I experience much of what you described with each "titration" aka going up in meds. It takes a few weeks to level off for me.

And, if you would, please post the ranges of you labs - something like this:

FT3 .8-4.8 (or whatever) and the result 4.2

Hi,
Reference ranges FT4 are 0.82-1.77 FT3 2.0-4.4. Just keep in mind that I did take meds the armour 4 hours prior to blood. Levoxyl was about 6 to 7 hours before. I am in my third week of meds and quite frankly feeling worse than the other 2 weeks. Elaine Moore said it take about 3 weeks to notice full effects of a dose change. Does that mean these symptoms should taper off in about a week?
Thanks,
Fran

Titration varies with everyone, but an average could be a month. But that does not mean you will feel better until your dosage is optimized, and that means many titrations. Yeah, we've all been thru it. No way out of it.

I am not like the norm,I usually don't feel dose increase until 6 weeks or 8. It's always been like this with me. I usually don't get hyperish feelings right away. Everybody is different but your FT3 seems a little high. My range is 2.7-4.2, so you're at the top and that's the one you "feel". FT4 is a storage hormone. I think you're on too much but that's my opinion.

Since you took your Armour 4 hrs. before the blood draw, you most likely "caught" your FT3 level when it was peaking. (T3, which is in Armour, peaks 2-4 hrs. after ingestion)

I suspect your average FT3 level is closer to 3.8 which suits many, many people.

Your FT4 level is really low and definitely showed the need for the increased levo dose.

Now, some of that levo could be converting to T3 so there's a chance your FT3 level will increase along with your FT4 level.

Sometimes, things even out on their own.

Unfortunately, there's no predicting just what a new dose, med or dosing combination will do.

Bottom line, however, most people experience symptoms after dose adjustments.....and symptoms will remain until *after* levels have optimized.

I hope you will stick with your current dosing regimen, get labs 6 wks. after you started it and continue to ask your doctor for appropriate dose adjustments.

Changing doses "mid-stream" will only delay progress. That's why it's best to get small dose adjustments so our suffering is minimized.

And, adjusting to doses of thyroid hormone replacement is MUCH harder than adjusting to doses of anti-thyroid drugs. As we both know, franda, we were able to feel the effects of a new ATD dose within a few days....and get accurate labs at 3 wks.

We have to deal with a slow and steady approach when taking thyroid hormone replacement - it's the pits but that's what it is.

I have 3 suggestions:

1. if you're not dividing your Armour dose into two/day, you might consider doing so. This can help with any transient hyper symptoms one might have from the T3 in it.

2. Make sure you do not take your meds (especially Armour) before the blood draw

3. Try to get your blood drawn around the same time of day each time. This way, you're comparing apples to apples

You're halfway through the titration on your current dosing regimen....hope you can hang on until labs. Please take good care of yourself in the meantime....and hold on tight for the ride :)

As you near optimal levels, you'll find some of your symptoms are less severe....some might even disappear. You'll most likely have symptoms when you achieve "the most commonly comfortable" levels so, you'll need to "wear" those levels for a couple weeks to see if symptoms dissipate.

Yes, it's a very slow process It is possible to achieve freedom from thyroid symptoms but it's a freedom we have to fight for.

For whatever it's worth, I "feel" a too-low or too-high FT4 level.

I can have hypo symptoms if my FT3 level is optimal for me but, my FT4 level is too low for me.....or vice versa.

Even though FT3 is the active hormone (and FT4 is the storage hormone), certain parts of the body (brain, pituitary, muscles tissue and more) need adequate levels of FT4 (since T4 is converted to T3 "on-site" vs. getting a direct supply of T3 from the thyroid)

Sorry - I just remembered something.

T4 (levo) has a 7-day half-life which means it takes 7 days for half the dose to be used up and a full 14 days for the full dose.

Therefore, you are just beginning to feel the effects of your new levo dose.

Since hypo/hyper symptoms overlap....and your FT4 level would be too low for most people (especially Graves' patients), your symptoms are most likely hypo.

And, again, it's highly unlikely that your average FT3 level is 4.2 since you took your Armour within 4 hours of the blood draw.

It's really, really important to not take our meds before we have our blood drawn.

Otherwise, levels can be skewed artificially high. This might prevent a doctor from giving us a needed dose increase....and certainly stands a chance of stalling our progress.

Hang in.

Shoot me now...but I have something else to add.

There is no way, no how that a slower pulse (60 bpm) indicates hyPERthyroidism.

However, an erratic pulse is classic hyPO.

And, if you're not dividing your Armour dose, that, too, could contribute to an erratic pulse.

I think I'm done now lol

That pulse thing totally happened to me and wigged me out big-time! It would slow down (60 bpm) then speed up to ridiculous rates (110 resting pulse rate). this is when I started the very FIRST titration (not the first dosage of meds, but the next one up) with my thyroid medication.

I thought I was having a heart attack at first, but I wasn't. It's one of those things I had to "ride out" until my body got used to the new dosage. Then it was time to do it all over again.

Splitting my dosage, taking it at EXACTLY the same time every day, and making sure I laid off the caffiene helped, and when I finally got to the right dosage - it got better and disappeared completely. Of course, when my levels are "off" it comes back....

When I was going thru the usual titration process right up until my lab levels became in the upper ranges, I experienced pulse rates between 55 and 155 within an hour of each other for couple years. Also heart palps. This occurred also with my hypoadrenal meds when I first started them.

Thanks for all the advice. I have another problem because I think my doctor is pulling the plug on my meds. She has told me to go back to my endo for refills. So does anyone know a doc who knows what they are doing with all this in the NY/ NJ area? I could really use a name and phone # or location of the doc. It doesn't have to be an endo either just somebody who knows what they are doing. Please don't tell me top thyroid docs because one of the doctors on there was terrible. She kept my numbers at the lowest part of the range and then kept telling me none of my symptoms were thyroid and that my tests were normal. By the way palps are improving to some degree with the levoxyl slowly though. I have had palps and heart racing from the beginning of this disease and the 15 months I was on just Armour. They are actually minimizing as my levels get a little better so I'm sure it is due to being hypo.
Thanks, Fran

Dang - sorry to hear you're being referred back to an endo. But, VERY happy to hear the palps are finally improving - yay!!!

Another member on here is doing VERY well with Dr. Condren in Somerset. Only problem - he doesn't accept insurance.

My son's fiance is struggling to find a thyroid-savvy doctor as well. She made an appointment with this guy who looks promising:

http://www.drpodell.org/natural_hypothyroid_therapies.shtml

I am aware of someone who did very well with Dr. Borenstein in Manhattan.

You might want to take a peek at the ThyroidChange doctor recommendation list as well (that's how the other DS member found Dr. Condren):

http://www.thyroidchange.org/patient-recommended-doctor-list-us.html

I agree that the doctor recommendation lists don't always work but, it's the best we have to work with right now.

Another idea is to call local pharmacists (including compounding pharmacists) and ask for contact info for doctors who prescribe Armour. You'd want to speak directly to the pharmacist vs. the counter help.

I suggest you make it clear that you're not looking for recommendations but, instead, that you want to continue taking Armour and are looking for a doctor who prescribes it.

No guarantees on that one, either but it's a start.

I suggest you make appointments with several doctors and keep meeting doctors until you find one that is thyroid-savvy. You can always cancel the open appointments.

While I'm happy with my current doctor (seeing her since 2009), I maintain a list of supposedly thyroid-savvy doctors within a 50-mile drive.

I plan on getting labs with any new doctor and accepting any thyroid hormone prescriptions they're willing to write (I won't necessarily fill those prescriptions unless I need them but at least I stand a chance of having the meds I need until I find a new Dr. Workable)

Best of luck to you!

Please keep us posted.

Hi and thank u for the info. I will give it a try. When u were talking about hanging on for the ride. Do u mean that symtoms of hypo and normal to hyper rotate. I think I spoke too soon because last night I was up all night not only with insomnia but pretty bad palps. The palps had been improving but they always seem to be there at night. Bad insomnia for a few nights also. It felt pretty hypo to me. Again I would like to ask u if this is normal to expect? I am so screwed up. Sometimes I feel a little better and see improvement and other times nothing to worse. 3 going into the 4th week of 37.5 titrating up from 25mg. I will most likely do bloodwork next week.
Thanks again,
Fran

CD beat me too responding to you. I see Dr. Condren. He is very open to being partners in your health. He charged $200 for the first visit and $100/half hour for follow up visits. He was on the Thyroid Change website. I have been seeing him for a little over a year now. He's very receptive to increases and will let you pretty much try anything.

I hope you feel better soon!

When I said "hang on for the ride", I was referring to the fact that we usually don't get relief from symptoms until *after* our levels are optimized....

Yes, we might get some glimpses here and there when we'll feel a bit better but, again, until our bodies are getting what they need on a regular basis, we're not going to feel well most of the time.

So, yes, it's normal to expect....unfortunately :(

Once both my FT4/FT3 levels were well above 75% of range, the symptoms weren't anywhere as horrendous as they were when either level was lower.

Once my levels optimized in June 2011, my remaining symptoms slowly dissipated in the weeks afterwards.

There were a few times since then that symptoms returned (never as bad as they were during titration) and my labs always explained why.

I've found that I really need to keep getting labs done every 4-6 wks. if I want to prevent the development of symptoms.

If I do this, I can "catch" a change in my levels, and my doctor will agree to a dose adjustment. There's a chance I'll develop a couple of minor symptoms before the dose adjustment kicks in.

I was jumping for joy this past year when the doses I started taking in September of last year actually "held" me throughout this year (I didn't need any dose adjustments). It felt AWESOME!

I didn't expect that to last forever and I'm still getting labs every 4-6 wks. As things turned out, an antibiotic I was taking had the expected effect on my levels and my doctor ordered a small dose increase that took care of things.

It's wonderful to have the horrors of titration behind me.....and it will happen to you, too.

Just keep keeping on....and find that thyroid-savvy doctor :)