Thanks for clarifying the various things you've tried....I wasn't sure if you tried some of the OTC thyroid preparations that are out there (and not too useful).
Since it's highly likely that you have Hashi's (the most common cause of hypothyroidism), there's no wonder the things you tried haven't worked since they didn't correct your hypothyroidism.
I can't explain why things were better when you were on vacation (although everything should be better when on vacation ).
It's really too bad that you haven't found a doctor that can recognize what is obvious to us. My labs were very similar to yours (without a rT3 test) when I started thyroid hormone replacement.
I must admit, I'm still liking the idea of you trying to find yet another doctor. Have you tried getting contact info from local pharmacists (including compounding pharmacists) for doctors that Rx Armour and/or Cytomel?
Doctors that prescribe these meds tend to be more thyroid-savvy. I will not deny that some doctors seem to get fixated on the rT3 issue but, I still believe from my research that correcting the hypothyroidism should take care of any rT3 issues.
Bottom line, you just might have better luck with yet another doctor. I think I told you I saw 4 different doctors (including 3 endos) before finding one that "gets thyroid". My situation isn't unusual - in fact, it's not uncommon for patients to see 6 (or more) doctors before getting a proper diagnosis/treatment.
Before the invention of thyroid blood tests, doctors diagnosed and treated based upon symptoms. The invention of the TSH test in the 1970's set things back a LOT for thyroid patients.
I wish you the utmost success with your new treatment - I hope you'll continue to keep in touch on here to let us know how things go.
Hey!
Well, I want to hold off on finding another doctor, just yet. This doctor is very savvy, I think. She already prescribed me armour without me asking for it and isn't opposed to the cytomel route, but would rather me try the slow release-t3, due to the up's and downs that it has (cytomel). She is going to review my lab work in a few weeks and see if I need my dose of armour increased.
You said that your labs looked my like mine. What did it take for you to start feeling better?? I'm currenly on 1/4 grain of Armour. What were you taking and at what dose did you start noticing a difference?
I didn't realize you were still taking Armour....wow, adding Cytomel makes for quite the "T3 heavy" dosing regimen.
I still think your FreeT4 level needs help.
Re my history (I'll try to keep it as short as possible).
My labs at the time I started meds were:
FreeT4 1.2 (.82-1.76) and FreeT3 3.5 (2.0-4.4)
My doctor started me on 25mcg levothyroxine (T4 med) and, within 6 wks. my levels had risen to the top of the range. I wasn't feeling well but, obviously, it wasn't appropriate to increase my dose.
However, within a few weeks after those labs, symptoms started to ease and were gone by the time of my next labs. Because I was feeling good, my doctor didn't increase my dose. (my levels had dropped a bit - they were still in the upper third of the range)
Within 2 wks., symptoms returned with a vengeance and labs showed my levels had dropped to mid-range. The next 4 months were spent with levo dose increases and, a few weeks after my levels "hit" the top of the range (what I later realized were optimal for me), my symptoms once again disappeared. I was up to 75mcg levo at this point.
I was "good" for 3 months with stable levels and symptom-free. Then, I had a few symptoms return and discovered that my FreeT3 level had dropped. My doctor added 5mcg Cytomel (I divide it into two doses/day) and, a few of those symptoms eased.
Next labs showed my FreeT4 level dropped (as is common after starting Cytomel - it's a biochemical thing). The next 4 months were spent with levo dose increases in an attempt to restore my FreeT4 level.
By the time I started what became my optimal levo dose, I had a very small number of symptoms. They began to ease within a week of starting that dose and I've been symptom-free since then. (This entire part of my history took 15 months)
I did have one, short time last fall when I developed achy knees (usually a hypo symptom for me), I got my regular labs - my FreeT4 level had actually gone too high. My doctor decreased my levo dose by 6.25mcg/day and the achy knees were gone within a week.
Not that my dose would be considered relevant to anyone else's situation but, I've been stable on alternating doses of 112/125mcg levo and 5mcg Cytomel for quite some time.
Stable levels are what I've always dreamed of....and are what I hope others can enjoy.
I'm wondering what you did between 2006 and 2011 to increase your cortisol? Is that when you tried the Cortef? Is there anything you can recommend for adrenal fatigue? Have you re-done the saliva test yet?
I've been hypo since 2007 and diagnosed with adrenal fatigue that has flared from time to time but always held at bay with adrenal supplements/time. I think I've fried them enough at this point that supplements are not going to work. I'm dizzy every day now and cannot tolerate even the slightest stress. We've also been bumping up my thyroid meds 3 times since Aug and each bump has been debilitating. My doc currently has me on 2 Adreset per day and 1 Andrenogen (which has raw adrenal concentrate and i've been reading I should be on adrenal cortex only as the whole adrenal contains adrenaline which is bad for adrenal fatigue.)
And I agree with Sammy. Your regimen does seem T3 heavy for someone with your labs. I have heard of the method of getting rid of the Reverse T3 by using Cytomel but I thought the premise of that was to do Cytomel only.
I didn't realize you were still taking Armour....wow, adding Cytomel makes for quite the "T3 heavy" dosing regimen.
I still think your FreeT4 level needs help.
Re my history (I'll try to keep it as short as possible).
My labs at the time I started meds were:
FreeT4 1.2 (.82-1.76) and FreeT3 3.5 (2.0-4.4)
My doctor started me on 25mcg levothyroxine (T4 med) and, within 6 wks. my levels had risen to the top of the range. I wasn't feeling well but, obviously, it wasn't appropriate to increase my dose.
However, within a few weeks after those labs, symptoms started to ease and were gone by the time of my next labs. Because I was feeling good, my doctor didn't increase my dose. (my levels had dropped a bit - they were still in the upper third of the range)
Within 2 wks., symptoms returned with a vengeance and labs showed my levels had dropped to mid-range. The next 4 months were spent with levo dose increases and, a few weeks after my levels "hit" the top of the range (what I later realized were optimal for me), my symptoms once again disappeared. I was up to 75mcg levo at this point.
I was "good" for 3 months with stable levels and symptom-free. Then, I had a few symptoms return and discovered that my FreeT3 level had dropped. My doctor added 5mcg Cytomel (I divide it into two doses/day) and, a few of those symptoms eased.
Next labs showed my FreeT4 level dropped (as is common after starting Cytomel - it's a biochemical thing). The next 4 months were spent with levo dose increases in an attempt to restore my FreeT4 level.
By the time I started what became my optimal levo dose, I had a very small number of symptoms. They began to ease within a week of starting that dose and I've been symptom-free since then. (This entire part of my history took 15 months)
I did have one, short time last fall when I developed achy knees (usually a hypo symptom for me), I got my regular labs - my FreeT4 level had actually gone too high. My doctor decreased my levo dose by 6.25mcg/day and the achy knees were gone within a week.
Not that my dose would be considered relevant to anyone else's situation but, I've been stable on alternating doses of 112/125mcg levo and 5mcg Cytomel for quite some time.
Stable levels are what I've always dreamed of....and are what I hope others can enjoy.
Wow!! sammy, I can't believe I missed this post!
So, your lab ARE very close to mine. Perhaps I should ask to be put on Synthroid or another type of T4, instead of Armour?? I've been on a 1/4 grain as of now for about a month with no change.
This is very interesting. I'm sure I've ask you this before, but what were the symptoms you experienced? Just as a refresher, mine are constant fatigue, unrefresshing sleep, difficult to exercise, depression/cranky, and brain fog.
Thanks for all your guidence. If my levels haven't budged, I'm going to request T4 only!
So, your lab ARE very close to mine. Perhaps I should ask to be put on Synthroid or another type of T4, instead of Armour?? I've been on a 1/4 grain as of now for about a month with no change.
This is very interesting. I'm sure I've ask you this before, but what were the symptoms you experienced? Just as a refresher, mine are constant fatigue, unrefresshing sleep, difficult to exercise, depression/cranky, and brain fog.
Thanks for all your guidence. If my levels haven't budged, I'm going to request T4 only!
My levels *were* very close to yours - I'm SO glad they're nowhere near that now.
That 15mg Armour dose might have been enough to lower your TSH but do nothing to improve your hypothyroidism. You see, once the body detects more hormone, it reduces its production of TSH. This, in turn, will mean the thyroid isn't being stimulated to produce as much hormone. This could very well cause your FreeT4/T3 levels to be lower than they were before treatment.
I wouldn't rule out Armour. A large, double-blind study showed that most people feel best with a T3/T4 meds regimen. However, many people do well with just T4.
You probably know that Armour is made from porcine thyroid. Porcine thyroid has a higher proportion of T3 than T4 compared to human thyroid. This results in a proportionately higher FreeT3 level compared to FreeT4 level and many people are fine with this.
So, you could still take Armour but, in a higher dose...and possibly add some Synthroid to the mix. This would help keep your FreeT4/T3 levels more balanced, if needed.
It's really a matter of making meds choices/dosing decisions that make the most sense based upon labs and symptoms.
I actually have a Word document that contains a list of all the symptoms I had so, lucky you gets the copied and pasted version (with female issues deleted ):
No energy/strength/stamina
Off-balance
Chills at night
Clutziness
Constipation
Gas/bloating
Itchy inside ears and/or itchy skin
Hair loss
Tingly fingers/toes
Loss of libido
Achy knees and/or joint pain
Blurry vision/reduced night vision
Interrupted sleep/waking early
Air hunger
Brain fog
Lacking motivation
Dry/itchy/painful eyes…puffy eyelids
Over-emotional
Ear fullness
Since you've mentioned your difficulties with exercise, you might be interested to know that I could barely complete a 40 minute power walk when my levels were too low for me...and I've been an avid exerciser my entire life.
I am now starting my 2nd round of the P90X program - this just goes to show you what optimal levels can do for a person.
Needless to say, I don't have any of the other symptoms on "the list" - yay!
You're like the female version of me! ;-) I can BARELY get through 40 minutes on an elliptical machine and I use to be able to do an hour after power lifting (before my issues)
So... what would you say I should talk to my doctor about with regards to up'ing my Armour? Where should I jump to from here, and for how long after that should I increase again (providing labs/symptoms don't show problems?)
I guess... what would be a compareable increase to get my T4 levels in the 95%
The inability for me to be able to exercise at my usual intensity was quite annoying, to put it mildly. I obviously understand your frustration.
Unfortunately, we just can't start what we think will be our optimal dose since the body only has the capacity to "process" small amounts of hormone at any given time.
Many moons ago, I read what I consider a great analogy to explain why we need to make small dose adjustments.....
The hypothyroid body is like a dried-up sponge. Just as we can't expect the sponge to be able to absorb its full capacity of water in one pour, the hypothyroid body cannot absorb all the necessary hormone at one time. If we add too much hormone at any given time, it will "overflow" and cause symptoms. Adding too much hormone at any given time only delays the process.
I'd be inclined to ask the doctor to increase your Armour to 30mg (1/2 grain).
The FreeT3 level reaches steady state in the bloodstream within 3 wks. after any dose adjustment.
Since Armour is "T3-heavy", I'd be inclined to optimize the FreeT3 level (let it get as high in the range as feels comfortable - definitely 3.8 or higher).
You could probably accomplish this by getting labs/dose adjustments every 3-4 wks. until this happens.
Then, if you are still dealing with symptoms, I'd address the most-likely-to-be-lagging FreeT4 level and add some T4.
If you do add T4 at any point, you would need to wait 6 wks. for labs since it takes a full 6 wks. for the FreeT4 level to reach steady state in the bloodstream.
If we choose to get labs any sooner than the time it takes for levels to reach steady state in the bloodstream, we can get artificially higher readings.
This could motivate a doctor to leave things as they are....and this is yet another factor that could delay progress.
That's a very good analogy! I like that, and it makes sense. Sad that it takes that long. I'm sure everyone longs to just take one pill and find out a few days later that "It's Working" or "It's not" Much like depression... lol!
How was your hunger? Did you find yourself hungry a lot? Could eat all day? I know I can! LOL... but it could also be the depressions. I also have what I believe is hypoglycemia. If I don't eat every 3.5 hours, I get really cranky and such. Been check out all around for diabetis... but I'm fine from that stand point.
Now, I just need to get my damn doctor to up my meds. I called her today and she didn't want to take me from 15mg of Armour to 30mgs without redoing my labs... ugh!!
).
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