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Question about Hyperthyroidism while on medication

Hi
I'm on Armour Thyroid (2grains)and I currently take them both together at 4:15 in the morning and prior to that I was splitting them taking one at 4:15am and the other one around 12:00.

Recent Endo phone call about my Lab numbers she stated I was Hyper (silent) hyper unsure what "silent" hyper actually means and she wanted to reduce my 2 grains to 1.5grains, I refused the change I'm not hyper per my own feeling and according to description of symptoms I read and my own prior personal struggle with hyperthyroidism anyway I have noticed for a very long time and I'm talking even while taking syntyroid and cytomel that I have periods of breathlessness with mild palpitations.  Is it possible that I'm hyper and if so why doesn't it affect me until 4-6 hours after I take my medication?
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1756321 tn?1547095325
This is from Dr Mercola's article How To Monitor Your Treatment With Natural Hormone Therapy...

"Armour Thyroid Dosing -- TWICE a day.

The most common starting dose for patients with hypothyroidism is Armour thyroid, 90 mg which is cut in half with a razor blade and half is ideally taken twice a day, 10 to 20 minutes after breakfast and dinner. If you have trouble remember taking them, then take the entire dose before breakfast. It is also ideal to chew the tablet before swallowing. Taking it after meals also helps to reduce volatility of the blood-level of T3. If the patient has any problem breaking or cutting the pill, they should purchase a pill-cutter at the pharmacy. The TSH, Free T3 and Free T4 are then repeated in one month and the dose is adjusted.

Taking the Armour thyroid twice a day overcomes traditional medicine's major objection and resistance to using natural thyroid preparations - its variability in its blood-levels. Most doctors using Armour thyroid are not aware that Armour thyroid should be used twice daily and NOT once a day. The major reason is that the T3 component has such a short half life and needs to be taken twice daily to achieve consistent blood levels."
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2 Comments
Do you think these hyper symptoms would come 4 to 5 hours after ingesting the Armour thyroid ?
The half life of T3 is about 4 to 6 hours. The full effect of T3 will only last about 4 to 6 hours before it basically starts wearing off.
Avatar universal
When you are taking thyroid med, a low TSH is not indicative of hypothyroidism, unless you have hyper symptoms due to excessive levels of Free T4 and Free T3 levels, which your doctor has not even tested.    In the absence of FT4 and FT3 results, I am very skeptical of hyperthyroidism, for two reasons.   One is that the symptoms you mention are more likely to be related to being hypo, not hyper.  Second. is that the 2 grains of Armour is only equivalent to 132 mcg of T4 and the average thyroid gland produces the equivalent of 100 mcg of T4 and 10 mcg of T3, which is the equivalent of 130 mcg of T4.  So your dose is only equal to the average daily output of a thyroid gland.  When you consider the loss due to absorption of the med being less than 100%, it is unlikely that you are over-medicated.  

If it were me I would not agree to a reduction in meds without tests for the biologically active thyroid hormones Free T4 and Free T3.  If you can get them to do that then while you are there you should also ask for Vitamin D, B12 and ferritin.  
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Hi Gimel
Here are my recent lab numbers and FT3 was not tested only T3 however I will get the FT3 next time since I threw a tantrum to my Endo who also told me FT3 doesnt matter only TSH. Good grief . I did not reduce my 2grains.

I don't think I'm hyper but Iam a little concerned with breathlessness and mild palpitations about 4-5 hours AFTER I take my 2 grains of Armour thyroid and this has been only happening 4 weeks.  It's 7:15am here and no breathlessness or palpitations I took my meds at 4:15am.

Sept 24, 2018
TSH: 0.090 (L)  (0.27 - 4.20)
T3: 98.7 (80-200)
FT4: 1.02 (0.93 - 1.7)
NOT FT3 ORDERED
Avatar universal
Those lab results sure don't indicate any possibility of hyperthyroidism.   Instead they are on the hypo side.  

Consistent with what Red_Star has mentioned, T3 reaches peak effect on serum levels in about 4 hours, so the timing of you being breathless and having mild palpitations makes me think you should try splitting the dose and taking half in the a.m. and the other grain in the early afternoon.    When you go back for re-testing, assuming you will finally get Free T3 along with Free T4, will they also agree to test for Vitamin D, B12 and ferritin?
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Funny you mention Ferritin...no they wont tell because I've been menopausal for 15yrs (hysterectomy) and my B12 was  tested and it was very well above the lab levels but I supplement that and my calcium was in range just lower end and I was told they wont retest.  

Maybe I don't get this hypo thing and you would think after 2 yrs I would.  I feel fine my mental state is better than its been over these 2 yrs but my weight is a big  problem but Ive been battling psoriatic arthritis flare that was brought on by having my thyroid yanked which has made me very inactive over past 7 months and basically I've just given up on my health.
Avatar universal
Of course weight gain is sometimes associated with diet and exercise habits; however, many people gain weight and have difficulty losing weight because of low Resting Metabolic Rate (RMR).    RMR represents the number of calories that you wold burn daily if you did nothing but rest comfortably without moving around.  Your actual metabolic rate is RMR plus the effect of exercise.    For some reason doctors seem to downplay the possibility of hypothyroidism causing significant weight gain; however this is not accurate.  Note the following formulas for estimating the normal RMR of a man or woman.  

English RMR Formula (Imperial)

Women: RMR = 655 + (4.35 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years)

Men: RMR = 66 + (6.23 x weight in pounds) + (12.7 x height in inches) - (6.8 x age in years)

According to this formula if a woman started eating 200 additional calories daily, she would slowly start gaining weight and it would continue until her RMR increased enough to offset the added calories.    In order for this to happen, she would have to gain approx. 46 pounds before her increased RMR would balance out the 200 additional calories per day.   I calculated this by using the 200 calories divided by the 4.37 used as a constant for the weight part of the formula.

Of course metabolic rate is significantly affected by thyroid.  I have been told that the difference in RMR before and after adequate treatment for a person with severe hypothyroidism was as much as 450 calories per day.    Assuming that to be reasonably accurate, over an extended period, I figure that would equate to about 104 pounds lost, without anything else being changed regarding diet and exercise.  

So the reason I went through this is to encourage you to pursue all the necessary testing and adequate treatment.  Ideally, in addition to the Free T4 and Free T3 tests, at least initially you should test for Reverse T3, cortisol, Vitamin D, B12 and ferritin.  It is very important to make sure they are all optimal.


Helpful - 0
Avatar universal
Of course weight gain is sometimes associated with diet and exercise habits; however, many people gain weight and have difficulty losing weight because of low Resting Metabolic Rate (RMR).    RMR represents the number of calories that you wold burn daily if you did nothing but rest comfortably without moving around.  Your actual metabolic rate is RMR plus the effect of exercise.    For some reason doctors seem to downplay the possibility of hypothyroidism causing significant weight gain; however this is not accurate.  Note the following formulas for estimating the normal RMR of a man or woman.  

English RMR Formula (Imperial)

Women: RMR = 655 + (4.35 x weight in pounds) + (4.7 x height in inches) - (4.7 x age in years)

Men: RMR = 66 + (6.23 x weight in pounds) + (12.7 x height in inches) - (6.8 x age in years)

According to this formula if a woman started eating 200 additional calories daily, she would slowly start gaining weight and it would continue until her RMR increased enough to offset the added calories.    In order for this to happen, she would have to gain approx. 46 pounds before her increased RMR would balance out the 200 additional calories per day.   I calculated this by using the 200 calories divided by the 4.37 used as a constant for the weight part of the formula.

Of course metabolic rate is significantly affected by thyroid.  I have been told that the difference in RMR before and after adequate treatment for a person with severe hypothyroidism was as much as 450 calories per day.    Assuming that to be reasonably accurate, over an extended period, I figure that would equate to about 104 pounds lost, without anything else being changed regarding diet and exercise.  

So the reason I went through this is to encourage you to pursue all the necessary testing and adequate treatment.  Ideally, in addition to the Free T4 and Free T3 tests, at least initially you should test for Reverse T3, cortisol, Vitamin D, B12 and ferritin.  It is very important to make sure they are all optimal.


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1 Comments
Hi Gimel
Quick update:  I have been splitting my 2 grains of Armour Thyroid as you suggested to see if it would get rid of the breathlessness and mild palpitations and it seems to have worked.   It's weird though why I could take 88mcg synthyroid and 15mcg Cytomel and never had issues.  Oh well.
Avatar universal
Glad it helped.  What options do you have for trying to locate a good thyroid doctor?    Are you restricted by insurance?  
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1 Comments
Hi Gimel
I have located a new endo and will see her and get my bloods done in January but I do have to pay out of pocket for her my insurance requires a referral and referral is only available to me if and only if I can not get appointment within 30days...follow-up not included and my current Endo would be a follow-up appt. although I can't get appointment.

My Endo insists I'm no longer hypo but hyper "rolling my eyes" Its my understanding that I will forever be hypo since I have no thyroid even with medication....do you believe this?
Avatar universal
What assurance do you have that the new Endo is going to be a good thyroid doctor that will treat clinically for symptoms, rather than just based on TSH results?  If you are going to have to pay out-of-pocket, you need to be sure of getting what you need.  
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Hi Gimel
I have no guarantees that she won't be and Epic failure but based on others reviews of her she seems pretty open minded and a thyroid sufferer herself. I'm willing to eat the cost of one appointment and won't waste my time or hers if she doesn't listen to me or only believes that TSH is king.  I also have another appointment with my (Orginal endo clinic) just a different Endo who seems to be more popular then the others 2 weeks after the one I'm paying for I'm going to compair them and see which way to go.  

My criteria:
Blood work..... T3,FT3,FT4, TSH and Antibodies (and) female hormones and Ferritin (any others?) B12/Vit D already tested.

Listening skills.... don't dismiss me or make be feel like a depressed fat thyroid person.

Knowledge..... How/If my autoimmune suppressing medication affects my thyroid levels and does my Psoriatic Arthritis and "LACK" of Female Hormones also affect my thyroid levels. Pretty much does my "constant" body inflammation affect my thyroid levels.

Do you recommend anything I should pursue with these people?

Avatar universal
I think since you are going for it I would also ask for Reverse T3 and cortisol.  

If the doctor infers that your wight issue is just a matter of eating less and moving more, explain that you think it is a matter of low metabolism due to still being hypothyroid, and volunteer to take a test for Resting Metabolic Rate.  With that info we could figure out just how low your RMR really is.  
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1 Comments
Hi Gimel,
I had a reverse T3 done March of this year and a Cort Salivary test that consisted of  (3 mouth swabs) one for each of the 3 days and had to swab my mouth at 11pm every night. I was offered no information from Endo on these results after repeated attempts. I guess my Cort was fine?

ReverseT3 Results:   19.3  (9.2 -24.1)

Cort Salivary test (Midnight Ranges) <0.010- 0.090

Day 1:  1.590
Day2: 0.027
Day 3: 0.023

All swabs were done at 11pm.
Avatar universal
Not sure why cortisol tested at that time, since it is lowest of the day.   Don't think anything was learned from those tests.  

Please let us know how it goes with the doctor, and also post your test results and reference ranges shown on the lab report so we can help interpret.
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1 Comments
That probably explains why she never would discuss the test.
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