Need help understanding...

[bizzylizzy06]

Been On Armour 60mg for several months...
On 9/26/17- I went to cancer dr follow up on an immune system problem I have & one of the normal run-of-the-mill tests he checks is tsh (I did not take my Armour prior to having my blood drawn). My tsh results were 4.77 (0.34-5.60)

Then, 3 days later my endocrine dr FINALLY came back to work & is able to see me after having been off work for 12+ weeks from having open heart surgery. He gave me orders for labs. (I went the next morning to have my blood drawn, & I DID take my 60mg of Armour beforehand) Here was the result from 9/29/17:
TSH-11.10 (0.27-4.20)
FT3-4.0 (2.6-4.4)
FT4-0.99 (0.8-1.70)
ACTH-36.8 (7.2-63.3)
Cortisol-11.8 (6.0-18.0)
Vit D-38.7
Vit B12-412 (211-946)
C-peptide-3.0 (1.1-4.4)

(Note the incredible difference in tsh)

I'm having severe hypo symptoms. Went back to dr on 10/31 and got new orders for repeat labs and then increase Armour to 90mg...What does my body need? Do you think adding time released t3 would help? Ugh....I'm at such a loss and don't have the energy to keep going down rabbit holes...

[gimel]

Armour has adequate T3 to take care of your needs, if you get the dosage right.  Your Free T4 of .86 is barely in the range, and the range is far too broad also.  Your Free T3 of 2.9 is only at 17% of its range, and that range is far too broad also, due to erroneous assumptions used to establish both ranges.  I assume that you took your med before the blood draw for those latest tests, which would make the results higher than the average effect.  Even the AACE/ATA Guidelines for Hypothyroidism suggest that the morning dose should be deferred until after blood draw.  

Please note again, the prior quote from an excellent thyroid doctor, "in tests done about 24 to 28
hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."   So you need to increase  your Armour dosage as necessary to relieve symptoms.

So your results are nowhere near those suggested levels and you are suffering with hypo symptoms.  As I mentioned, a good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and free t3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not just test results.  If your doctor is unwilling to treat clinically, as described, then you can try to influence his decision by giving him a copy of the link above, and ask him to reconsider.  If that doesn't work then you will need to find a good thyroid doctor that will do so.  

And don't forget to supplement with Vitamins D and B12, and also get tested for ferritin and supplement as needed to optimize to at least 100.

[gimel]

What your body needs is enough thyroid hormone to relieve hypo symptoms.  That has to be the objective for treatment.  TSH is a pituitary hormone that is affected by so many things that is indicative of thyroid status only when TSH is at extreme values.    TSH has only a weak correlation with Free T4 or Free T3, and negligible correlation with symptoms, which are patients' concern.  A good thyroid doctor will treat a hypothyroid patient clinically, by testing and adjusting Free T4 and Free T3 levels as needed to relieve symptoms, without being influenced by resultant TSH levels.  Symptom relief should be all important, not test results.  TSH should never be used to determine med dosage.  Hypo patients taking adequate thyroid med usually have a suppressed TSH level.  Contrary to most doctors' belief, a suppressed TSH does not mean hyperthyroidism, unless there are accompanying hyper symptoms due ot excessive levels of FT4 and FT3.

It is reported that "in tests done about 24 to 28
hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates for the lower FT4 levels on NDT."  Your levels don't appear to be optimal since you took your med before the blood draw, which can cause false (higher) results.  Which makes me ask if you deferred your Armour until after the blood draw for the recent tests?

In addition, hypo patients are frequently deficient in Vitamin D, B12 and ferritin.  You need to supplement both your Vitamin D and B12.  D should be at least 50 ng/mL,  and B12 in the upper end of its range.  You also need to test for ferritin and supplement as needed to get up to 100.  All 3 are very important for a hypo patient to feel best.  

You can read about this in the following link.  I highly recommend reading at least the first two pages, and more, if you want to get into the discussion and scientific evidence for all that is recommended.  


http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

[bizzylizzy06]

Thanks gimel!! My dr told me to make certain I took my Armour as scheduled so I did. I take it about 3:30-4am with lab draw somewhere around 8-8:30am.

Here’s my lab results from 10/31 on 60 mg of Armour...

Tsh- 5.68 (0.27-4.20)
FT3- 2.9 (2.6-4.4)
FT4- 0.86 (0.8-1.70)
Vit D-39.3 (in the sufficient range)
Sodium- 143 (133-145)
Chloride- 106 (96-108)

[bizzylizzy06]

Does these numbers suggest adding more Armour could help balance everything out or would adding just more T3 (perhaps compounded time released T3) or supplementing with just T4? What’s your thoughts?

[bizzylizzy06]

Today is Day #3 on the 90mg of Armour & day #2 of adding back in a probiotic & I can already tell a difference. I’m still feel somewhat tired but I’m not struggling as hard & a$$ dragging like I have been for weeks on end...I feel a little more bright eyed & bushy tailed

[bizzylizzy06]

forgot to mention: also have been dx with hashimoto's & labs drawn on 10/31 will get back tomorrow