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Old 07-08-2012, 01:25 PM   #1
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Is it time to switch to desiccated?

I've been in hypo hell the past year and a half. Originally diagnosed in 2006 and things had gone pretty well with minor med tweaking here and there... but my Free T's have been unstable since Aug of 2011. To add to that it has been discovered that I have a high reverse T3 and now my doc is reluctant to prescribe any more T4. I'm currently taking 175 of Synthroid and 20 of Cytomel. Symptoms - just can't get enough sleep, always fatigued, lightheadedness/dizziness daily, and my latest is heat intolerance, which if GREAT since we are right in the middle of a heat wave.

I've had 7 med increases since December 2010 and I would REALLY like to get a handle on all of this. I have had a few moments of feeling like maybe I was headed in the right direction over the past year, but honestly I think it was early May when I felt that way last. I've contemplated switching over to desiccated or a combination of desiccated and synthroid in the past but I think people here urged me to hang on as it seemed my numbers were close to being optimized. I'm not feeling that right now.

Something else i've noticed is that i have a high fasting blood sugar now, usually around 112. My blood sugar after meals seems fine and I even had an A1C earlier in the year that came back at 5.4 so my doc did not seem concerned. I've read a correlation with high blood sugar and Reverse T3. does anyone know if high blood sugar causes Reverse T3 or is it the other way around? Would taking a med to regulate my blood sugar help with the Reverse T3?

So if I were to ask my doc to switch me to desiccated what would you recommend? NP Thyroid? NatureThroid? I wanted to try to keep about the same amount of T3 & T4 that I am currently getting and assuming my next labs show I need an increase of T3 and T4 I was thinking this might be a good combo:

Currently on 175 Synthroid and 20 Cytomel

3 grains of NP Thyroid would have 114 T4, and 27 T3. If I added 75 of Synthroid to that I would have 189 T4 and 27 T3.

Is that too big of a jump from where I am now? (Assuming my free T's are 50% of range or lower.) Will it be a big adjustment for my body to get used to the dessiccated?

Thanks for your opinions!

 
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Old 07-08-2012, 01:30 PM   #2
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Re: Is it time to switch to desiccated?

Wanted to throw my lab history in there too. Might be missing a few.

TSH 11/8/2006 7.1

Started on 75 of Synthroid.

Labs 3/7/2007
TSH: .53 (.40-5.50)
FT4: 1.7 (.8-1.8) 90.00%
FT3: 353 (230-420) 64.74%

Labs 5/22/2007
TSH: 1.59
FT4: 1.5 (.8-1.8) 70.00%
FT3: 332 (230-420) 53.68%

Felt great the weekend of memorial day (5/31/2007).

Florida 10/6-10/13/2007, felt VERY faint.

Labs 10/24/2007
TSH: 2.25
FT4: 1.3 (.8-1.8) 50.00%
FT3: 269 (230-420) 20.53%

10/26/2007 Increase Synthroid from 75 to 88

Labs 12/5/2007
TSH: 2.194
FT4: 1.3 (.61-1.76) 60.00%
FT3: 3.0 (2.3-4.2) 36.84%

12/6/2007 Added 5 of Cytomel, Kept Synthroid at 88

Labs 5/2/2008
TSH: .827 (.350-5.5)
FT4: 1.23 (.61-1.76) 53.91%
FT3: 3.3 (2.3-4.2) 52.63%

5/9/2008 Increase Synthroid from 88 to 100, Cytomel at 5

Labs 9/12/2008
TSH: 1.247 (.450-4.5)
FT4: 1.32 (.61-1.76) 61.74%
FT3: 3.2 (2.3-4.2) 47.37%

Labs 1/28/2010
TSH: .55 (.40-4.5)
FT4: 1.0 (.8-1.8) 20.00%
FT3: 339 (230-420) 57.37%

Labs 11/18/2010
TSH: .56 (.40-4.5)
FT4: 1.1 (.8-1.8) 30.00%
FT3: 3.7 (2.3-4.2) 73.68%

12/10/2010 Increase Synthroid 100 to 112, Increase Cytomel 10 to 15

Labs 01/22/2011
TSH: .34 (.40-4.5)
FT4: 1.1 (.8-1.8) 30.00%
FT3: 3.4 (2.3-4.2) 57.89%

After that Increase Synthroid 112 to 125, Cytomel at 15.

Labs 04/16/2011
TSH: .34 (.40-4.5)
FT4: 1.4 (.8-1.8) 60.00%
FT3: 5.0 (2.3-4.2) 142.10%

Labs 08/18/2011 (anxiety attacks, lightheadedness)
TSH: .03 (.40-4.5)
FT4: 1.3 (.8-1.8) 50%
FT3: 4.6 (2.3-4.2) 121.05%

8/27/2011 Increase Synthroid 125 to 137.5, Decrease Cytomel 15 to 10

Labs 10/3/2011
TSH: .07 (.40-4.5)
FT4: 1.2 (.8-1.8) 40%
FT3: 3.0 (2.3-4.2) 37%

11/2/2011 Increase Synthroid 137.5 to 150, Cytomel kept at 10

Labs 12/12/2011
Hemoglobin A1C: 5.4 (<5.7=decreased risk of diabetes)
TSH: .07 (.40-4.5)
FT4: 1.3 (.8-1.8) 50%
FT3: 3.1 (2.3-4.2) 42%

12/21/2011 Increase Synthroid 150 to 175, Cytomel kept at 10

1/18/2012 – very dizzy week

Labs 01/28/2012
TSH: .02 (.4-4.5) LOW - Out of Range
FT4: 1.5 (.8-1.8) 70%
FT3: 3.8 (2.3-4.2) 78.9%
Reverse T3: 41 (11-32) HIGH

03/24/2012 – not feeling well all week, very dizzy

Labs 3/29/2012
TSH: <0.01 (.4-4.5) LOW - Out of Range
Free T4: 1.6 (.8-1.8) 80%
Free T3: 3.4 (2.3-4.2) 57.9%
Reverse T3: 40 (11-32) HIGH

4/5/2012 - Synthroid kept at 175, Increased Cytomel 10 to 15

Labs 5/22/2012
TSH: <0.01 (.4-4.5) LOW - Out of Range
Free T4: 1.3 (.8-1.8) 50%
Free T3: 3.2 (2.3-4.2) 47.37%
Reverse T3: 39 (11-32) HIGH

6/6/2012 - Increasing Cytomel from 15 to 20, keeping Synthroid at 175.

 
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Old 07-24-2012, 06:32 PM   #3
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Re: Is it time to switch to desiccated?

Waiting for my most recent labs to come back now and I feel like a crack wh@re waiting for my next fix. I'm not sure what direction my dr. will want to go but I desperately need a med increase. I seriously have several moments throughout the day where I feel like I could just deflate and topple over. Considered going to a cardiologist to get my heart checked, but then that seems pointless when I know I am hypo.

Anyone here gone from a cytomel/synthroid combo to dessicated or dessicated/synthroid?

Anyone know of a good thyroid savvy doc in the St. Louis area? I am seeing a good one but am catching crap from one of my BFF/co-workers/fellow thyroid sufferers for still being so sick and thought maybe a second opinion would not hurt and might get her off my back.

 
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Old 07-25-2012, 04:37 AM   #4
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Re: Is it time to switch to desiccated?

Hypothyroidism (inadequate FreeT4 and/or FreeT3 levels) can cause elevated blood sugar.

I'm aware of many people who have switched to desiccated or desiccated/T4 with success.

I've heard good things about Dr. Christian Wessling - he prescribes Armour and is listed on the Top Thyroid Doctors site.

For whatever it's worth, the most common therapeutic desiccated doses are 90-120mg. Since most people respond better to desiccated, the starting dose is usually slightly lower than the comparable dose of synthetics or, at the most, equivalent.
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Old 07-26-2012, 05:20 PM   #5
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Re: Is it time to switch to desiccated?

Thanks Sammy - I see someone in Dr Wesslings office now. She did help bring me back to health after my initial diagnosis, but I've been struggling for close to 2 years now. She has agreed to med increases along the way but now this RT3 thing is making her not want to increase my T4.

You think it's wise to start desiccated at lower doses even with Armour being reformulated? I guess I always assumed that so many people found great relief from Armour because they were not previously taking any T3.

 
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Old 07-26-2012, 07:06 PM   #6
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Re: Is it time to switch to desiccated?

Will the person in Dr. Wessling's office prescribe Armour and T4 for you?

If she won't give you more T4 now, what makes you think she'll prescribe an appropriate dose if you switch?

I honestly don't know what I think about Armour. It seems to either work for some people or it doesn't work at all.

If we knew it would work for you, I'm still not sure I'd make a "lateral switch" (equivalent dose to the current) since it seems people respond much better to Armour (and I agree probably due to the T3 in it)

I do know that, due to the fact that Armour contains thyroglobulin, the T3 is more of a slow-release formula.

I will tell you this much - if you're considering switching meds only because of an uncooperative doctor, I think you're better off switching doctors.
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Old 07-27-2012, 09:01 AM   #7
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Re: Is it time to switch to desiccated?

She actually wanted to switch me to Armour when I first started seeing her several years ago. But that was a few months after diagnosis and I had been SOOOO sick and had made some progress and did not want to upset the apple cart. And I have considered swithching a few times over the years, but then again, did not want to have to go through the process of getting optimized. I guess I am getting desperate after struggling the past 2 years.

And i guess ideally I'd prefer to increase my T4 meds and T3 meds both (assuming my labs are similar to the last ones) but since my doc is hesitant to increase the T4 I guess I was hoping to get more bang for my buck through desicated. (And since it is hard to get exactly the same ratio in desicated I was trying to round up a bit as i definitely did not want to go backwards.)

My doc is pretty cooperative. I think I am just a mess.

 
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Old 07-27-2012, 10:39 AM   #8
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Re: Is it time to switch to desiccated?

I completely understand the evolution of things. My doctor offered Cytomel 3 months before I thought I needed it - a levo dose increase worked that time. The next time she offered it, I opted for yet another levo dose increase but realized within a week I should have accepted her offer. Thank goodness she gave me another chance (not all doctors do). Hindsight can be 20/20 but, I wouldn't beat myself up about it. There's no guarantees that Armour will work for you.


I think you should capitalize on this:

Quote:
Originally Posted by Heckofagal View Post
My doc is pretty cooperative.
And have a heart-to-heart talk with her about how you're interpreting your labs...how they relate to your history. You can tell her you appreciate her concerns. However, you'd like to be given the opportunity to try something, just to see if it helps.....and ask her to let you try some more T4 since you are thisclose to what might be optimal levels.
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Old 07-31-2012, 10:46 AM   #9
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Re: Is it time to switch to desiccated?

Yep, I was thinking it was time for a heart to heart talk.

Got my labs back:

Labs 7/18/2012
TSH: 0.01
FT4: 1.3 (.8-1.8) 50%
FT3: 3.6 (2.3-4.2) 68.42%
RT3: 33 (11-32)

So my RT3 has come down quite a bit. My biggest complaint is fatigue and this spaciness i experience several times a day where it feels like i could just pass out. Hard to explain. Very annoying. I've also had issues with heat intolerance but last Saturday it was a bit cooler and i made it to the pool with some friends.

 
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Old 07-31-2012, 11:24 AM   #10
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Re: Is it time to switch to desiccated?

Heckofagal

I'm happy to see that your rT3 level decreased. Since your FreeT3 level increased, I'm not surprised.

The best news to me is that your Cytomel dose increase caused a predictable increase in your FreeT3 level *and* it didn't cause your FreeT4 level to decrease.

I'll tell you this much - if I had your levels, I'd be very fatigued and suffering with brain fog along with a bunch of other symptoms.

I need my FreeT4 level to be at least 95% of range to be symptom-free....and my FreeT3 level at least 75% of range.

Being close isn't good enough when we're talking about optimal thyroid hormone levels....it's similar to the concept of being pregnant or not...there's no in-between.

I hope you can get the T4 dose increase you need.
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Old 08-02-2012, 10:36 AM   #11
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Re: Is it time to switch to desiccated?

She was very accommodating and very eager to bring me back to health. She agreed to increase my synthroid from 175 to 188 and to increase my cytomel from 20-25. I'm not sure if I should increase both... Any comments?

She is also sending me to get a thyroid ultrasound, which i've never had.

 
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Old 08-02-2012, 01:39 PM   #12
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Re: Is it time to switch to desiccated?

This is great news - congrats!

Did she share any reasoning behind increasing your Cytomel?

I think you might get different opinions as to whether or not you should increase both meds at the same time.

We know that, without a doubt, your FreeT4 level needs help so, increasing your Synthroid makes sense.

I'm not sure if you know your optimal FreeT3 level but, your most recent level would be optimal for most people (60-80%, as you know).

There's a chance your FreeT3 level will increase as a result of your T4 dose increase. I note that this has happened in the past for you.

With that in mind, and my preference for the slow and steady approach, I'd go with just the Synthroid dose increase for now.

I'm blown away that you've never had a thyroid ultrasound before - glad you're finally getting one!

Best of luck to you moving forward!
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Old 08-02-2012, 06:26 PM   #13
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Re: Is it time to switch to desiccated?

After discussing some things she asked how I felt about my levels. She said there was still room for improvement with my T3 but that some people feel hyper if their T3 gets too high. I asked how low my RT3 had to be to let me add more synthroid. She said we could try it now, but warned that it was possible that it could just turn into reverse T3 and then cause issues utilizing the T3 level I did have. I asked if she thought raising both would help to keep it from converting to RT3 (not sure why that would happen) and she said we can try and see what happens.

I think I will just take the synthroid for now. I really thinks getting my T4 up will help tremendously.

I think she knows I read and do enough research that she truly trusts my opinion. I have HORRIBLE white coat hypertension (won't even post my numbers here it is that embarrassing). And while most dr.s would have been afraid of me stroking out, she knows I keep an eye on my BP and test at home. She asked if my BP had been testing fine at home and I told her the night before it was 121/80 and that morning it was 117/79. So she was fine with that. I've been going to her for years and she knows this is expected.

 
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Old 08-02-2012, 06:59 PM   #14
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Re: Is it time to switch to desiccated?

I can appreciate her line of thinking. However, I believe that there comes a time in a patient's life when optimizing the FreeT4/T3 levels puts an end to rT3 issues.

You might be at that point....you might not be.

More than anything, I'd hate to see you overshoot your goal....and the risk with that is in your FreeT3 level (she acknowledges that this has been an issue for other patients).

Despite what some doctors might say about people only needing optimal FreeT3 levels since "T3 is the active hormone", I disagree completely.

I "feel" my FreeT4 level just as much as my FreeT3 level. Both need to be optimal if I am to be without symptoms.

Yes, T3 is our active hormone so, of course, it's important to have adequate levels of that.

However, some parts of the body need "fresh" T4 to convert "on-site". That's why we also need adequate levels of T4.

Healthy people have FreeT4 levels near the high end of the range for a reason.

I'm glad you have the type of relationship that you do with her. I have similar with my doctor. It sounds like you both are working together to help you achieve wellness....that is the goal after all, isn't it?
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Old 08-02-2012, 07:24 PM   #15
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Re: Is it time to switch to desiccated?

She discussed the "2 things" that cause high reverse T3 .... And did not mention stress so I threw out that everything I've read mentioned severe stress as a factor, and that I HAD been under severe stress.

I also told her the last time I felt GREAT was several years ago when my Free T4 was between 70-90% of range (showed her on my list of labs) and that is what I wanted to shoot for

 
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