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What would cause my FT4 to be low, FT3 to be high & normal tsh & how to fix it?

I take 105mg Armour @4:30am everyday. Here lately when I take it I feel like dog doodie. I'm sluggish, extremely fatigued, can't get out of bed...I just don't feel good. I have no appetite, hair falling out, dry brittle hair/nails, can't concentrate/focus, memory problems, swollen fingers, legs, face, heart palpitations & the depression & anxiety ( mostly depression) is off the charts!! But tgen on days when I don't take it, I average @ 21k steps on my pedometer. I feel pretty good. Today is the 3rd day where I haven't taken any of it. I'm a little tired today but no worse for the wear. I also suffer from adrenal fatigue and have to take 5mg of oral hydrocortisone every morning (if I go any lower than 5mg I feel like I'm going to die!) My endocrinologist is baffled by my FT4 being on the lower end of normal, my FT3 on the upper end of normal & normal tsh. What would/could cause this imbalance where I'm not making enough FT4 but what I do have is being converted too much (I'm guessing) & how would I fix it? I suspect the RT3 may have something to do with it because  one of my liver enzymes were elevated (isn't the liver where rt3 takes place?) Would you lower the dose of Armour & perhaps adding a little more T4 or just scrap the whole Armour thing & just try maybe a sustained released T3?  I'm so confused about all this. Here's my latest labs (last dose Armour taken 24+ hours prior to blood draw)
FT4- 0.94 (0.82-1.77)
FT3- 4.0 (2.0-4.4)
Tsh- 0.759 (0.450-4.50)
TPO (Ab)- 28 (0-34)
Cortisol- 9.4 (6.2-19.4)
ACTH- 28.7 (7.2-63.3)
Alt- 33 (0-32)
4 Responses
649848 tn?1534637300
COMMUNITY LEADER
Yes, I'd decrease the Armour and add T4 med.  I doubt rT3 has anything to do with it, but you can have it tested next time you have blood work.  Many people on Armour, or other desiccated hormones have lower Free T4 and higher Free T3, because of the high T3 content in Armour and T3 being more potent than T4.  It's not unusual to have to do this in order to balance out the Free T4 and Free T3.  Most of us feel best with Free T4 about mid range and Free T3 in the upper half to upper third of its range.
2 Comments
Thanks Barb!!
Now, if you don't mind I've got 2 more questions for you...
-1.) Having not taken my Armour in over 3 days, is there any harm, risk or side effects associated with stopping cold turkey? I actually feel more bright eyed & bushy tailed with noticeable lessened fatigue & daytime drowsiness. I hope it's not short lived.
2.) Once on thyroid meds, is it a lifelong commitment or is it possible (speculating a HPA axis malfunction) the system can right itself?
Oh, one last question. Can taking too much Armour cause weight issues; making it almost IMPOSSIBLE to lose weight despite getting plenty of exercise & eating a healthy & nutritious diet?
649848 tn?1534637300
COMMUNITY LEADER
Don't mind at all if you ask more questions...

1)... You might be feeling better not taking the Armour because your FT3 is coming down, and no, there aren't really any side effects of quitting thyroid med cold turkey, except if you need them, you're going to go hypo again and you'll have to start all over getting your levels back up.  Your feeling of well being "will", most likely, be short lived...

2) Whether or not thyroid meds are lifelong, depends on what caused you to need them in the first place.  There are some transient forms of hypothyroidism, but even those, often, end up being permanent.  The most common cause of hypothyroidism is Hashimoto's Thyroiditis, which is autoimmune and does not go away, therefore, medication is lifelong.  

I'm not sure what you mean that you're speculating an HPA malfunction causing you to be hypo...please explain.

And last, but not least - anything can happen, but it's unlikely... If you have too much Armour, you would be hyper, which, typically, causes weight loss, not weight gain.  

Not having enough T4 leaves you a bit hypo, which could cause weight gain.  

You'd be much better off to, simply decrease your Armour dosage and add some T4 to get FT4 and FT3 balanced and you'll, most likely feel much better.  

As for the weight, you could have either too high cortisol levels or too high insulin levels.  Both have a tendency to cause us to store fat. I had to really change my diet, drastically, in order to lose any weight at all, then I keep stalling...
Avatar universal
How would one know what dose of Armour would be optimal without it being just a guessing game? Instead of taking Armour, where the amount of T3 & T4 may fluctuate or where it gives me the right amount of one but not the other (kind of like it's doing now) would it be more beneficial or appropriate to look into something like getting a compounding pharmacy & make a sustained released T3 like cytomel to get the T3 I need then a T4 like Synthroid? My thinking is to take individual T3 & T4 to be a more accurate dose & perhaps taking a sustained released T3 would be easier on my body versus a T3 that's short lived & immediately used up.

On a side note (not sure if this matters or is relevant) but according to Wilson's Temperature Syndrome) my body temperature has been averaging 97.7 & cannot get it any higher than that. ( http://www.wilsonssyndrome.com/thyroid-and-fluid-retention/  ) This website mentions temperature, sustained released T3 to help increase temp & helping thyroid.

What I meant by the hpa axis malfunction was if my thyroid issues are being caused by adrenal insufficiency & I got those issues under control, hypothetically could it  help my thyroid levels return to baseline?

I'm going to see my endocrinologist today at 10am. Are there any questions/concerns you can think of I should ask or mention? He's on the brink of retirement (he looks like he should've been on the Ark with Noah) and maybe is starting to be a few French fries short of a happy meal, if you know what I mean. It's like it's getting more difficult to put these clues & puzzle pieces together. So the better I'm armed with questions & possible solutions beforehand the better.
Thanks again Barb!
1 Comments
Sorry I missed your question in time for your appointment...

Many of us are on individual T4 and T3 medications.  I, personally, take Levoxyl for my T4 and generic Cytomel for my T3 and I'm doing fine.  We've had several members that have tried the sustained release compounded T3 and didn't do well, mainly because those are meant to be taken every 12 hours and doctors, typically, only prescribe them for once/day.  Regular T3, like Cytomel, and it generic counterpart, Liothyronine are generally, also taken twice/day, depending on the dose.  I only take 5 mcg/day, so I take it all at once around late morning to noon.

Wilson's Temperature Syndrome is not a recognized medical condition, so I doubt seriously you'll get a doctor to listen.  My temperature almost always runs low.

Do you have any evidence that your thyroid issues are caused by adrenal insufficiency? Again, this isn't a recognized medical condition.  Only adrenal conditions, such as Addison's or Cushing's are recognized adrenal issues.

If you have an adrenal imbalance, it's more likely caused by thyroid deficiency than the other way around, because when the thyroid fails, the adrenals kick in to help make up for the lack of thyroid hormones.  

What time of the day were your cortisol and ACTH tests done?  The ACTH is good and the cortisol is "in range", so I'd guess a doctor would consider that good, as well.

Please let me know how your appointment turned out.
Avatar universal
Before I would just jump on the bandwagon to agree with lowering Armour and adding T4.

I will ask because I didn't see it anywhere is to ask you this question:

How do you take your Armour?  Do you take it all at once in the morning or split the dose with half in the morning and the other half in the early afternoon?
Your first sentence in your original post states : "I take 105mg Armour @4:30am everyday."

which strongly leads me to believe you are taking it all at once.

Reason I ask is if you take the entire dose all in the morning,  you could be inducing a "roller coaster" effect.  Where you SLAM a huge amount of T3 into your body.  Temporarily go Hypo from that huge shot of T3, then as the T3 peaks about 4 hours after taking it, and then slowly fades away. You go through a HUGE cycle.  And it is hard for you and your body to regulate this.

TSH is almost worthless to begin with. And even less so when on Thyroid meds, especially with any substantial amount of T3 in it (Like Armour).  Frankly I'm surprised your TSH isn't totally suppressed.

So if in fact you are taking your Armour all in one dose in the morning.  I would suggest you first try splitting your dose in half.  Take the first half when you wake up.  And take the second half about 2PM or so.

This will help keep the amount of T3 in your bloodstream more level.  As the first half will increase and peak in about 4 hours, it will then start to wane away, and then you take your 2nd half, so that it starts to ramp up about the same time as your first dose is disappearing, the full impact of the 2nd dose will hit about 4 hours after you take it (say 6PM) and then start to wane away.

Be careful not to take the 2nd dose too late or you may find it hard to go to sleep.

Even splitting your dose may not solve all of your problem, and it is very possible and actually pretty likily that you may still find you want or need to add some T4 medication in.  But I would first start with splitting your existing dose and see if that helps.  Then go from that point to start to attempt to optimize.  This will have a similar effect of "time release" compounding. Without the cost and complexity of having a pharmacy create tailor made custom formula's.

In regard to the "guessing game of dosage".  Well it is called trial and error, or a more fancy term in medicine a "clinical trial".  That is why they call it PRACTICING medicine.  
Everyone works a bit differently and everyone feels well at different levels of FT4 and FT3.  So there is no way around the trial and error.  This is why it is so critical to keep a log of your blood labs, how your feel and your symptoms and your dosages of medications when those labs were done.  This way you can best correlate for YOU, what works best for YOU.  and you will have documentation to show if any changes you make are improving things or not.  Also in the case when you finally feel "great".  You will then know the blood labs that result in you feeling well. So if anything gets out of balance again, you have a pretty narrow target to at least aim for in order to adjust medication dosages.

Just my thoughts!
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649848 tn?1534637300
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