Hypo Symptoms/"normal" labs. Just got on armour

[Mischa251]

Hi All,

First, I have to say just reading this forum has been invaluable to me, in becoming more informed and not feeling so alone in what I've been experiencing the last year.

Im a 44 year old female. I've always been very athletic and very fit. I played competitive beach volleyball for most of my adult life, and never had a problem losing weight if I needed to, until 2013. This is a little long, so please be patient.

After going to a doctor with a cold in the early part of last year, they determined I had elevated blood pressure. Doesn't run in my family, I watch my sodium, and ALWAYS exercised and eat very healthy, so it was a little surprising. After about 2 months, I then noticed I wasn't able to lose a few pounds by amping up my exercise and diet, and my blood pressure was rising.

I finally went to my GP in May, and I was diagnosed borderline HBP. She didn't want to prescribe meds, instead trying the dash diet. I did, and surprisingly...I was gained more weight, losing hair, and found I was cold all the time. She tested my thyroid, only tested the TSH at that time, (I knew nothing about the other panels I SHOULD have tested). At that time my TSH was 2.36.She also tested my adrenals and they were normal as well. PM 4.3.
(never did the saliva test, I'm going to do that soon on my own.)

She thought everything was "normal" and sent me on my way.

What happened after that was crazy hot flashes, palpitations, (especially at night) , insomnia, and I started to develop some tingling in my fingers and toes, only at night though...never felt it throughout the day. She then did some diagnostics for lupus, and they looked normal as well. All the while, I could now "feel" my blood pressure, cant describe it, just knew it was not getting better, also came more anxiety.

Went back and she finally put me on a 25mg of metoprolol. My diastolic was still high, so she upped it to 50mg a day, still didn't control my diastolic to a normal range...then finally 100mg a day. Needless to say, being on that much metoprolol makes it VERY difficult to exercise. I still run on the treadmill 45 minutes, 5 days a week, but can barely keep up at 4 miles an hour with decreased heart rate from the metoprolol, whereas before I was doing 6.5 mph. I don't huff and puff, my legs are just tired.

Did a holter monitor and ECHO for the heart, both normal too.  

Also started getting irregular periods, and got my FSH tested. in September, which was 13.5, which shows perimenopause is happening. FUN. Also at that time:
TSH was 3.18, it went up since the last time.
T4 8.9
vitamin d  30.7.

During this whole time, I've probably ballooned up to my all time high weight. All while trying to exercise more and cut out gluten, complex carbs and then sugar.  

Within the past month, I started a very strict, low glycemic diet. Alot of proteins and vegetables. Gained even more weight. My normal temperature in the morning is about 96.3 now, hands are always freezing, dry/brittle hair and nails, brain fog, allergies off the charts (i'm allergic to everything, but I noticed I was sneezing MUCH more than ever) and my diastolic was still not below 85. Sooooo, dr. prescribed 25 mg of hczt, (I'm only taking half of it in the morning).

This last stretch had my doctor thinking to test my TSH again, and it started me on my own personal journey to research more than the TSH, and brought me to several of these boards.  I know she thinks I'm nuts, and I didn't want to call her and ask her to run all these other tests, so I just ordered them on my own and paid out of pocket. Here are the latest:

TSH: 2.98
T4: 9.1
TPO ab: 17
Reverse T3: 20
Free T4: 1.26
Free T3: 3.0

After reading about hypo, and the new ranges for TSH that labs don't use, I just noticed that i'm borderline and perhaps that could be the problem. I faxed her my newest labs, and pretty much pleaded to her, that my symptoms
are pretty much all hypo related and I'm at my wits ends.

She called back the next day, and agreed that the TSH values alone are controversial (Wilsons Temperature Syndrome) and wants to start me on a very low dose (15mg of Armour) once a day. She wants me to monitor
my blood pressure even more now, and my heart rate, and I'm told Armour can affect those...but at least she was willing to listen to me and try this.

My questions now are:

1. Is 15mg a day to low a dose? I've read too low can be harmful too?
2. She wants me to test my TSH ONLY in 6 weeks. Nothing else! Of course, I'm going to test more, but what should I be looking for in those labs that I can provide to her as evidence instead of just relying on the TSH only, which is concerning considering all of the evidence that supports the other crucial labs for the free T3s/T4s.
3. My doctor, bless her heart, is actually very kind, and willing to listen to me, and seems to be progressive. I don't want to ruin our relationship by always doubting her, but the mere fact that she relies only on the TSH is concerning. Have any of you had experience in "schooling" your doctors and actually encouraged them to seek new approaches towards thyroid disorders? Or should I just go to an endo? By the way, most endos in this area (Pittsburgh) are very reluctant to diagnose on symtoms alone, so I feel I have a gem in this doctor I currently have.

Thank you so much for reading and any insight would be DEEPLY appreciated!

mischa

[goolarra]

As I said above, T3 can raise your blood pressure initially.  T3 almost always takes a little getting used to.  How high was your BP compared to what it's usually been running?  As you get used to it, your BP should normalize in a week or two.

When adrenals are off, it can also make tolerating thyroid meds difficult.  It's a very good idea to get the 24-hour saliva test.

Has your doctor diagnosed RT3 dominance?  I'm not convinced that your FT3:RT3 ratio is low enough to be a real problem.

[Mischa251]

Hi,

Well, my blood pressure shot up today...the highest its been for a while....I called my doctor and she wants me to stop the Amour asap. I'm just so tired, sad, and was so hopeful I was on my way to recovery, even with such a small starting Armour dose.....but my blood pressure and getting that under control is most important now.  

I will most definitely have to see a specialist, but I've been reading a lot about the adrenals...last time I took the 24 hour urine test, it was invalid due to some meds I was taking that I didn't now affected the results...so Id like to do the saliva test now. I've read the adrenals can definitely cause HBP, and the other hypo symptoms/weight gain I been having...

My question is, is there any medication that can help with the RT3 dominance that doesn't elevate blood pressure?

Ugh, sad :(

[goolarra]

Your D was very low, and it was the end of summer when D levels are usually highest.  Definitely check to make sure your level is coming up.  If D isn't present in sufficient quantity in cells, T3 can't get into the nucleus.  So, you can feel hypo even with perfect serum FT3 and FT4 levels.  I'm not telling you to do this, but just as a point of reference, I've heard of people with D deficiency taking 50,000 IU per week until levels get a little better, then tapering.  It's something to ask your doctor about.

Splitting any form of T3 into two halves is always best.  However, if all you have left is crumbs, what you take in each dose is questionable (gives a grain a whole new meaning...LOL).  I wouldn't worry too much about splitting it at this dose.  If you go to a half grain, you can always start taking a quarter grain in the morning and one in the afternoon then.

Good question on the conversion issue.  It's a very controversial subject.  Mainstream medicine tends to discount RT3 as even an issue.  There are lots of opinions on if/how it should be treated, for how long, it's cause, how RT3 and FT3 interact with cells, etc.  Since your TPOab was negative, and your FT4 is good, indicating that your thyroid is functioning well, I think it's quite possible that meds could become unnecessary.

Conversion is not a thyroid process; it's a metabolic process.  Some conversion happens in the liver and kidneys, but a lot of it happens in cells in response to demand.  So, there's a lot more going on "downstream" from the serum levels we can measure.  Unfortunately, there's no practical way to measure tissue thyroid levels in living, breathing animals bigger than a mouse.    

I should mention that some of us who have Hashi's are only TGab (thyroglobulin antibody) positive, so you should probably get someone to throw that test in when you can.  By far, many more of us are TPOab positive, but you have to test both.    

[Mischa251]

Thank you so much for taking the time to give this information. I really appreciate it. This board is fantastic.

I only had my Vitamin D checked at the end of the summer and it was 30.7 range 30-100. I've been supplementing with Vitamin D ever since ( 10,000 mcg twice a week.) until I get tested again

I heard that breaking up the dosage in armour is better than once daily. So, I split my itty bitty 15mg Armour pill, but i'm guessing that's not necessary since it's such a small dose? lol  I was just concerned with the high blood pressure, and taking it all at once initially (albeit such a low dosage).

Since it's more of an issue with the T3 conversion, and the marginal hypo labs, is Armour something that would be used indefinitely, or just until the symptoms dissipate? Ive read some differing opinions on that.

Thank you so much for taking the time to give this information. I really appreciate it. I haven't looked at the message yet, I shall do that now.  This board is fantastic.

[goolarra]

T3 can both raise and lower BP.  I know that sounds ridiculous, but it can raise it slightly until you get used to it and then stabilize it once on a consistent dose that's right for you.  So, in your case, it's best to start out low and increase as tolerated.

Did you see the names in the PM I sent you?  The one doctor I pointed out is very well respected.  I'd be careful of MS's list...

Your FT4 looks really pretty good.  It's at 46% of range, and the target for FT4 is about 50%.  So, you're right where you ought to be on FT4, which indicates your thyroid is working well.
.  
On the other hand, FT3 is only 25% of range, and many people find they still have symptoms until FT3 is 50+%.  Also, the ratio of your FT3 to RT3 is a little on the low side.  It's 15, and reference range for the ratio is 10-20, the closer to the high end, the better.  Many people will argue that FT3:RT3 ratio should be 20+.

So, what I see here is a healthy thyroid with perhaps a problem converting enough T4 to T3 or shunting too much conversion toward RT3.  There are only two ways the body can get rid of T4, either convert it to the active hormone, T3, or convert it to the biologically inert RT3.  We typically convert one at the expense of the other.  How much is converted to T3 versus RT3 is adaptive.  Converting relatively more to RT3 is the body's defense mechanism during crisis...illness, trauma, starvation (including starvation dieting), etc.  RT3 puts us into a kind of "hibernation" (more torpor actually) state until the crisis goes away.  However, sometimes RT3 remains high once the stimulus that caused it has gone away, and that's when it becomes a problem.

You've probably already done some reading on RT3 dominance, which has also been called Wilson's Syndrome or Wilson's Temperature Syndrome.  

So, back to question #2:  I think Armour is the right choice for you.  It has a relatively high T3 content, and it's your FT3 that looks like it needs work.  Your FT4 is good already, so you shouldn't be looking to change that more than a little bit.  What you want to see is your FT3 go up and your RT3 go down (or at least stay the same, which with higher FT3 will improve the ratio).  Now, I have to caution you that our initial dose is seldom where we end up.  Sometimes when we first start on meds, labs can actually deteriorate, rather than improve, and symptoms can sometimes get a little worse.  It takes patience to find where we feel best, and it's a slow process of testing, evaluating symptoms, adjusting meds over and over until we feel well.  

Since your labs only look marginally hypo, I'd have to ask if you've had vitamins and minerals tested.  Deficiencies of D and B-12 can both have hypo-like symptoms, and D is necessary for T3 to be used on the cellular level.  B-12 might be as well, but I haven't seen that connection enough to believe it wholeheartedly yet.  LOL

The enzyme that catalyzes the conversion of T4 to T3 is a selenium-based enzyme.  So, selenium should be checked if conversion is a possible issue.


  

[Mischa251]

Thanks for the response and the info! I did see Mary's list, and found one, but his waiting list is into the summer! I can still make an appointment though.

My blood pressure seems to be doing well now, so it is a little scary to think this could raise it. :\

Here's the reference ranges:

Reverse T3: 9.2-24.1
Free T4: 0.82 -1.77
Free T3: 2.4-4.4
TSH: 0.450-4.50
T4: 4.5-12.0
TPO-: 0-34

Thank you again!

[goolarra]

15 mg is a low starting dose, but it's usually much better to start out low and increase slowly.  One worry is your BP.  There's quite a large T3 component in Armour, and T3 tends to raise your BP.  So, I think your doctor is being very reasonable starting you out low.

What are the reference ranges on your FT3 and FT4?  Ranges vary lab to lab, so you have to post them with results.  More on question #2 after I see ranges...

#3 is a loaded question!  I gave up on my PCP and found an endo, but that approach doesn't always work either (it did for me...I was very lucky).  Many endos only want to deal with diabetes and aren't very good thyroid doctors, so you have to vet them ahead of time before making an appointment.  

One of our members keeps a list of doctors recommended by other forum members.  There are three in PA, none in Pittsburgh, but I'll PM those names to you.  Go to the blue bar at the top of the screen, click My MedHelp and look in your Inbox.