Aa
A
A
A
Close
Thyroid Disorders Community
26k Members
1947387 tn?1325644930

Sudden intolerance to Armour

I have been taking Armour thyroid 75 mcg split up since June of 2013. Armour has so far been great. I am more tired on it than cytomel, but I think that's because my dose has been a little low.

Had some kind of painful throat infection this Christmas. The inside of my throat wasn't red, and my heart was racing so I assumed it was thyroid. In the following months, I lost my appetite and 5 lbs and had a high resting heartrate ~100 bpm. Also started having vivid dreams and daydreams which was normal for me prior to thyroid treatment but I haven't experienced in a couple years. Oversleeping a little too. I was fine w/ all of that feeling overall pretty good - no mood swings, decent concentration, enjoying life and work.

I needed a refill of Armour before I could get in to my thyroid doctor so my PCP gave me a 1 mo. refill of Armour and ran a blood test (she said she needed to have some documentation for writing the prescription). Results were as follows (w/ the previous September lab for comparison):

February:
Taken at 9 am, 1 hour after morning dose
TSH:  2.95 normal = .4 - 4.7
Ft4:    .78 normal = .78 - 2.19
FT3:   3.48 normal = 2.18-3.98

September:
Taken at 3:30 pm exactly in between morning and afternoon doses (per thyroid doctor's instructions)
TSH: 1.12 normal = .45 - 4.5
FT4:  .96  normal = .82 - 1.77
Reverse T3: 11.4 normal = 9.2-24.1
T3: 97 normal 71-4.4
FT3: 3 normal = 2.0 - 4.4  

I was very upset about the lab result because of concerns about fertility. I began taking my Armour doses without food (previously took at the same time as meals). Also started taking 200 mcg selenium tablet daily. As well as taking 90 mcg instead of prescribed 75 mcgs for about 2 weeks before deciding this was a bad idea. This was all fine for about 1 month (my hair did start shedding a lot).

I don't know if this was related... but I noticed a sudden change the day after having a large sushi meal on April 3rd, which I know is extremely high in iodine. I felt drained and exahusted. Blood pressure was very low (for me): 75/55, pulse racing. I started having "rage attacks" about 30 mins after each dose of Armour. After 3 days, at my husbands insistance, I decreased my dose. Still had exhaustion and rage. I stopped my pills for 2-3 days, and then slowly started taking them again. I felt the rage and racing heartrate go away, but when I started trying to take my pills again, the reactions returned (less intense). The rage attacks I have ONLY experienced when on Synthroid-only and my reverse T3 was very high. It's almost like a psychotic sensation that lasts about 30 minutes.

I have an appointment w/ my thyroid doctor in 2 days and will talk to her about this, but I honestly don't think she knows a lot about atypical symptoms. She has said this, and the reason I see her is that she is very honest and open minded, however I think her experience is limited.

1) Is it proper to take Armour on an empty stomach? It seemed like when taking it with food I was not absorbing it the T4 component very well.

2) I have my annual insurance wellness appointment in a few days too. They will test TSH and FT4. I am planning to request FT3 and anti-TPO antibodies. Are there any other specific labs I should ask them to add?
19 Responses
1756321 tn?1547098925
It is recommended to take thyroid hormone on an empty stomach which allows for maximum absorption. Allow at least one hour before eating. Iron and calcium can interfer with thyroid hormone absorption so take vitamins or supplements with iron or calcium at least 2 - 3 hours apart.

Serum T4 concentrations peak 2 to 4 hours after you take T4 medication and remains above normal for approx 6 hours. I test my thyroid levels in the morning before eating breakfast or taking thyroid medication.
Avatar universal
I also agree not to take medicine before blood test and take blood test first thing in the morning also.
I also agree not to eat with meds for a hour and not to take vitamins until lunch hence taking meds when you first awake with water.
it is hard to read test if you just took your meds but you do sound like your doage is high. DId you check what the writing on the pill said to make sure the pharmacy didnt make a mistake?  When this happened to me, the dr asked me to not take the pills a few days until dr apt just to be on the safe side but the dosage being too high didnt show up until a month later although all my symptoms were over medication. May be a bad batch of armour or if your medicine was in the sunlight or heat which can make It less potent .
Avatar universal
test for vit d deficiency, vit b12 , dhea and hormones progesterone estrogens and testosterones if you are over 40 and ask about reverse t3 since you are feeling so weird .
if you hormones are off or vit d, you can also feel very moody....and off center...the adrenals and thyroid are all interconnected and effect eachother...and the brain and the heart and the hormones, sleep, weight, etc
Avatar universal
In post above, I think you had a typo in your post above.  I think you meant that T3 peaks about 4 to 6 hours after taking it, NOT T4 as stated in the post above.

rach7612,

T4 takes several weeks to stabilize in your blood while T3 takes hours!

I'm not sure why you are upset with the lab tests.  They both show you pretty high up in the FT3 range (about 72% of range) and fairly low in the range for FT4 which is not uncommon for people on Natural Dessicated Thyroid.

The rule of thumb is that FT3 to be betwen 50% and 66.7%.  You are testing at or slightly above 70%.  So you may be a bit overmedicated.  This seems to be consistent with you stopping for a couple days and some of your hyper symptoms to disappear.  And this would only be a result of FT3 being removed as T4 takes weeks to have an impact. Since you felt a difference in only a couple days would be T3.

So my opinion trying to put things together.  As you changed your dosage to be on an empty stomach your abssorption may have been increased which resulted in you slipping into hyper.  Your blood labs showing you abouve 67% would also be on the hyper side of the rule of thumb.  Your stopping of Armour for a couple days and your symptoms being relieved also suggests T3 was a bit too high.

Conclusion from this is that you are likely a bit over medicated.  So a reduction may be in order. You will have to discuss that with your DR as far as the dose. But like normal, I would make changes pretty slowly and not make any dramatic changes.

As this all seems to be or primarily T3 related, the results should be felt fairly quickly. In the matter of days.  So you should be able to make these small adjustments in a few weeks at a time. (as in 2 or 3 weeks) rather than 6 weeks which is the norm for T4 adjustments.

Another option. If you were feeling well when you had the same dosage and taking it with your meal. Then you could just go back to taking it with your meal. Why re-invent the wheel?????

Just my opinion.
1756321 tn?1547098925
Hey flyingfool, I did mean T4. I added some more info...

Info from Thyroid Manager - Adult Hypothyroidism...

"9.8.1 PHARMACOLOGY OF THYROID HORMONE REPLACEMENT PREPARATIONS

Levothyroxine.

"Serum T4 concentrations peak 2 to 4 hours after an oral dose and remain above normal for approximately 6 hours in patients receiving daily replacement therapy 5,6 . The gradual conversion of T4 into T3 in various tissues increases serum T3 concentrations so slowly after thyroxine absorption that with daily levothyroxine administration, no significant changes in circulating free T3 are detectable."

***

"Before the first dose of T3, serum T3 levels were 153 +/- 43 mg/100 ml; after T3 the levels increased promptly reaching after 4 h a peak of 264 +/- 90 ng/100 ml. Afterwards T3 levels showed a similar peak after each dose: 262 +/- 77 and 266 +/- 78 ng/100 ml, slightly decreasing in the intervals between the doses: 227 +/- 63 and 255 +/- 69 ng/100 ml. After the last peak T3 levels showed a slow decline during the night."

- Twenty-four hour variations of triiodothyronine (T3) levels in patients who had thyroid ablation for thyroid cancer, receiving T3 as suppressive treatment. J Endocrinol Invest. 1980 Oct-Dec;3(4):353-6.


Avatar universal
Wow.  This T4 spike within hours of taking T4 is completely contrary to everything I have ever read or seen.  Also the last sentence of the first paragraph seems to indicate that no matter how much T4 you put in, it won't affect the FT3 levels!  ?????

IfT dosage results in a nearly immediate (2-4 hrs), we should be recommending that no one ever take their thyroid medication prior to a blood draw.  This has only been a recommendation related to T3 as we all understand that this works in hours.  While T4 takes weeks to stabilize in the blood.

What you reference seems to indicate that a rush of  T4 is prodcued and apparently fairly quickly eliminated from the body or converted. As it seems to have not been converted entirely.  However what is normally see in blood labs results is a typical rise in FT4 levels as T4 dosage increases (in general assuming no Hashi's attacks and significant decreases of thyroid output). Also the FT3 levels rise over time at least when approaching optimization.

So this reference study is very interesting to me.  As it is completely news to me at least!
1756321 tn?1547098925
When I'm in a panic due to breathing issues, I take eutroxsig (T4 only) and maybe 1 to 1 1/2 hours later (haven't exactly timed it) I can breath better. If I don't take my T4 daily I'm in trouble!  I do have cellular resistance issues as well as Hashi's so I'm not a typical case.  

I found this comment online on the Thyroid Disease UK comment board: Is it better to take Thyroxine before a blood test or better not to?...

"According to our friend Professor Weetman the blood levels of T4 are high up to l2 hours after ingestion, and the optimal time for taking
a blood test would be 12-24 hours after ingestion. This information is buried somewhere in the transcript of Dr. Skinners FTP hearing.

The amount of thyroid hormones in the body fluctuates quite considerably during the day, and if you were to be dosed according to a spike
after taking meds you would be feeling pretty miserable for the rest of the day. It is the accepted practice not to take thyroid hormones
in the 24 hours before testing, and those who forget and take their pills ( it does become automatic after a while) usually have an
excessively high reading of the T4 and T3, with reduced TSH levels and are in danger of having their meds cut, as has happened to Kara."
1947387 tn?1325644930
Thank you both- this reassures me greatly

1. The Feb. blood test was taken from me unexpectedly by my PCP. Normally for thyroid labs I take 6 hours after my morning dose (halfway between doses which I'm supposed to take 12 hours apart). This is my doctor's preference, but I keep reading that most people have thyroid labs in the morning before pills..?

In the 2 years I've seen this doctor, she's never decreased my medicine like the previous doctor. However my TSH has never been "low" since seeing her either.

2. You are right- I may be overreacting a bit. My concern is that taking Armour w/ food I am not absorbing most or any of the T4 part of my pill. From my experience, when the T4 number is low, my hair is falling out and I feel strange even if T3 and TSH are normal. I am concerned about possible pregnancy in the near future if I am not diligent at maintaining good levels. Perhaps I should be adding a small amount of synthroid to my armour thyroid?

3. I have had my blood test -pending results. This was an annual wellness screening for my health insurance. That doctor did ultrasound of my throat and stomach and said there are cysts on my thyroid gland. No idea what it means. She also couldn't find one of my kidneys which makes me question her competence (it was there last year). She would not add anything to the blood test, but vitamin D was included.

4. I have also now seen my thyroid doctor. Her recommendation based on the lab test and my symptoms preceding that lab (tired) is to increase dose from 75 mcg to 90 mcg. She recommended not taking it on an empty stomach since that seemed to cause side effects.  So far I've had no negative symptoms from taking 90 mcg. The next lab she prescribed is for FT3, FT4, T3, Reverse T3, and TSH. Depending on that lab and symptoms, maybe I will try taking on empty stomach again.

5. Not familiar with this eutroxsig- but this makes sense to rely on T4 which, like your article stated, is converted gradually.  On shortness of breath, most doctors start talking to me about asthma, even though I tell them it happens right after I take my medicine. Sad to say, the doctor at my "wellness exam" was of little help- she saw cytomel in my records from last year and asked if this was a birth control pill >=(

I will update when I receive the blood test...
1947387 tn?1325644930
I received some tests back from the doctor..

Thyroid, Iron and Vitamin D levels all normal.
TSH = 3.15 this is higher than what my thyroid doctor would like, but lab classified as normal
T4 = .86 normal = .82-1.77
These were taking in the morning, fasting.

I am having a number of symptoms which I initially still think are Armour thyroid-caused but can't be sure.
   - Irritable
   - Irrational anger that I can't justify
   - No tolerance for the heat (compared to others)
   - Brief episodes of muscles stiffening, feeling confused, repeating words
   - Exhausted, worn out from easy tasks

Can this also be explained by stress? Have been dealing w/ a highly stressful personal situation since roughly similar timeframe when symptoms worsened.

The doctor felt a mass in my abdomen where my left ovary is. I had an ultrasound but pending the results. Not sure if that's something that could be causing hormone abnormalities as well.

My thyroid doctor is slow as molasses and says we can wait 4 months for for a follow-up blood test since I changed doses from 75 mcg to 90 mcg.
1756321 tn?1547098925
Those symptoms you list are possible symptoms of hypothyroidism which fits in with your labs as well.  Stress will not be helping any. My hypothyroid symptoms worsen with stress.

I had a 25cm ovarian cyst on my left ovary.  I have read causes of ovarian cysts include high estrogen, hypothyroidism, insulin resistance (stated to be the likely cause of PCOS). I think mine was still insulin resistance even though it's just one big cyst. :)
Avatar universal
You appear undermedicated.

Any Dr who is prescribing a medication with T3 in it and is not testing for Free T3 borders in my mind on malpractice!

On Armour you should almost expect that the TSH will be completely suppressed due to the T3 in it.  ANd yours is over 3 which the AACE even considers hypo if over 3.0.  

And your Free T4 is at the floor of the range which is not too unusual for someone on Armour or other NDT medicine.

So your symptoms, and your blood tests both seem to indicate you are Hypo.  So an increase in dosage seemed totally approptiate.

However the primary component of Armour is T3 and T3 is fast acting. There is really no reason why you can't be tested in 3 weeks or so.  While the FT4 numbers may take longer to rise up, you can at least get a sense of how you are feeling and what the blood labs show as a result.
1947387 tn?1325644930
Thank you. Did you have your cyst surgically removed or take medicine to decrease it? I have no clue if I have a cyst or not. The doctor told me nothing other than she felt a mass and refer to ultrasound.

I have been interpreting these symptoms as over-replacement, but I haven't had a lab test  while I've currently felt that way. This recent lab test I had taken a 3 day break from my pills the previous week because of racing heart, irritable, angry, and overheated. After a break from the medicine these symptoms stopped, but I felt exhausted. So the lab isn't reflective of whatever state I had those symptoms.

I did not have these issues with Armour for the first 8 months I was taking it. This makes me wonder if this particular refill was a bad one.

Also, are seizures a symptom of thyroid imbalance? I am reading about focal seizures and it sounds exactly like the episodes of sudden anger, muscle stiffening, repetitive speaking/actions. It subsides when I take an anxiety tablet, which coincidentally I've learned is also used to treat seizures.

1947387 tn?1325644930
Thanks - My thyroid doctor actually always tests T3 (along w/ TSH, T4, reverse T3 and total T3)! These labs were done by a different doctor for an insurance physical.

"On Armour you should almost expect that the TSH will be completely suppressed due to the T3 in it.  ANd yours is over 3 which the AACE even considers hypo if over 3.0."

I keep seeing people mention this, but I don't recall my TSH ever being below 1.5 or 2 minimum on Armour. Will discuss w/ doctor next time why mine is not lower. Even on cytomel-only, my TSH was usually ~3.

"And your Free T4 is at the floor of the range which is not too unusual for someone on Armour or other NDT medicine. "

Thank you- This makes me feel much better. My FT4 has always been very low on Armour which made me a little worried I'm not absorbing the medicine correctly.


I will persevere with the 90 mcg dose and see if maybe I just need more time to adjust. Other than taking with food, is there a way to slow down the impact of the T3 medicine? I already split the dose in two. Would it be unheard of to divide it into 3 separate doses?
1756321 tn?1547098925
I had my cyst and left ovary surgically removed.  I had my surgery date moved to an earlier time not only because I was very ill because of this, but just in case it was cancerous (although I really didn't think it would be after all that time).

I had to stop Armour as my FT4 was too low at 14 pmol/L (10 - 20) and causing severe bradypnea at this range.  Way too low for me due to my cellular issues. But I've read that is pretty normal for Armour to keep around mid range. In my case it's just a no go zone. In your case you aren't even midway!

***

Epilepsy Advocate - Epilepsy Risks and Causes...

"What are common causes of seizures?

Examples of risk factors in people who do not have epilepsy are:

Disturbed levels of body water/electrolytes (mostly sodium, calcium, or magnesium)
Disturbed levels of blood glucose (sugar)
Can result in seizures in some people who have severe hypoglycemia
Reduced oxygen to the brain
Seizures can result from a heart attack, head injury, or stroke
Raised body temperature
Altered sleep patterns
Seizures can occur at particular times during the sleep cycle in those with epilepsy
Disturbed hormones
Seizures can be a symptom of thyroid problems. Correcting a thyroid imbalance can stop the seizures
Toxicity
Seizures can occur as part of a toxic reaction"
649848 tn?1534637300
COMMUNITY LEADER
Not everyone on a T3 medication has suppressed TSH, so don't feel badly that you don't.

It's typical for those on desiccated hormones to have a low Free T4 and many have to add a T4-only med to bring up the levels.

It's also normal for symptoms to worsen or for new symptoms to appear, following a dosage change.

You can split your 90 mg dosage of Armour into 3 doses, as long as you don't take the last dose too late in the day.  Typically, it's recommended not to take it after 3:00 as the T3 may interfere with sleep.  

What time do you normally take your first dose?
1947387 tn?1325644930
Thank you thank you- that is good to know. The only time I ever had a "suppressed" TSH causing a decrease in medicine dose was the first 2 blood tests I had after starting synthroid and I believe it was a false result because the actual T4 was still very low.

I take the first dose ~7:30 am. Second dose I used to take after dinner or just before bed (I often forgot to remember to take it sooner). Didn't seem to cause sleep problems because I am usually tired anyway.

For the past 2 months I've been taking the second dose between 3-5 pm depending on when I eat lunch/snack. I Was attempting to take on as empty of a stomach as I could for it being mid-day, but I think I feel better taking the pill with food.

I am good at always taking my pills, but not so good w/ consistent timing on dose two.
1947387 tn?1325644930
hmm fascinating and scary too..
649848 tn?1534637300
COMMUNITY LEADER
It's quite possible that your 2 tests that showed suppressed TSH were accurate... mine dropped immediately when I started on thyroid medication and has never come back up

If you're taking your first dose at 7:30 am, you should be taking your second dose much earlier than dinner time.  If you want to split into more than 2 doses, you could take the first at 7:30 am, the second around 11:00 am and a third around 3:00 pm. This would keep your levels more stable throughout the day, which will help keep you from getting tired, except in the evening, when you want to be tired at bedtime.

The T3 in the Armour is fast acting - meaning it goes to work quickly and is used up within a few hours.  Free T3 is the hormone that correlates with symptoms, while FT4 and TSH do not.  FT4 is a storage hormone and can't be used by individual cells in the body; it must be converted to FT3, which is the hormone actually used by individual cells.  FT4 is, basically, "inert" until it's converted to FT3.  FT4 is constantly being converted, so it's important to keep an adequate FT3:FT4 ratio.

Consistency is extremely important with thyroid medications, particularly those with T3 in them, since the T3 acts quickly, but doesn't stay in your system for more than a few hours.
Avatar universal
When we say that T3 acts quickly or fast.  We mean that the peak of it is about 4 hours after taking it.  It ramps up to the peak and then peter's out in about 8 hours or so.

So it is used up in HOURS. While T4 being a storage hormone takes WEEKS.

I think T3 doesn't seem to be affected by food/eating while T4 absorption is.  Since Armour has a lot of T3 in it, Armour would be less affected by taking it with food than a straight T4 medication.

As barb stated, consistency is key.  If you take it with meals/food then always do it.  This will mean the absorption is about the same every time and then making a change to the dosage will be apples to apples comparison.

Some people on Armour can tolerate having the FT4 low in range with the FT3 where it is in the upper half to upper third of the range.  Other people cannot and they need to have a synthetic T4 added to bring a better balance of FT4 to FT3.  You may be one of them.

Also if there is more FT4 available, it provides your body with a bit of a reserve to convert ito T3.  So you may want to discuss with your Dr to add a synthetic T4 with a possible small decrease in your Armour and give that protocol some time (at least 6 weeks) to see how it works.

Just a suggestion to discuss with your Dr.
Have an Answer?
Top Thyroid Answerers
649848 tn?1534637300
FL
Avatar universal
MI
1756321 tn?1547098925
Queensland, Australia
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Here’s how your baby’s growing in your body each week.
These common ADD/ADHD myths could already be hurting your child
This article will tell you more about strength training at home, giving you some options that require little to no equipment.