Conversion help -tirosint/cytomel to NDT

[nuttmegs17]

Hello!  I'm hoping someone can help me :)

After being on a cytomel (10 mcg split throughout the day) plus armour 90 mcg or 1.5 grains my FT4 had tanked to the bottom of the range and even bit below while FT3 was above range.  I had been on this combo for over two years never feeling great.  In fact I had a very difficult time accepting the armour from the very beginning so we moved super slowly.   I tended to get bloating and swelling and we titrated up slowly as a result.  Then in the spring. I was super tired lethargic and we decided to switch to tirosint and cytomel.

It's been ok. I've not been regulated but I seemed to accept it ok. Unfortunately some annoying  side affects (which I never experienced on the other combo) emerged:  sleep problems (wake up super groggy and zombie like. Hard to get out of bed etc). Sinus issues (specifically at night but sinus probs were  never a prob before switching...I'm now nursing what appears to be a sinus infection.  Sigh) and super painful cystic acne.  Prior to thyroid probs I'd only ever Really break out In the t zone   In fact despite hairloss etc. my skin was my only point of pride as silly as that sounds!). Now it's gotten to the point where it actually hurts to lay with my face on the pillow at night.  As we have increased the tirosint (t4) the worse my zits have gotten so I do see a Connection.  Based on my levels I am sure I need to increase further

So that brings me to my next experiment.  Looking back, another option could have been to 1. Try an NDT other than armour (thinking NP THyroid or ERFA...at the time I wasn't aware there were other options besides armour!) ) and/or  2. drop the cytomel which would have dropped my ft3 into acceptable ranges while also allowing my FT4 to rise ( for me whenever I add T3 I can expect my FT4 to drop dramatically).  Perhaps it's worth trying?  Maybe I wouldn't experience the same side affects.  So I have a couple of questions

1.  How much thyroid should I ask for ? I am currently on 113 tirosint plus 20 cytomel.  Based on some charts out there that seems to be near 2 grains?  Is that about right?  I figure if my ft4 doesn't raised enough I could always supp a tiny amount of tirosint as needed.

2.  I have hashis and could have sworn I saw a post on here with someone saying armour raises antibodies in hashi people.  Is that true?!

Any feedback would be appreciated!

[Barb135]

If your FT3 was about to go over the top, you didn't really need the extra cytomel.  With a 0.8 FT4, you really only need to add a small amount of T4 med.

Remember, fatigue can apply to either/both hyper and hypo, so you have to also look at other symptoms.  FT3 is the hormone that correlates with symptoms, while TSH and FT4 don't.

[nuttmegs17]

Thanks guys!  Seems as though you agree that trying again would be worth a shot.   I am going tomorrow to get labs done and will report back with the numbers in a week.  I don't have my latest handy but my ft4 last time ( before we increased t4 was .80 (forgot the range but that was the very bottom.  I have to fight to get my dr to adjust my t4 meds bc he is of the mindset .8 is ok even though it's nowhere near 50% of the range...for me when it gets that low I get incredibly fatigued ). But my t3 was near the top (literally about to go over).  

[Barb135]

What are your actual, current, thyroid levels?  Please include reference ranges, since those vary lab to lab and have to come from your own report.

There are 2 ways to calculate the dosage of desiccated vs synthetic.  Dessicated has 38 mcg T4 and 9 mcg T3 per grain, so if you'd raised your desiccated according that, ahmee's calculation would be correct, and would seem logical; however, according to the conversion charts, 1.5 grains (90 mg) of Armour is equivalent to 150 mcg levothyroxine "or" 37.5 mcg cytomel (liothyronine), so if you'd raised to 2.5 grains, you'd probably have gone over the top, as you did with the addition of cytomel.  
http://thyroid.about.com/library/drugs/blconversionchart.htm

It's not unusual for FT4 to be lower in those taking a desiccated med.  Perhaps you should have added a source of T4 med to increase your FT4 levels, rather than cytomel to raise FT3 levels.

[ahmee]

Is there a reason you didn't just add more desiccated after reaching 1.5 grains, instead of adding cytomel? It's no wonder your FT4 was down the tubes-- you were taking 23.5 mcg T3 and 57mcg T4, a very unusual balance. If you'd raised to 2.5 grains desiccated instead of the NDT + cytomel combo, you'd have been taking 95mcg T4 and 22.5mcg T3 and might have felt better. If you want to try again with desiccated, this seems to be a good target dose.

I would assume from your symptoms (grogginess, acne) that on your current combo of tirosint & cytomel you are inadequately dosed and still hypo.

There are other brands besides Armour indeed-- NP, Naturethroid, Westhroid-P (very few fillers), Erfa (though it must be sourced from Canada).

I have not heard that bit about armour raising antibodies. Antibodies usually decrease with any thyroid med. You can try supplementing selenium if you'd like to see the numbers go down, but really there's not much to be done except understand that with Hashi's, the attack will continue in the future, possibly necessitating future dose raises.