new here with a lot of questions

[catherine46993]

I am new here but not new to thyroid disease, unfortunately. I was diagnosed with Hashimoto's disease ten years ago and put on thyroxine. The dosage was gradually increased until my TSH was 0.2-0.4. My doctor at the time felt a low-in-the-range TSH would calm the antibodies, and it turned out he was right. FT4 levels were also measured each time and looked OK; 1.3-1.6 depending on dosage (0.8-1.8). FT3 levels were never tested.

Six months ago, I went to a new doctor, a so called hormone therapist who works with natural hormones. She took a lot of tests, both blood and 24 h urine tests, and we spent an hour going through the results. It turned out my T3 levels in urine were very low (below the normal lower range) and my T4 levels only mid-range although I was taking 200 mcg of thyroxine at the time.

I have been on Armour Thyroid for the past six months. I did fine on it until about a month ago, when I started feeling both tired and wired at the same time. I am currently taking 5 grains of Armour daily and my latest labs were: TSH <0.001, FT4 1.1 (0.8-1.8) and FT3 4.1 (1.7-3.7) 24 hours after latest dose. I also take 25 mg of hydrocortisone daily for adrenal fatigue and started taking it when I started taking Armour.

Are my FT4 levels suboptimal on 5 grains of Armour? My FT3 levels are slightly out-of-range and I was wondering if maybe I should cut back on Armour and add some T4 instead to balance my hormone levels? Luckily, my doctor does not care about my TSH at all, so it's all about finding the right balance between FT3 and FT4.

The reason I'm wondering is that both T3 and T4 were low in the 24 h urine test when, on 200 mcg of thyroxine, you'd expect higher T4 levels. Should this be interpreted to mean that maybe I was not only T3 deficient (from inadequate T4 to T3 conversion), but also that I was T4 deficient? 5 grains of Armour give me 190 mcg of T4, so more or less what I was taking before, but now I also get 45 mcg of direct T3 every day so maybe I don't need that much T4 now?

I should add that I have been doing fine on Armour and have not had any of the problems reported elsewhere. The pills even melt nicely sublingually and absorb quickly. They are not grainy or chalky, but not sweet either. Anyway, they seem to work just fine. Before I was put on 5 grains, I was on 30, 60, 90 and 120 mg, and they all worked fine.

[gimel]

Agree with your doctor about getting Free T4 to around the middle of the range.  You can help reduce your Free T3 and increase your Free T4 by doing as you mentioned, substituting some T4 for some of your high dose of Armour.

I think you should also get some further tests done next time you go in.  I'd request Reverse T3, Vitamin D, B12, ferritin, magnesium, and a full iron test panel.

[catherine46993]

Based on body temp (in the morning, before rising, and in the afternonn) as well as on the fact that my hands and feet were still cold. Also, my FT4 levels did not climb above 1 until I reached 240 mg of Armour, and although my doctor prefers to go by FT3, he also thinks that FT4 levels should not be too low. In fact, it's been very difficult for me to strike a  balance between the two hormones on Armour, which is  why I've been wondering if indeed I could use a little less Armour and some T4?

[gimel]

Five grains of Armour Thyroid is a huge dose.  I have to ask why were you being increased if you were "fine" at lower doses?  Dosage is really irrelevant.  How you feel should be all important.