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6520489 tn?1382447286

>>>I want Armour instead of synthetic<<<

I have had Hypothyroidism for 2 years.  I have been taking NDT for a year that I get mail order.

My GP acknowledges the my labs are fine, but he doesn't want to give me a prescription for Armour.
(I want to get Armour now because it is easier and faster and less expensive than the imported NDT).  

Instead he referred me to an Endocrinologist and said I should discuss this with him.  I don't want Levothyroxine.  What's the best way to discuss this with the endo?  The best way to be persuasive in my discussion?
19 Responses
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649848 tn?1534633700
COMMUNITY LEADER
I learned the hard way, that I have to advocate for myself, because if I simply follow the doctor, blindly, I will be kept ill.  The pcp who diagnosed my hypothyroidism, refused to run antibody tests to determine whether or not I have Hashimoto's, simply because the treatment wouldn't change. He also refused to run FT3 (said it was only for "research" -- say what?) He also tried to control my hypothyroidism, by adjusting TSH and as soon as my TSH dropped to the basement, he started pulling me off my med... whoa!  Talk about a basket case.

It was only because I had some voice problems and had, previously had a couple of vocal cord surgeries, that I got sent back to the ENT, who took one look at me and said "what the h--- happened to you?".  I explained it all and he wrote an order for antibody blood work, and sent me for an ultrasound; he ultimately diagnosed Hashimoto's and referred me to the endo.  That was my "come back".

Unfortunately, too many people sit back and say "s/he's the doctor, s/he knows best".... not so, at all, especially, when it comes to thyroid.

Actually, you're entirely correct, about the delivery system; that's why I do so well with Tirosint, because it's a gelcap, so it dissolves more fully and is better absorbed; I don't have Crohn's, but I do have a problem with absorption.  My T3 tablets don't dissolve well, sublingually, but I do chew them; seems to make a big difference in how they work. I know others, also who chew their meds.
Helpful - 0
6520489 tn?1382447286
Thanks for the specifics Barb.  I picked up my Armour today and located my pill splitter.  I talked to the pharmicist today about taking pills sublingually compared to swallowing.   The delivery system may play a big part in how much of the active ingredient that I get.  My Chrone's surgerys have left me with a tiny small intestine and that means not much surface area to absorb nutrients or meds. Barb, by experimenting with quantities, you really take an active roll in staying in good health.  How many people do we know that prefer to take a passive role and expect the Doc to be in control?
--Jeff
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I'm currently getting blood work every 6 months, because my levels have been stable for some time, so my dosages haven't changed much.  When we were actively adjusting dosages, I was getting blood work every 6 weeks.

I take 88 mcg Tirosint (T4 gelcap), and 10 mcg generic T3.  My latest adjustment was in August 2013, when I bumped from 7.5 mcg T3 to 10 mcg T3.  We did not test after the 6 weeks, because my FT3 level was just slightly low, for me, and my endo knows that if I get too much T3, I'll back off on it.

Every time I have blood work, I have TSH, Free T3 and Free T4.  Because I'm on a T3 medication, it's important to make sure FT3 levels are staying where I need them.  They are pretty much my "wellness gauge", though I do make sure I have enough FT4, as well.  We don't even look at my TSH, because it's lived in the basement, at < 0.01 - 0.01, for the past 5 yrs.

I take my Tirosint, when I get up every morning, wait about 30 minutes, then take 5 mcg T3 med, along with blood pressure med.  About noon, I take the other 5 mcg T3 to carry me through the rest of the day.  

Most of us on any type of T3 medication, including desiccated, find that splitting the dose into multiple doses works best, since T3 is fast acting and doesn't stay in the system very long.  Splitting the dose over the course, of the day, better insures that we have a steady supply.
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Avatar universal
Congrats on finding a doctor who will listen to your requests. Hopefully he will catch on to your request for FT3 because it is an important test. Endos never like desiccated thyroid but some, like yours and mine, are amenable to anyone who insists on it. For what it's worth, at my last blood draw my FT3 was around 83% of range and FT4 62% of range, and I feel great. I take 2.5 grains Naturethroid (desiccated thyroid like Armour) per day split into two doses.
Helpful - 0
6520489 tn?1382447286
Thanks Barb,
How often do you get blood tests?  Do you get Blood tests regularly and what do you test?
--Jeff
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649848 tn?1534633700
COMMUNITY LEADER
I agree that wanting desiccated hormone because it's "natural" isn't a legitimate reason.  I don't agree that FT3 is not important.  It's true that T3 spikes the level, which is why we always tell people on T3 med NOT to take their T3 until after the blood draw.  That lets you know how much FT3 is in your blood without the T3.  I would never have gotten as far as I have without being able to monitor FT3 and adjust T3 med accordingly.  AND I think it's somewhat dangerous to prescribe a T3 med and not keep track of FT3 levels, because a lot of people on desiccated hormones tend to run a pretty low FT4, which can make it appear that levels are fine, but FT3 can get too high, pretty quickly, when you're taking that much T3 med.

All of that said, I'm glad you liked the doctor and that he spent so  much time with you; that's pretty rare.  Also glad that he was willing to continue your medication of choice.

Best of luck.
Helpful - 0
6520489 tn?1382447286
I saw my Endo this morning.  He's been in my NH town practicing for 25 years.  It was a good 60 minute visit (actually an hour+).  He agreed with me continuing NDT in the form of Armour Thyroid.  Mainly based on the fact that I reduced my lab numbers with NDT.  He said he felt a T3 free test was not accurate when you are on NDT because it spikes the level of T3, but said he had no problem with me continuing on Armour.  He also said it was more difficult to adjust the levels of NDT compared to T4 meds, and fine tuning is critical when treating Hypothyroid.  Told me that it was easy to OD on Iodine so be careful about what I eat.  Said many people that want NDT do so because it is "natural" and that is not a legitimate reason.  Felt very comfortable with this Doc. BTW I had 2 BP's taken, one before the visit and one after.  Before 159, after 134 (I didn't note the bottom numbers).  130ish is a good place for me to be.  I take no BP meds and don't want to.  I repeat, this forum is invaluable and I appreciate the input.  --Jeff
Helpful - 0
6506604 tn?1382104872
Good Luck Jeff

I am taking a different route before I see an Endo.  A friend turned me onto Functional Medicine.  These are doctors that break down the root cause of the problem.  For all I know my body be in a slump from foods, stress etc.


Thom
Helpful - 0
6520489 tn?1382447286
Barb, thanks for the info.

I am going to see what this new Doc says tomorrow, then figure out plan B.
Sometimes when I go into a multi Doc paractice, I ask the people at the front desk which of your doctors has the best sense of humor or which doctor is your favorite. Both loaded questions, but sometimes you get an interesting response.

Last week I went in to a new Doc (the neurologist) and said I am here to interview for the new patient position, is there still an opening?

I appreciate you getting back to me,
--Jeff
Reply
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649848 tn?1534633700
COMMUNITY LEADER
gimel and flyingfool have covered the basics; I'm sending you a PM regarding a doctor.
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6520489 tn?1382447286
Thanks so much for reading my comment and responding. This forum is great because members specifically respond to what you say.  Sad to say, most people on most forums respond sympathetically but usually in generalizations.

I saw a neurologist last week for a questionable CT scan.  Turns out that the shadows on the brain image are nothing to worry about.  The Doc was very young and had only been in this first practice for only 3 months.  I try to interview the Doc as much as he interviews me.  Knowledge, experience, a sense of humor and openness to alternative therapies(complimentary medicine) are the 4  qualities that I look for in a good Doc for me.  He had one out of 4 (knowledge).

You are correct, Free T3 was missing from the labs, so I'll see what this Doc says tomorrow(Wednesday 9am) about taking additional labs.  I started ordering NDT from an overseas resource I found on stopthethyroidmadness website.  Janie, the owner of the site, seems to do a good job in presenting information.  I would like to get Armour because it is a domestic source and is under the scrutiny of the FDA. and it is now pretty cheap.  I look forward to asking this new Doc about Hashimotos.  I only take supplements and the NDT after 45 years of Chrone's.  At 65 years old all the Docs I have been seeing(my Medicaire is now in full swing) are amazed that I don't take a laundry list of meds.
That's why it is important to pick Docs that accept alternative therapies.
I accept traditional meds when absolutely needed.

Again, Many thanks for the comments.
--Jeff
Helpful - 0
6520489 tn?1382447286
Hi,  I have an appointment tomorrow at 9am for an hour, so I am writing down my questions and re-reading all of the knowledge-filled content in these posts.
I will let you know what happens.
--Jeff
Helpful - 0
Avatar universal
I saw no tests for Free T3. Only for Total T3.  This would be like testing to see how much gas is getting to your cars engine by checking the fuel gauge to see how much gas is in the tank. Sure you need gas in the tank of the engine to work. But it could be completly full and have a clogged fuel line or a broken fuel pump and your engine would not get enough gas to run right.  Checking for Free T3 is like checking the fuel flow rate at the fuel injector or carburator right before entering the engine itself.

because of this conept, the "total" tests and T3 uptake tests are outdated and of little value.

Once a person has an autoimmune system disorder, that person has a dramatically higher chance of having other autoimmue conditions. So having Chrohn's would make you more susceptible to having Hashimoto's.  Not to mention that Hashimoto's is the most common cause for Hypo in the modern world!

How are you able to go ahead on you own and order a NDT prescription medication?
Helpful - 0
6506604 tn?1382104872
Jeff

Keep us posted of what your endo says!  My situation is much like yours.My GP wanted to give me synthroid based on TSH alone which was 6.18.  My endo appointment is not till Nov 8th.  I am more partial to Armour or something NATURAL!


thanks

Thom
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Avatar universal
This link was written by a good thyroid doctor for patients that he sometimes consults with from a distance, after initial testing and personal evaluation.  I thought you might get some good insight, before seeing the doctor.

http://hormonerestoration.com/files/ThyroidPMD.pdf  
Helpful - 0
6520489 tn?1382447286
Thanks so much for your thorough response.
Do you think there is a connection between Chrohn's
Disease and Hypothyroidism?  Or for that matter, most
other autoimmune diseases including Hashimotos?

On Wednesday, when I see the Endo, I will ask some questions based on your reply.

We spend 6 months, starting next Friday near Ocala Florida.  Do you know of anyone in the Ocala, Gainesville, Crystal River area of Florida that I can see?

Again, thanks so much for your comment.
--Jeff B.
Helpful - 0
Avatar universal
So you  were started on thyroid meds due to low thyroid hormone levels.   Have you been tested for Hashimoto's Thyroiditis, another autoimmune disease?  If not, the definitive tests are both TPO ab and TG ab.  Since you have another autoimmune system problem, with your diagnosed hypothyroidism, it is very likely that Hashi's was the cause.  If so, positive test results will make it much easier to get the Endo to continue with your meds.

Be aware that Endos are frequently diabetes specialists, not thyroid.  Also, many of them have the "Immaculate TSH Belief" and only want to use TSH to diagnose and treat.  That does not work.  Although TSH is supposed to accurately reflect levels of the actual thyroid hormones, in reality TSH cannot be shown to correlate well with either Free T3 or Free T4, much less with symptoms, which are the most important consideration.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  So you should always make sure they test for both Free T3 and Free T4 each time you are being tested.  

Further, many Endos that do test beyond TSH then use "Reference Range Endocrinology" and will tell you that a test result that falls anywhere within the reference range is adequate.  That also doesn't work.  The ranges are far too broad to be functional at all levels for all patients.  Many members say that symptom relief required Free T3 in the upper part of its range and Free T4 around the middle of its range.

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  Some hypo patients are able to achieve symptom relief by taking enough T4 med.  This works as long as the patient adequately converts the T4 to T3.  If not, then T3 needs to be added to the meds, and increased until symptoms are relieved.  

Don't be surprised if your Endo does not agree with what I've said.  The vast majority have been trained otherwise, it seems, and are very rigid in their approach.  You can find out by asking if the Endo is willing to treat clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms.  Also ask if willing to prescribe T3 type meds.  If either answer is no, then you should look for a good thyroid doctor elsewhere.  If you will give us your location, perhaps a member can recommend a good thyroid doctor, based on personal experience.  
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6520489 tn?1382447286
Hello,
Thank you for responding.  I have had Chrones disease (autoimmune) for 45 years.  Six years ago a naturopath prescribed Armour Thyroid for my low Thyroid and it worked at leveling my TSH.

Last year my TSH was high and my GP prescribed Levothyroxine, but I went ahead and got a non-prescription NDT.   My GP (who I like) thinks the synthetic is more effective than the natural and doesn't want to prescribe Armour.  He suggested I speak with an Endocrinologist, who I will see next week.

here are my last few labs:

Lab Results History
All Lab Results
T3, TOTAL                                                                                                09/18/2013 07:00
Description                                           Result                                         Flags      Range
T3, TOTAL                                              1.15                                                             0.60-1.80
Comments
T3, TOTAL:
New methodology effective 12/10/2012. Please note new reference ranges.
PSA, TOTAL                                                                                              09/18/2013 07:00
Description                                           Result                                         Flags      Range
PSA, TOTAL                                            1.45                                                             <4.0
Comments
PSA, TOTAL:
Testing performed on Siemens Centaur.
TSH                                                                                                           09/18/2013 07:00
Description                                           Result                                         Flags      Range
TSH                                                        1.890                                                           0.358-3.740
T4, FREE                                                                                                    09/18/2013 07:00
Description                                           Result                                         Flags      Range
T4, FREE                                                 0.92                                                             0.76-1.46
T4 (THYROXINE), TOTAL                                                                         09/18/2013 07:00
Description                                           Result                                         Flags      Range
T4 (THYROXINE), TOTAL                        7.0                                                               4.5-12.1

TSH 5.220 H 0.358-3.740
T4, FREE                                                                                                    06/28/2013 06:56
Description Result Flags Range
T4, FREE 0.95 0.76-1.46


T4, FREE                                                                                                    06/13/2012 06:55
Description Result Flags Range
T4, FREE 0.89 0.76-1.46

TSH                                                                                                           06/13/2012 06:55
Description                                           Result                                         Flags      Range
TSH                                                        6.840                                            H             0.358-3.740

A little difficult to see, but I don't see a way to attach report.

Thanks, Jeff
Helpful - 0
Avatar universal
Well, let me ask the questions that an Endo would ask.  What was the basis for your diagnosis as hypothyroid?  Was it based on the tests for Hashi's, TPO and TG ab?  What were your TSH, Free T4 and Free T3 test results at that time?  Note, many Endos won't even be concerned with Free T3.  Were you started on NDT med?  If not, what type med were you started on and why did you change to NDT type?  Was it based on still having hypo symptoms, or was it due to lack of conversion of T4 med to T3, shown by your Free T3 and Free T4 levels?  Please post your current lab results and reference ranges shown on the lab report.  Are you symptom free right now?
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