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4524270 tn?1355878350

How to tell is this is correct armour dose.

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 However, a year ago I felt withdrawn and mildly hypo, so we tested TSH: 4.98.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 We doubled Synthroid (100mcg) for two months, and now TSH is 2.5, but I feel exhausted, withdrawn, depressed, scattered, dull, voice is gravelly, strong cravings for carbs/sweets and hot/spicy, gained 20 lbs, fingers and face are puffy.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.
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Avatar universal
For one thing you are moving too fast, it takes a minimum of at least three to 6 weeks for a replacement hormone to become fully active in your system, and Armour is a Combination T4/T3 Hormone replacement, most MD's wait 6 weeks between dosage adjustments and lab work, your playing a dangerous game upping dosages every week, you are taking a risk of getting slammed when all that medication catches up to you. If you over do the medication you take the risk of going Hyper instead of being Hypo, I would go back to 60mg/1grain, split the dose and take 1/2 in the am, and the same in the afternoon. You have to give thyroid replacement hormone time to work, it just does not react that quick, like you have a headache and take an advil. You need to have your MD do blood work after the first six weeks and then adjust the dosage, in addition you need to have your MD do a Free T3 and  Free T4 Tests, do not adjust meds by TSH , it is not accurate to adjust dosage. He/She should base dosage by those results and your symptoms, and only do small increment increases. Regards FTB4
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Avatar universal
To explain why you or your MD should not rely on TSH, TSH is "Thyroid Stimulating Hormone" it is not a thyroid hormone, it is a hormone sent to the thyroid by the Pituitary gland located in the brain, when the T3 is low, the pituitary send a hormone to "Bump or Stimulate the thyroid into secreting more T4 into your system, then your system converts the T4 to T3, after your system absorbs all the T3 that it needs, what remains is called Free T3, this is the most important level to test for and how you feel with symptoms, Free T4 is done also, they can compare the percentages of each to determine if your body is converting from T4 to T3. So if your MD is not sure, Insist on The Free T3, Free T4 and the TSH, then when the lab results come back, get a copy, post the results here, include the test level, and the reference ranges provided for each. Then we can advise and comment on wheere you are  at regarding thyroid and dosage
Best Regards FTB4    (And stop raising that Dosage!) lol
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4524270 tn?1355878350
Thank you for your response! I will reduce to 1 and 1/2 grains and see how it goes with the next lab. The next blood test is in late January or early Feb. My Dr is not comfortable prescribing Armour. I wanted to get on it before seeing a new endo, because my new endo is also reluctant to prescribe it. He has patients on it though.

For some reason, my temp was 97.2. this morning. Lower than it has been in a week.

I'm aware that TSH is unreliable as an indicator of my thyroid and I've been frustrated that my Dr uses only that test. I had to ask him for the antibodies tests! But he listens to how I feel generally and he is open to trying this. I went in to him armed with research and told him the next time we do tests I will need to have the frees done.

And yes, I have raised the dose quickly, risking that will catch up to me. I really hope it doesn't. If I don't feel hyper by late January, I can see how I'm feeling. I'll post results and ranges when I have them. I really appreciate the help here.

Again, thanks!

Alittleblues
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Avatar universal
When did all these increases occur?, also taking Armour gives you a little more energy because of the T3 in the medication, it raises you metabolism,
Do not let your MD talk you out of taking Armour for some stupid reasons that they come up with, like it is not FDA approved or it is dangerous, these are all "Old Doctors Tales" that when they have tunnel vision come up with.  I too have Hashi's and I am taking Armour, I have been through Levo, and Synthroid also. Could you Post your last Thyroid blood work, including reference ranges for each level. Also, Has he done Vitamin D and Vitamin B12 levels, please include them also, if he did not do those tests, you should request them in addition to the Free T3 and Free T4, and as long as you are at, have him throw in Iron. Many thyroid sufferers have issues absorbing nutrients from the food we eat, Deficiency symptoms can occur along with thyroid symptoms,ie: muscle pain/cramps, fatigue and lowered immune system.  Take Care and please post those labs. Regards FTB4
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Avatar universal
in my opinion, any Dr who is prescribing a medication with T3 in it and not testing for Free T3 is bordering on malpractice.

Yes those changes are WAY too fast.  I think it is a good idea to cut back. I completely understand your desire for quick results. Trust me. But that is NOT the best approach. And if you by self medicating like this have a bad reaction, it will only taint your Dr even further from every wanting to prescribe Armour every again.  You don't want to mess this up  for yourself, but also for others.

If on the other hand you take this slowly and it all works out. The Dr is likely to gain confidence with it and hopefully be able to help a future patient out.

Basal body temp in my opinion is probably more accurate than a TSH test.  However that's not saying much.  Also basal body temperature for a female who is still of child bearing years and not post menopausal can really only test for their basal body temperature for a short time during their menstrual cycle.  I can't remember when it is but if I recall I think it is only a few days to a week after her last period.  Ovulation etc have an effect on body temp.  So you have to be careful about using body temperature as such a precise gauge.

Testng for Free T4 and Free T3 every 6 weeks is the way to go.

Hashi's as you probably know is a progressive disease where your immune system slowly decreases your thyroid gland to produce thyroid hormone.  So you will likely have to have increased dosages of medication over time to make up for that loss of thyroid.  This is why it is good to know you have this situation so that you can keep getting tested enough to "catch" when a small bump in medication dosage is needed.

Many people here have found that they need to have BOTH of the following to feel well:

1) The Free T4 (FT4)  to be in the MIDDLE of the range (50%) or slightly higher

and - that means in addition to

2) Free T3 (FT3) to be in the UPPER 1/3 of the range (66.7%)

Notice that these are WELL up into the reference range!  Simply being somewhere within the reference range is NOT sufficient for many if not most people!

Everyone is different and they feel well at different levels. But the above target seems much more accurate to shoot for than simply the wide reference range.

Do NOT let any Dr tell you that you are "fine" simply because your TSH is at a certain level or that your FT4 and FT3 are "somewhere" within range.  If that is the case, they you will have to start searching for another Dr.

"immaculate TSH belief" and "reference range endocrinology" are two of the things Dr's will do that will keep you from feeling well.  And the only choice you have is to educate your Dr providing reams of medical studies and hope the Dr changes his mind or find another Dr.  Both have worked but both take a tremendous amount of patience and persistence.

Helpful - 0
4524270 tn?1355878350
Thanks to everyone who has replied. My increases occured over a month but I decreased to 1 and 1/2 grains a couple days ago. I have considered how my Dr will have more against Armour if it doesn't go well, so when I went in, I told him we will need to check adrenals and do other tests if it Isn't going well. To me, Armour shows problems that already exist because it does help the metabolism. If the body can't handle it, there is probably something else going on.

My Dr doesnt like to prescribe it because he knows little about it. He talked me out of it before and this time I went in armed with information, determined to try it, and he agreed. We will have the appropriate tests in January. He does have a few other patients on Armour.

I bought the whole "TSH only" sell for a long time but not any more.  I'm concerned I may have had Hashimotos for years but had no idea because the TSH was "normal," (For me, optimum is about 1.5 anyway.) Because the antibodies are so high I probably will end up needing more than I'm taking currently. Right now, on the lower dose, I definitely feel more tired.

I take my temp before waking every morning. It has dropped the last two days. I just took it now, after being up for hours also, and it's 97.8.
Helpful - 0
Avatar universal
Stick to your guns and demand The Free T3 and Free T4, since he does not seem to treat thyroid very much you can win him over being armed with more facts on Thyroid! And don't forget to post rthe results. Good Luck FTB4
Helpful - 0
4524270 tn?1355878350
Thanks for the encouragement! I will post the results and already told him we will need to do those tests next time.

After only a couple days on a lower dose, my voice is becoming gravelly again, where I was seeing improvement on 2 grains, and I'm super scattered. Should that improve if I give it enough time to build up in my body? I'm feeling less focused and energetic on the current dose of 1 and 1/2 grains. Hearing my gravelly voice is depressing, plus I work in a job environment where I deal with people all day.

I didn't mention this before, but what the heck: I'm super puffy and practically stopped urinating the last two months I was on Synthroid. When I hit the 2 grain dose, I started to pee again. That might be too much information, but I hoped I was starting to lose some of the water retention.

My initial question was how will I know if I'm the correct dose? I'm feeling so scattered.
Helpful - 0
4524270 tn?1355878350
Can you help me understand the conversion table for dosing between Armour and Synthroid? I saw a few conversion charts online but what I want to know is, how does the T3 in Armour effect how potent it is or how efficiently is works?

I was feeling symptomatic on 100mcg synthroid. I was feeling better on 2 grains of Armour, but is that way stronger because of the T3? Do Armour patients usually need higher or lower doses than they had on Synthroid?

If you or anyone else can help me understand this, or if you can point me to a reliable website, I'd appreciate it. Thanks
Helpful - 0
Avatar universal
Here you go:


          Armour       Synthroid
         1/4 grain      18-25mcg
          1/2               74-100
          1.5               111-150
          2 grain        148-200
    Ypu are taking too much @ 2 grains, you need 1/2 grain to equal 100mcg         FTB4
                                                                                
      
Helpful - 0
4524270 tn?1355878350
Thanks. I wonder why I feel worse on 1 and 1/2 grains. I was very symptomatic after two months on 100mcg Synthroid, so that may not have been enough.

Does the T3 in Armour make less T4 mcg necessary?

My basal temp has dropped since I cut back, but I want to track it for the next weeks to see if it rises as the Armour builds.
Helpful - 0
4524270 tn?1355878350
I mis-typed the TSH before at 2.5. Years ago, when my TSH lowered, I felt better, except for the depression. I haven't had hypo symptoms or depression for ten years, but now I think my withdrawal the last few years has been a symptom. That and a very slow weight gain, until two months ago where my cravings and sudden weight gain were alarming! I had some extreme stress to deal for some time, so withdrawing made sense, at least before everything else went askew a couple months ago.

Here are my last results as they appear on paper:

test:                                                  
Thyroid AB           77             reference:    < 40 IU/ML
Microsomal AB     6771              "                <= 60  u/ml
T4                         8.5                "           5.53 - 11.0 ug/dl
TSH                      2.05               "           .465 - 4.68  uIU/ml

I'm open to anything helpful you can surmise from this. Thanks



Helpful - 0
4524270 tn?1355878350
Correction: My symptoms began months ago. I have had sleep disruption for a while, but that was worsening. I was alarmed when my hair started thinning and my voice suddenly became gravelly. That is my "wake up" symptom. "Wake up! You are definitely hypo!" And every time I stepped on the scale I was a pound heavier. I went to my Dr  and he prescribed double-dose Synthroid for two months, which wasn't relieving the symptoms. Which led me to start the Armour.

I felt like I needed to clarify the timing.
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Avatar universal
The medication takes time as said above, you cannot expect miracles in a week or two, it takes at a minimum of 4-5 weeks to get a good idea where you are in regards to your thyroid. You have to stop self medicating, all these stops and starts or up and down dosages just cause delays in balancing out your system, decide on a little lower dose than 2 grains, 2 grains being equal to 200mcg of Synthroid is a high dose for someone just starting out on a T3/T4 mecication. The reason you feel so much better on the high dosage is due to the T3 cranking up your metabolism, but can have a negative effect if it is abused, you must take small steps, until you get to a stable, and consistant tested level. The more you go back and forth, the more you delay getting well.   Regards FTB4
Helpful - 0
4524270 tn?1355878350
Thank you so much. I'm frustrated because I was feeling better on the higher dose, seeing some improvement in my voice and in sleeping for several hours straight. I figured out I have been at 11/2 grain dose for three weeks now, with the one week at the 2 grains.

What can I expect if I'm at too high a dose? I appreciate your patience with me. I have learned a lot about Armour but would like to know how I will know if this is too much or too little.
Helpful - 0
Avatar universal
Like we have stated, the reason you are feeling better is the T3 portion of a T3/T4 Hormone, the T3 gets used up quick, usual 5-7 hours, The T4 portion stays in your system longer and takes time to convert to T3. Until you get that T4 up, you are not going to be consistant. The higher dose you speak of is the T3, look at it like taking amphetamines, they were prescribed to be taken in small doses, at those doses they remaim fairly safe, but once you abuse them, because they make you feel good and give you a burst of energy, but what damage are they doing to your internal organs and heart, one of the most severe symptoms of Hyperthyroid is the heavy load that is placed on the heart due to an overworked metabolism. If you stack up all this T4 in a short period of time, it could make you hyper, and give you a whole new set of symptoms to deal with. At least four members here have warned against rushing and self medicating, why would we be making these statements? Because what you are doing is taking a risk with your health, You ask, "How will I know how much is too much or too little?" You do it the way we have advised "Small Steps" You raise the dosage a little bit, you wait 6 weeks and have a blood draw,wait for your Free T3 and Free T4 then if you are still low you increase a little again, its not rocket science, you have patience and take your time. If not then your body pays for it in a negative way. FTB4
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Avatar universal
I was diagnosed with hypothyroidsm in May, 2009. I took the generic(I can't spell it) for synthroid and was retested after 6 weeks. My doctor also checked the free T3 and T4. She made adjustments and my tsh went from 6.1 to 4.6. she felt I should be super  now. But the truth was, I only felt a bit better. One Monday, I did...I felt so good it was almost like I used to feel. but by Tuesday, it was wearing off and by Wednesday it was gone.

I was doing a lot of research on the Internet and asked her if she was going by the old window or the newer one. She was using the older one and didn't want to get my level lower than 4.1. She scheduled me for a visit with a local encrinologist who explained everything she had already told me. He was going by the old window too. So since I was doing a bit better I just stayed with her.

After about a year I noticed I was developing a lump in the upper center of my breastbone. I've been watching it for a couple years now. this week I checked online for info on what is located in this area. The Thymus gland is in the same location. It is supposed to hold white blood cells and fat and shrink after puberty. But mine has grown enough to puch the breasbone up.

A year ago I moved to the norht Georgia area and looked for a new doctor,. My doctor in Ohio was Chinese and always open to listen to my concerns and read the info I copied from the Interet. This doctor is from  India and the info on them said they treated geriatic patients and used some holinistic treatments. I'm not sure what that is but I hoped it meant they stay up to date on medicine and treatments.

Not so, she is not as open to discussion, did not check the amount of dosage my Ohio doctor prescribed and gave me the feeling we 'elderly' don't know what we''re talking about. At 79 years old I'm 'older' not elderly. As a result in May 2012 she gave me 50 mcg of Synthroid instead of the 100 mcg. I think that's right, I don't have it here in front of me. My TSH test in September 2012 was 4.6. I said that was higher than my test in Ohio, should she raise the dosage...she said it's in the range and is okay.

I have an appointment January 4, 2013 and plan to take some info I found on the Internet that suggest there is a connection between the thymus and the thyroid glands. It was on www.ehow.com and states "According to the Womens' Guide toThyroid Heath, low thyroid function can cause a reduction in the production of hormons by the thymus galnd."

So my question is, if that statement is true can the Synthroid I'm taking to raise my low thyroid also cause the thymus to grow????

Has anyone else had this experience with their thymus?
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Avatar universal
Hello, First of all, 4.6 TSH is on the high side of an old range, the new range recomended by the American Board of Endocrinologists advise 0.2-3.0 or 3.5  so your THS would be a little high, indicating Hypothyroid or underactive thyroid condition. Also, if you wish to get as many responses and information regarding your questions and issues, that you post a question on the main page rather than in response to someone elses as yo have acidentally done, I hate to have you retype your whole post, unless you can copy and paste it on a new page. If you go to the main forum page, which lists all questions and post at that location. Also, Did they do a Free T4 and a Free T3 in addition to the TSH? If they did, please include those and the references that were provided for each. We will help in responding to any questions you may have. Best Regards FTB4  
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4524270 tn?1355878350
" At least four members here have warned against rushing and self medicating, why would we be making these statements? "

That's what I needed to know: Why you are making these statements.

I wanted to know if Symptoms would tell me if it's too much or if I must wait for labs. I am symptomatic, with little or no relief after being at this dose for a few weeks. I haven't had shaking or any other hyper symptoms and my blood pressure is consistently excellent so I would need to know why I should still not increase. Your last post helped me understand that by sharing a little about how the science works. That's what I need to make a good decision.

Thank you for the information and also sharing about your own experience.

Alittleblues
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Avatar universal
The only reason we or I seemed to harp on being patient is so you don't flip to Hper. Lets say for example I say or advise you to go ahead and take some extra Armour since you don't feel good and it may help you. One of two things could occur 1, You get better, and your labs come out fine.
2, You take just enough T3 to make you feel better, but since T4 is like a stockpile in your system, all of a sudden your conversion kicks in and you start getting a huge dose of T3 that comes from this stock pile of T4 that you have built up over the last three weeks or so, because you were taking 2 grains of Armour a day, Now you are going Hyper, and when the six week period comes up and you do your labs, your levels are going to be so far out of whack, you have to go through another two six week periods before you straighten out. I would never advise you to increase your own dosage without knowing where your levels are at. In addition Armour is only about 9% T3, some buffers or binders and the rest is T4, T3 reacts right away, T4 builds up. I don't want you to get upset with me or any other members here, we are here to help you, not make you frustrated or streesed out. All we can do is offer the knowledge we have, and everyone reacts different to thyroid medications. Sometimes we have to just grit our teeth and accept a little misery to achieve a longer lasting goal. I hope this answers your question of why I think you should wait before increasing your dosage any further until you get your lab results. When you get them, you are welcome to post them for members to advise and comment. Best Wishes and Good Health FTB4
Helpful - 0
4524270 tn?1355878350
I appreciate that you're trying to help and am not frustrated. I just needed more information. I needed to know why, not just because you told me so. :-)

As passionate as some responses were, I didn't feel my actual questions were answered. Thank you for the information in the last two posts especially. I may have to hit some bumps in the road--hopefully not many-- but I'll figure this out.

Hope you and others here have a very happy new year!


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Avatar universal
I understand your concerns over dosing and here is how we do it in south Florida. You increase your Armour dose by 1/2 grain every two weeks until your symptoms abate. You keep a record of how you feel during this time. If you go hyper, you don't take your pill that day, and cut back by 1/2 a grain. Your body tells you what your optimal dose is, not the blood work. Your TSH will be on the low end at your optimal dose. We do not wait 6 to 8 weeks for lab results to increase the dose. Each morning, before you get out of bed, you place your hand on your heart. If it feels rapid-if it is, it will be obvious-skip your dose that day and cut back by 1/2 grain. It's that simple. I am a nurse practitioner, as well as, a hypothyroid patient.
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Avatar universal
Please go to another doctor that speacialize in the thyroid, it seem to me your body is not accepting, every time they change your med it usually take 6 to 8 wks for my medicine to kick in, i have had graves disease and hypothyroid, and now my endroconoligist, i have low blood pressure and high cholesteral and fibromyalgia, i have never been on armour dose, i am currently
being tested for hashimoto due to this, there are more test that they need to do, get a second opinion, this doctor is messing with your body and throwing everything off, Get a second opinion
Helpful - 0
Avatar universal
How do you account for the build up of T4 without doing blood work?, The best procedure is using both Free T3, Free T4 results and symptoms, also skipping doses is not good practice. It takes longer than one day for your body to react then one day. And the waiting period is at least 4 to six weeks. On again off again everyday is not a good procedure. and we are all
Hypo and Hyper thyroid patients.   FTB4
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