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General Thyroid/Hashi's Question
I have diagnosed Hashi's. I'm a male 44 years old. Have had this condition about 4 years. Have taking Synthroid or the generic brand since. I'm on 112mcg dosage. Today got my lab results.
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
I've been to Mayo several times. My head is in a fog. My ears ring and I'm a bit dizzy. They tell me it has nothing to do with my thyroid. Seems back around Thanksgiving I started feeling this way. Some days are better than others. I take my meds at 9:00PM each night on empty stomach. I used to take in the morning but researched that it might be better to switch to evenings so I did. 5 weeks ago my TSH was 5.62 at Mayo Clinic. I'm comptemplating on switching to Armour. Any thoughts? I know in my mind and heart, the way I am feeling is because of my thyroid.
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
I've been to Mayo several times. My head is in a fog. My ears ring and I'm a bit dizzy. They tell me it has nothing to do with my thyroid. Seems back around Thanksgiving I started feeling this way. Some days are better than others. I take my meds at 9:00PM each night on empty stomach. I used to take in the morning but researched that it might be better to switch to evenings so I did. 5 weeks ago my TSH was 5.62 at Mayo Clinic. I'm comptemplating on switching to Armour. Any thoughts? I know in my mind and heart, the way I am feeling is because of my thyroid.
I am anxious to see everyones response to this thread but id like to chime in on my opinion.
If i was on synthroid and was debating of switching completely over to armour OR try a couple weeks of adding some ft3, I would certainly try the cytomel.
I WISH i could add or subtract some of the t3 in my prescription. I know the armour has too much t3 in it for me. I would try the t3 first if i was in your shoes, but others may disagree.
If i was on synthroid and was debating of switching completely over to armour OR try a couple weeks of adding some ft3, I would certainly try the cytomel.
I WISH i could add or subtract some of the t3 in my prescription. I know the armour has too much t3 in it for me. I would try the t3 first if i was in your shoes, but others may disagree.
I'm on 112's of Synthroid. Doc today prescribed 90mcg I believe of Armour. Does that sound right? How many "grains" is that?
COMMUNITY LEADER
Gotta get all this down here where I can see it together....... lol
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
You're on 112 mcg synthroid....... your doctor prescribed 90 mg (or mcg - big difference) of Armour.
Let's put that into a different perspective........
Armour is dosed in mg or grains...... 1 grain = 60 mg; 1 grain/60 mg = 38 mcg of T4 medication + 9 mcg of T3...... 90 mg is only 57 mcg of T4; you're currently on 112 mcg of T4 and your FT4 is close to dropping into the basement; why would you want to decrease that?
Yes, you can always increase your dose of Armour, but why take steps backward, when it's not really necessary?
Since FT3 correlates best with symptoms, why not just add a small amount of cytomel/T3 and see how it goes. In case you didn't realize, I'm agreeing with Bruce........ lol
Sometimes adding a very small amount of T3 will do the trick, though it won't do it over night...... even a fast acting medication needs time to get into your system.
Just out of curiosity, if you take your medication at 9:00 pm on an empty stomach, what time do you have your last meal/snack of the day?
TSH = 2.93 (.4-4.5)
FT3 = 2.5 (2.3-4.2)
FT4 = .89 (0.8-1.8)
You're on 112 mcg synthroid....... your doctor prescribed 90 mg (or mcg - big difference) of Armour.
Let's put that into a different perspective........
Armour is dosed in mg or grains...... 1 grain = 60 mg; 1 grain/60 mg = 38 mcg of T4 medication + 9 mcg of T3...... 90 mg is only 57 mcg of T4; you're currently on 112 mcg of T4 and your FT4 is close to dropping into the basement; why would you want to decrease that?
Yes, you can always increase your dose of Armour, but why take steps backward, when it's not really necessary?
Since FT3 correlates best with symptoms, why not just add a small amount of cytomel/T3 and see how it goes. In case you didn't realize, I'm agreeing with Bruce........ lol
Sometimes adding a very small amount of T3 will do the trick, though it won't do it over night...... even a fast acting medication needs time to get into your system.
Just out of curiosity, if you take your medication at 9:00 pm on an empty stomach, what time do you have your last meal/snack of the day?
what was that barb? I almost thought i saw you say that you agree with me. I told this fine young gentleman my recommendation as we are friends but we both wanted to see what you and the other "elders" would say LOL
also if t3 in theory is 4 x stronger than t4, wouldn't 13 MG t3 = 52MG t4?
also if t3 in theory is 4 x stronger than t4, wouldn't 13 MG t3 = 52MG t4?
According to the conversion chart for Armour thyroid, 1.5 grains (90 mg) of Armour is roughly equivalent to 150 mcg of Synthroid. So, that switch would be a fair increase in overall meds as well.
I'm going to play devil's advocate and disagree with both Bruce and Barb. Both your FT4 and FT3 levels are SO low that you have no idea yet how well you convert as there's barely enough T4 there for conversion.
You could try Armour, you could try Cytomel added to your Synthroid; or you could try the simplest...a simple increase in Synthroid until your FT4 is midrange and see where that takes your FT3 and your symptoms. I think you're just plain undermedicated at this point.
I'm going to play devil's advocate and disagree with both Bruce and Barb. Both your FT4 and FT3 levels are SO low that you have no idea yet how well you convert as there's barely enough T4 there for conversion.
You could try Armour, you could try Cytomel added to your Synthroid; or you could try the simplest...a simple increase in Synthroid until your FT4 is midrange and see where that takes your FT3 and your symptoms. I think you're just plain undermedicated at this point.
i saw the chart but still don't understand the math.
if 1 grain armour is .38 of t4 and .9 of t3, and t3 is 4x stronger than t4,
wouldn't 1 grain armour be equal to 74mg of synthroid?
if 1 grain armour is .38 of t4 and .9 of t3, and t3 is 4x stronger than t4,
wouldn't 1 grain armour be equal to 74mg of synthroid?
COMMUNITY LEADER
Bruce, I did agree with you until goolarra chimed in......really, I still do, because dosing T4 and T3 separately, tends to be much easier for many of us..
I googled a conversion chart and totally agree that what goolarra posted is what the conversion chart says. Apparently, I've been looking at the whole picture incorrectly...(yep I do make mistakes). I thought I had this down pat; now I'm forced to slink away and study some more; that's not all bad, but I won't do it tonight........... lol
I googled a conversion chart and totally agree that what goolarra posted is what the conversion chart says. Apparently, I've been looking at the whole picture incorrectly...(yep I do make mistakes). I thought I had this down pat; now I'm forced to slink away and study some more; that's not all bad, but I won't do it tonight........... lol
Well, I haven't yet asked for T3, but could. I seem to have side effects from Synthrid. Or at least I think they are from Synthroid. But maybe they are from just being undermedicated. Every Sunday evening, I've been taking one 112 pill, and then another half. That is a straight recommendation from the endo at Mayo Clinic Scottsdale. Back about 4 weeks ago, my TSH was 5.62. Highest I've ever seen it. Doc didn't think it was out of line too much and recommended the extra half pill once a week. He said he seen TSH levels at 1200 in people before which I thought was crazy. He assured me the symptoms I'm having are not from Synthroid. I've got dizzyness, blurry eyes, fast heart rate, shakes, ear ringing, and almost like an ear tingling in my left ear. I drop weight rapidly and then gain it back rapidly. My appetite goes from nothing to like I haven't eaten in weeks. I've got this little tickle in my throat but my doc said nothing wrong. No nodules, inflamation of the thyroid. I seem to have an incredible amount of engery too. I can work for hours out in my yard and thats after working all day at work at an IT administrator. If the dosage he is giving me of Armour is equal to 150 of Synthroid, I think I'm going to try it. What is the worst that can happen? My body won't like it either? What can I be looking for as far as side effects are concerned wth Armour?
COMMUNITY LEADER
Are your doctors only looking at the TSH, or are they taking the low FT's into consideration, too?
A person with TSH of 5.62 can feel just as bad as one with TSH of 1200. When you had TSH of 5.62, what were your FT levels.
Side effects of synthroid are those of being hyper, which is what most of your symptoms are, but of course, some of them can be present in hypo, too. It doesn't matter what your TSH is, as long your FT's are good for you. Some people tend to have a higher, or lower, TSH than others, and it doesn't always correlate with the FT's.
It takes foods different lengths of times to leave your stomach; some could be 4-6 hours or more, so waiting only 3 hours after eating means that you could still have food in your stomach that could prevent proper absorption of the medication.
Don't forget that, along with the T4, there's the T3 in Armour. The T3 in Armour is much more potent than synthetic T3. If I read the chart right, that 90 mg of Armour would also be equivalent to 37.5 mcg of synthetic T3, which is a pretty hefty dose, especially to start with. You might, at least, want to split the amount into multiple doses/day, so you aren't dumping all that T3 into your system at one time. T3 is pretty fast acting and peaks within a few hours, then the effects begin to diminish, leaving you with peaks and valleys. Best to keep the level stable.
A person with TSH of 5.62 can feel just as bad as one with TSH of 1200. When you had TSH of 5.62, what were your FT levels.
Side effects of synthroid are those of being hyper, which is what most of your symptoms are, but of course, some of them can be present in hypo, too. It doesn't matter what your TSH is, as long your FT's are good for you. Some people tend to have a higher, or lower, TSH than others, and it doesn't always correlate with the FT's.
It takes foods different lengths of times to leave your stomach; some could be 4-6 hours or more, so waiting only 3 hours after eating means that you could still have food in your stomach that could prevent proper absorption of the medication.
Don't forget that, along with the T4, there's the T3 in Armour. The T3 in Armour is much more potent than synthetic T3. If I read the chart right, that 90 mg of Armour would also be equivalent to 37.5 mcg of synthetic T3, which is a pretty hefty dose, especially to start with. You might, at least, want to split the amount into multiple doses/day, so you aren't dumping all that T3 into your system at one time. T3 is pretty fast acting and peaks within a few hours, then the effects begin to diminish, leaving you with peaks and valleys. Best to keep the level stable.
I agree with Barb's math regarding actual T3/T4 content in the Armour. That's why I posted it as "the Armour conversion chart says...".
When you add the actual T4 content to the T3 content time 4, it doesn't compute. I'm thinking that perhaps the conversion chart is adjusted for "most people on 150 mcg Synthroid need 1.5 grains Armour to get the equivalent effect".
How long have you been on meds altogether? The symptoms you post in your latest post do indeed sound more hyper. If you haven't been on meds for very long, that might be from starting too high or increasing too rapidly, or you could just be one of those aberrations like me who is comfortable lower in the ranges.
When you add the actual T4 content to the T3 content time 4, it doesn't compute. I'm thinking that perhaps the conversion chart is adjusted for "most people on 150 mcg Synthroid need 1.5 grains Armour to get the equivalent effect".
How long have you been on meds altogether? The symptoms you post in your latest post do indeed sound more hyper. If you haven't been on meds for very long, that might be from starting too high or increasing too rapidly, or you could just be one of those aberrations like me who is comfortable lower in the ranges.
There are different amounts lissted for equivalent conversion of T4 to NDT.
I have seen some that shows one grain of NDT, 60 mg, as the equivalent of 100 mcg of T4. I have seen other info that says that one grain is equivalent to 75 mcg of T4.
An NDT site lists one grain as containing 39 mcg of T4 and 9 mcg of T3. The different conversion factors are due to the question of whether one mcg of T3 has the effect of 4 mcg of T4, or should it be higher. Some say it should be as high as a factor of 8. With a factor of 4:1, a grain of NDT is equal to 75 mcg of T4. With a factor of 6:1, a grain of NDT would be equal to 93 mcg of T4, so approx. 100 mcg of T4. To be on the conservative side, the conversion of 100 T4 being equal to one grain of NDT, makes sense.
I was also curious about the statement, " The T3 in Armour is much more potent than synthetic T3." I have never seen that anywhere before. Can you provide a link? Perhaps it explains why I had poor success with Cytomel and Synthroid, compared to Armour Thyroid. Could it have been due to an incorrect dosage?
I have seen some that shows one grain of NDT, 60 mg, as the equivalent of 100 mcg of T4. I have seen other info that says that one grain is equivalent to 75 mcg of T4.
An NDT site lists one grain as containing 39 mcg of T4 and 9 mcg of T3. The different conversion factors are due to the question of whether one mcg of T3 has the effect of 4 mcg of T4, or should it be higher. Some say it should be as high as a factor of 8. With a factor of 4:1, a grain of NDT is equal to 75 mcg of T4. With a factor of 6:1, a grain of NDT would be equal to 93 mcg of T4, so approx. 100 mcg of T4. To be on the conservative side, the conversion of 100 T4 being equal to one grain of NDT, makes sense.
I was also curious about the statement, " The T3 in Armour is much more potent than synthetic T3." I have never seen that anywhere before. Can you provide a link? Perhaps it explains why I had poor success with Cytomel and Synthroid, compared to Armour Thyroid. Could it have been due to an incorrect dosage?
COMMUNITY LEADER
I've run across that a couple different places; will try to find it.
COMMUNITY LEADER
Sorry; I read it again; don't know what I was thinking - bit of brain fog, there. I meant to say Armour has more T3 than the human body produces and going by the conversion chart that I was looking at, 37.5 mcg would be a pretty hefty starting dose. .
hey Barb, Looks like you changed your photo. Nice. Anyways, great thread. So anthony is looking to switch to armour, but i really think he should try just the cytomel first. That way he can add a little in at a time and at least with the t3, he can control how much he wants. He can take 112 of t4 and add 5mg of cytomel and see how he does. If after a week or so he adjusts he can add more. However with armour, it is what it is. And frankly I hate the way the t3 makes me feel. I would MUCH rather have a nice high ft4 and be able to raise my t3 as needed, rather than having a high ft3 and a low ft4 as seen in a lot of the NDT people.
I am very tempted to switch to t4, but still worried. Maybe ill try a compound or something.
With all this being said and all these discussions and math, if i am on 2.75 grains of erfa and wanted to switch to a t4 (leslie bloomberg told me the same thing you guys did by the way) what would be the proper about of t4 for me to start with? isn't it 20% less than the equivalent?
I am very tempted to switch to t4, but still worried. Maybe ill try a compound or something.
With all this being said and all these discussions and math, if i am on 2.75 grains of erfa and wanted to switch to a t4 (leslie bloomberg told me the same thing you guys did by the way) what would be the proper about of t4 for me to start with? isn't it 20% less than the equivalent?
I don't know about others here, but after being a part of your saga of many years, now that you have made some progress, I refuse to give you any information that might enable you to change your meds again. LOL
COMMUNITY LEADER
Hey Bruce -- can't you see that I tripped up earlier in this thread, with the T3/NDT issue? Obviously, I'm not a math wiz either, so, not walking down that road with you tonight....
Personally, I prefer the synthetics because I can control them individually, which I've had to do in the past couple of days, due to hyper symptoms; so you're right, with NDT, you get what you get. See, I'm agreeing with you again.... horror of horrors....lol
We have to keep in mind that not everyone can use the same meds, so synthetics might work best for me, but not for someone else; just like NDT might work best for some, but not for me......when it's all said and done, we all have to make our own choices.
Personally, I prefer the synthetics because I can control them individually, which I've had to do in the past couple of days, due to hyper symptoms; so you're right, with NDT, you get what you get. See, I'm agreeing with you again.... horror of horrors....lol
We have to keep in mind that not everyone can use the same meds, so synthetics might work best for me, but not for someone else; just like NDT might work best for some, but not for me......when it's all said and done, we all have to make our own choices.
My doctor looks at all of it...TSH, FT3, and FT4. They are within the range so he says all is good. I'm the one who pushed for Armour. I have yet to take any. I feel my symptoms are either hyper or from the Synthroid. I can say, that I take my Synthorid at 9:00PM. I get these symptoms around 10:00AM the next morning. Ringing in ears, dizzy a bit...not horrible. Shaky hands. Also, I have an extreme amount of energy. Meaning, I don't exhibit hypo symptoms if you ask me. I wake up at 4:45AM on a normal work day, hit the gym, ride 10 miles, and then do some really solid circuit training. Then work 7:00AM to 3:00PM. I then come home, make dinner (yes, I'm the cook in the house), work out in the yard, mowing, raking, etc. until 10:00 probably. Then I go to sleep. I don't feel exhausted. I notice at times, my heart rate is very strong, and more rapid than normal. Other times, heart rate is completely normal. By the way, the Mayo endo said its complete myth about taking Synthroid with food. You obviously get a better absorption rate on a completely empty stomach but he said a lot of people actually do better taking it on a full stomach. No one at Mayo clinic has given even the remote possibility that I may be a bit hypo or hyper. They too looked at all the FT3, FT4, and TSH. I now demand it...not just TSH. Not one doctor has said your FT4 and FT3 are in range, but a bit low. They just say they are in range. For me, from my neck up (my head) is where I have the problems. As I write this, it is 10:30, and my ears ring, I've got a groggy headachy feeling, and some tingling in mainly my left ear. Also, just to note, I did ask about Armour and other natural thyroid medications. He said people typically start having all kinds of different troubles when they start self medicating, breaking pills in half, adding different natural thyroid medications, cytomel, etc. The body gets confused. I see so many people out here changing stuff up on an every other day basis. That seems ludicris. It takes a while for any of this medication to work. I maybe a bit under medicated for sure so I'm going to continue taking that extra half pill once a week, like the endo doc said, for now. He said it would bring my TSH down, and you know what, it did....dramatically. Over four weeks, it went from 5.62 to 2.93. In RANGE! And since it seems no one out here, no one, can properly provide a true conversion chart, I won't take the Armour unless my symptoms get much worse. I've had morning cortisol checked, testosterone checked, adrenals checked. All check out folks!~
Oh, and one more thing. I've spoken to at least two different endo's on the ever changing TSH. I have been told that TSH changes all the time, throughout the day. It could be 1.5 on minute and then two hours later at 4.5. Thats how it works....and it makes sense. TSH is what is says....when you body needs more thyroid hormone, you would expect your TSH to be higher. And vice versa. Not one person out here can tell me when their body needs more thyroid hormone. If you could, then you would be a billionaire becuase you could easily cure hypothyroidsim or hyperthyroidism by coming up with a way to medicate based on when you body needs hormone.
Just thought I'd join the party here and throw out some info that might be of further interest to you. Many of our members, myself included, report that relief from hypo symptoms required that FT3 was adjusted into the upper third of its range and Free T4 adjusted to around the middle of its range. Scientific studies have shown that FT3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.
As has already been mentioned above, just being within the low end of the range is frequently inadequate for hypo patients. My explanation for this is that the ranges for thyroid tests are established on data from the total population of patients. Then the assumption was made that about 2.5% of of people are hypo and 2.5% were hyper, so reference range limits were drawn based on those assumptions.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
This would not be such a huge problem if doctors used the ranges as guidelines within which to adjust levels as necessary to relieve symptoms. Instead, as your doctor did, they use the ranges as pass/fail. This is totally wrong.
As long as you have hypo symptoms, with your levels of Free T3 and Free T4, it is an indication that your meds need to be increased until your biologically active thyroid hormones (Free T3 and Free T4 ) are adequate to relieve symptoms. It may be that you need more T3 in your meds; however, since your Free T4 and Free T3 are both low in their ranges, you may be able to increase both by just increasing your current med. If your Free T3 level starts to lag behind your Free T4 level, then that would be an indication that you are not converting the T4 to T3 adequately,and you could add a source of T3 to your meds.
As has already been mentioned above, just being within the low end of the range is frequently inadequate for hypo patients. My explanation for this is that the ranges for thyroid tests are established on data from the total population of patients. Then the assumption was made that about 2.5% of of people are hypo and 2.5% were hyper, so reference range limits were drawn based on those assumptions.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
This would not be such a huge problem if doctors used the ranges as guidelines within which to adjust levels as necessary to relieve symptoms. Instead, as your doctor did, they use the ranges as pass/fail. This is totally wrong.
As long as you have hypo symptoms, with your levels of Free T3 and Free T4, it is an indication that your meds need to be increased until your biologically active thyroid hormones (Free T3 and Free T4 ) are adequate to relieve symptoms. It may be that you need more T3 in your meds; however, since your Free T4 and Free T3 are both low in their ranges, you may be able to increase both by just increasing your current med. If your Free T3 level starts to lag behind your Free T4 level, then that would be an indication that you are not converting the T4 to T3 adequately,and you could add a source of T3 to your meds.
After the following paragraph, I meant to add a comment.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
If the FT3 and FT4 data bases were similarly purged of the suspect hypo and hyper patient data, from my background in statistical analysis, I have previously estimated that the range for FT3 would increase from 2.3 - 4.2 up to approximately 3.2 - 4.3 and for FT4 increase from .60 - 1.50 to approx. 1.0 - 1.55. I think this is why we hear from so many members with FT3 and FT4 in the lower end of their ranges, yet they still have hypo symptoms.
I have run across thyroid info that called these higher levels "functional levels", as contrasted with the so-called "normal" ranges.
About 10 years ago the AACE finally accepted that there were lots more hypo patients than their assumption, so they purged their data base of suspect hypo patients and recalculated the range for TSH. The range dropped significantly from .5 - 5.0 down to .3 - 3.0. Unfortunately, they have not done the same correction for Free T3 and Free T4.
If the FT3 and FT4 data bases were similarly purged of the suspect hypo and hyper patient data, from my background in statistical analysis, I have previously estimated that the range for FT3 would increase from 2.3 - 4.2 up to approximately 3.2 - 4.3 and for FT4 increase from .60 - 1.50 to approx. 1.0 - 1.55. I think this is why we hear from so many members with FT3 and FT4 in the lower end of their ranges, yet they still have hypo symptoms.
I have run across thyroid info that called these higher levels "functional levels", as contrasted with the so-called "normal" ranges.
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