Confused and seeking guidance

[JenniC1972]

11 years ago after the birth of my 2nd child, unbeknownst to me (was not symptomatic) I became hyperthyroid. Did some reading at the time and noted this happens in a lot of women and that most women neutralize. Certainly what I hoped for, as I did not want to take meds. Not a med taker at all! At any rate, never saw Endo, but lab normalized only to begin experiencing hypo sx. Lab was WNL, but I felt horrible, couldn't think, forgetful, etc. Saw Integrative Med doctor who did trial of Armour. Seemed to help for most part for several years, although off/on started to have periods of feeling sluggish, foggy thinking, etc. I should add I also have low Progesterone and so I do use cream for that and did so after birth of second child, as well.
At any rate, in last several years have started to feel worse and feel, after reading, my adrenals are not healthy either. I am currently taking Armour 60mg( on that dose for about 2 months, up from 30-45 mg alternating ) and Progest. Cream, and vitamins and supplements.
Saw new Endo at urging of my Women's HC provider because have been feeling really fatigued...bone tired! Too tired to raise my arms to fix hair or drive!

Lab showed TSH 2.42 (.30-5.10) FT4 .91 (.73-1.95) FT3 4.5 (2.3-4.2) Endo said won't go up on Armour bc of high FT3.
Offered for me to stay at current dose of Armour or try Synthroid 100mcg and titrate up.
I have noted in past feel better when TSH under 1.
Advice? I am scared to try Synthroid and am worried it may stress adrenals even more. Thought maybe it's my adrenals making me feel so bad, but my TSH was so high I think there must be something going on with Thyroid too.

I am at a loss of what to do and what to make of these results.
Thanks in advance!

[goolarra]

I'm quite certain that everyone who takes T3 has a spike in their FT3 afterwards.  If it doesn't spike, then there's not enough when it crashes.

My only suggestion...I know, I know, this is getting expensive...would be to see another doctor and lose that lab report with the spiked T3 before you do.

100 mcg of Synthroid is listed as the equivalent of 60 mg Armour.  However, the fast acting T3 in Armour is going to desert you before the T4 in the Synthroid has time to build up.  So, there will be a period of time in there where you might see symptoms return or worsen.  Do you have enough Armour left to do half and half for a while?

No, you don't have to split Synthroid because it's only T4.  T4 is very slow acting.  It takes 4-6 weeks to build to its full potential in your blood.  The theory is that the body will naturally convert the T3 it needs from the T4 when it needs it.  For some of us that works.  Others convert slowly and just need some T3.  If you haven't tried it, it's worth a try.  In many ways, it's the most "natural" way to go in that it keeps the conversion process in place and delivers T3 "on demand".

Best of luck if that's what you decide to do, and let me know how you do.

[JenniC1972]

Well heard back from doctor. He refuses to increase thyroid. He says that even though the initial FT3 was at a peak, if at anytime it is elevated, it puts stress on the heart and bones, etc.  He called in Synthroid at a dose of 100 mcg which is slightly more than I'm taking of Armour, but said I can stay where I'm at with Armour or try Synthroid. Pretty frustrated, mostly because I spent $300 to see him as a new patient. I guess I will try the Synthroid and hope I am one of those people that does well on it. I have been splitting my Armour as was suggested. That is not a possibility with the Synthroid, so is there not an issue of sustainability of energy levels like with Armour?

[JenniC1972]

Thanks for your help. Faxed results yesterday, just waiting on a call back.

[goolarra]

So, it's pretty obvious how much taking your meds before the draw inflated your FT3.  Now, FT3 and FT4 are both too low.  Based on that, if I were you, I'd ask my doctor to increase the Armour.  If you really do get to a point where FT4 is too low, but FT3 is high, you could then think about adding T4.  However, at the moment, I think you just need a simple increase.

[JenniC1972]

Had my lab redone and results were TSH 1.52 (.30-4.00) FT4 .63 (.60-1.75) and FT3 2.9 (2.3-4.2). These results were in a.m. before takings meds. So advice based on these results? Again I'm on 60 mg Armour.

[goolarra]

The general rule is to not take any meds with T3 in them before the draw, unless of course, your doctor specifically tells you to, in which case he's probably used to looking at inflated FT3 labs and won't freak out over them.

As to whether you increase Armour or add some synthetic T4 to it, I'd have to see your new labs to comment on that.  It would depend on where your FT3 was in comparison to your FT4.

Don't believe all the horror stories you read.  There are a number of (very vocal) authors out to vilify T4-only meds.  Because T4 didn't work for them, they're of the belief that it doesn't work for anybody.  That's just not true.  I, and many others, have no problem with T4-only.  Beware of anyone who tells you that there is only one therapy that works for everyone.  We're all different, and different approaches work for each of us.  Unfortunately, we all have to be our own guinea pigs to find out which is best for us, individually.      

[JenniC1972]

He didn't ask and I honestly wasn't sure if I should take it or not?! I have read both ways. He was a new doctor for me and $300 and 20 minutes later, although he was nice, I certainly didn't feel like we crossed all the bridges we should have. I may ask about retesting and then if results are the same I can ask to do as you said. If the FT3 is not elevated would you suggest increasing Armour or doing what you originally suggested? I am just not wanting to abandon the Armour for Synthroid alone! I've read too many horror stories!

[goolarra]

If you can, set some kind of alarm to remind you and split the dose.  That keeps FT3 levels much more even throughout the day.  Most people will experience an energy letdown in the afternoon unless they split the dose, but even if you don't, it's best to keep levels as constant as possible.

The T3 in your Armour is very fast-acting and peaks in your blood in 3-4 hours.  So, your FT3 was artificially inflated since it was drawn at just about peak time.  Was your doctor aware that you'd just taken your meds?  If he wasn't, you might ask for a retest.

[JenniC1972]

Yes, when adrenals were tested by saliva testing, I start out slightly low in morning, bottom out mid day to afternoon and then climb back up in evening. I don't climb so high that I can't sleep, but I do note I have more energy in evenings usually. If I remember correctly, I had taken my Armour that morning and then had blood draw say 3-4 hours later. I have split dosage before, but am not currently doing that. I found that I'd often get busy at work and forget to take it.  

[goolarra]

Have your adrenals been tested?  If not, what symptoms indicate adrenal stress?  Your high FT3 level can make you feel like you have an adrenal problem.

Your FT3 is too high and your FT4 is too low.  In order to feel well, most of us have to have a balance of both...usually FT4 around midrange and FT3 in the upper half to upper third of range.  

Instead of switching entirely to 100 mcg Synthroid, you might ask your doctor about lowering your Armour a little to bring your FT3 down and adding in a little Synthroid to bring your FT4 up a bit.

How do you take your Armour?  Do you split into two half doses?  Had you taken it before this blood draw?  If so, how long before?