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Old 01-18-2013, 05:01 PM   #1
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Unclear About Dose Optimization and Lab Results

Hello,

I'm fairly new here and I have been so thankful to find this community. Thank you in advance for any advice you may be able to grant me.

I've been symptomatic for about 6 months total now, although I have only been on hormone replacement for about 7 weeks, about to start my 8th week. No improvements to speak of which has been frustrating. Here are my most recent labs as of recent:

TSH .35 (.36 - 3.74)
FT4 .99 (.76 - 1.46)
FT3 4.0 (2.18 - 3.98)
TPO 0.5 IU/ml (0.0 - 9.0)

Please bear with me and try to follow this. These labs represent about 6 weeks total on Armour Thyroid, but only 2 weeks of that time on 1 grain. I moved up every two weeks from 1/2 grain. So after I had worked up to 1 grain and had been on 1 grain for 2 weeks I had the labs drawn. So, total of 6 weeks, but only 2 weeks at 1 grain.

Fast forward to now--> Currently I'm now completing my 4th week at 1 grain. In 2 more weeks I am going to have a follow up lab drawn to reflect 6 weeks total on 1 grain. Bottom line is that absolutely nothing has changed to speak of. I am still feeling pretty bad right now. Brain fog, tinnitus, fatigue, tingling/numbness, nothing has really changed, arrg!

With all that aside I have 3 questions:

1) I've read story after story of the person who needed to keep raising their Armour Thyroid dosage to relieve symptoms. Is this the case even if your FT3 is already high in it's range and your FT4 is at least mid-range? Do people take more even with in range Frees?

2) I guess I'm just losing hope because I can't believe I don't feel any changes yet. Granted the lab was taken only about a week ago so I don't know if maybe there is some lag happening here, but c'mon. Is it really possible to lag this long and feel no change?

3) A nice little side symptom, has anyone experienced a tight feeling in the throat? I have been taking a daily dose of selenium as I have read is supposed to help with this feeling but it doesn't seem to be helping. It sort came and went for a while as I was titrating up, but lately it seems to just be hanging around. Should I push for that ultrasound?

Any insight would be very helpful. Thank you.

 
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Old 01-19-2013, 09:39 AM   #2
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Re: Unclear About Dose Optimization and Lab Results

I'd be curious to see your original, untreated labs. Did a medical doctor prescribe for you, or is this something you're doing on your own? On what basis was treatment started?

The things that jump out at me are:
This less-than full replacement dose has pushed your FT3 above range. Makes me wonder if it was already adequate/optimal and the med made it excessive. A former active male member here from whom I learned much always said that men's optimal levels are lower than women's... That mid-range is usually enough for them, while women needed theirs in the upper third. Maybe you've passed your "sweet spot", which would produce/sustain symptoms just as readily as inadequate levels. It also might cause the discomfort in your throat.

Selenium aids the conversion of T4 to T3. It's hard to think your intake of it can make so much difference that FT3 would become excessive; but if you already easily convert, it might be wise to stop taking the supplement to see if the FT3 comes into a better spot in its range.

Your FT4 is in the 30th percentile. Granted, that's slightly lower than most men need; but if you raise your Armour dose, your FT3 will soar through the roof. That's probably not what you want to happen. Could be that a T4-only med is a better fit for you, if you are a "good converter".

And last... Symptoms don't generally disappear within mere weeks. It takes time to work up to the optimal dose, and usually a couple of months longer for healing to take place and symptoms to completely disappear.
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Old 01-19-2013, 02:26 PM   #3
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Re: Unclear About Dose Optimization and Lab Results

Thank you for your response. I really appreciate your insight.

My diagnosing lab was taken in October, no FT3 unfortunately. The diagnoses was made based on family history and TSH. My family thought that my symptoms sounded like thyroid so they urged me to request the test. I asked for a full panel thyroid test but the doc did TSH and FT4 only.

October 19th
TSH 4.2 (.36 - 3.74)
FT4 1.05 (.76 - 1.46)


Went on Synthroid for about 6 weeks 25 mcg. Couldn't tolerate it and after about a week went down to 12.5 mcg due to insomnia/anxiety. Did not help any of my symptoms. Had another lab drawn in November, TSH and Morning Cortisol only:

November 30th
TSH 6.27 (.36 - 3.74)
Cortisol 12.6 (4.3 - 22.4)

Due to symptoms/TSH not improving my Doctor switched me to Armour partly by my request and also because he thought my symptoms would respond to the T3. Started on 1/2 grain and worked up to 1 grain as stated above. Had new labs drawn and was able to talk him into FT3 and FT4 and TPO.

January 8th
TSH .35 (.36 - 3.74)
FT4 .99 (.76 - 1.46)
FT3 4.0 (2.18 - 3.98)
TPO 0.5 IU/ml (0.0 - 9.0)

Do you think I need to take immediate action and switch something up, or should I wait it out for 2 weeks and get the lab that reflects 6 weeks at 1 grain? Hope that question made sense.

I think you're right, maybe I am converting fine and I should have stuck to the Synthroid and got past the "adjustment" period. I just honestly felt some really whacky feelings on the Synthroid, I'd wake up trembling slightly and I'd have a really tough time falling asleep for like 4-5 days in a row. I'd be running on 1 hour of sleep. That scared me so I told doc and he backed down my dosage to half. I just remember taking Armour and not feeling the harshness I felt from Synthroid. But that could all be in my head haha. At this point I'm just fairly frustrated and confused on the whole matter and wonder if I needed the treatment in the first place. Your mind starts to wander when you have felt bad for so long and then you start treatment and still feel bad. You start to wonder if it's not something else that's going on.

 
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Old 01-20-2013, 06:39 PM   #4
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Re: Unclear About Dose Optimization and Lab Results

Believe it or not, I couldn't take Synthroid in even the smallest dosage, either. I became symptomatically and clinically hyperT in just weeks. My then-endo told me to stop taking it until I could "tolerate" it. With TSH of 7 and loads of symptoms, I wasn't about to go untreated. I found a doctor who'd prescribe Armour, and I never had that hyper-sensitivity again. It was exactly as you described... Armour seemed 'gentler' on my system. It was as if Synthroid hit like a Mack truck.

Clearly, your TSH shows you need treatment. It can be a challenge to figure out what kind. Don't expect a fast fix. Lots of trial and error is the general norm.

Here's a thought... I don't know much about cortisol levels, but I do know that low levels can make thyroid hormone "pool" in the blood without its entering the cells. That causes hyper-like symptoms. Your cortisol seems low in its range; I don't know if it's too low, though. But if it is, concurrent treatment with adrenal support may help you to tolerate the thyroid hormone better.

If you plan to stick with Armour, you really must have both free T tests to monitor the dose. I'm glad your MD agreed to it this time; you must make sure he does each time.

I did lots of "sticking it out" during my titration process, which lasted 9 months. I actually felt worse during that time than I'd ever felt before treatment. So, I'm inclined to tell you to hang in there for 2 weeks until your new labs are done... Unless you absolutely can't tolerate it a minute longer. If you can't, just get the labs now and see what's up. If they're pretty close to the last levels, I wouldn't go any higher with the dose until you see if it will "settle in" eventually. Then you can decide how to proceed, depending on which way it goes.

Try to have patience. I know it can be hard. It sounds like you have a pretty good MD, one willing to work with you. So few of them are willing to prescribe natural hormone, you know. That's a plus.

Hope you'll let us know how it goes from here.
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Old 01-20-2013, 09:26 PM   #5
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Frank157 HB User
Re: Unclear About Dose Optimization and Lab Results

Quote:
Originally Posted by midwest1 View Post
Believe it or not, I couldn't take Synthroid in even the smallest dosage, either. I became symptomatically and clinically hyperT in just weeks. My then-endo told me to stop taking it until I could "tolerate" it. With TSH of 7 and loads of symptoms, I wasn't about to go untreated. I found a doctor who'd prescribe Armour, and I never had that hyper-sensitivity again. It was exactly as you described... Armour seemed 'gentler' on my system. It was as if Synthroid hit like a Mack truck.

Clearly, your TSH shows you need treatment. It can be a challenge to figure out what kind. Don't expect a fast fix. Lots of trial and error is the general norm.

Here's a thought... I don't know much about cortisol levels, but I do know that low levels can make thyroid hormone "pool" in the blood without its entering the cells. That causes hyper-like symptoms. Your cortisol seems low in its range; I don't know if it's too low, though. But if it is, concurrent treatment with adrenal support may help you to tolerate the thyroid hormone better.

If you plan to stick with Armour, you really must have both free T tests to monitor the dose. I'm glad your MD agreed to it this time; you must make sure he does each time.

I did lots of "sticking it out" during my titration process, which lasted 9 months. I actually felt worse during that time than I'd ever felt before treatment. So, I'm inclined to tell you to hang in there for 2 weeks until your new labs are done... Unless you absolutely can't tolerate it a minute longer. If you can't, just get the labs now and see what's up. If they're pretty close to the last levels, I wouldn't go any higher with the dose until you see if it will "settle in" eventually. Then you can decide how to proceed, depending on which way it goes.

Try to have patience. I know it can be hard. It sounds like you have a pretty good MD, one willing to work with you. So few of them are willing to prescribe natural hormone, you know. That's a plus.

Hope you'll let us know how it goes from here.
You sure know how to put someone at ease. Maybe you should be a Doctor. Thank you for the insight. The information is very useful and I will definitely check-in down the road and let everyone know how it's going. I think the cortisol thing is very suspect and I have thought about that a few times already. I'm also going to pursue a dietary route with a naturopathic doctor. Maybe investigate some of the foods I've been eating for many years and address possible food allergies and such. I will maybe post some info on that too if I have any successes. I may or may not reply back here with another question in the next week or so if that's ok. Thank you again! Your wise-ness is much appreciated

 
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