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autoimmune reaction to protein in Armour Thyroid?
My wife's Dr is wondering if some of her health problems are possibly related to an auto-immune reaction to a protein within Armour Thyroid (NDT). She has Hashi's and has had other auto-immune reactions, most recently a year ago an autoimmune reaction called Hymolytic anemia. (body "sees" red blood cells as foreign invader and attacks and kills the red blood cells, leaving the body anemic simply be not having any red blood cells to carry oxygen)
So the Dr. is considering converting her to an equivalent dose of combined synthetic T4 (synthroid) and T3 (Cytomel)
My wife is currently on 3 grains (180 mgs) of Armour daily. she splits the dose for half (90 mg) in the morning and the other 90 mg at 4PM.
For history, my wife had done OK with combined T4 and Cytomel in the past. But the Dr retired and sent my wife on a roller coaster ride. She got so "fed up" and finally found a Dr who would prescribe Armour, and she worked her way up to her current dosage.
Anyhow, has ANYONE ever experienced or heard about a person having an allergic (auto-immune) reaction to protein in Natural Desiccated Thyroid (NDT like Armour) before?
So the Dr. is considering converting her to an equivalent dose of combined synthetic T4 (synthroid) and T3 (Cytomel)
My wife is currently on 3 grains (180 mgs) of Armour daily. she splits the dose for half (90 mg) in the morning and the other 90 mg at 4PM.
For history, my wife had done OK with combined T4 and Cytomel in the past. But the Dr retired and sent my wife on a roller coaster ride. She got so "fed up" and finally found a Dr who would prescribe Armour, and she worked her way up to her current dosage.
Anyhow, has ANYONE ever experienced or heard about a person having an allergic (auto-immune) reaction to protein in Natural Desiccated Thyroid (NDT like Armour) before?
Since last update we have gotten back my wife's cortisol tests.
Test time = 7:30AM cortisol = 0.28 (0.04-0.50) range index for time frame 8AM-10AM
Test time = noon cortisol = 0.04 (<OR - 0.21) index time 12PM-2PM
Test time = 10:30 PM cortisol = <0.3 (<OR-0.09) index time 10PM-1AM
So it appears that her cortisol is not high and within range.
Anybody else know how to better cypher these results? I am assuming "OR" in the reference range stands for ORiginal test sample in the morning.
Test time = 7:30AM cortisol = 0.28 (0.04-0.50) range index for time frame 8AM-10AM
Test time = noon cortisol = 0.04 (<OR - 0.21) index time 12PM-2PM
Test time = 10:30 PM cortisol = <0.3 (<OR-0.09) index time 10PM-1AM
So it appears that her cortisol is not high and within range.
Anybody else know how to better cypher these results? I am assuming "OR" in the reference range stands for ORiginal test sample in the morning.
3 Comments
Was there no evening test? There are usually 4 tests; there should have been one about 6:00 pm...
Nope. I also was hoping for a middle of the night test as well.
There isn't, typically, a middle of the night one, but I'm surprised there isn't a 6:00 pm test.
I question the 10:30 pm result since 0.3 is greater than 0.09. Is there a typo? Should the result be < 0.03?
When I had my cortisol test and some of the results came back super low, like your wife's noon one, my NP was not happy with them. My morning one was nearly 3 times higher than it should have been, but as she put it "the rest of the day, I couldn't be found"... in other words, my levels were "too low". We don't want them too high, but we don't want them non-existent, either.
I question the 10:30 pm result since 0.3 is greater than 0.09. Is there a typo? Should the result be < 0.03?
When I had my cortisol test and some of the results came back super low, like your wife's noon one, my NP was not happy with them. My morning one was nearly 3 times higher than it should have been, but as she put it "the rest of the day, I couldn't be found"... in other words, my levels were "too low". We don't want them too high, but we don't want them non-existent, either.
COMMUNITY LEADER
Did your wife's doctor happen to mention why he suspected a protein in the Armour as being a suspect for your wife's problems?
gomel,
The testosterone/sex hormones have been a bit of a "fight" with my wife.
She has had some testing in the past, but has been extremely reluctant to get updated tests. She once was scheduled for a month long saliva test for the sex hormones to see how they fluctuate throughout a complete menstural cycle. but that didn't work out for several reasons I won't get into. But suffice it to say that I have been advocating and mentioning to my wife to ask to have this done again. But she has refused to ask the Dr to order the test again etc.
The snap shot she has had three different tests for the sex hormones. All taken in the follicular phase, all on the first day or within the first 3 or 4 days of starting her period. The first test showed her testosterone to be at ZERO percent of the range, the other two tests taken on month and like a year later showed her Testosterone to be BELOW normal range. Her progesterone and estrogen seemed mid-range (ish).
barb135.
my wife has a cardiologist appointment scheduled for February 12th. I suspect (or hope) that a beta blocker will be discussed if not prescribed.
I think her Dr. was just trying to establish ahead of time to "rule out" a cardiologist or anyone else that her heart rate issue is overmedication. So I think we have established that fact.
My wife doesn't have really too much symptoms of Hypo. in fact she tends to be a little on the "hot" side. But she is soon to be 48. her blood tests for LH and FSH would not really indicate that she is in or starting menopause. At least not yet. But given her age could be starting really at any time.
Notice the very wide reference rage with both the FT4 and FT3. This range seems to be much wider than what is more commonly reported from what I've seen on this forum by members over the last several years. So the percentage of a much wider range may be a bit misleading.
The timing of things really stink for my wife. Like I said we had convinced the Dr. to add in some T4 . But the dr. did also lower the Armour, Back in December of 2017 he kept her Armour at 180mg and added 25 mcg. then in March of 2017 (4 months later) lowered her Armour to 150 mg and upped the T4 to 50 mcg.
These changes resulted in a small increase in FT4 level, and ultimately a lowering of the FT3 level. made her feel worse and she remained TSH supressed and no change in heart rate. In June 2017 he agreed that the reduction was not working and asked where she had remembered feeling the best. And that was back to 180 mg Armour (split dose) only. Which is where she is at today.
She has a Dr appointment on Jan 15th and I will attend that appointment with her.
as stated I think the Dr is leaning toward combo T4 and T3 medication. I don't have a huge problem with that. However my perference would be to go back to attempting to at a minimum keep her FT3 levels about where they are at now or slight increase, and add in T4 again to slowly work up to 50% of the range. If that requires some reduction in Armour to keep the Dr. happy (for now) to keep her FT3 from going too high, well OK. The question is how high is "too high" as that can only be determined if she starts showing signs of Hyper.
The problem is that she is "sort of" showing traditional signs of being overmedicated. As she is generally hot, can't sleep, and has higher heart rate.
The sleep issue is a non issue in my mind and my wife as well. As she has NEVER been able to have quality sleep and frequently wakes up throughout the night. This has never changed since being clearly Hypo, to now and all the roller coaster rides she has been on with various Dr's manipulating her thyroid dosage. (mostly way under prescribing dosage. And the number of Dr's was attempts to find a Dr who was worth his/her salt and had a clue!)
My wife dropped off her cortisol samples this morning. So we should have some results in the next few days.
The testosterone/sex hormones have been a bit of a "fight" with my wife.
She has had some testing in the past, but has been extremely reluctant to get updated tests. She once was scheduled for a month long saliva test for the sex hormones to see how they fluctuate throughout a complete menstural cycle. but that didn't work out for several reasons I won't get into. But suffice it to say that I have been advocating and mentioning to my wife to ask to have this done again. But she has refused to ask the Dr to order the test again etc.
The snap shot she has had three different tests for the sex hormones. All taken in the follicular phase, all on the first day or within the first 3 or 4 days of starting her period. The first test showed her testosterone to be at ZERO percent of the range, the other two tests taken on month and like a year later showed her Testosterone to be BELOW normal range. Her progesterone and estrogen seemed mid-range (ish).
barb135.
my wife has a cardiologist appointment scheduled for February 12th. I suspect (or hope) that a beta blocker will be discussed if not prescribed.
I think her Dr. was just trying to establish ahead of time to "rule out" a cardiologist or anyone else that her heart rate issue is overmedication. So I think we have established that fact.
My wife doesn't have really too much symptoms of Hypo. in fact she tends to be a little on the "hot" side. But she is soon to be 48. her blood tests for LH and FSH would not really indicate that she is in or starting menopause. At least not yet. But given her age could be starting really at any time.
Notice the very wide reference rage with both the FT4 and FT3. This range seems to be much wider than what is more commonly reported from what I've seen on this forum by members over the last several years. So the percentage of a much wider range may be a bit misleading.
The timing of things really stink for my wife. Like I said we had convinced the Dr. to add in some T4 . But the dr. did also lower the Armour, Back in December of 2017 he kept her Armour at 180mg and added 25 mcg. then in March of 2017 (4 months later) lowered her Armour to 150 mg and upped the T4 to 50 mcg.
These changes resulted in a small increase in FT4 level, and ultimately a lowering of the FT3 level. made her feel worse and she remained TSH supressed and no change in heart rate. In June 2017 he agreed that the reduction was not working and asked where she had remembered feeling the best. And that was back to 180 mg Armour (split dose) only. Which is where she is at today.
She has a Dr appointment on Jan 15th and I will attend that appointment with her.
as stated I think the Dr is leaning toward combo T4 and T3 medication. I don't have a huge problem with that. However my perference would be to go back to attempting to at a minimum keep her FT3 levels about where they are at now or slight increase, and add in T4 again to slowly work up to 50% of the range. If that requires some reduction in Armour to keep the Dr. happy (for now) to keep her FT3 from going too high, well OK. The question is how high is "too high" as that can only be determined if she starts showing signs of Hyper.
The problem is that she is "sort of" showing traditional signs of being overmedicated. As she is generally hot, can't sleep, and has higher heart rate.
The sleep issue is a non issue in my mind and my wife as well. As she has NEVER been able to have quality sleep and frequently wakes up throughout the night. This has never changed since being clearly Hypo, to now and all the roller coaster rides she has been on with various Dr's manipulating her thyroid dosage. (mostly way under prescribing dosage. And the number of Dr's was attempts to find a Dr who was worth his/her salt and had a clue!)
My wife dropped off her cortisol samples this morning. So we should have some results in the next few days.
COMMUNITY LEADER
I agree that your wife's FT levels are too low and she needs a higher dose of medication. I'm all too familiar with that "need to exercise/lose weight, but can't because of the heart rate" issue...
Has anyone considered putting your wife on a beta blocker to see if that will help control her heart rate, while she gets her thyroid hormone levels up to the point she needs them? Beta blockers need not be permanent (I can use myself as an example) though, some must stay on them, long term. A thorough heart work up should be done, since keeping one hypo in order to prevent the high heart rate is just as bad for her health as the high heart rate...
It would seem that even though the doctor has been willing to prescribe the Armour, he's still got something of the "TSH lover" in him, or he wouldn't be so focused on it, thinking that a cardiologist would only think high heart rate is due to suppressed TSH. Any good doctor, regardless of the specialty, knows that one is not hyper unless thyroid hormone levels are too high. It was actually my cardiologist that benefited me the most when it came to my suppressed TSH, since my endo was scared to death of it...
I'd also caution against getting complacent about thinking her thyroid might be "dead" because her antibody levels have dropped down. Mine did the same thing, but have suddenly come back up again, indicating a new autoimmune reaction, for some reason.
Has anyone considered putting your wife on a beta blocker to see if that will help control her heart rate, while she gets her thyroid hormone levels up to the point she needs them? Beta blockers need not be permanent (I can use myself as an example) though, some must stay on them, long term. A thorough heart work up should be done, since keeping one hypo in order to prevent the high heart rate is just as bad for her health as the high heart rate...
It would seem that even though the doctor has been willing to prescribe the Armour, he's still got something of the "TSH lover" in him, or he wouldn't be so focused on it, thinking that a cardiologist would only think high heart rate is due to suppressed TSH. Any good doctor, regardless of the specialty, knows that one is not hyper unless thyroid hormone levels are too high. It was actually my cardiologist that benefited me the most when it came to my suppressed TSH, since my endo was scared to death of it...
I'd also caution against getting complacent about thinking her thyroid might be "dead" because her antibody levels have dropped down. Mine did the same thing, but have suddenly come back up again, indicating a new autoimmune reaction, for some reason.
I haven't heard of a reaction to the protein but I have read some people having reactions due to microcrystalline cellulose filler. The solution for one woman was to use acidophilus as a filler, not cellulose.
Something else to consider is a condition called dysautonomia (malfunction and overreaction of the autonomic nervous system). The autonomic nervous system can be influenced by many factors, including anxiety, thyroid function, endocrine function, stress, hormone changes.
Something else to consider is a condition called dysautonomia (malfunction and overreaction of the autonomic nervous system). The autonomic nervous system can be influenced by many factors, including anxiety, thyroid function, endocrine function, stress, hormone changes.
Rather than speculate on an autoimmune reaction to protein within Armour, why not first fix the known problem (insufficient FT34 and FT3 levels) by increasing her Armour dosage, and see how she is doing afterward? Recall that an excellent thyroid doctor has stated, "in tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level
compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the dose is reduced."
There is an old saying, "If it quacks like a duck and walks like a duck, it is most likely a duck". She needs to get her FT4 and FT3 levels optimized.
Also, it will be good to have the diurnal saliva cortisol panel results, and also the testosterone. Has she been tested for the other important hormones, estradiol and progesterone? Also, are her Vitamin D, B12 and ferritin optimal?
compensates for the lower FT4 levels on NDT. These patients have no symptoms or signs of hyperthyroidism--if such occur the dose is reduced."
There is an old saying, "If it quacks like a duck and walks like a duck, it is most likely a duck". She needs to get her FT4 and FT3 levels optimized.
Also, it will be good to have the diurnal saliva cortisol panel results, and also the testosterone. Has she been tested for the other important hormones, estradiol and progesterone? Also, are her Vitamin D, B12 and ferritin optimal?
lots of other health issues. Mainly she cannot remain asleep. She is currently being tested for adrenal fatigue and cortisol (saliva multiple in a day), potentially low testosterone, and rapid heart rate.
Her heart rate is in the "limbo" area. That is; her resting rate is high, but not high enough for any Dr. so far to want to do anything about it. yet it shoots up very high with ANY amount of exercise. So it is not right nor is she able to really do any sort of exercise to lose weight.
Looks like arthritis in knee(s). Yet losing weight would help, but between possibly not optimized thyroid and her rapid heart rate makes it nearly impossible to lose weight.
I will have to go out and get most recent thyroid labs. She may have had blood drawn today.
blood drawn 11/10/2017 so "only" one month ago
TSH= not tested has been suppressed for a long time
FT4 = 0.81 (0.78-2.19) = 2.1% of range
FT3 = 3.38 (2.77-5.27) = 24.4% of range
She has been on Armour starting on July 11, 2014 and increased every few months reaching 180 mg Armour on August 28, 2015.
Just prior to her having the hymolytic anemia spell last year, (November 2016) they were beginning to add some T4 in addition to the 180 Armour (about mid-summer) in an attempt to get her FT4 levels up to mid-range. But they thought that may have put her into rapid heart rate. Rapid heart rate is a symptom of being very anemic. The result was that she was taken off of all the T4.
After the anemia thing was cleared out. her heart rate remained high. As a clinical trial, the Dr. started cutting her Armour dosage down from 180 grains. In two small decreases. The result had NO EFFECT on helping reduce her heart rate and she felt much worse as her hypo symptoms came back. So the Dr. thankfully wrote that into her records that it seems the heart rate is NOT due to her suppressed TSH and thyroid level. As he knew or the Dr. believed, no cardiologist would seriously look into her case because of immaculate TSH belief (my paraphrase as her TSH is suppressed). So he wanted to document that it is NOT from over medication of thyroid!
Yesterday she her Hashi's antibodies tested again. As it has been nearly two years since her last tests for these.
12/11/17
TPab = 22 (0-35) In Feb 22, 2016 her value was 62
TGab = <20 (0-40) same as back in Feb 22, 2016
I suspect the decrease in TPab is because the antibodies have already successfully killed her thyroid. So there is little need for a large # of antibodies as they have done their job!
Her heart rate is in the "limbo" area. That is; her resting rate is high, but not high enough for any Dr. so far to want to do anything about it. yet it shoots up very high with ANY amount of exercise. So it is not right nor is she able to really do any sort of exercise to lose weight.
Looks like arthritis in knee(s). Yet losing weight would help, but between possibly not optimized thyroid and her rapid heart rate makes it nearly impossible to lose weight.
I will have to go out and get most recent thyroid labs. She may have had blood drawn today.
blood drawn 11/10/2017 so "only" one month ago
TSH= not tested has been suppressed for a long time
FT4 = 0.81 (0.78-2.19) = 2.1% of range
FT3 = 3.38 (2.77-5.27) = 24.4% of range
She has been on Armour starting on July 11, 2014 and increased every few months reaching 180 mg Armour on August 28, 2015.
Just prior to her having the hymolytic anemia spell last year, (November 2016) they were beginning to add some T4 in addition to the 180 Armour (about mid-summer) in an attempt to get her FT4 levels up to mid-range. But they thought that may have put her into rapid heart rate. Rapid heart rate is a symptom of being very anemic. The result was that she was taken off of all the T4.
After the anemia thing was cleared out. her heart rate remained high. As a clinical trial, the Dr. started cutting her Armour dosage down from 180 grains. In two small decreases. The result had NO EFFECT on helping reduce her heart rate and she felt much worse as her hypo symptoms came back. So the Dr. thankfully wrote that into her records that it seems the heart rate is NOT due to her suppressed TSH and thyroid level. As he knew or the Dr. believed, no cardiologist would seriously look into her case because of immaculate TSH belief (my paraphrase as her TSH is suppressed). So he wanted to document that it is NOT from over medication of thyroid!
Yesterday she her Hashi's antibodies tested again. As it has been nearly two years since her last tests for these.
12/11/17
TPab = 22 (0-35) In Feb 22, 2016 her value was 62
TGab = <20 (0-40) same as back in Feb 22, 2016
I suspect the decrease in TPab is because the antibodies have already successfully killed her thyroid. So there is little need for a large # of antibodies as they have done their job!
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