Armour and blood result questions

[alexisb112]

I am currently on 3 grains (180mg) of Armour. I have been on it for over 2 months and I feel slightly better, but de days I feel constipated and very tired. Not all of my hypothyroid symptoms have gone away.

I just got my lab results back and they are the following:

Vitamin D- 60 ng/ml
T4 free- 1.6 (0.8-1.8 ng/dl) range
T3 free- 3.6 (2.3-4.2 pg/ml) range
T3 reverse - 37 (11-32) ng/dl (out of range)
TSH- less than 0.01 L

I am not sure what the out if range RT3 means? Do I need more armour or T3? I don't know what to do as I am still having hypothyroid symptoms.

Any help would be greatly appreciated.

[jenjen1966]

Liothyronine is generic cytomel.

[alexisb112]

Okay, thanks!

[gimel]

The bottle just says Liothyronine, so apparently it is just a generic T3 med.  

[alexisb112]

What brand of T3 are you on? Are you on Cytomel, or something else?

[Jackie419]

This helps a lot, thanks to you both for posting :)

[gimel]

Free T3  3.8                    range of 2.3 - 4.2
Free T4 1.1                         "         .8 - 1.80
TSH  .02                             "         .4 - 4.5
Reverse T3   26                  "         9 - 28

Ratio of Free T3/ Reverse T3     1.46     (recommended ratio is 1.8 or better)

Vitamin D    53                      30 - 100
Vitamin B12    653               200 - 1100
ferritin    50                           20 - 380       ( recommended is around 90)


I should also note that due to the rate with which T3 meds affect serum levels, the ratio of Free T3 to Reverse T3 is affected by the time of your last dosage as compared to when blood is drawn for the tests.  So this ratio is only a rough estimate of what my daily average ratio might look like.

[alexisb112]

Okay, that makes sense.
Thank you for your reply!

[Jackie419]

Good thread! Gimel, just for reference would you mind posting your last labs? Thanks!

[gimel]

After the first month, I will further reduce  1/2 grain of Armour and add another 5 mcg of T3, and continue the second month and then re-test.

[alexisb112]

So you are going to be one the reduced Armour and added T3 and then get retested, or do that for a month and then go back to the original 3 grains and then get tested?

[gimel]

Yes, I reduced by 1/2 grain of Armour to 2 1/2 grains, and added 5 mcg of T3.  Will do that for a month and then do the same again and go back for new tests of Free T3, Free T4 and Reverse T3.  

[alexisb112]

I have just started taking B12 and Selenium. Those are some really good points and I will look into those options and talk to my doctor.

If you don't mind me asking, have you started taking less Armour and adding some T3?

[gimel]

A couple of thing come to mind while looking at your test results.  Be aware that just because your TSH is suppressed below range does not mean that you are hyper.  TSH is frequently suppressed when taking significant doses of thyroid meds.  You are hyper only if you  also have hyper symptoms due to excessive levels of Free T3 and Free T4.  So don't let the doctor tell you to reduce meds because of suppressed TSH.

Next is that your Free T4 is higher than it needs to be, which is around the middle of the range.  Your Free T3 is typically high enough, so continuing hypo symptoms are likely due to the ratio of Free T3 to Reverse T3 being too low, due to excessive Reverse T3.  The ratio of Free T3/Reverse T3 is reported to be the best measure of tissue thyroid levels.  You can read about it in this link.

http://nahypothyroidism.org/thyroid-hormone-transport/#reverseT3

As for the best approach, you might find this to be worthwhile.  I received this info from a good thyroid doctor, that I highly respect.  Per his recommendation It seems that the best approach would be to reduce the Armour dosage and substitute some T3.  This reduces the T4 available for conversion to RT3 and keeps Free T3 high enough to help symptoms.  


"As you can anticipate from what I've said, I don't subscribe to the idea that RT3 is always bad and one must take T3 to get rid of all of it. Armour his quite high in T3 and low in T4 compared to thyroid gland production (4:1 vs. 14:1 T4:T3 ratio). In fact, when people take Armour their RT3 will usually be lower and their FT3 much higher most of the day. So I just give such patients Armour thyroid until/unless Armour does not seem to be effective at strong doses and they seem to still overconvert T4 to RT3. Again, one has to then reconsider whether their body may be right and they cannot tolerate strong thyroid effects for some other reason. To increase thyroid effect in someone on Armour who has a high RT3 or persisting symptoms, I'll first lower the Armour and add some T3 to see if that will produce optimal effect. That will lower the RT3 even more, and usually works well."

Interestingly I have a similar situation and just yesterday I started following this advice.

One last thing is that hypo patients are frequently too low in the ranges for Vitamin B12 and ferritin.  B12 levels that are too low can cause some hypo like symptoms.  Ferritin levels that are too low can inhibit conversion of T3 to T3 and cause excess conversion of T4 to RT3.  So if you haven't tested for B12 and ferritin, that would be a good idea.