The search feature isn't working right now so, I can't check for previous posts of yours that might have listed some labs and/or your history.

I have some general information to share with you.

Firstly, Cytomel is a fast-acting med so, taking it every other day isn't a good idea at all. The days you take it, you'll probably feel better and the days you don't, you'll probably feel worse.

Another thing worth mentioning is that thyroid meds take awhile to affect our levels. And, whatever dose we take won't necessarily optimize those levels. In the meantime, we can have symptoms.

You really need to be on *some* type of med for longer than a month to know what it might accomplish for you.

Now, just to play it safe, I would take the Elavil at least 4 hours away from any thyroid med you take since anti-depressants have been known to affect thyroid hormone levels.

If you are feeling up to it, please share some recent labs here....and also your symptoms.

Your diarrhea might not be related to your thyroid disease....you might have some food sensitivity issues or, sorry to say, another kind of disease.

for whatever it's worth, of course we can have symptoms before we are diagnosed....and we can also have symptoms as we titrate up on our meds dose - it's all due to moving thyroid hormone levels.

Here's a list of hypothyroid symptoms taken from thyroid textbook "The Thyroid and Its Diseases" - while not every person will have every symptom, I think it's handy to know that what we experience isn't necessarily unusual

Fatigue
Swelling of eyelids
Emotional instability
Lethargy

Dry skin
Choking sensation
Low endurance
Dry mucous membranes

Fineness of hair
Slow speech
Constipation
Hair loss

Slow thinking
Weight gain unexplainably
Blueness of skin
Poor memory

Paleness of lips
Dry, thick, scaling skin
Poor concentration
Shortness of breath

Dry, coarse, brittle hair
Depression
Swelling
Paleness of skin

Nervousness
Hoarseness
Puffy skin
Anxiety

Loss of appetite
Puffy face or eyelids
Worrying
Prolonged menstrual bleeding

Swelling of ankles
Easy emotional upset
Heavy menstrual bleeding
Coarse skin

Obsessive thinking
Painful menstruation
Brittle or thin nails
Low motivation

Low sex drive
Dry ridges down nails
Dizziness
Difficulty in swallowing

Sensation of cold
Hearing loss
Weakness
Cold skin

Rapid heart rate
Vague body aches & pains
Decreased sweating
Pounding heart beat

Muscle pain
Heat intolerance
Slow pulse rate
Joint pain

Non-restful sleep/interrupted sleep
Pain at front of chest
Numbness or tingling
Insomnia

Poor vision
Protrusion of one or both eyeballs
Thick tongue
Weight loss or gain

Sparse eyebrows/loss of outer third of eyebrows
Swelling of face
Wasting of tongue
Gas/bloating


And, it's not uncommon to deal with hyper symptoms as our bodies adjust to T3-containing meds such as Armour and Cytomel. The best we can do is increase our dose in small increments.....and divide the dose throughout the day.

Here's some information Dr. Mercola wrote about Armour:

http://www.mercola.com/article/hypothyroid/treatment.htm?e_cid=20111121_DNL_HTL_thyroid

I found this on the drugs.com drug interactions checker:

http://www.drugs.com/interactions-check.php?drug_list=2189-1435,168-74

It seems that mixing Armour and Elavil can either worsen your hypothyroidism or make you thyrotoxic.....I found the same interaction for Elavil and Cytomel as well as Elavil and levothyroxine (Synthroid)

This tells me that Elavil has the capacity to interfere with thyroid hormone levels.

Maybe your doctor can Rx you a different type of med (although, I'm still not sure just what hyperthyroid symptoms you are dealing with......)

My labs came back last week:
TSH- 4.06 (normal ranges 0.45-4.50)
T3 uptake 23.2 (normal range 23.4-42.7)
T4 12.9 (normal range 4.5-12.5)
Free T4 1.2 (normal range 0.8-1.7)
Free T3 3.0 (normal range 2.0-4.8)
They are still waiting for my reverse T3 results for some reason.
My symptoms that I have lived with for 14 years are:
Very tired all the time no matter how much sleep I get
I am under weight, never been able to gain weight except when I was pregnant
Low appitite, I usually skip a meal in the day (usually either breakfast or lunch)
Chronic Diarrhea
low blood pressure
I can't stand being cold
I have a very slight tremor, barely can see it

When I first started the cytomel, I would get bursts of energy in the morning (like I was on something) and then crash in the afternoon, but then I couldn't sleep at night and I got migraines everyday, so she had me cut it in half everyother day, from there I didn't notice a difference except the tiredness got worse, The depression got worse, I started feeling angry everyday all day long for no reason. I feel irritable, I started having women issues once a month that I never had before. The diarrhea cut down to every three days vs everyday or other day. If I got anymore than half the pill I wouldn't sleep for two days straight. It drove me nuts! I wake up most mornings feeling like I was hit by a bus, I ache everywhere and I have a headache. Most the time it fades as the day goes on, but it's a pain to deal with.

So far I have been tested for Crohns, Ultcer colitis, Addisons, and celiac. All are negative.
I've done some slight research, the only other disease I could find that partains to the intestines is a form of Lupus. So I might get tested for that soon. I'm just soo frusterated being told first it's not related to my thyroid, then being told by a bunch of people and doctors that it is related, but I just don't understand that they can tell me I have Hashimoto's when I have chronic diarrhea, it makes no sense to me at all. As far as the food allergies, I went off gluten and dairy. I've even cut out certain fruits and veggitables and other things, It made no difference. Except made me loose a bunch of weight that I shouldn't have lost. So I don't know what else to do, I have been at this since July!

I haven't started the elavil, I was just wondering if it would be safe. I know it will help with most of my symptoms which is what I really need right now even if it requires that I take something I don't really want. My endo did say it was safe with the cytomel, but she didn't say anything about Armour. I just need it to go away. I can deal with all of my symptoms just not that one. It's been 14 years and I've never dealt with my depression, because it's never been this bad and the same with my anxiety, now I'm nervous anytime I go anywhere.

Thanks for bringing me up to speed.

Well, with the exception of the diarrhea, all your other symptoms are classic hypo.

And, your labs are most definitely hypo.

While we don't look at pituitary hormone TSH for dosing purposes, please know that TSH > 2.0 is suspect for hypothyroidism so, without a doubt, you are still quite hypo.

Thyroid-savvy doctors diagnose and treat based upon the thyroid hormone levels - FreeT4 and FreeT3.

And, they try to bring the patient's levels up to the types of levels healthy people have - upper half/upper third of the range.

This is well-documented in thyroid textbooks and I do wonder if many of today's doctors failed Thyroid 101. (I think you realize that 50% of all doctors graduated in the lower half of the class)

Anyhooo, based upon your lab's ranges for FreeT4, most healthy people would have a FreeT4 level above 1.25 and most likely closer to 1.43.

Based upon your lab's ranges for FreeT3, most healthy people would have a FreeT3 level above 3.4 and often closer to 3.96.

You might find that your need your levels a little higher than this but, most people don't feel good with them lower.

So, with both your FreeT3 and FreeT4 levels needing help, I don't understand why you were first taking only a T3 med (Cytomel).

Armour might help you since it contains both T4 and T3.

Please know that Armour is made from porcine thyroid that contains a higher proportion of T3 than T3 as compared to human thyroid.

This results in a proportionately higher FreeT3 level compared to the FreeT4 level.

Some people are fine with this. Others find the need to add some T4 in the form of levothyroxine.

So, sorry to say, it doesn't seem like your doctors were doing right by you in the beginning. And, I think you can now understand why.

How much Armour does the PA want you to start with? Is she telling you to divide the dose?

Dr. Mercola has some great advice about taking Armour - especially about taking it after eating to ease the impact of "direct drive" T3.

I know many people take Armour on an empty stomach but, if you had trouble with Cytomel, taking it after eating might work better for you.

The worse that could happen is you'd need a higher dose.

And, based upon Dr. Mercola's writings, it does make sense to divide the dose. (I take 5mcg Cytomel and divide the dose into 2/day for the exact reasons he states)

No matter what, you want to be consistent with whatever you do. This will keep your thyroid hormone levels more steady and minimize symptoms.

Maybe, once your levels are optimized, the diarrhea will settle down.

I'm so sorry you're struggling like this but, please know there is light at the end of the tunnel.

If you get labs every 6 wks. and work towards optimizing your levels, you stand a very good chance of being free from thyroid symptoms.

That's where I'm at...and it's wonderful :)

If the endo said the Elavil was OK to use with Cytomel, I wouldn't worry about using it with Armour.

Again, consistency is key when dealing with thyroid disease.

If it turns out that the Elavil affects your levels, you'll just need to remember that if you stop taking it.

Same thing applies to hormonal birth control, changes in fiber intake, changes in weight.....possibly even changes in the seasons.

Thanks, I am trying very hard to be patient. They are starting me on 15 mg of Armour and see how I do. And I'm doing everyday, so we'll see how it goes. I'm just not sure how long it takes to notice if it's making me better or worse. The cytomel was the second dose, I knew it was making me worse. I hope this works or helps. I have a friend that is on it and they ended up putting her on three pills of Armour a day and she now feels great, she doesn't have the same issues as I do. Which makes me feel sooo alone. I can't find anyone to explain or relate to my situation.

15mg Armour is a VERY small dose. It's the equivalent of 9.5mcg T4 (levothyroxine, Synthroid, etc) and 2.25mcg T3 (Cytomel)

If you had a chance to read Dr. Mercola's article, you would have seen that 90mg is the most common starting dose.

I'm not sure if you'll feel anything.

I do hope you keep in touch with your doctor so you can get a dose increase sooner rather than later.

You are not alone with your struggles - I think we've all been where you are and many on here are still struggling.

I know I had the hardest time with my first 2 endos. The third endo lasted all of the first appointment and labs. My now-former GP of 20 years was no help, either.

What's their plan for follow-up with you? As in, how long are you expected to take 15mg before further evaluation?

cd3764,

thanks for providing the range of optimal doses - i've written them down - and they will be my guide!

They will recheck me in 4 weeks, but she said I can call in about a week if I can't handle the med. But from what you are explaining, I think you are right, I may not feel a thing. We'll see. I am very discouraged. All she said was if it was too strong then we would go back to what I was doing, she didn't really discuss increasing it. So we'll see what she says in 4 weeks.
The last PA told me she wanted a smaller dose because they didn't want to throw me into hyperthyroid, would increasing my dosage or starting at a higher one raise it too high too fast? I'm nervous now that if I feel worse, they won't increase it, they'll take me off, but if you say that I may feel better if they increase it. Not sure what to do. But they are hoping that once my levels are normal, my stomach issues will straighten out, that is my hope and prayers, but we'll see.

Also, do you know of any of the effects that pregnancy would have on the thyroid? By chance? The reason I am asking is because when I was pregnant, I felt just fine (except the tired thing) but I had no other issues, my stomach was completely normal.

vanillabear

Your levels are such that it's highly, highly unlikely 15mg would through you into hyperthyroid.

The thing is - many people have symptoms when titrating up on the meds dose. You see, the body is in a state of flux as we adjust our doses and this can mean symptoms.

I am very curious to understand just what you are going through when you say you have hyperthyroid symptoms.....if you would please describe what you've been dealing with, it could provide another piece to your puzzle.

Also, have you ever taken Synthroid/levothyroxine? If yes, please describe your experience.

I don't really know why you felt better when pregnant although, maybe the hormones related to pregnancy somehow made your hypothyroid symptoms feel better.

Anyway, once you fill in some more of the blanks, we can probably figure out what's been going on.

barbell

You said "Remember one thing, unless a person is completely on Armour themselves it is next to impossible to give advice to someone who is on it and it is working for them."

Does your doctor take Armour?

vanillabear

I forgot to mention something.

You shared with us that you have no appetite which is very common when dealing with hypothyroidism.

You also shared that you usually skip a meal.

If you could somehow get something into yourself (maybe a protein shake), it would be very much to your benefit.

You see, optimal thyroid hormone metabolism requires steady blood glucose levels.

I think you can understand that skipping meals does not provide for this.

I found the following site awhile ago and, the administrator has some really good information on there - it confirms much of what I've found during research only in layperson's terms. Here's the section called "Eat to live" that explains why eating regularly is so important:

http://www.thyrophoenix.com/eat_to_live.htm