Hypothyroidism Support Group
Hypothyroidism is the disease state caused by insufficient production of thyrohormone by the thyroid gland. There are several distinct causes for chronic hypothyroidism, the most common being Hashimoto's thyroiditis and hypothyroidism following radioiodine therapy for hyperthyroidism. Advanced hypothyroidism may cause severe complications, the most serious one of which is...
So, long story short... I have been on Synthroid since my TT in 2010... added T3 (Cytomel) last year and felt AWESOME until 6 months later I got an excruiating headache like a migraine that would not go away. Endo took me off of the Cytomel suspecting that was the culprit and a week later- the headache vanished.... Three months after that, I started to drag my butt again and felt sluggish... I asked for Armour and he asked to try the Cytomel again so I obliged.... to every other day. Perfect again. But was worried that the headache from hell would return again. Went to my PCP and she refused to put me on Armour because my TSH was "too low" but according to my Endo- it was low because of the T3 I was taking. Went to my GYN who also deals with endocrinology patients and she happily prescribed Armour to me. I was elated! Fearful but elated! I skipped one day of my Synthroid (as I was taking at night) and started the Armour the next morning. Was taking Synthroid 112 mcg at bedtime and Cytomel 5 mcg every morning. She prescribed Armour 90 mg (1 1/2 grain). Day 1- took it 6 am, 2 pm, and 10 pm... stayed up ALL NIGHT with hot flashes. Day 2... 6 am, 10 am... skipped 2 pm.... due to HOT FLASH GALORE all day... what the heck? I thought Armour was like gold to thyroid patients? Is this normal? has anyone else experienced this? Here are my last two labs:
Date: 12/28/2012
Free T4: 1.21 (range 0.82-1.77)
Free T3: 2.2 (range 2.0-4.4)
TSH: 1.440 (range 0.450-4.500)
Note: I felt terrible in December- palps, extra tired all the time. Was not on T3.
Date: 3/15/2013
Free T4: 1.54 (same range)
Free T3: 3.3 (same range)
TSH: 0.243 L (same range)
Note: Felt better but still dragging my butt in the mornings taking the Synthroid at bedtime and T3 in the mornings. Endo stated TSH is low due to T3 suppressing it and refused to switch me to Armour til my TSH came up. How can it when I take T3?
Any advice, suggestions, and sympathy appreciated :).
Date: 12/28/2012
Free T4: 1.21 (range 0.82-1.77)
Free T3: 2.2 (range 2.0-4.4)
TSH: 1.440 (range 0.450-4.500)
Note: I felt terrible in December- palps, extra tired all the time. Was not on T3.
Date: 3/15/2013
Free T4: 1.54 (same range)
Free T3: 3.3 (same range)
TSH: 0.243 L (same range)
Note: Felt better but still dragging my butt in the mornings taking the Synthroid at bedtime and T3 in the mornings. Endo stated TSH is low due to T3 suppressing it and refused to switch me to Armour til my TSH came up. How can it when I take T3?
Any advice, suggestions, and sympathy appreciated :).
1. When did you start Armour?
2. You *are* taking Armour only at this point, right?
3. Why are you dosing 3 times a day with armour?
I think this might be a case of "it doesn't matter what you take, as long as you take the optimal dosage for you". And, you have not been optimized as of yet.
Lab Result % of range Target range (low-high)
(dec)
FT4 1.210 41.05% 1.39 1.77
FT3 2.200 8.33% 3.44 3.92
(mar)
FT4 1.540 75.79% 1.39 1.77
FT3 3.300 54.17% 3.44 3.92
As you can see, in December - you had a Free T4 that was only about 41% of the target range (range where most people feel good)
And a Free T3 of 8.33%...which is the bottom of the barrel.
In march, your FT4 came up to 75.79% of the target range..but still not optimal. And your FT3 came up to 54.17% of the target range.
Again...better, but far from optimal.
It's difficult to tell exactly what's going on with you without knowing when you had your meds switched...
But, you can see that you're still not in the 'target ranges' or where "most" people feel well.
As our resident expert, CD likes to say: You're either optimized (in the target ranges) or not. Just like you're either pregnant or you're not.
Close doesn't count. You will require a dosage increase.
As for which doc to go with...stay with the one who isn't so focused on TSH. TSH should be at 1 or below for any patient being treated with any type of thyroid replacement meds.
Oh...and I SO feel your pain. As you can see...I'm up at 3 in the morning!
Oh, and it can wax and wane with dosage adjustments.
For me, they get really bad just after a dosage adjustment...but within a few weeks they usually subside.
Long time!!!
So sorry to hear of your issues.
I think I know what the problem is.....you are getting a LOT more T3 in your new Armour dose than with the 5mcg Cytomel you had been taking previously.
There's also the possibility that the new Armour dose isn't providing enough T4 for you.
1 1/4 grains of Armour contains 14.25mcg T3 and 57mcg T4.
As you can see, your new Armour dose now contains almost triple the amount of T3 you used to take......and less than 1/2 of the T4 you used to take.
I know people who used to take T4 only refer to Armour as "gold" and I believe it's due to the fact that they were finally getting much-needed T3.
Each of us needs optimal levels to be free from thyroid symptoms.
For most of us, this means FreeT4 levels near the high end of the range and FreeT3 levels above mid-range.
I'm not sure what meds/dose(s) those 3/15/2013 labs correspond to but, your FreeT4 level could have been a little higher and the same applies to your FreeT3 level.
Hopefully, you get labs at least 6 hours after any intake of thyroid meds.
If those 3/15/13 labs reflect levels with meds in your system, your average levels are most likely lower.
No matter what, it's clear you need more T3 but, tripling the dose isn't the way to do it.
It would have been better for your doctor to start you on 1 grain Armour which would provide 9.5mcg T3 and 38mcg T4.....along with at least 75mcg Synthroid.
This would equate to pretty much the same amount of T4 you used to take and a higher T3 dose.
Once you got used to that and get labs 6 wks. later, I would expect you to need a Synthroid dose increase.
It's usually best to adjust one meds dose at a time because both the FreeT4 and FreeT3 levels are affected.
If any of this doesn't make sense to you, please let me know what areas are confusing and I will gladly clarify.
(BTW I'm amazed that you fared well with taking Cytomel every other day. Cytomel has a short half-life and the effects of the dose usually wear off within the course of one day (blood levels might be good but we're talking about how we feel) I actually take my Cytomel in two divided doses/day......this prevents hyper symptoms after the dose and an afternoon crash)
IMHO you've been taking thyroid hormone replacement for too long to still be having issues. I hope you can get your doctor to adjust your meds in a logical manner based upon what you had been taking and what your levels indicate you to need. This is our only hope of feeling well.
CD: I know I was MIA. I was doing fine on the synthroid except dragging my butt a lttile.... when the endo added the Cytomel- it was AMAZING. I felt SO SO much better. However, I think I had a lightbulb moment this week and figured out that I may just be one who needs to have a higher Free T4 than T3 and with Armour, I would have the opposite which wouldn't benefit me. I plan to ask my endo when I see him again (in 6 weeks) about the possibility of doing Synthroid and a small dose of Armour instead.
Side note: I was taking my Synthroid at night at bedtime (4 hours after dinner) and taking my Cytomel in the mornings every other day. At first, it was rough but after about a month, I felt normal again. My labs between December and March changed I think due to the switch to taking my Synthroid at night. My dose of Synthroid stayed the same. All I did was have Cytomel added every other day.
I'll keep you posted via my journal my progress or what i end up doing as I seem to entirely too confused to know what direction I am going right now. I was desperate to get the hot flashes to go away so I stopped the Armour as of today (Day 3).
Even though you didn't ask for it, I have some advice to offer :)
Firstly, if you stay on any form of T3, I suggest that you try to take the same size dose every day.....it's just better for your body due to the short half-life of T3.
Just as when we were taking ATD's, sharp pill cutters can be our best friends.
I also suggest that you take a peek at the labs you had when you were feeling well. If you were 100% with those labs, I suggest using them as a target when asking your doctor to adjust your doses (of whatever you take).
If you weren't 100%, I suggest you aim for levels that are similar to the types of levels healthy people have and then finetune from there.
Knowing your optimal levels can help you convince a doctor to maintain them. Doctors often get confused by our symptoms and will change our meds/dose the wrong way.
Sharing my symptoms journal with my doctor as it relates to my labs was proof to her just what types of levels I need to stay symptom-free. It has helped me negotiate the proper dose.
(I joined the 20% of Graves' patients who go hypo after remission and have been taking replacement for 3 years now)
Based upon your most recent labs, it's clear you need more T3 and T4.
I still think your issues with hot flashes are due to the fact that you are getting triple the amount of T3 than you used to get.......too much too soon.
I also suspect that you would eventually feel the significant reduction in T4.
Just as with ATD's, slow and steady wins the race.
Best of luck to you moving forward!!