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Avatar universal

Thyroid replacement only works for a few weeks and have to keep increasing dose.

I started on desiccated thyroid about six months ago.  My doc has given me leeway to adjust the dose myself (within reason of course).  Started with 1 grain Naturethroid and worked my way up to 3 grains when I finally noticed my symptoms were improved.  But the relief only lasted about three weeks.  I have been increasing my dose by a half grain every month or so and each time I have a "honeymoon period" then start feeling bad again after a few weeks.  I'm up to 4.5 grains now and have noticed the symptoms starting to return.  My doc doesn't have anything to contribute, only to suggest that some people need over 5 grains a day.  My doc also doesn't rely on TSH, only on my symptoms (thank goodness).  Has anyone else experienced the "honeymoon" issue and if so, do you finally reach your perfect dose?  Or is there something else at play here?
4 Responses
Avatar universal
Please post your latest.thyroid related test results and reference ranges shown on the lab report.  Also, please tell us about the symptoms you have.  
1756321 tn?1547095325
I had a similar problem as your taking Armour. But forget about the honeymoon period...I hadn't even got married yet LOL. I was taking 3 grains of Armour and having major breathing issues (my worst hypothyroid symptom) and was back onto synthetic T4 (50mcg) very quickly! Long story short, in that instance it was an absorption issue with natural desiccated thyroid extract.

The other time I had to take high doses of medication was under immense stress and I was up to 400 mcg a day. That looks to be due to high cortisol (stress hormone) causing elevated reverse T3. I eventually was able to drop back to 50 mcg a day.

***

Except from Miss Lizzy - Reverse T3 (RT3) When Normal Thyroid Treatment Isn’t Working...

"What are the symptoms of Reverse T3 (RT3)?

Hypothyroidism that won’t respond to desiccated thyroid treatment (at a proper dose)."

"What causes Reverse T3 (RT3)?

The body naturally produces some RT3 and this is fine for many people. The problem arises when the Free T3 to Reverse T3 ratio is too low (below 20:1) because the RT3 then gets in the way of the T3, causing hypothyroid symptoms. Here are some common causes for a low FT3/RT3 ratio:

Extreme dieting, the RT3 increases to slow the metabolism and make better use of the available food
Low Ferritin
High cortisol, this disturbs the balance of the thyroid hormones
Low cortisol, this again disturbs the balance of the thyroid hormones
Insulin dependent Diabetes
Low Vitamin B12 levels"

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Excerpts from the book: Thyroid Diseases: Clinical Fundamentals and Therapy by Fabrizio Monaco, Maria A. Satta, Brahm Shapiro, Luigi Troncone...

"There is some differences in the rate of absorption between animal and synthetic preparations. After a single oral dose of synthetic L-T4, the absorption is approximately 70 - 80%, 20 - 30% being recovered in the stool.  It is absorbed rapidly, mainly in the distal small bowel, reaching maximum plasma levels in 2 to 4 hours."

"Variability of absorption also occurs with desiccated thyroid, dependent on proteolytic enzymes of the gastrointestinal tract. Since desiccated thyroid and thyroglobulin preparations contains T4 and T3 incorporated into thyroglobulin, to release thyroid hormone the crude preparations must be hydrolyzed by gastrointestinal proteolytic enzymes, which indirectly influence the absorption of T4 and T3."
Avatar universal
Thank you for the information so far.  I actually haven't had labs since starting the thyroid replacement.  I'm going strictly on relief of symptoms as a guide.  Symptoms are: restless legs and leg pain at night, myxedema (puffiness) around jaw line and upper arms, general fatigue and aches/pains, feeling cold deep in my back (like a cold spot).  All symptoms resolve completely a few days after raising my dose.  The aches and pains, fatigue, and puffiness are the symptoms that I notice most that return after I adjust my dose
Avatar universal
Symptom relief is all important, but in your case I think you need to better assess what is going on so I recommend that you get tested for Free T4, Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin.  The best test for cortisol is a diurnal saliva cortisol panel of 4 tests from different times of the day.  These are tests for free cortisol.    Few doctors will order that test panel, instead only ordering serum (total) cortisol, which is not as revealing, but at least an indication of cortisol status.  

If nothing shows in those tests, there is the possibility of thyroid hormone resistance.  I have gone through that myself and found that I got the best response by reducing my Armour dosage and adding T3 until symptoms were relieved.  I did not, however, get temporary relief as you mentioned.  I just drifted into being hypo again, and increasing the Armour did not provide relief.  Only after reducing my Armour from 4 grains and adding significant T3 did I finally get symptom relief.  
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649848 tn?1534633700
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1756321 tn?1547095325
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