Updated labs look worse!

[JennaS]

Hello,

I got new labs in today and was hopeful for a review.  My Dr. added additional T4 in the form of Synthyroid along with my Armour to get my lab numbers up...after about 10 weeks...I think my labs looks worse now than before.

These labs are my labs today while I am on Armour 90mgs and Synthroid 25mcg.  10 weeks ago, I was on 105mg Armour only. I am showing todays labs first compared to 10 weeks ago.

TSH- 0.32 on a range of 0.5-5-----10 weeks ago it was at 0.25
FT4 - 0.47 low on range of 0.58- 1.64   -10 weeks ago it was at 0.73
FT3- 2.6 on range of 2.0-4.4   - 10 weeks ago it was at 4.9
Reverse T3 11 on range of 9.2-24.1 - 10 weeks ago it was at 10.1

10 weeks ago, I was taking 105mg of Armour. Because my FT4 was low, and I learned on this site that it should be in the mid to upper range...I convinced my doctor to increase my meds. He did so by adding t4 Synthroid 25mcg to 90mgs Armour.  I don't think my labs look very good today and not an improvement, especially the FT4. His nurse that called and left a message told me to stop taking the Synthroid all together and to try 120mgs of Armour 6 days per week and 60mgs on 1 day per week.  And that they would look at my TSH in 3-4 months.  Well, I already know that they will need to look at all of these labs again.  It doesn't make sense to look at just the TSH, does it?

So, it looks like I am going to increase to 2 grains of Armour...which is the highest dose I have ever taken in 15 years since my RAI thryoid removal.

Any suggestions on if this looks like the right track to be on?

Thank you so much for any help or suggestions.  Be Blessed!!!  :)

[flyingfool]

Suppression of TSH can happen from oral thyroid replacement.  It seems more sensitive to occurring with T3 medications but it can happen with T4 alone.

Armour has a lot of T3 in it.  So taking Armour you are more likily to suppress TSH sooner than if on T4 only.

Because Armour has a lot of T3 in it and little T4.  This is why it is not uncommon for people taking Armour or any natural dessicated thyroid (NDT) medication to even have ample level of FT3 yet very low FT4 levels.  Some people feel fine this way, other not.

My wife is one of  those people who seems to be getting the FT3 levels up where they need to be and is feeling OK.  yet her FT4 levels are rock bottom.  And she too recently added in Synthyroid (T4) medication in addition to her Armour with the idea to get her FT4 levels up towards the middle of the range while also not going Hyper.  So it may be possible that my wife too will maybe need to lower her Armour dose and increase the T4 dose.  Only time and further blood testing will tell how to optimize her dose.

Splitting the dose when taking a T3 medication is important for some people.  This is because T3 is used up in HOURS.  As mentioned before it peaks about 4 hours after taking it and then starts to wear off.  So by taking it only in the morning, you are giving the body a MASSIVE surge of T3 that increases in your blood for about 4 hours and then wanes off for the rest of the day. This is why you report having energy earlier in the day and only want to "Chill" out in the afternoon. Because you have used up a large portion of the T3 by then.

If on the other hand you take half of the dose in the morning, and then take the other half in the early afternoon, then this helps more level out the amount of FT3 in your blood. Because the 2nd dose kicks in as the 1st dose is losing its punch. So you stay a little more even keeled and should give you a little more energy into the evening.  But do not take the 2nd dose too late or you may have trouble getting to sleep.

Taking the 2nd dose is a matter of discipline. You have to set a timer or something and always keep a supply of hlaf pills with you in your purse or at work or whereever you typically are to have handy when it is time to take the 2nd dose.

I know my wife has forgotten to take her 2nd dose due to being busy or forget or whatever, and she is really dragging by dinner time and into the evening.

[Barb135]

TSH is a pituitary hormone that stimulates the thyroid and once the thyroid no longer produces anything, whether it be from RAI like you had or whether the thyroid has been "killed off" by antibodies, such as mine has been, TSH does nothing, because the thyroid can't respond.  In addition, TSH can fluctuate by as much as 75% over the course, of a day, and it's affected by a lot of things, besides thyroid hormones, so, at best, it's only an indicator of thyroid status.  

TSH is often suppressed when one is on adequate dosages of thyroid hormones and no, it doesn't mean you're hyper.  Hyper is only if you have too much thyroid hormones, which causes hyper symptoms... You can look at your labs and see that you aren't hyper, which in your case would be over medicated, not really hyper, plus you don't have hyper symptoms.

My TSH has been suppressed since I was started on thyroid hormones in 2008, even when I was very hypo... I've never been over medicated or had hyper symptoms, except those that can apply to either/both hyper or hypo.

Doctors who use TSH as the sole basis for prescribing medication, often, tend to keep their patients ill.  

If you have to see your doctor in order to get FT3 and FT4, then by all means, you should do so, but I'm not sure I'd wait 3-4 months; I'd want to do it in no more than 2 months...

I can't really tell you what you'd be better off at, but I believe you'd be better off at the smaller Armour dose with the added Synthroid... Of course, your doctor would have to agree to give you that.

While I've self medicated many times, I don't advocate it for anyone else especially when you're on a relatively high dose of Armour, because some of the Synthroid is going to convert to T3 also, and while it's unlikely, your FT3 could flip you to hyper if you added the Synthroid on your own...

You'll have a pretty good idea within 2-3 weeks how the Armour is going affect you.  If you don't feel right, you can then call your doctor and request a change.  

[JennaS]

Hi Barb,

I do have refills on the Synthroid, so I suppose I could keep taking it to get the FT4 up. I would be going against what my doctor suggested; however at this point I will have to make a doctor's appointment in 3-4 months anyhow, in order to get him to check my Ft3 and Ft4 along with the TSh. Otherwise, he will only call in an order for the TSH.  I am frustrated at not being able to get to where I need to be in all these years with my labs.

I do have some questions that I need to understand better. Please explain to me why TSH becomes suppressed on Armour when someone has had a RAI. What does it mean if TSH is suppressed? Does it mean that it is considered HYPER? or does it mean that it no longer matters?  I don't completely understand it.  However, I do believe that my doctor has looked at only my TSH alot and only once a year at my Ft3 and Ft4 and they have for the most part always been low in the range....which I am now understanding could mean that I am actually hypo.  Why hasn't my doctor realized this???

Considering my labs, would I be better at 120mgs of Armour or 105 mgs Armour and 25mcg of Synthroid in order to bring the FT4 up? I wish I knew what the magic number was for me.

BTW, I am not splitting my Armour. I take it in the a.m.

I think my doctor will go along with whatever I feel works best...he is getting ready to retire soon.

Thanks so much for your input and suggestions..it means more than you know.    My Best to you all!

[Barb135]

Hi Jenna... I totally agree that your FT3 was high because of having taken the med prior to having the lab, but since you did, it's not a valid test and we have no idea what your FT3 would have been had you not been medicated.  

We "do" know that this last FT3 is way too low and your symptoms are certainly hypo.

I think this increase to 2 grains is going to raise your FT3, but will leave your FT4 on floor of the range like it was previously.  You're going to need some T4, but it sounds like it's debatable, at this point whether you'll be able to get your doctor to try it again...

Are you taking all of the Armour at one time or are you splitting it into 2 doses during the day?

[JennaS]

Hi Barb,

Thank you for your response....I wonder if taking this new increase of 2 grains of Armour will help my overall labs. I do believe that my FT3 was high only because of when I did the labs shortly after taking meds. I don't however want to risk going hyper. But, I guess I won't know unless I try it. :)

[Barb135]

Jenna - since you took your Armour just 2 hours prior to your last blood test, you really have no idea what your FT3 was at that time, because you got a false high.  

When your doctor added the Synthroid, most likely, he should not have reduced the Armour dosage, because your FT4 was way too low on your last blood work.  He should have left you on the 105 mg Armour and added the 25 mcg Synthroid, then tested (without taking medication prior to the blood draw) to see what your levels are.

When taking T3, you should never take medication the day of the blood draw until "after" you've had the draw, because it will always give a false high so you can never figure out where you are.  Taking T4 medication can cause a slight increase if blood is drawn within a couple of hours of taking the medication...

I have no idea why they would only test TSH, when you've had RAI and your TSH is already on the low side.  You'll probably have to insist that FT3 and FT4 be tested, also.  

Your symptoms are definitely those of being hypo.

[JennaS]

Hi flyingfool,  and thank you for your thoughts.
Yes, 10 weeks ago, when I was on Armour only. I had my blood drawn 2 hours after taking meds. This is why my Ft3 is high. In order to balance out and increase my ft4 my dr. tried something new by adding in Synthroid.

I honestly don't think it has helped.  I don't feel horrible, but I could feel alot better. I think I am borderline hypo on this dose.   I am hopeful that going to 2 grains of Armour and eliminating the Synthyroid will help me significantly.

My symptoms are: I am having a strange muscle twitch in my face. I am very tired at night and I sometimes have to force myself to get up and get moving in the mornings. By 4 or 5pm...I am ready to chill out for the evening. I wish I had more energy, more motivation. I also have gained about 5 lbs since adding the Synthroid.  My eyes look puffy on the tops on my eye lids. That I believe is a sign that I am hypo.  

I learned on this site that my Ft4 should be more in the middle range....all these years mine has been in the cellar low.  I was hopeful that will one day change and I know what it's like to feel normal again.

I think I have gotten used to feeling like crap and have just adapted myself to it over these 15 years...because quite often my doctor will only look at my TSH.

[flyingfool]

Two thoughts.

First,  10 weeks ago did you take your medication (Armour) prior to your blood test and if so about how long. Was it the same this 2nd draw?  That is are you comparing apples to apples here.  As T3 from the Armour gets into the bloodstream quickly. As in it peaks after about only 4 hours after taking it.

Secondly as you know TSH is nearly a worthless test.  This is especially more likily to be useless since you are on Armour and the T3 can and often does easily suppress TSH.

I am a bit surprised by the disappearance of the T4 from the synthyroid.  it is not uncommon with people on Armour to have low in range FT4 levels.  Some people feel fine with this as long as there is enough FT3.  Others need both the FT4 and FT3 levels to be in balance.

10 weeks ago your FT3 level was OVER the top.  Which makes be wonder if A) you had taken your Armour a couple hours prior to the blood dray or B) you were over medicated.

I do not follow your Dr's logic about INCREASING your dosage of Armour above your previous highest dose with a blood lab showing the FT3 OVER the top of the range.  Even if that test was not representative because of previously taking the medication it is not completely logical until you rule it out.  Also the fact that the DR said they wanted to relook at the TSH makes me believe that this Dr doesn't understand the likilyhood of suppression by the Armour.  And again. The logic doesn't make a ton of sense based on the lab values. That is;  Why would the Dr INCREASE the dosage if they were looking only at TSH and that the TSH was already supressed.  That would only further ensure further suppression of TSH.  So I am not all together sure what your Dr is considering with the dosing changes.  I'm not saying that they are wrong. I just don't quite follow.

Finally, what symptoms are you having?  How do you feel.  The numbers are FAR less important than how you feel.  if you feel fine, why change a thing.  If you don't feel fine, what are your symptoms?