How to tell is this is correct armour dose.

[Alittleblues]

I'm new here, so here's a little history: I'm 48 years old. I was hypo years ago, but decided to go off Synthroid. Without treatment, I had no symptoms for ten years, and a 'normal' TSH (4.5.) which we tested every six months. However, a year ago I felt withdrawn and mildly hypo, so we tested TSH: 4.98. We did not do an antibody or T3 test.

I've been taking Synthroid ever since, but in the past 5 months, I've became very symptomatic. TSH was 46. We doubled Synthroid (100mcg) for two months, and now TSH is 2.5, but I feel exhausted, withdrawn, depressed, scattered, dull, voice is gravelly, strong cravings for carbs/sweets and hot/spicy, gained 20 lbs, fingers and face are puffy. I don't recall if I have any short term memory. :-) And now my hair is thinning.

So it's Hashimotos. My TPO antibodies are 6771.

Because Synthroid is clearly not relieving the symptoms, my Dr is supporting me to try Armour, but he knows little about it. Because my antibodies are so high I decided to start on one grain. I felt more energy after I took it, but not noticeably better, so after a week I decided to up to 1 and a 1/2 grains. No shakes or other issues and I'm sleeping better, so I think it's helping. After another week, I went up to 2 grains, which I split between 3 doses. I plan to stay on 2 grains for two or three weeks. My morning temp was averaging 97.3, but now hitting 97.8 almost every day.

How --or when-- can I tell if this is the correct dose? How will I know if it's too much or too little?
I would really appreciate advice.

[gimel]

If you take a look at this link to the 2012 issue of Clinical Practice Guidelines for Hypothyroidism, by the AACE and ATA associations, you will note on page one that,  "The guidelines are not inclusive of all proper approaches or methods, or exclusive of others, The Guidelines do not establish a standard of  care, and specific outcomes are not guaranteed.  Treatment must be made based on the independent judgment of health care providers and each patient's individual circumstances.  A guideline is not intended to take the place of physician judgment in diagnosing and treatment of particular patients."

http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2012.0205

All this is generally ignored by many doctors who lock in on TSH as the predominant diagnostic they need, and if it is above range, then they will also test for Free T4.  If Free T4 is within its range, then many will not treat, regardless of symptoms.  The guidelines do mention some of the symptoms that can be related to hypothyroidism, but then go on to say that, "While the exercise of calculating clinical scores has been largely superseded by sensitive thyroid function tests, it is useful to have objective clinical measures to gauge the severity of hypothyroidism."

Unfortunately most doctors have interpreted the Guidelines as rules to follow and use that as an excuse to deny treatment for many hypo patients.  The only real value to TSH is to distinguish between primary (autoimmune system related ) and central ( hypothalamus/pituitary related) hypothyroidism.  Suffice to say we could talk all day about why this situation exists, but TSH cannot be shown to even correlate well with the biologically active thyroid hormones, Free T4 or Free T3 much less correlate with symptoms.  Yet, symptoms are why we go to the doctor, not our TSH levels.  

Even when the doctor tests for Free T4, the range for it (and also Free T3) are faulty, because of the erroneous assumptions used to establish them.  As a result a Free T4 or Free T3 in the lower half should be suspect for being hypo, and further evaluated.  

As for something you can show your doctor, this might be a good talking paper.  This link was written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

Since you mention dosing, you might also be interested to know the following, taken from a study by Fraser, et al.  "  “It is clear that serum thyroid hormone and thyroid stimulating hormone concentrations cannot be used with any degree of confidence to classify patients as receiving satisfactory, insufficient, or excessive amounts of thyroxine replacement…The poor diagnostic sensitivity and high false positive rates associated with such measurements render them virtually useless in clinical practice…Further adjustments to the dose should be made according to the patient’s clinical response.”

Also from a study in the British Medical Journal.   "In a study published in the British Medical Journal, Meir et al also investigated the correlation of TSH and tissue thyroid effect. It was shown that the TSH level had no correlation with tissue thyroid levels and could not be used to determine a proper or optimal thyroid replacement dose. The authors concluded that “TSH is a poor measure for estimating the clinical and metabolic severity of primary overt thyroid failure. … We found no correlations between the different parameters of target tissues and serum TSH.” They stated that signs and symptoms of thyroid effect and not the TSH should be used to determine the proper replacement dose."

[LAR33]

I'm new to this "taking charge of my health" thing and I'm battling my doctor over dosing with Armour.  I just went to the American Board of Endocrinologists website and I can't find where they state that TSH should be .2-3.0 or 3.5.  Can you help me with something I can show my doctor?  

[gimel]

Thanks for telling us your experience.  Information like that is good for new members to read about.  

I also was just curious about what your thyroid test results looked like from the time you were feeling so bad, and then when you were feeling good.  It is always interesting to see what levels work best for members.  

[LAHss]

Your advice is "right on!". I have just completed 2 1/2 years of a TSH/T4 doc who kept showing me that everything was within range - and yet I felt as if I was going to die!. It wasn't until I did my own private tests (through True Health Labs, via the Internet) of complete Thyroid panels that I was able to see that although I was within range, every one of the measurements was about one unit above the minimum range bar. I calculated the T3/T4, T3 to reverse T3 ratios and saw for myself that things were way out of whack and therefore why I was feeling so ill. With that knowledge I got very angry, I finally flipped and went to the insurance office of my HMO and demanded that I get a "sensible" Endo. She called another hospital, got me a different Endo and here I am with almost no symptoms, a clear head, no headache, no muscle pain, no joint pain, wide awake and back into life on Armour Thyroid. Why on earth we are up against this wall of obstinance from the medical profession I would truly like to know. Anyway, keep talking and keep this outrageous nonsense in the limelight.

[LAHss]

Your advice is "right on!". I have just completed 2 1/2 years of a TSH/T4 doc who kept showing me that everything was within range - and yet I felt as if I was going to die!. It wasn't until I did my own private tests (through True Health Labs, via the Internet) of complete Thyroid panels that I was able to see that although I was within range, every one of the measurements was about one unit above the minimum range bar. I calculated the T3/T4, T3 to reverse T3 ratios and saw for myself that things were way out of whack and therefore why I was feeling so ill. With that knowledge I got very angry, I finally flipped and went to the insurance office of my HMO and demanded that I get a "sensible" Endo. She called another hospital, got me a different Endo and here I am with almost no symptoms, a clear head, no headache, no muscle pain, no joint pain, wide awake and back into life on Armour Thyroid. Why on earth we are up against this wall of obstinance from the medical profession I would truly like to know. Anyway, keep talking and keep this outrageous nonsense in the limelight.

[Territam]

TSH testing doesn't work for me because I have pituitary issues