Avatar universal

Help dosing Armour thyroid

Hello there,
I had my thyroid removed in august 2018. Since then, I started in levothyroxine... it took me almost two year to find the right dosage but even then I felt was not good enough. I started to read books and papers about thyroid and decided to switch to armour thyroid. My dose on Levothyroxine was 88 mcg. The doctor switch me on 60 mcg armour thyroid. After 5 weeks on armour the TSH came back 47 and Free T4  in the lower limit. I started to feel very fatigue after 2 weeks in the armour thyroid. Now the doctor switched me to 90 mcg armour. almost one week into it and still have fatigue... the average pulse increased from 68 to 72 bpm. I am 5.2  height and 117 lbs so weight wise is a good limit.what should I do to reach the right dose?

Thank you,
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Avatar universal
You CANNOT accurately dose based on TSH.  TSH is about worthless for anyone taking thyroid replacement. And especially so when they are taking any significant portion of medication with T3 in it. Which Armour has!  

Gimel I think can provide links and evidence that when replacing thyroid hormone with oral medication (exogenous) in order to achieve symptom relief, it is almost a certainty that TSH will be suppressed.  Doctors do NOT know this, and thus they routinely UNDER medicate the patent who then never feels fully well, because the mis-informed Doctors attempt to keep TSH about 1, when they really need to suppress TSH and base dosage upon clinical symptom relief. NOT on TSH, or really even on Free T4 and Free T3 levels.

Also for your reference.  It is quite common for someone on Armour or any NDT medication that they remain low in FT4, even if FT3 levels are up and they feel good.  Some people despite having "good" FT3 levels, in order to feel well will have to add T4 medication to get their FT4 levels up to mid-range.  Everyone is a little different.

personally I think that there is value in having FT4 in the blood in the middle of the rage, even if you felt good at or below FT4 range levels. As it still retains a "storage" amount of thyroid that can be made available if your body needs more thyroid.  If you don't have any FT4 there will not be this "reserve" or "back up" supply even available should your body need it.

remember to NEVER take your Armour before you have your blood lab.  It is best to keep all the "variables" as close to identical as possible for blood draws. This is most commonly accomplished by NOT taking any thyroid meds, and having the blood drawn about the same time early in the morning each time.  Then you have the ability to compare and gain trend data, over time and with changing dosages.  

I STRONGLY recommend you keep a diary where you keep track of the date, and the medication dosage and the blood levels and IMPORTANTLY list your symptoms and how you felt at that time. This way you can link your symptoms to your blood levels. And have evidence to "prove" to a Dr at what levels you feel well. This becomes particularly important IF and WHEN you switch Dr's.  As it is not uncommon to finally "train" a doctor to look at your symptoms and dose based on that and NOT simply TSH or any blood lab range.  But then that Dr. moves, retires or passes away, or you move and you get a new Dr. And they absolutely FREAK when your TSH is suppressed and then cut your dosage and you crash and feel like crap again.  if you have evidence of a diary linking your symptoms and clinical data compared to blood labs,, at least you have a fighting chance to defend your position as to keeping your dosage you are on, and NOT letting the Dr crash you and you feel like crap again, and have a LONG journey to dig yourself back out of a hole.

Since your current Dr only seems interested in TSH. I would strongly encourage you to start looking ar eound for a new Dr who will treat YOU,.  and NOT a certain lab value. Especially as something as inaccurate and useless as TSH for the basis of dosing.  That is just my opinion.
Helpful - 1
I already looked for a new doctor but the soonest appointment is november. Until then I have to work with what I have. T4 is low 0.9. I felt better when it was in the middle range. The doctor said it will take more time for T4 to build up and I dont know if thats true or not. Do you know how long it takes for T4 to build up? Should I wait another month to see my T4 or just 2 weeks?
Thank you very much for your response. I really appreciate that.
Avatar universal
If your doctor is one of the many who really only pay attention to TSH, for both diagnosis and treatment then I would not bother with him any longer.  You need a thyroid doctor that will adjust your FT4 and FT3 levels as needed to relieve symptoms, without being influenced by TSH levels.   If  you don't know of such a doctor, please give us your location and perhaps we can suggest a doctor that has been recommended by other thyroid patients.

Also, I am surprised that you don't seem to have many symptoms.  Please make sure you don't overlook any.  There are numerous symptoms of hypothyroidism, but following is a list used at the Mayo Clinic.   Do you have any of these?

Increased sensitivity to cold
Constipation (if you have to use laxatives, then answer is yes)
Dry skin (if you use skin creme then answer is yes)
Weight gain
Puffy face
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Impaired memory
Enlarged thyroid gland (goiter)
Helpful - 1
Maybe I have few more on the list like Increased sensitivity to cold , impaired memory and thinning hair. The only one that is trouble me right now is fatigue. I am Chicago area. I would be so greatful if you can tell me about a doctor in this area that has more experience in this field.  
Avatar universal
When you take your med before the blood draw it causes FT4 and FT3 to spike for hours.   Doctors done' know this, or don't pay attention to it, even though the AACE/ATA Guidelines for Hypothyroidism recommend that the morning dose be delayed until after the blood draw.   To have a more accurate picture of your FT4 and FT3 I highly recommend that in the future you delay your med until after the blood draw.

When I read that "it took me almost two year to find the right dosage but even then I felt was not good enough."  I expected that your doctor was adjusting your dosage based on TSH levels, which is wrong.    There are extensive data showing that TSH has only a weak correlation with FT4 and FT3, and a negligible correlation with symptoms, which are the reason patients go to their doctors.  A good thyroid doctor will always test FT4 and FT3 and adjust as needed to relieve hypo symptoms, without going too far and creating hyper symptoms.  Many of us have found that to require FT4 around mid-range, and FT3 in the upper half of its range, and adjusted as needed by the individual to relieve symptoms.  These levels will often suppress TSH and cause the doctor to think you have become hyper and need a med reduction.  That is also wrong.  

Regarding med dosage, since you had a thyroidectomy, you need a dosage that is a full daily replacement amount.   88 mcg of T4, or even 90 mcg of Armour is not going to be enough.   There are data that an average thyroid gland produces 94-110 mcg of T4 and 10-22 mcg of T3 daily.  When you take med orally, the absorption is only about 80%, so that means the replacement med dosage should average about 117-137 mcg of T4 and 12.5-27 mcg of T3.  Armour thyroid contains 38 mcg of T4 and 9 mcg of T3, so you can see that 88 mcg of T4 was not nearly enough.  Even 90 of Armour is only 57 mcg of T4 and 13.5 mcg of T3.  

So you need a doctor tht understands and agrees with clinical treatment, based on symptoms, notbased on just getting TSH within range.  If your doctor does not agree, then you will need to find one that will treat clinically.  

In addition, hypothyroid patients are frequently deficient in Vitamin D, B12 and ferritin, so you should make sure those are tested and then supplement as needed to et D up to 50 min, B12 in the upper part of its range, and ferritin should be at leasst 100.  All 3 are important for you.  

If you want to verify what I have said, click on my name and then scroll down to my Journal and read at least the Overview ofa paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective.  
Helpful - 1
I completely agree with what you said. I really thank you very much for getting back to me. I really appreciate that.
The problem that I have right now with my doc is that he doesn't want to test me after two weeks in the new dose. He wants to wait 4 to 6 weeks and I dont want to wait on a wrong dose that long.
Avatar universal
For discussion with the doctor you might keep in mind that there is a site that says the average thyroid gland produces 94-110 mcg of T4 and 10-22 mcg of T3 daily.   Yes, this is the average, but it is worthwhile to evaluate in terms of your med dosage.  

So knowing that thyroid med is only absorbed about 80%. to achieve the equivalent amount of T4 and T3 from thyroid med would require the dose to be about 2 grains to 3.5 grains.    So 2 grains would be on the low end of that.  Also important to note that there is no biochemical test that accurately determines your thyroid status.   Doctors like to keep thyroid med dosages low because they erroneously think that TSH accurately defines a person's thyroid status. Not true and they cannot provide any data to show TSH correlates well with a patient's thyroid status.  So they adjust med dosages according to TSH and that almost always results in under-medication.   Your thyroid status is best determined by the presence or absence of symptoms typical of hypothyroidism.  There is so much variation in Free T4 and Free T3 levels required by different patients to feel well, that they best serve to track changes from med dosage changes.   And typically patients need Free T4 around the middle of the range, and Free T3 in the upper half of its range and adjusted from there as needed to relieve symptoms.    And of course Vitamin D, B12 and ferritin must be optimal as well.
Helpful - 0
Gimel thank you very much. I will keep this in mind when I talk to my doctor. Thank you again. Very helpful.
I did tested positive for Covid. So far the symptoms are mild. I am not 100 recovered this is just the 6th day since my first symptom .
Back  again and still not very good. I was on 90 mcg of armour for three months. At beginning of december i started to feel very tired. My free T4 increased from 0.8 to 0.9 so almost nothing. My TSH 0.05 ... at this point i did not know if the symptoms were hyperthyroidism or hypothyroidism. I decided with the doctor i need more T4 so i reduced Armour from 90 to 60 mcg and add 25 mcg of levothyroxine. After a month on this dose my TSH was 3 which is more like hypothyroidism and free T4 increased to 1, which is very little.  I still feel very tired and told the doctor maybe a better idea would be to increase levothyroxine to 88 mcg and keep armour thyroid at 60 since 25 mcg of levothyroxine increased my free T4 by 0.1. I hope this dose will be ok but Who knows!
Avatar universal
never heard of increasing dosage when sick.

chills and fatigue are low thyroid symptoms as well.  Just because you have been near someone doesn't mean  you will get it. And usually the symptoms from what I have heard start showing up within a couple of days. So if it was a week ago then I'm not sure how likely it is you were infected. Although it is possible of course.

What the media doesn't tell you is that the VAST majority of the people have mild or even llittle to no symptoms.  Under about 70 years of age even if positive have survival rate of like 99.6%  instead the politicians and media seem to indicate the sky is falling and if you get it you will die.  inciting fear above what is proportional to the actual risk.  But that is just my observation.

They also do not inform the population of the false positive rate.  Most people falsely believe that a false positive of say 2% means that if you test positive, that 2% of them are false.  The truth is the opposite what it means in reality is that of EVERY person tested, 2% of them will indicate a positive result INCORRECTLY. So if they test 10,000 people, with a 2% false positive rate, that would result in a reported "number of cases" of 200 "new cases".  ALL of them would be incorrect and they actually do NOT have the virus. Plus the few percentage points of people that test positive that are in fact infected.   In fact, the number of incorrectly false positive "cases" vastly outnumber the actual number of cases.

The result of which means that of all the "new cases" that the media bloviates about, the VAST majority of them in fact do NOT actually even have the virus.

The British government states that the assumed (because no one has actually measured it) false positive rate is between 0.8% and 4+%.  Some independent studies have suggested the fase positive rate is dramatically higher, in fact exceeding 10%. But the British government health care I believe uses I believe 2.3% as the assumed rate of false positive of the PCR test.

the numbers of cases also shift all over the place to the point t hat the reported numbers are completely unable to be trusted or used as any sort of actual gauge.  many places do NOT report the number of negative tests. They ONLY report the positive numbers, skewing any statistical reliability.  Then errors are "found", then they "dump" the corrections into the numbers, and the stats all change, and they do not give any indication as to what the cause is for the radical shift in the numbers of both positive and negative. etc.  This is all completely crazy.  So there is really no way hardly to tell what is REALLY going on or what is the truth.

What I never hear, and what is most curious to me is that outside of masks and social distancing and quarantining. There is literally hardly ANY discussion of what people can do to help them NOT get covid in the first place.  Things like Vitamin D at adequate levels  has in studies shown infection rate of even getting infection by a whopping 47%.  Also those folks who have ample Vitamin D levels that actually test positive, the hospitalization rate is cut by nearly 50%, and only about 2% of the people with COVID in the ICU have ample vitamin D.  And with vitamin D levels above I think 40 ng/dl the death rate is a fraction of a single percent.  Therefore, simply be having vitamin D levels above 30 and ideally between 40-60 dramatically cut the chance you will get infected, dramatically reduce the severity of the infection and the survival rate is huge.

So why don't we hear about how something as cheap and easy to do as to get blood test and supplement with vitamin D could vastly improve the numbers??????

is it just me, or is it the old adage:  "follow the money".  As big Pharma do NOT make HUGE profits when people are healthy. And they do not sell vitamin D. So they won't make any money from it.  Also if the infection rate was cut in half, and survivability is extremely high with population with ample vitamin D. Well there would be little or ANY need for a vaccine, of which the big Pharma stand to make tens if not hundreds of Billions if not  Trillions of dollars if they have to vaccinate virtually every single human being on the planet like they are talking!

But these are just the rantings of a guy on the internet. So take it for what it's worth.
Helpful - 0
Wow Thank you very much for your input. I will not worry that much! Anyway the Doctor agreed to increase my dosage to 2 grains But he warned me it might be too much.

I will let know any news!
Avatar universal
I am confused. Back on septermber 11th you stated in answer to Gimel:

marina26m Sep 11
Yes, i took the thyroid med in the morning before the blood draw. I was on 60mcg Armour Thyroid for 5 weeks. I had 4 days (random days) when i thought the med was too strong and I took half of the dosage.

Perhaps that was prior to switching to 90 mg. But have you had a blood test result since switching to 90 mg?  If so, what were the lab results?
Helpful - 0
Yes the first test i did on Armour 60 mcg was done wrong in the sense I took the med before the test. After that i took two more tests: 2 weeks after taking 90 mcg. At this point doctor suggested to keep the same dose and tested back in 4 weeks. So these latest results are on 90 mcg for 6 weeks and i did not take the meds before the test.

Another thing that i just found out is that I might have covid because a friend was a week ago in our house that tested positive.  Since I started on90 mcg I had an average pulse of 72bpm and now increased to 78. I have mild symptoms of covid like headeachs chills and fatigue. I got tested but I did not get the results yet. Do I need to increase the dosage of medication when sick?what do you think?

Thank you
Avatar universal
REMEMBER to NOT take your med before the blood draw!!!!

DEMAND that the FREE T3 be tested. Total T3 is obsolete and of little value.

It is common that people on Natrual Dessicated Thryoid like Armour will tend to get the Free T3 level up and feel good, and still have low Free T4 levels. Some people are OK with that, other still don't feel well until they also get their Free T4 level up to about the middle of the range. This would require adding synthetic T4 med like Levvo or synthroid in addition to the Armour.  Every person is different.
Helpful - 0
I did not take my med before the draw. Ok I will also ask for free T3. Thank you.
Avatar universal
When taking desiccated type thyroid med Free T3 is usually higher in range than Free T4.   when you get your Total T3 we will try to assess that result along with the Free T4.   I am certain that your dosage is still too low.  Dosage should be adjusted as needed to relieve hypo symptoms without going so far a sto create hyper symptoms.  FT4 and FT3 levels help guide to that optimal dosage.   In addition for optimal effect, it is very important that your Vitamin D is at least 50, B12 in the upper part of its range, and ferritin at least 100.  If you cannot get your edoctor to treat for symptoms then you will need to find one that will do so.  
Helpful - 0
Thank you very much! You are very helpful.
Avatar universal
Didn't they also test for Free T3?
Helpful - 0
They test for total T3 bit I don't have the results yet
Avatar universal
T4 can take up to 6 weeks to stabilize in the blood.  I can't recall how long you have been on this current dose.  I think it is only about 2 weeks, so another month would give you about as much as you can expect to get from that dosage change.  

Remember NOT to take your Med in the morning before you get the lab draw. This may show less FT3 in the blood and won't really change the FT4 level that much. Assuming you will still be lower in the range for FT4, it would then allow your Dr to feel more comfortable with raising y our Armour dose again. Assuming of course your TSH doesn't get suppressed and the Dr will freak out and CUT your dose.
Helpful - 0
I am 4 weeks on the current dose. The last lab tests i took it two weeks ago. Ok Then I will wait few more weeks before I get the new tests.
Thank you very much!
Ok so6 weeks after i started on the new dosage of 90 mcg. TSH cam back 1 and free T4 is still at 0.9. I think this free T4 is still low for me. I dont feel at my optimum level. I can walk 4 miles but if I run i will get exhausted and normally i shouldn't feel like that. How do I increase my free T4 level. Do I just have to increase the dosage to 2 grains or is there any other option?
Avatar universal
you are on only 1 grain of Armour.  Most people I believe to feel well are more often taking between 2 and 3 grains.

My wife and daughter both do better on dual synthetic, than they ever did on Armour.  Other people have different results.  But you are clearly undermedicated currently.
Helpful - 0
I was switched on 9o mcg one month ago. TSH came back 3 which is still high but the doctor said to wait one month at least before getting the thyroid blood test. I feel much better than two weeks ago but I want to feel even better.
Avatar universal
Sending you a PM with info.  To access, just click on your name and then from your personal page click on messages.
Helpful - 0
Avatar universal
Sorry, I should have also asked if you took your thyroid med in the morning before the blood draw for those tests?  Also, what dosage were you on when those tests werre done and how long on that dosage?
Helpful - 0
Yes, i took the thyroid med in the morning before the blood draw. I was on 60mcg Armour Thyroid for 5 weeks. I had 4 days (random days) when i thought the med was too strong and I took half of the dosage.
I also want to mentioned that since I started on levothyroxine  two years ago, I started to take vitamin D few times a week  iron supplements, Calcium. I also drink beet and carrots juice 3 times a week (one glass) and a green juice 2-3 times a week( 2 glasses).
I eat meat in moderation, I am trying not to eat meat few days a week ( typically 2-3 days).  Another thing that I noticed, was when my TSH, T4 or T3 are not in range I crave sugar... and there are times when I eat ice cream or chocolate  even if I know I shouldn't do that.
I also take probiotics.
I hope that helps...
As of today I am still tired... not like I was last week...but still.. I also started to have some heartburn (I never had heartburn in the last 10 years)
One thing that I was thinking..... why  cant I take for example one or two times  a week levothyroxine until my TSH gets  to a normal level?
Avatar universal
Please post your thyroid related test results and their reference ranges shown on the lab report.  Also, since symptoms are even more important, please tell us about all the symptoms you have.  
Helpful - 0
T3,Free Interface External 4.1 pg/mL 2.3 - 4.2 pg/mL
TSH Interface External 47.55    Reference Range   > or = 20 Years 0.40-4mIU/L
Free T4 Interface External 0.8 ng/dL 0.8 - 1.8 ng/dL

Cortisol,Total Interface External 22.1 mcg/dL mcg/dL
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0

Ferritin Interface External 63 ng/mL
16 - 154 ng/mL

Two weeks after starting getting armour thyroid I started to be a little tired. I was still continue with my daily routine. However, after that  I was even more tired, not be able to concentrate, i couldnt run anymore. I am still walking 30 min now but I feel very tired after that.
I have some muscle ache but other than that I dont have any other symptoms.

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