What dosage should I take

[Sigi1979]

I have had hypothyroidism since 1990 and have taken various medications in the past including Synthroid and Levoxyl. It has been a roller coaster ride to say the least.
In October 2006 I switched to Armour 90 mg, and have been on it ever since.
in Feb 2007 my TSH was 0.24 (0.5-6.0); FT4 was 0.99 (0.75-1.54); FT3 was 357 (230-420).
Dosage was lowered to 60 mg Armour
In Aug 2007  TSH was 1.98 (0.5-6.0). Dosage stayed the same
In May 2008  TSH was 0.27 (0.5-6.0); FT4 was 0.94 (0.75-1.54); Dosage stayed the same
In Oct 2008   TSH was 0.59 (0.5-6.0) ; FT4 was 0.84 (0.75-1.54);  FT3 was 241(230-420)
Dosage was lowered, 60mg cut in half + ½ cut in half again. I took ¾ of the tablet= 45mg
In Mar 2009  TSH was 7.07 (0.5-6.0); FT4 was 0.67 (0.75-1.54); FT3 was 255 (230-420)
This was a big change and I was told to increase dosage, which I did (to 60 mg again; full tablet)
First day went fine, second day I could not sleep all night. Woke up constantly (wide awake) with my heart pounding out of my chest.  I hung in there for 5 days and didn’t get any sleep, either that or the increased dosage made me severely irritable. Went back to the ¾ tablet and after 2 additional days I can sleep again. Problem is I feel very sluggish, depressed, low on energy and I am concerned that the TSH will continue to climb. What is going on? Any help is appreciated.



This discussion is related to hypothyroid, should i see a specialist.

[gimel]

So, your Armour dosage was cut in to 60 mg in Feb. 2007,  due to rapid heartbeat and sleep difficulties, and stayed that way until Oct. 2008.  During this time your TSH, T4 and T3 were all basically toward the low end of range. In Oct. 2008, your dosage was dropped to 45 mg.  Were you experiencing heart pounding/sleep difficulty or fatigue /depression  during the Feb. 2007 to Oct. 2008 period before the dosage change?  Why was your dosage dropped to 45 mg.?

[Sigi1979]

Doctor reduced the dosage from 90 to 60 mg Armour because I couldn't handle the rapid heartbeat and sleep difficulties. By the way, my Endocrinologist moved away in 2006 at which time most of the bouncing around occured. Hard to find another Endocrinologist in another city (travel will take 2+ hours one way) and most of them will not accept medicare. So I'm kind of stuck.

[Sigi1979]

Cytomel, even in the smalles dosage, did not agree with me. Don't think I will try that again. But I might go back to the Levoxyl to see how that will work out. Thanks for the suggestion though.

[gimel]

Just to clarify. In Feb 2007, when you were on 90 mg of Armour, your TSH was .24. free T4 was .99, and your free T3 was 357.  At that time your dosage was reduced to 60 mg.  Was this because you were having the heart pounding and no-sleep nights?  Or was it because of the low TSH?

[Smilerdeb]

My advice would be to go see your Doc to get you on Cytomel and T4 med.
Armour is good for some but not everyone.
At least taking the 2 T3 and T4 meds, your Doctor can watch the dosage of T3.
More accurate and more presise until you are at the right levels that are comfortable for you.
I dont advise taking a T4 med with Armour.
You are just doubling up on T4 (which in turn converts to T3 anyway and cause more problems).
Hope that helps.

[Sigi1979]

I think his main reason was that Armour was a natural thyroid treatment vs. the other synthetics. He did mention that T3 was important and Armour covered it all. I seem to have responded okay to it after the initial dosage was adjusted to 60 mg. But right now I'm not sure anymore as to what works or not. I'm thinking about going back to Levoxyl but that too will need the right dosage and who knows what that is?

[gimel]

Why did the doctor first decide you needed a T4/T3 combo med.?  Was there some indication that you needed more T3, that you were not converting T4 adequately?

[Sigi1979]

I felt okay with 60 mg Armour for about a year. Still had hypo symptoms but not as bad. Then I started to get the pounding heart that wouldn't let me sleep so I cut back to 3/4 of a tablet (45mg). My dry skin worsened and so did my lack of interest in anything, simply have no energy. But also can't live with the pounding and irretability that comes from increasing the dosage.

[gimel]

During what period of time were you feeling your best?  At that time did you still have some hypo t symptoms?

[Sigi1979]

Thanks for the reply. I have learned to live with no energy, tiredness and depression. Sometimes its better but it's never how I would love to feel. I see a difference with an increase in dosage but can't handle the no-sleep nights and the heart pounding. Seems like when I have more energy I also find myself more irritable. So it's a vicious circle.
Right now I'm wondering if I should take two different meds, one Armour (with T3) and another like Levoxyl (w/o T3); maybe 30 mg of Armour and a small amount of Levoxyl to bring TSH down. Unfortunately, Armour only comes in 30/60/90 mg. Hard to manipulate.
I'm just wondering if there is an undercurrent condition that just would mess with the thyroid.

[gimel]

It appears that you have one  of the many doctors that regulate their patient's meds by the TSH test result.  By this I mean trying to keep the TSH around 1.0, with the belief that anything lower is bad. Frequently this does not work adequately to relieve a hypo t patient's symptoms. Many members here do not agree with that and have found there to be no problem if TSH is suppressed even below the low limit ( by the way the reference range has been revised to .3 - 3.0).   Hypo t patients seem to do best when their doctor checks and regulates meds based on the Frees (Free t3 and Free T4) and by their symptoms, rather than by TSH, as long as there are no unwanted overt hyper t symptoms created.  Many members have reported feeling best when their free T3 is in the upper 1/3 of its range.  I noted from your test results that even with Armour that your free T3 and free T4 levels remained in the low end of their range.  Were your hypo t symptoms relieved during this time?

By the way, other members have report similar results with T3 type meds, when increasing too quickly.  They have recommended smaller increases, with enough time between increases to allow the body to get used to the new level.

[Sigi1979]

Does this last test indicate something that I need the doctor to check for?