to achieve by it. I think you can question him without making it look like you are questioning "his decision", but rather you are questioning if you misunderstood or someone you talked to in his office was mistaken.
Please don't stop posting until you understand. That's what we're here for.
Armour contains BOTH T3 and T4. So, your doctor is suggesting 60 mg Armour plus 15 mcg Cytomel, and you will be getting about half as much T4 as you are taking now and 24 mcg of T3 (you are taking 10 now, so that's a big increase).
With the drop in T4 meds, your FT4, which is already low in the range is likely to go even lower. The big increase in Cytomel might raise your FT4 since less will have to be converted to T3 because of the high dose of T3 you will be taking. It's impossible to predict exactly what this new combination will do to your numbers.
"...the increase in t4 med (Levoxyl) dropped the numbers." Did it drop TSH only, or FT3 and FT4 as well? In theory, when TSH gets very low, it can indicate that you are taking too much meds (you are hyper). However, in practice, many things affect TSH. Many people find that once on meds (especially meds with T3 in them), their TSH goes very low and never goes back up. So, it is no longer a reliable indicator of if you are hypo or hyper. When that happens, TSH has to be ignored, and you have to look at FT3 and FT4 instead.
Has the doctor who prescribed this seen your most recent labs or is he going on last year's labs??? "I have no idea how he is going to react to my questioning of his decision." This is a VERY unconventional treatment. You deserve to know what made your doctor decide on this approach and what he expects to achieve by it. I think you can question him without making it look like you are questioning "his decision", but rather you are questioning if you misunderstood or someone you talked to in his office was mistaken.
Please don't stop posting until you understand. That's what we're here for.
This is the last post on this, but understand, while it is simple math to most, it is not to me.
As I go over the translation of numbers, I see that what will be the average intake of medication will look like this:
Armour 60 mg = 38 mg t4
Cytomel 15 mcg = 15 mcg T3
So, my 10% range will drop to 38% and the T3 will increase. Will this increase elevate the t4 at all?
The biggest problem for me is understanding that the increase in t4 med (Levoxyl) dropped the lab numbers. Doesn't the lower number indicate that I am getting too much t4? When the tsh reads low, does that not indicate hyperhyroid? Please be patient with me, as I have been told both, yes and no on this issue, with previous doctors.
I have no idea how he is going to react to my questioning of his decision. And, I do not have a back up plan, should things go badly. I will post generically, should I not hear from you.
As I go over the translation of numbers, I see that what will be the average intake of medication will look like this:
Armour 60 mg = 38 mg t4
Cytomel 15 mcg = 15 mcg T3
So, my 10% range will drop to 38% and the T3 will increase. Will this increase elevate the t4 at all?
The biggest problem for me is understanding that the increase in t4 med (Levoxyl) dropped the lab numbers. Doesn't the lower number indicate that I am getting too much t4? When the tsh reads low, does that not indicate hyperhyroid? Please be patient with me, as I have been told both, yes and no on this issue, with previous doctors.
I have no idea how he is going to react to my questioning of his decision. And, I do not have a back up plan, should things go badly. I will post generically, should I not hear from you.
I used to live in the Tampa Bay area (Largo) before moving back here to Oregon. I wish it were a local problem where you are, but when I read your post, all I could think of was the line from Woody Guthrie's song "...from the redwood forest to the gulf stream waters...". I'm afraid that's more the scope of the wasteland of competant doctors. I'll be singing that in my head all day...
Have I suggested you talk to Barb135? She's in the Ocala area, which I know is a ways from you, but she has an endo who at least seems open to manipulation. LOL It might be worth the drive.
It's a dilemma...hard to know if you're going from the frying pan into the fire. Shopping for doctors gets expensive. "He (out-of-pocket doctor) added, I could increase my usage of t3 and some of t4, stating it was up to me..." It sounds like he might be willing to do it. No reason to alienate either of them...one or the other might become useful at some point. I wish I could say "you should definitely do this", but it's all one big experiment, and we're all the guinea pigs. We react so differently that all we can do is try something different. Nothing ventured, nothing gained...
Have I suggested you talk to Barb135? She's in the Ocala area, which I know is a ways from you, but she has an endo who at least seems open to manipulation. LOL It might be worth the drive.
It's a dilemma...hard to know if you're going from the frying pan into the fire. Shopping for doctors gets expensive. "He (out-of-pocket doctor) added, I could increase my usage of t3 and some of t4, stating it was up to me..." It sounds like he might be willing to do it. No reason to alienate either of them...one or the other might become useful at some point. I wish I could say "you should definitely do this", but it's all one big experiment, and we're all the guinea pigs. We react so differently that all we can do is try something different. Nothing ventured, nothing gained...
First, I thank you for responding to this-You can not know how I appreciate it. I must inform you, that I have 2 endos', both very dated in their approach. The out of pocket doctor, last lab, was only looking at tsh, surprisingly dismissed the 'real need' for Cytomel. While it was he who told me I was hyper, he said whatever I was doing in June I should do. Like I can remember June, lol.
He added, I could increase my usage of t3 and some of t4, stating it was up to me, dismissing me with, "See you in January".
He, however, was the one that wrote the Cytomel, under great resistance-I might add, despite the labs of virtually no registering of t3, and at the time, a case of Rt3 dominance.
Meanwhile, the under insurance endo, said everything was perfect, and while he argued the Armour, he gave in. And, scheduled a return visit in 6 weeks.
I have not started the Armour, having been through a crash before. As bad as I feel now, I know that it could be a lot worse.
Come Monday, I am not sure who to call or what to say. If I inform the expensive doctor I had another lab done, and am considering a switch, I can predict he will drop me. And a rational part of me, thinks that may be ok.
I have been entertaining the thought of a whole new endo. Worst of it is, I am on a fixed income and have spent some real money, and gone through some serious insanity to get to this point. Tampa Bay and even as far as Bradenton, has proven to be a wasteland for competent doctors. I simply do not know where to go, at this point. I guess I could try to talk to both, and see which one agrees to increase the Levoxyl. I'll keep you posted. Thanks again.
He added, I could increase my usage of t3 and some of t4, stating it was up to me, dismissing me with, "See you in January".
He, however, was the one that wrote the Cytomel, under great resistance-I might add, despite the labs of virtually no registering of t3, and at the time, a case of Rt3 dominance.
Meanwhile, the under insurance endo, said everything was perfect, and while he argued the Armour, he gave in. And, scheduled a return visit in 6 weeks.
I have not started the Armour, having been through a crash before. As bad as I feel now, I know that it could be a lot worse.
Come Monday, I am not sure who to call or what to say. If I inform the expensive doctor I had another lab done, and am considering a switch, I can predict he will drop me. And a rational part of me, thinks that may be ok.
I have been entertaining the thought of a whole new endo. Worst of it is, I am on a fixed income and have spent some real money, and gone through some serious insanity to get to this point. Tampa Bay and even as far as Bradenton, has proven to be a wasteland for competent doctors. I simply do not know where to go, at this point. I guess I could try to talk to both, and see which one agrees to increase the Levoxyl. I'll keep you posted. Thanks again.
What makes me apprehensive about the switch is that right now at 75 Levoxyl and 10 Cytomel (a ratio of 7.5 to 1), your FT4 is very low. On 60 mg of Armour, you will be getting only 38 mcg of T4 and 9 of T3. Your FT4 is going to crash.
One approach would be to ask your doctor about increasing the Levoxyl. Your FT3 is a little on the low side, but that should come up with more T4. I think it's always best to change one variable at a time so you can really isolate the effects of the change.
It's true that not everything can be blamed on the scapethyroid, but with an FT4 at 10% of range, I think we can still blame it. What about the other 90% of the range? Why can't your doctor consider using up some of that? The fact of the matter is that he's looking at your TSH and nothing else.
On the other hand, you might try the Armour. The numbers I quoted above for equivalencies don't tell the whole story. Even though synthetic hormones and desiccated are virtually identical, for some reason people often react to them differently. Some people only feel well on desiccated. Even when desiccated is replaced by the exact same amounts of synthetic T3 and T4 as desiccated has, they don't feel as well.
Your doctor wanted to start you on 60 mg. Did he give you any idea of a schedule for re-testing and adjusting dose?
One approach would be to ask your doctor about increasing the Levoxyl. Your FT3 is a little on the low side, but that should come up with more T4. I think it's always best to change one variable at a time so you can really isolate the effects of the change.
It's true that not everything can be blamed on the scapethyroid, but with an FT4 at 10% of range, I think we can still blame it. What about the other 90% of the range? Why can't your doctor consider using up some of that? The fact of the matter is that he's looking at your TSH and nothing else.
On the other hand, you might try the Armour. The numbers I quoted above for equivalencies don't tell the whole story. Even though synthetic hormones and desiccated are virtually identical, for some reason people often react to them differently. Some people only feel well on desiccated. Even when desiccated is replaced by the exact same amounts of synthetic T3 and T4 as desiccated has, they don't feel as well.
Your doctor wanted to start you on 60 mg. Did he give you any idea of a schedule for re-testing and adjusting dose?
I am apprehensive to switch, as well, to be honest. I am exhausted, quite frankly, and by 3pm, I am unconscious. I sleep til 10 am, most day and am barely awake past 11 pm, most nights. This is unusual.
The symptoms that are new, are the aches, occasional chest pain, the palpitations, and confusion.
Should I increase my Levoxyl? And perhaps the Cytomel? I just saw my endo and he says everything is just fine, despite what I told him about how I feel. He said not everything could be blamed on Thyroid. Yet, I recently gained 10 lbs. I am truly tired of it all and don't believe they know what they are doing.
The symptoms that are new, are the aches, occasional chest pain, the palpitations, and confusion.
Should I increase my Levoxyl? And perhaps the Cytomel? I just saw my endo and he says everything is just fine, despite what I told him about how I feel. He said not everything could be blamed on Thyroid. Yet, I recently gained 10 lbs. I am truly tired of it all and don't believe they know what they are doing.
You're not really on the hyper side (according to your labs). FT4 is at 10% of range (50% is the rule of thumb). FT3 is at 53%, which is just barely in the upper half of range, which is the rule of thumb for FT3.
However, those rules were meant to be broken if you FEEL hyper. What are your other symptoms?
75 mcg of Levoxyl is approximately equivalent to 45 mg of Armour, and 10 mcg of Cytomel is roughly equivalent to 24 mg. So, that's 69 altogether. At 60 mg, you'll have a little overall decrease.
60 mg of Armour contains about 38 mcg of T4 and 9 mcg of T3. So, your T4 intake is going to be almost cut in half, while T3 will rmain close to the same.
When switching from synthetics to desiccated, or vice versa, it's a little like starting over. Since the T3/T4 balance in desiccated is a constant and the two can't be manipulated separately, your FT3/FT4 balance is going to change significantly. It's once again going to be a case of experimenting until you get it right. My worry is that your FT4 level is so low at the moment that the decrease in T4 is not altogether a good thing.
Good luck with it.
I hope it's better on your bones and relieves your pain, but only time and a little experimentation with rebalancing on the new meds will tell.
However, those rules were meant to be broken if you FEEL hyper. What are your other symptoms?
75 mcg of Levoxyl is approximately equivalent to 45 mg of Armour, and 10 mcg of Cytomel is roughly equivalent to 24 mg. So, that's 69 altogether. At 60 mg, you'll have a little overall decrease.
60 mg of Armour contains about 38 mcg of T4 and 9 mcg of T3. So, your T4 intake is going to be almost cut in half, while T3 will rmain close to the same.
When switching from synthetics to desiccated, or vice versa, it's a little like starting over. Since the T3/T4 balance in desiccated is a constant and the two can't be manipulated separately, your FT3/FT4 balance is going to change significantly. It's once again going to be a case of experimenting until you get it right. My worry is that your FT4 level is so low at the moment that the decrease in T4 is not altogether a good thing.
Good luck with it.
I hope it's better on your bones and relieves your pain, but only time and a little experimentation with rebalancing on the new meds will tell.
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