Excessive Hair Loss and Hypo -- Are Labs Ok, or Not Ok?

[EsmeMarie]

I really need help on my lab values... Can someone clarify/explain my lab values? Here are my recent lab values with the ranges. My dr who is treating me for hypo has me on 60 mg Armour daily. She says my thyroid is fine, but my hair is falling out like crazy, and the hair loss has never stopped.

TSH: 1.75 (Normal Range is 0.45 - 4.5)
FT3:  2.6 (Normal Range is 2.0 - 4.4)
FT4:  1.04 (Normal Range is 0.82 - 1.77)

Many thanks to all the people on this forum who have experience and wisdom in this area.

[EsmeMarie]

Thanks for all the great advice, I switched today to taking my Armour into (2) divided doses, so I'm hoping this helps in some way.

This is probably really hard to answer, but how do you know when things start to improve? I was going to get labs done this week, but my dr now wants me to get up to 180mg, stay on 180mg for one week, and then get labs done to see where my levels are at.

I know from all the replies that someone said hair loss is the last thing to get resolved. But is this a matter of weeks or months? I'm still cold all of the time, I'm constipated, and I'm still very tired. It's hard to understand, since I can't really determine if I feel any better being on 135mg of Armour (where I am right now) vs. when I was on 60mg of Armour for months. I really feel like this thyroid mess is a kind of mystery. The bright side is that my husband told me the other day that I seem like less of a grump lately :)

[Barb135]

I've never heard of having to wait 2 hours to eat after taking thyroid medication.  Not eating or drinking is for the benefit of the T4 portion of the Armour and typically, you can eat/drink 30-60 minutes after taking it, so you could take 1/2 the dose at 5 AM, then take the other 1/2 dose 30-60 minutes before you have lunch.  T3 is not so particular and can be taken with or without food.  I take my second dose of T3 at lunch time.

For that matter, you could even split your dose into 3 and take 1/3 in the morning, 1/3 just before lunch and 1/3 mid afternoon... just don't take it after about 3:00 or the T3 could interfere with sleep.

You can experiment and see what works best for you.  I don't know that your stomach needs to be "totally" empty when you take Armour.  The worst that can happen is maybe you'd need to adjust your dosage a bit to accommodate.  The most important thing is that once you find something that works, be consistent.

[EsmeMarie]

How do you recommend splitting Armour if I take it at 5am every day?... just take the other 1/2 dose around 12 noon?

Also, can I eat or drink anything AFTER I take the Armour, since 12 noon is lunch-time for me. I asked the pharmacist and he said black coffee was okay after taking Armour, but basically no food or drinks until 2 hours after taking the Armour, so after the 5am dose, I've been having black coffee around 5:30am, and then not eating anything until 7am or later. Do I need to take Armour on an empty stomach?

Thank you so much for your and everyone's advice here :)

[Barb135]

Most of us taking a med with T3 in it find that it works best to split the total dosage into 2 doses - typically, half in the morning and half around noon or early afternoon.  This spreads the T3 out over the course, of the day and keeps it level in your system throughout the day.  

This might be a stretch, but maybe some of your hair loss is because you're getting a jolt of the T3 in the morning, then, when it leaves your system within a few hours, you have nothing the rest of the day, so you're basically hypo most of the time.  

It's correct that you should NOT take thyroid medication prior to having thyroid labs drawn, particularly, those meds containing T3, such as Armour

[EsmeMarie]

This is the magic question-- how do you know when you're at the right dose? I'm on 120mg Armour 1x/day now (I take it around 5am every morning when I get up), and I have not noticed any difference. My hair keeps falling out like crazy, and I'm now getting another bald spot. My blood pressure is the same, and I do not feel any symptoms of hyper whatsoever, and my weight keeps creeping up.

I "think" I am less foggy than before, and I "think" I am less tired, but it's so hard to tell b/c I still find it hard to concentrate, and I am tired all of the time and could take a nap everyday if I was able to.

I am so glad you said NOT to take your meds before the next blood draw b/c I'm having labs done on Friday, so I will refrain on meds until after the blood draw.

I live in Baltimore, MD.

To: badthryoid-- please find a new doctor. I was not able to find an Endo who would treat me, the Endo I saw only ran the TSH blood test and said I was low-normal and said everything was fine. Even my regular internist said Endo's typically only look at "Reference Range Lab Values" and will ignore your symptoms and only look at your lab values and therefore, dismiss that anything is wrong. I do not understand this, but that has been my experience.

[dgmootry]

I just wanted to let you know that i too had thinning hair when I was hyper, and then due to RAi I am now hypo and I noticed my hair thinning and very dry, my Vit D was very low and my Ferritin was low and Vit B12 low I'm now supplimenting these, If you havn't had yours checked would be a good idea to have them checked.  plus getting my thyroid levels where they should be my hair has grown more then it has ever and it seems alot thicker, plus stressing over it will also make your hair fall out, I know that not stressing is easier said then done, I too am on Armour, do you split your dosage? and also when you have your blood drawn to check your levels make sure you don't take your Armour before your blood drawn, I always get an early appointment and I wait till after to take my  morning Armour, just a thought good luck

[jacrjacr]

what town do you live in..he sounds like a keeper for a dr....

[jacrjacr]

don't wait, find a new doctor or go get your own labs done from a source online for around 60.00 at healthone.com and see for yourself where your levels are and take that test to a doctor......that is what I did in your position several years ago.....

[Barb135]

I had hair loss when I was hypo, as well, but once my levels got up to a good point, for me, my hair did grow back, though it took a while, since, as flyingfool, mentioned, hair regrowth is one of the last things the body does as it heals.  Recently, I began losing hair again and I upped my dosage; the loss has already stopped and I can feel some "stubble" growing back in.

[badthyroid]

Hello, I was seeing my Endo. I went in to see him because of my hair falling out to the point my hair dresser backed up and looked scared after she shampooed my hair an she went on asking me what I am doing for this or if I have seen a doctor. She scared me I didnt know how bad it was. But anyhow my Endo , after talking with him at the visit, he told me that I was either getting too much or not enough of something an went on to order TSH, FT3, and FT4 blood tests, plus a 24 hour urine for cortisol. Of course everything so the nurse said came back normal, but she went on asking me if I needed my meds increased, What meds I asked, no one has ever givin me meds for this. I welcome meds to make me feel better. My family doctor looks at me like he doesnt believe me, he will go on and do a TSH blood test only, and his office calls me back on those results and says that there is meds at the pharmacy waiting for me for my cholesterol. So i go get those and never hear what my thyroid results are...ugh..So now here I am I think Im going to go back to my family doctor and demand a good Endo. and I have a picture to show him of my hair that I found in my sink after combing it after taken a shower. theres so much it makes my heart fall to my stomach an gets me wanting to get sick. I feel hopeless ..But I need answers. I want to get a perm but Im too afraid that all my hair will fall out. I feel yuk about how I look these days..

[ahmee]

I have read that it does grow back for some people, but in my case I have androgenic alopecia, which I believe was triggered by hypothyroidism, but from which I don't expect to recover lost hair without the help of minoxidil. If it was just TE and not TE+AA, I would expect all hair lost to come back. If you have round, completely bald patches that may be alopecia areata, a different hair problem with autoimmune origins. In any case, thinning hair can be very distressing, I know it well, but toppik is great and keeping busy enough to keep your mind off the matter helps too. Feel free to send me a message if you want to talk further about it.

Once I reached the aforementioned meds point, the hair loss slowed noticeably within two weeks or so, and subsided completely over the next couple of months. It's good that you seem to have found a compassionate, competent doctor.

[bedheadblonde]

If you just increased yesterday, you might not feel it for a while.The doc you're seeing seems like a good one-I'd keep with the slow and steady increase to see how it does.

[EsmeMarie]

What did you do for the hair loss when it was falling out? My crown is really bald now and it's starting to extend to the front of my head. I'm using Toppik, but it's getting hard to cover without a lot of hair. My hair is soooo thin, I can't believe how bad it is. And sadly it is still a few weeks before my wig will be ready.

More questions on hair:

1. Has anyone's hair turned gray/silvery gray? My hair has gone really gray, which is extremely unusual for me b/c I have never dyed my hair, but it looks so bad now. I'm terrified of dying it for fear of more falling out. I have female relatives in their 60s who still have black-brown hair (like me) who barely have any gray.

2. Does hair not grow back when the thyroid gets balanced? I thought that it did grow back, but after reading what you've experienced, now I'm super concerned. Does it grow back at all? Do you have bald spots?

3. How long does it take for the hair to stop falling out, once your meds get increased?

Now for some good news I think...

I got a 2nd opinion and saw another integrative dr yesterday, but this one specializes in thyroid disease. The first thing he said when reviewing my records was, "why has no one increased your thyroid dose?!". I said, "because my dr thinks she will give me a heart attack", and he said, "that is nonsense".

He is having me do a saliva adrenal test, which I have never had done. He is also increasing me fast-- 15 mg of Armour thyroid every 5 days, until I see him again in 1 month. I am so glad to finally be treated aggressively. He wants me to check my blood pressure and if I notice any adverse symptoms, I have to call him immediately. The reviews on this dr are excellent, and it takes months to see him.

What do you guys think? I increased to 75 mg of Armour yesterday and as usual, I can't even tell. He thought my labs were really low and thought like you guys do--- that I was definitely undertreated. He even felt my hair and could not believe my dr let it get this bad. I showed him all the hair I lost yesterday before seeing him and I could tell he thought it was bad. I really am terrified of going bald, so I'm praying this gets turned around quickly.

[ahmee]

I had telogen effluvium (chronic hair loss) when hypo. The loss itself has completely subsided, though I have had trouble regrowing what was lost. It wasn't until I reached about 1.5 grains (90 mg) of Naturethroid (desiccated thyroid med like Armour) that my hair loss slowed. I am currently on 2.5 grains (150 mg). In my opinion, many people on desiccated end up undermedicated because their doctors look at the suppressed TSH which so often happens on this med and don't want them to increase beyond 60mg or so. However, it wasn't until 120mg (2 grains) that most symptoms fully subsided for me (temp sensitivity, hair loss and texture, brain fog), and even after that I needed to raise again when symptoms partially returned. When I raised my dose it was 1/4 grain (15mg) at a time, every few weeks, so I did raise pretty fast in the eyes of some, but it worked very well for me. I could tell that I would feel better for a few days to a week after a raise, but then symptoms would return. I slowed down with the raises once I approached 2 grains but I believe people, when adequately treated, often end up in the 2-3 grain range. But yes, it is highly individual, so I just mention that as food for thought. You need a doctor who will listen to your symptoms and adjust meds accordingly! Your levels are still low, as goolarra explained above.

[flyingfool]

Hair loss for some people is the first symptom to show for Hypo and unfotunately it is the LAST symptom to disappear.

in your body's physiological response and priority.  Almost everything is a higher priority than growing hair or putting any energy into growing hair.  So when stressed one of the first things the body will do is to stop doing the thing on the bottom of the priority list which is for some people losing hair.  This is why one of the primary top reported symptoms of Hypo is losing hair, along with fatigue and cold intolerance.

It is often not uncommon when first starting thyroid hormone replacement to initially feel WORSE. this is because your body is trying to do extra ordinary things to try its best to "make up for" the lack of thyroid hormone and it cranks up other hormones and edrenals etc.  And then all of a suddent (from the body's point of view) BANG, there is this thyroid hormone and it doesn't have a chance to adjust so for awhile it is out of balance until the body figures out what is going on.  If you are intolerant of medicine these feeling worse symptoms will be dramatic and often times will appear to give you Hyper symptoms.  In whcih case the Dr will panic and yank the meds completely putting you on a roller coaster ride of hell.

While a particular dosage may be too big a jump, it does not mean that you will not end up at that dose or even much higher eventually.

I have read that there is a "feedback loop" that is tied especially to Armour or other natural dessicated thyroid meds and it is about a 2 week cycle.  And at least one site recommended that increases for Armour should be done in small increments about every two weeks. What you describe above seems to be in direct agreement with that theory.

Hyper is most commonly associated with:

Rapid heart beat (high pulse) or racing heart beat.  Afib
heat intolerance - sweating
insomnia in that you cannot get to sleep
weight loss

Other signs that also cross over to Hypo are:

Anxiety
Panic attacks
general feeling of being hyper active and too much energy.  Like having too much caffeine and getting the shakes etc.

Certainly not a complete list but I think you get the general idea.

[EsmeMarie]

To: Bad thryoid:  

What kind of dr are you seeing? I noticed my hair falling out well over 1 year ago, but nobody believed me. I finally went to my regular internist, who ran a bunch of tests and figured it was stress. Then in June 2013, my hairdresser who used to cut my hair every 3-4 weeks told me my hair was noticeably thinner, so I started taking biotin (made no difference).

I have been to a dermatologist, my GYN, an endocrinologist, a trichologist (hair-loss specialist), and then back to my regular internist, who I had gone to see first. It was my regular internist who said-- ok, this is not stress for this to still be going on. So she ordered TSH, FT3, and FT4. My labs all came back low, and she said-- something is wrong, your thyroid is off, let me send you to another dr who is a traditional internist, but also practices integrative/functional medicine.

If you are seeing a traditional dr, find an integrative dr who can treat hypothyroidism. I found an integrative dr, but not one who can treat my hypo, as she insists my thyroid is fine and believes increasing my meds will give me a heart attack. Sadly, the worst dr I went to in my quest to figure out my hair loss was the endocrinologist-- he only ordered TSH and said I was low-normal.

To: flyingfool and goolarra:

This is even scarier to know b/c the integrative dr I am seeing now has ordered TSH, FT3, and FT4, and she is the one who said my lab values (posted above) are fine. My hair loss is so bad that I am having a partial wig made, and I have to use Toppik now.

My integrative dr started me out on 15 mg of Armour, which I never even noticed. Then we went to 30 mg of Armour, which made me feel warm and overall better, but the hair loss never stopped, and soon thereafter, I started feeling lousy again, so it was as if the 30 mg lost it's effect on me. Then a few months later, we went to 45 mg, which I never noticed, and now I'm on 60 mg. I have never noticed any symptoms when increasing, but the times in b/t increasing have been lengthy.

I am 45 yrs old and have no heart problems, or any other health issues, and my GYN has verified I am not perimenopausal.

This might sound stupid, but how do you know if you can tolerate meds? what kind of symptoms would be hyper? The only thing my dr has told me was to watch for heart palpitations, sweating, and shakiness.

I really cannot thank all of you b/c now I'm really glad to be getting a 2nd opinion.

[goolarra]

How much to increase how fast is a very individual thing.  It all depends on how well you tolerate meds.  If you increase too fast, you can have hyper-like symptoms (in my opinion, even less "pleasant" than hypo symptoms).  

Did you start out directly on 60 mg Armour, or did you work up to it?

How old are you?  How long do you think you've been hypo (ballpark)?  Any history of heart arrhythmia?

[badthyroid]

Hello, I am having the same symptoms as you. My doctor just called me with my test results an he says I am just fine. I say Really?? I have half of a thyroid I have the left half only now. I had a nodule in my right half in 2004. He did not put me on any medicine , now after 4 years I'm having these symptoms and I do not no what to do. I would love to take medicine to feel better but he doesn't see the full picture of how I'm feeling. Now I want to come back in the office to talk to him but the nurse says she will have to call me back on that. I'm being swept under the rug. I do not no why. I hope you get to feeling better soon.

[EsmeMarie]

Hi Goolarra,

Thank you tremendously for your input.

Other symptoms I am having are I am tired beyond belief, I am cold as ice most of the time, and despite working out and not eating any differently, I keep gaining weight.

I am about to see another dr to get a 2nd opinion, and this guy is familiar with thyroid issues, Is there a protocol
or rules about how much and/or how fast to increase Armour.

[goolarra]

Your labs look like you are undertreated.  FT3 is only at 25% of range, and many of us, especially those taking desiccated, find that FT3 should be upper half to upper third of range.  

FT4 is also low.  The guideline for FT4 is 50% of range, and yours is only 23%.

TSH is also a little on the high side.

Aside from hair loss, do you still have other hypo symptoms?