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T3 and T4 not improving on Armour

My NP is working on finding the right dosage of Armour for me.  I personally think she's being too conservative, upping it slowly.  After several months, I'm up to 75 mg.  While my TSH has been steadily decreasing, my T3 and T4 don't seem to be budging.  Actually, all numbers actually got worse during the latest lab test.  Why is this and what can I do about it?
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Avatar universal
Please post your lab results including reference ranges.

Taking a natural dessicated thyroid (NDT) you should not be surprised if the TSH gets suppressed completely. When you take a medicine with T3 in it, it is quite common for the TSH to become supressed.

I bet dollars to doughnuts that your Dr is ONLY looking at the TSH.  And as it is coming down your Dr is happy.

But if you are still symptomatic - What are your symptoms and have they improved since starting medication?

I do think that is a very conservative approach to slowly raising the dosage.  But slow is better than too fast.

One possible reason that your FT4 and FT3 levels don't change much, is that your body is soooo starved for thyroid that it is using every single drop of the medication.  That the conversion of the T4 into T3 is happening so that you use up all your thyroid and have little left over for "storage" or remaining excess hormone.  Just a thought.
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Avatar universal
Another thing to consider is that, assuming your thyroid gland is able to produce thyroid hormone when stimulated by the TSH, then it could be that as your meds reduce the TSH levels, less natural thyroid hormone is being produced, thus offsetting the effect of the meds.  There is even a scientific paper that theorized that serum levels of thyroid hormone would not really start rising until the TSH is suppressed and the dosage is raised enough to start exceeding the initial levels.  

Following is a link to the paper, and following that is a conclusion taken from the introduction written by Dr. John Lowe.  

  http://www.thyroidscience.com/hypotheses/warmingham.2010/warmingham.intro.7.2010.htm

"When a hypothyroid patient (whose circulating pool of thyroid hormone is too low) begins taking exogenous thyroid hormone, a negative feedback system reduces the pituitary gland's output of TSH. This decreases the thyroid gland's output of endogenous thyroid hormone, and despite the patient's exogenous thyroid hormone's contribution to his or her total circulating thyroid pool, that pool does not increase—not until the TSH is suppressed and the thyroid gland is contributing no more thyroid hormone to the total circulating pool. At that point, adding more exogenous thyroid hormone will finally increase the circulating pool of thyroid hormone. The increase must occur for thyroid hormone therapy to be effective. The patient's suppressed TSH, then, does not indicate that the patient is over-treated with thyroid hormone; instead, it indicates that the patient's low total thyroid hormone pool will finally rise to potentially adequate levels."
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Avatar universal
Thanks for your input.  Labs are:

TSH = 1.31  ( range is .350  - 4.5)
Free T3 = 2.3  (2.1 -4.1)
Free T4 = .7 (.6 - 1.7)

Symptoms:  sick fatigue, low body temp, cold hands/feet, low-ish blood pressure.  I also wake up several times each night and I'm up for good at 3:30 a.m.

I have done the saliva cortisol - ok in morning, crash in afternoon, spike at night.

I'll keep pushing for an increase.  NP was reluctant because she said I could lose bone mass.
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Avatar universal
The NP just repeated what she was told or heard somewhere about loss of bone.  A low TSH cannot cause bone loss.  If she is concerned that the low TSH means you have become hyper, that is incorrect.  There are scientific studies showing that a majority of hypo patients have suppressed TSH when taking adequate doses of thyroid meds.  So, if the low TSH is supposed to mean tht your thyroid levels are too high, then how come your Free T3 and Free T4 are at the very low end of the ranges.  You really need more thyroid med not less.  Have a look at his link, written by a good thyroid doctor.

http://hormonerestoration.com/files/ThyroidPMD.pdf

In the link, note this statement, "Thyroid hormone does not cause bone loss, it simply increases metabolism and therefore the rate of the current bone formation or loss. Most older women are losing bone due to their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies. The solution is not life-long hypothyroidism, but the correction of their other deficiencies."

In the same link, also note this statement, " the ultimate criterion for dose adjustment must always be the clinical response of the patient."

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Avatar universal
You're right, your FT3 and FT4 are at rock bottom. Usually we look for FT4 in the upper 50% of range and FT3 in the upper third of range because that is where most patients report feeling good and symptom free. Simply put, you need more Armour. Every so often the doctors will pull out the bone mass or heart health scare tactics, but being hypo is also very unhealthy for the heart and all other parts of the body. If your doctor has any studies to support the bone mass assertion I would be curious to see them.
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Avatar universal
So frustrating - I went back to the NP but she would only up my Armour from 75 to 90.  I then have to wait yet another month to recheck my labs and make adjustments at that time.  In the meantime, I suffer.  Unfortunately I live in a small community so not many options.  As it is, I have to drive 30 miles to see this NP.

I know it's wrong, but what's the danger in upping the Armour on my own (little bit at a time)?  I'd have to fess up when I return to her but at least I might be feeling better.
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Avatar universal
Before commenting further, please confirm if those lab results were before or after taking the 75 mg of Armour.  Just want to be sure about that.
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Avatar universal
(I posted a reply earlier but apparently it didn't go through)

Thank you.  Yes, the lab results were taken after I had been on 75 mg for 1 month.

My NP initially started me at 15 mg, re-tested after 1 month and then bumped me up to 30 mg.  It then went up to 45, 60 and 75 - each with a month wait in between.

I was actually starting to feel much better on 60  mg but knew there was still room for improvement.  I then went up to 75 and felt like I was back to square one - no energy, waking every hour, nightly leg cramps, etc.

I just returned to the NP last week and she bumped me up to 90 mg but refused to go any higher.

Should I ask for a referral to an endocrinologist?  It's 3:30 a.m. as I write this and I've been up for over a 1/2 hour.  I need sleep!
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Avatar universal
Obviously your Free T3 and Free T4 were still at the bottom of the range, which is too low for most people.  Clearly you will need to increase both by increasing your Armour dosage; however, in view of the cortisol test results you mentioned, that may need to be addressed even before further action on your FT3 and FT4 levels.  Would you please post the actual saliva cortisol test results and reference ranges for each result.

Did the NP take notice of the cortisol test results and make any comment about it?
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Avatar universal
Cortisol levels:

a.m.  25.9 (13.0 -24.0)
noon 7.2 (5.0 -8.0)
afternoon 3.1 (4.0 -7.0)
nighttime 10.1 (1.0 - 3.0)
DHEA-S Average 4.89 (2.0 - 10.0)
Cortisol/DHEA-S ratio 9.5 (5.0 -6.0)
Estradiol 3.1 (.5  - 3.0)
Estriol 2.2 (1.0 - 3.0)
Progesterone 240.1 (5.0 -95)
Melatonin bedtime 21.1 (12.0 -23.0)
Testosterone a.m. 95 (20.0 - 60.0)

The NP actually sent me to an herbalist for adrenal issues and she is the one who ordered the testing.  I gave the NP the results but I don't think she "get's it."  The herbalist gave me a bunch of supplements and had me do a series of liver flushes which is maybe why I felt much better for a little while.  I just can't afford to return to her.  
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Avatar universal
The cortisol result at nighttime certainly would seem to tie in with your sleep problems.   Have a look at this link and see what you think.

http://www.moodcure.com/correcting_cortisol_levels.html
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Avatar universal
Thanks.  Very interesting book.  I'm wondering...  Is there anything a doctor could prescribe? I've spent hundreds of dollars on supplements already, trying to go the more natural route.  Now I need something covered by insurance if possible.
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Avatar universal
I'm sure that if there are supplements available to address the problem, doctors will have numerous medical options available.  Perhaps you should ask your NP if she can prescribe something.  I know your Free T3 and Free T4 will need to be increased, but at this point it may be best to work on the cortisol issue, and stabilize that before pushing further with your thyroid meds.  Especially since your biggest concern seems to be lack of sleep.  
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Avatar universal
Not to keep picking your brain but..... What does the high testosterone and progesterone mean and what can be done to bring those levels down.  I'm a 48 yr old postmenopausal woman, by the way. :)
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Avatar universal
Glad to try and answer anything I can, but you're getting into unknown territory for me with your questions about high progesterone and testosterone.  I am going to ask another member to have a look at your questions.  One thing that did occur to me is whether you are taking any supplements or meds that could affect those levels?
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649848 tn?1534633700
COMMUNITY LEADER
Sorry to be late to this party, but gimel asked me to take a look and reading over the thread, there are a couple questions I have.. actually, more than a couple - sort of like "a lot"... LOL

48 yrs old and post menopausal?  I don't mean to pry, but is that natural or surgical menopause? How long have you been post menopausal? I also notice that your Estradiol is slightly over range. Gimel's question regarding medications/supplements is a valid one. Are you taking any HRT, such as premarin, patches, etc?

As far as the cortisol levels, that is a concern and I agree with gimel that often adrenal issues must be resolved, before thyroid function can be addressed.  What happens is that when the thyroid doesn't work right, the adrenals kick in to pick up the slack.  If the adrenals get too overworked, they just sort of "poop out" and don't work right.

Questions about the adrenal tests - what time was the nighttime cortisol test?  What had you been doing/feeling just prior to that?  Had you been under a lot of stress, in the days, just prior to these tests?  Do you make sure you start "settling in" for the evening, early enough to let your body/mind slow down for sleep?

Have you had vitamin B12 levels tested?  If so, what were the results and reference ranges?

Sorry, I probably asked a lot more questions than you care to answer, but with more information, we might be able to point you in the right direction.

I don't think you need anymore liver flushes... the body is designed to flush itself, if everything is working properly... If you have doubt about liver function, you should ask the NP to do liver function tests.  I'm sure the reason the herbalist had you do those flushes is because the majority of conversion of FT4 to FT3 is done in the liver.  The problem is that it's up to the liver to metabolize a lot the meds/ supplements we take, so we do have to be careful not overtax it.

What supplements did the herbalist put you on to flush the liver and which ones to enhance adrenal function?  How long have you been on these supplements?  Some of them take months to work; some don't work at all.

Okay, I'll stop here and let you catch up... LOL
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Avatar universal
Wow.  I am so thankful for all this information!!  Let's see...

- Little background.  I'm a pretty high level athlete.  I was heavy into triathlon training around the time my periods stopped at age 42.  They never came back.  I've since learned the dangers of endurance training while under fueling on a vegetarian diet.  Not a good combination,  I've learned.  I backed off that but took up bodybuilding.  I'm sure my hormones took another big hit with the competition dieting.

I give this background because I'm sure it is why my body became overstressed.  There is no stress in my personal life - good job, good family, etc.

Looking back at my thyroid tests over the years (they only tested TSH, never T3 or T3 until 2012) my TSH was always on the very low end of the reference range.  I was always told everything was normal.

Oh, my Ferritin has been rather low also - 28 (14-350 ref range) and as low as 16 in the past couple years.

B12 tested high at 1359 (160-1000) in Aug. of 2012.

Blood testosterone level - free testosterone was actually low at .2 (.2 - 1) in Feb. 2013.  It was the saliva test that came back high.

In April of this year, I started adrenal cortex, adapt, adaptamax, seriphos, chromium GTF, "liver support", selenium, magnesium.... I think that's it.  By August, I was feeling really good.  I stupidly started exercising more (couldn't help myself - it felt great).  By mid-Sept., I was back to square one.  Lesson learned !

Any information/suggestions would be greatly appreciated!!!
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649848 tn?1534633700
COMMUNITY LEADER
Okay, your background info gives a good reason why you might have gone menopausal at such a young age, since your female hormones are high. Excess exercise can cause the menstrual cycle to go awry.  It can also cause the adrenals to stress out.

How often/how long do you work out?  You're not doing yourself any favors with your excess exercise.

I have to wonder what you were eating for protein if you're on a vegetarian diet?  And where is all your vitamin B12 coming from? Do you supplement that?

If you can go back to my original post and answer some the questions about the time of the nighttime adrenal test, as well as others that I've asked here, we might be able to see what's going on.

I'd also have to question the supplements you're on; did you research the ingredients of each one?  I've found that many supplements have ingredients that are just as harmful as the other ingredients are beneficial.

I'm far from an expert on testosterone, but from my research, blood testosterone is much more reliable than saliva... Do you have symptoms of high testosterone, such as abnormal aggressiveness (be objective), excess body hair, etc?
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Avatar universal
No more excessive cardio.   I still weight train for 1 1/2 each 5-6 days/week.  That may seem like a lot but I lift heavy which means lots of rest time between sets = longer workouts.  I have not done any cardio whatsoever in over a month.

Re:  protein  - in the early years before I learned about nutrition, I just didn't eat meat.  I didn't supplement with anything.  Lots of carbs by default.  For the past 6 years, I've devoured everything I can about nutrition (didn't also follow the information but learned what I could - there's so much conflicting information out there).  I began supplementing with protein powder, lots of egg whites, etc.  I don't supplement w/vit. B but use lots of nutritional yeast flakes

Sorry I missed the question re: cortisol timing.  I believe the nighttime test was taken at midnight but I'm not positive.  I do remember setting an alarm to wake up to do it.  My records don't indicate time.  I was experiencing the same symptoms I am now:  sick daytime fatigue, frequent waking at night/early a.m. wakening, bloated, water retentive, cold, low temp, lower blood pressure, bouts of anxiety (SO unlike the real me).

I don't have any symptoms of high testosterone so I'm starting to question the saliva results.

The herbalist was the one who suggested the supplements, dosage, etc.  I would happily go back to her but I going thru a bit of a financial hardship right now and just can't afford it which is why I am trying to learn all I can on my own.
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649848 tn?1534633700
COMMUNITY LEADER
What time do you go to bed and what activities do you perform in the hour or so prior to bedtime?

Vitamin B12 isn't toxic, but I'd advise you to go easy on the yeast flakes, as they most likely contain other vitamins as well.

Did you research the ingredients of the herbs that were given you by the herbalist?  Some of those could be responsible for increasing hormone levels.

Heavy exercise can cause increased levels of growth hormone, which could, in turn throw off all your other hormones.

The symptoms you've just listed above are those of hypothyroidism, and you probably do need an increase in your medication, though I'd advise you to continue going slow, until you're sure that the cortisol issue is resolved.  
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Avatar universal
I typically go to bed around 8:30 pm and have absolutely no trouble falling asleep.  Quite the opposite.   In the hour before bed, I watch a little tv and try to read (but usually fall asleep after a couple pages.)  I am so used to getting up at 3:30 that I have learned to enjoy the quite time to myself.  My sleep just hasn't been sound lately.  I wake up without an alarm, don't drink coffee and have enough energy to go to the gym at 5:00.  I've been having waves of fatigue around 9:00 and noon and sometimes 3:00.  I usually take a 20 min. power nap on my lunch break.  I've tried not napping, staying up later, etc. but my sleep is always interrupted and I always wake up at 3:30.  The power nap helps me get through the rest of the day.

I know what each of the supplements are for but didn't independently research them.  The herbalist chose and dosed the supplements based on my test results and symptoms so I deferred to her expertise.  I did have good results but they were short-lived.    Now, after having a taste of feeling better, it makes it that much worse to have this backward slide.
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Avatar universal
Wow, just reading back over my old posts.  I just got my most recent test results back.  I'm now on 3 grains of Armour and my free T3 and free T4 are EXACTLY the same.  Other than magnesium and iron, I am not taking any other supplements.  

I just don't know what else to do at this point.  
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Avatar universal
It's possible you may have a problem absorbing the medicine. I tried to absorb all of the info in your posts above, but just to recap, can you please confirm:

- What is your current dose? Are you really at 3 grains (180 mg)? I only ask because you posted 2 months ago saying you were on 1.5 grains (90 mg). Did you quickly raise the additional 1.5 grains in that time period, and if so, how long has it been that you are on the 3 grain dose?

- What time do you take your Armour? Do you split the dose in half, or take it all at once?

- Have you had any symptom relief at all since starting the Armour?

- Are you still taking the following supplements? If so, what time of day do you take them?
adrenal cortex, adapt, adaptamax, seriphos, chromium GTF, "liver support", selenium, magnesium


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Avatar universal
Sorry, just reread your last post. So the final question should be amended to say, "What time of day are you taking the magnesium and iron?"
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