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    Old 02-18-2005, 09:25 AM   #1
    djohnson
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    Sublingual Delivery, etc.

    Hello all; I was diagnosed about a month ago with hypothyroidism after experiencing all of the symptoms for several months. Thankfully, I have very liberal doctors who more or less allow me to direct my own treatment. Nonetheless, I'm a bit uncertain of what to do at this point, so if anyone could help me out I'd be sincerely appreciative.

    My initial labs were:

    TSH: 7.13 (.35-5.5)
    Free T4: 1.1 (.8-1.8)
    Free T3: 2.4 (2.3-4.2)

    I was started on 50mcg Levoxyl/day, taken once in the morning, and I followed that for two weeks. After some reading online, I switched to Armour (1 grain) and have taken that ever since.

    2 weeks after beginning Armour (i.e. 4 weeks after beginning therapy) I had these labs drawn:

    TSH: .22
    Free T4: 1.2
    Free T3: 4.4

    (I also had a a thyroid antibody test, but the results have not yet come back.)

    I have two questions:

    1. I took the second test fasting in the morning (I had other tests done as well, which is the reason for the fasting). I had taken my Armour beforehand on the advice of a doctor. After doing some reading here, it seems that perhaps that was a bad idea because of how quickly T3 is absorbed.

    Could the low TSH, as well as the high T3, be a consequence on the acute (i.e. 2 hours before the test) administration of Armour or does TSH only reflect chronic changes in thyroid levels? In the future, should I avoid taking thyroid medications before a blood test?


    2. My T4 barely changed during the four weeks. I had been taking my Armour (and levoxyl, when I took it) in the morning, then about 30 minutes later I would eat. The food I ate did contain significant amounts of calcium every morning, although I avoided iron. Because of my schedule, I more or less am required to eat quickly upon waking every morning and the calcium is mostly unavoidable. Consequently, it appears (to me) that the T4 is not being properly absorbed. Moreover, I've been feeling fatigued later in the day lately, which might suggest spiking T3 levels and low T4 levels.

    I've read here that sublingual administration of thyroid has worked for some people. First off, have any tests verified that the thyroid hormones can be properly absorbed in the mouth? Has sublingual administration worked better than oral when foods are consumed quickly afterwards? Are there any risks of the thyroid hormones being absorbed too quickly? Finally, does sublingual administration work with all types of thyroid meds (armour, levoxyl, etc.)?


    I'm sorry for the lengthy post. I did a search, but only found bits and pieces of information. I'll continue to look around, but I would be *very* thankful if anyone could offer any help at all!

     
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    Old 02-18-2005, 12:09 PM   #2
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    Re: Sublingual Delivery, etc.

    There are a few things that I can respond to- first, I'm not sure you have been on the Armour long enough to get the full effects to show up in your lab work. Second, going from 50 mcg of Levoxyl to 1 grain of Armour is quite a big increase to do at one time. I believe many times its best to slowly work your way up. Armour contains more t3 than t4 so therefore you might have to take t4 (levoxyl) along with the Armour to get your levels just right. It looks as if the 1 grain of Armour might be a bit much, but because you did take the meds before the lab work you may not have a true reading...how are you feeling (hypo, hyper)? I have read that the sublingual administration works well for many people, also, if you are feeling tired towards the middle of the day, you might consider spliting the dose of Armour and taking 1/2 in the morning and the other half about 8 hours later. You are lucky that you have doctors that are willing to work with you! I hope this helps a little- I'm sure there will more people that can give you more info. Best of luck!

     
    Old 02-18-2005, 02:16 PM   #3
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    Re: Sublingual Delivery, etc.

    Quote:
    Originally Posted by KBT's mom
    There are a few things that I can respond to- first, I'm not sure you have been on the Armour long enough to get the full effects to show up in your lab work. Second, going from 50 mcg of Levoxyl to 1 grain of Armour is quite a big increase to do at one time. I believe many times its best to slowly work your way up. Armour contains more t3 than t4 so therefore you might have to take t4 (levoxyl) along with the Armour to get your levels just right. It looks as if the 1 grain of Armour might be a bit much, but because you did take the meds before the lab work you may not have a true reading...how are you feeling (hypo, hyper)? I have read that the sublingual administration works well for many people, also, if you are feeling tired towards the middle of the day, you might consider spliting the dose of Armour and taking 1/2 in the morning and the other half about 8 hours later. You are lucky that you have doctors that are willing to work with you! I hope this helps a little- I'm sure there will more people that can give you more info. Best of luck!
    Thanks for your advice. I have been feeling quite fuzzy mentally as of late, and yes I do have a bit of a dip in energy toward the middle of the day. I'm simply not sure if this is due to too much of a T3 spike, a lack of T4/T3 balance, or some other factor. Even in the mornings, though, I hardly feel energetic.

    As the the effects of Armour, I suspect you're right, but after 4 weeks of some kind of T4, it seems reasonably safe to assert that I'm not ideally absorbing T4.

    Thanks again for the help!

    By the way, I'd be curious to hear if anyone has compared sublingual to oral delivery with blood tests.

     
    Old 02-19-2005, 02:22 PM   #4
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    Re: Sublingual Delivery, etc.

    Johnson:

    There are some basics you are still learning. I had a very hard time getting to the bottom of all these things too. so...I feel for ya.

    #1 Take meds at least eight hours away from blood tests for accuracy. You are going for a blood serum level. You want what the basic level is there...not one that has been recently fooled with.

    #2 The t3 spiking is not likely the reason why you are lethargic. It is most likely the opposite. You probably need more T-med...and to take split doses. To aid your t4 situation, take some pure t4 as well as your Armour. (many do it..with great success.)

    #3 KTB's mom has it right when she suggests a cold-turkey change out is not the best way to do protocol transition. You confuse your tissues...and your receptors that way.

    #4 No verifible tests on the sublingual methods are known...but its easier to do that to wait 4 hours for the bowl of cereal. I do it that way and am pleased with my bloodwork. Others here report better absorbtion. NO matter which way you want to run your meds with food...its important that you remain consistent for uniform blood/tissue treatment.

    Are there any dangers of taking T- med too fast like that? Probably not...the thyroid naturally produces whatever the body needs. Then the body elegantly breaks the molecules into whatever it desires...in a perfect dance. In fact...the other way through the stomach would actually be the wierd way to take hormone. What would be natural about that? Thyroid hormone doesn't get go through a person's tummy normally.

    Could you injure your tounge by using the sublingual method....? I hope not.

    ~S

     
    Old 02-19-2005, 02:48 PM   #5
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    Re: Sublingual Delivery, etc.

    Wow, this is quite a board!

    Thank you VERY much softcrush, that was exactly what I needed! I'm definitely still learning here, and your help is genuinely appreciated.

    I'm probably going to try switching to 50mcg T4 + 1/2 Grain Armour. It seems like that's the ratio of T3/T4 that a lot of people are using and enjoying. I'll stay on that for a while and then assess from there.

    One last question, then:

    I tried taking the aforementioned 1/2 Grain Armour + 50mcg T4 this morning sublingually. The Armour dissolved nicely, but about 30 minutes after putting both pills under my tongue, a tacky white residue remained. I swallowed the residue and subsequently ate breakfast.

    I'm not sure what the tacky substance was, but I'm hoping it was simply the binders from the tablet. Nonetheless, I can't help but wonder if it contained some unabsorbed T4.

    I'm currently taking a generic for Levoxyl for my T4. Has anyone else had this problem/noticed this? Is there another brand of T4 that dissolves better?

    EDIT: As an aside, do people find that the tablets dissolve more easily if first crushed by biting/chewing the pill once or twice? Or is this more likely to induce swallowing?

    Last edited by djohnson; 02-19-2005 at 06:55 PM.

     
    Old 02-20-2005, 09:32 AM   #6
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    Re: Sublingual Delivery, etc.

    Softcrush gave great info. I hav taken my meds sublingually for several years with no incidence and always very stable and predictable blood results.

    Based on wat you are saying, you are switching doses much faster than what you should always make slow, subtle changes and wait 6 weeks for levels of Free T4 to be stable.

    On the pills dissolving and leaving a residue, I have had the best luck with Unithroid (preferred) and Synthroid. I have also tried a generic, but it was more chalky than the other two and didnt' seem to dissolve quite as well. I haven't tried Levoxyl, but I know that Levoxyl tablets are softer and may dissolve faster.

    I also break my Unithroid and Armour up with my teeth a little so they dissolve faster. I don't know if it helps absorbtion, but I do it and just try to remain consistent. Consistency is important .
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    Last edited by Meep; 02-20-2005 at 09:32 AM.

     
    Old 02-20-2005, 01:48 PM   #7
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    Thumbs up Re: Sublingual Delivery, etc.

    I have found that white (50mcg) Synthroid pills are sweeter and easier on the tummy than the colored versions. YUM!

    Most of the t4 pills come in a white version for the 50mcg size. You may want to look into it.

    By far the chalkiest, flimsiest pill I've taken was a generic form of Armour. It also gave me pee urgency! Ya know...that's when you run to the bathroom and then you CAN'T go when you get there!

    PS: A lot of us ripped off the sublingual idea from MEEP. He's very cool! Thanks Meep...you rock!

    Last edited by softcrush; 02-20-2005 at 01:54 PM. Reason: added

     
    Old 02-23-2005, 05:43 AM   #8
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    Re: Sublingual Delivery, etc.

    Just wanted to add that when taking your hormones 'sublingually' it really shouldn't be under the tongue. You want to place the pills between your cheek and gums, where there's the least amount of saliva. This ensures as much of the hormones as possible are absorbed via the capillaries of the mouth, and isn't swept down to your stomach with the saliva you swallow.

    FYI, if you're doing it this way it takes longer to disolve, though.
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    Old 03-26-2005, 09:30 AM   #9
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    Re: Sublingual Delivery, etc.

    I'm intrigued here. Is the reason for interest, because one could absorb quickly sublingually, and thus alleviate waiting to eat breakfast?

    How long does it take the pills to absorb?
    Can you then eat breakfast immediately, without concern of GI absorption?
    Any idea how much better/worse absorption is, sublingually versus GI?

    Want to also just amplify Meep's comment .... consistency is key.

    You could probably take thyroid meds through your rear end if you wanted to .... just as long as you do it the same way each day, and use blood tests to confirm. If absorption that way is only, say 50% of otherwise, then you just double your dose.

    I, for example, thus far, have chosen to swallow my meds first thing in the morning, and wait 1 hour before eating. I could have chosen to take them with breakfast. You just see how your blood tests come out.

    If I remember right, absorption is typically about 80% via the GI tract, if taken without food, and about 40% with food. So, in theory, your blood tests would confirm the need to double the dose, if taken with food.

    I chose not to take them with food, because I would open myself up for other absorption factors. If I typically ate maybe coffee and dry toast one month, and the next month, typically added calcium fortified orange juice, or maybe beet juice.... that would likely change absorption significantly.

    Consistency is the key. Verify with blood tests.
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    Old 03-26-2005, 12:45 PM   #10
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    Re: Sublingual Delivery, etc.

    You could probably take meds through your rear[QUOTE]

    I thought this statement was funny. Not making fun for I have said some things like that too.

    When I take my Armour in the morning I do it sublingually. I put it between the cheek and gum. Leave it there until it absorbs into all the little capillaries.With generic Armour, there will be binders and fillers left.

    It works for me and seems to get my levels up faster.

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    Last edited by Lady50; 03-26-2005 at 12:47 PM.

     
    Old 03-26-2005, 03:22 PM   #11
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    Re: Sublingual Delivery, etc.

    Hi I am new, but I read an article (can't remember specifics exactly) about research done in Japan (found on Pubmed internet search (hope it's ok to say that) and talks about how some patients do better with absorption when the medicines are crushed for some reason. You may be able to find that. Pixiek

     
    Old 03-26-2005, 06:21 PM   #12
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    Re: Sublingual Delivery, etc.

    s'ok, Betty ..... it was meant to be funny..... even though, it's probably true anyway.
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    Old 03-27-2005, 11:53 AM   #13
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    Re: Sublingual Delivery, etc.

    Okay Heeeeeee!!!!
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