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Old 12-14-2007, 08:00 AM   #1
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sparkles916 HB User
Labs - Pls Help Me Decide on new treatment plan

[This post is based on saliva lab results - I am confused]

My dr mentioned that I might need to reconsider my treatment and resume levothyroxine in combination with a supplement of armour or cytomel.

For some reason, I can't tolerate 60 mg or more of armour, ( I have tried 75 which was too much, and then 60 became too much) so I am currently on 45 mg.

I was given 5 mcg cytomel to raise my t3 about 10 days ago. And it has not worked out for me. My mood is tolerable, my energy ok, but the jitteriness and anxiety it produces basically offsets any improvement. ( I tried less than 5, but mood suffered. The amt to support mood makes me jittery and anxious)

I have been thinking hard about this and have my suspicions that I am unable to tolerate the level of direct t3 I am getting with the armour and cytomel. Maybe it is due to my low/borderline adrenals.

I think I really need more t4, and a bit of cytomel to up the levels of t3.

My reason for thinking this is that I can't seem to find a proper dosage of armour and t3 that really leaves me stable.

My second reason, is that I suspect that my t4 and t3 levels are not optimum, if I am interpreting my saliva test results correctly.

The test states that the values reflect unbound "tissue delivery" concentrations which may not necessarily correlate with serum hormone levels.

I presume that even though I am not familiar with the ranges, and that the values are tissue delivery concentrations, that my levels are still too low?????


my FT4 is .21 (.17-.42ng/ml).


my FT3 is .24 and the ranges are (.21-.27pg/ml) [borderline low] and (.28-1.10pg/ml) [normal] . ( I guess the total range is .21-1.10)

Do you think that my thinking here is correct and I should go back to levothyroxine in combo with armour or cytomel? I am at a dead end since I can't up my armour, and I am hanging by a thread.

 
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Old 12-14-2007, 09:35 AM   #2
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Re: Labs - Pls Help Me Decide on new treatment plan

Hi Sparkles,

I just went through the same thing.
I was on 0.75 Armour, went hyper FT3 over the range, T4 went down.
Went down to 0.60 Armour, still didn't feel great.
My doctor just switched me to 0.30mg Armour and 0.50mcg Levothyroxine.
He thought I am getting too much T3 but not enough T4.
I will have to go back for labs in 3 weeks and hopefuly this will work for me.
Don't give up I know this is a never ending nightmare but like my doctor said, it takes time to find the right combination, everybody is different.
Your levels are realy low, why don't you try a Levo / Armour combination ?

Last edited by mauz; 12-14-2007 at 09:43 AM.

 
Old 12-14-2007, 10:41 AM   #3
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Re: Labs - Pls Help Me Decide on new treatment plan

Sparkles,
If I had your levels I would be in the hospital. I don't know if saliva testing is different than blood but your levels are very low. Your FT4 is 16% of your range and your FT3 is in the 3% range. My understanding is that both should be in the 50%-80% range until you feel better. Your FT3 should follow if you increase the amount of T4 that you're taking. Why are you taking Armour?

I took Armour for several months and slowly increased my dose according to my doctor's instructions. He didn't use blood tests though and went only by basal temperature. That's a bunch of crap. I finally saw another doctor who took a blood test and my FT4 was so-so but my Ft3 was way out of range. The problem with Armour is that it has both T4 and T3 in it and you can't adjust the amount of T4 vs T3 that you're taking. Taking a little Armour with synthetic T4 works though. Why don't you do that? Gradually take more Synthroid and test every 6 weeks between dose increases. Do that until your T4 is in the 50%-80% of your range. Then you can increase your T3 medicine the same way if you need to. Your T3 may increase to a normal amount once your T4 is normal since they are biologically linked.

Remember, if you're using Armour as a source of T3 than you'll have to lower the amount of synthetic T4 your taking if you increase your Armour. Armour has T4 in it to and it might raise your T4 too high if you don't.

David

 
Old 12-14-2007, 10:47 AM   #4
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Re: Labs - Pls Help Me Decide on new treatment plan

Sparkles......have you tried increasing your Armour in very very small amts ( like 1/4 of a 15 mg tablet) and waiting 10 days to 2 wks between increases. This is the only way I was able to increase. I know it takes longer but eventually you can get there. I get my Armour in 15 mg tablets cut one in 1/4's and add to my other 4 tablets to make 60mg + approx. 4 mg. I increase again in 10 to 14 days. I had no trouble that way and had no hyper symptoms at all. I stopped increasing for a while until I got more labs done because I was doing it without my dr.'s approval. Labs came back very low, so here I go again with dr's approval.

Another thought is............even though you are hypo, have you checked to see if you have any TSI (graves) antibodies. They will keep you from being able to increase meds without having hyper symptoms.

 
Old 12-14-2007, 11:03 AM   #5
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Re: Labs - Pls Help Me Decide on new treatment plan

Are you treating your adrenals? I know many people with adrenal issues are unable to raise their thyroid meds until their adrenals are in better shape, and I think all thyroid meds say to address adrenal issues first.

 
Old 12-14-2007, 11:03 AM   #6
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Re: Labs - Pls Help Me Decide on new treatment plan

Sparkles I have to agree with David.
I think raising your T4 first and see how much you convert into T3.
You can always add T3.

Good luck

 
Old 12-14-2007, 12:22 PM   #7
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Re: Labs - Pls Help Me Decide on new treatment plan

Thanks all for your suggestions.

In May of this year, I was on 88 mcg of levothyroxine. My labs were:

tsh .48 (.27-4.2)
FT4 1.42 (.8-1.70)
FT3 2.84 (1.80-4.20)

Here, my FT4 has room to decrease. I had prior been on 100 mcg of levo.

I went to a new dr to sort out the T3 situation, since I understand it is below optimum range.

SHMILY: On Armour, I tapered up since the summer. On Labor day, I started 45 mg. Went up to 60, fine for a while, then tried 75, a week later unable to tolerate it . Stayed on 60, and then 60 became too much (end of November).

Heckofagal: I think my adrenals cannot support any further increases in armour. My dr does not think I need to go the cortef route, she thinks that by improving my thyroid status, the adrenals will follow suit. I may try Isocort. However, for the moment, I am in a situation where I may have to increase my psych meds again, and I do not want to do that. So I don't know that I have time to test the Isocort before I alter my thyroid meds.

For the moment, I think I will try the levo and t3 adjunct (I have not decided on armour or cytomel) as both David and Maus recommend.

I am just concerned about where my t3 levels are now after taking the cytomel. My heart is still pounding today, even though I took no cytomel.

I wonder what dose of levo I should take? My dr always seems to prescribe too high an initial dose, like when I switched over to armour.

 
Old 12-14-2007, 01:18 PM   #8
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Re: Labs - Pls Help Me Decide on new treatment plan

Sparkles if you take your 45mg of Armour
which contains

T4 - 28.5 mcg
T3 - 6.75 mcg

I would start with adding 37.5 mcg of T4 which gives you 66mcg of T4
and 6.75 mcg of T3. You can always add a little more T4 if you need to.
your T4 looked good when you took 88 mcg of T4.
I guess that is what I would try but please ask your doctor.

Last edited by mauz; 12-14-2007 at 01:50 PM.

 
Old 12-14-2007, 01:53 PM   #9
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Re: Labs - Pls Help Me Decide on new treatment plan

[QUOTE=sparkles916;3350314]Thanks all for your suggestion

SHMILY: On Armour, I tapered up since the summer. On Labor day, I started 45 mg. Went up to 60, fine for a while, then tried 75, a week later unable to tolerate it . Stayed on 60, and then 60 became too much (end of November)



I couldn't tolerate increasing that amt either. I increased mine only 1/4 that amt. Maybe that would work for you. For me, the t3 in Armour was much more gentle than cytomel.

 
Old 12-14-2007, 05:13 PM   #10
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Re: Labs - Pls Help Me Decide on new treatment plan

Quote:
Originally Posted by SHMILY View Post
I couldn't tolerate increasing that amt either. I increased mine only 1/4 that amt. Maybe that would work for you. For me, the t3 in Armour was much more gentle than cytomel.
I totally agree that the cytomel is much less gentle than the T3 in Armour.

I spent almost more than 2 months tapering up on the armour from 15mg, by a 1/4 grain at a time. By early September, I was on 45 mg. I felt GREAT at every increase, followed by absolute hell while waiting for the next. Somehow, I just can't seem to find the right dose. My dr and I are starting to agree that maybe, I should give up on the Armour for a bit and try to restabilize on levothyroxine with Armour or cytomel added in (my choice - I think I will go with Armour for its gentler t3 action).

Believe me, I don't want to give up on the Armour idea, its just that I seem to need more thyroid hormone and can't go up any higher for extended periods than 45mg. My saliva tests were done at 60 mg.

My recent tests also showed adrenals at the lowest part of the range, and one below range - so I am suffering there. I just think, perhaps, that my adrenals can not handle a proper dose of Armour at the moment.

My ups and downs have been going on for more than 6 months, and I was, at least from a mood standpoint, more stable (not GREAT like Armour) on the levothyoxine at 88 mcg. That is the point I found myself able to cut back on my anti depressants and anti anxiety meds.

The last 6 months have been difficult on such low doses of the psych medications, and since I can't seem to get my thyroid hormone levels optimised on Armour, I am faced with the certain need to increase them unless I change my treatment plan.

I am sure I will be checking in to give a progress report. I am concerned about changing over during the holidays due to the stress, but I don't see how much longer I can hang on using the current treatment plan.

 
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