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Should I lower my thyroid med?

Hello, a functional doc just took my labs and it shows tsh is low,  .848 and t4 is normal, 6.8 and t3 is normal,172.
They think I am taking too much armour thyroid medication and suggested I lower it. I dont know what to do. I dont want to cause any problems....but I am wondering if my bouts of exhaustion and nervousness and irritability could be stemming from to high of dosage if the armour thyroid.
So if T3 and T4 are in normal range is it advisable to lower med?  I am confused, please help, thank you.
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Avatar universal
That is correct.  TSH does not accurately indicate your thyroid status when taking thyroid med.   The med dose should be adjusted as needed to relieve hypothyroid  symptoms.  Taking Armour thyroid, that usually requires FT3 above mid-range, and FT4 will be below mid-range.   When taking Armour thyroid, the FT3 typically runs higher in range than FT4.  But everyone can be different in their levels required to feel normal.  Along with that, of course, you also need to optimize Vitamin D, B12 and ferritin.

For now, you need to get your ferritin level higher, and if you want short term relief from your current symptoms, you can reduce your Armour dose, until you get your ferritin level optimal in about 4-6 weeks.
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Avatar universal
Doctors never tell patients, but the AACE recommends waiting until after the blood draw,  to take thyroid med.  The reason is that the med spikes your levels for a short time, giving you false high FT4 and FT3.  It also has a suppressive effect on TSH.  

So you really can't be sure of your real thyroid levels at this time; however, as I said,  I seriously doubt you are taking too much Armour, since your dose is only 60 mg.

I don't have any knowledge about the effect of tapering the antidepressant.  I do know of several examples where ferritin was too low for the FT3 level, causing symptoms kind of like yours.   You do need to supplement for ferritin by taking one tablet of iron daily.  A good source is  Iron + C , for which CVS has an inexpensive  generic.  I expect it will take 4-6 weeks for your ferritin to optimize.  In the interim you could cut your Armour, not because of your TSH level, but to help with symptoms.  Once you re-test in say 6 weeks and confirm your ferritin, then you could go back up on Armour.

After getting that straightened out, as I expect will happen,  the next steps will be to get your doctor to understand that the best way to treat hypothyroidism is not based on TSH level, but by adjusting thyroid med as needed to relieve symptoms, assisted by tests for Free T3 and Free T4, before the blood draw.   You also need to know B12, and supplement as needed to raise it to the upper part of its range.

If your doctor resists doing these thing, give a copy of my paper in this link, and request to be treated clinically, as described, not by TSH.

https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/
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2 Comments
Thank you, its alot to digest, i will work on it.
Hello Gimel,
    So if I am understanding you correctly,  one should not go by tsh levels but by FT3 and FT4 levels? If this assumption is correct,  what do u consider normal range for the FT3 and Ft4?   And if its below normal range what does this mean? And if it is above normal range what does this is mean?
    
Avatar universal
Lab results and their calculated reference ranges can vary from one lab to another.   I should have asked for the ranges but I was not expecting Free T4 and Free t3 results.  Please post those.

With your thyroid dose of only 60 mg of Armour I see no way for you to be hypothyroid.  

Another thing that is very important.  What time of day did you take your Armour and when was the blood draw that day?

Your Vitamin D needs to be at least 50, so you need to supplement with D3.  typically it would take about 1000 IU per day for you to get up to 50.  You also need to test for B12.  It is important for energy.  Most important, based on your symptoms, I think you need to test for ferritin, which  is the storage form of iron readily available for use.   It needs to be at least 100.  Ferritin levels that are too low for the Free T3 level can sometimes cause symptoms like those you mention.  

So before changing anything I suggest getting tested for ferritin and B12.  Can you make this happen?
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3 Comments
Wait a minute i found ferritin on the report! it is 57....so it is under a hundred...how do you change that ....take iron?...also...I daily take a b12 complex...i have for a long time.
The report says T3 free is 3.7, after that it says units is pg/mL.  And reference interval (which i am asuuming is the range u want?) Is 2.0 -4.4
The T4 free (direct) is 1.02......unit is ng/dL.....reference interval .82-1.77
Thank you
Wait a minute i found ferritin on the report! it is 57....so it is under a hundred...how do you change that ....take iron?...also...I daily take a b12 complex...i have for a long time.
The report says T3 free is 3.7, after that it says units is pg/mL.  And reference interval (which i am asuuming is the range u want?) Is 2.0 -4.4
The T4 free (direct) is 1.02......unit is ng/dL.....reference interval .82-1.77
Thank you
Also, I took the med in the morning and about 3 to 4 hours later had the test.
Avatar universal
Treatment for hypothyroidism should never be based on TSH.   Although TSH is a pituitary hormone that is used as a surrogate for a person's thyroid status; TSH has only a weak correlation with the actual thyroid hormones and a negligible correlation with a patient's symptoms which are the most important indicator, followed by the active thyroid hormones, Free T4 and Free T3.  

It appears you were tested for Total T4 and Total T3, which are not nearly as revealing as Free T4 and Free T3, which are the small portion of the Totals that is not bound to protein which makes it inactive.  

So, before going further please confirm what tests those are.  and also tall us all symptoms that you have.  Also what is your dosage of Armour thyroid?  Also if tested for Vitamin D, B12 and ferritin please  post those as well.
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1 Comments
Thank you for your response.
The above, I believe is just T3 and T4.
And yes also on the lab report it shows  a free T3, which is 3.7 and a free T4(direct) which is 1.02.
Vitamin d level is 39
I dont see b12 or ferretin on this report. My dosage of armour thyroid is 60mg
I have been on it for 10 years.
I was recently on 2 antidepressants and just weaned of of one of them.
So I thought maybe my symptoms were because of tapering an antidepressant., but maybe its because of too much thyroid med? I can have racing thoughts, i want to rush here and there,  I have to tell myself to slow down. I have nervousness,  get overwhelmed and stressed easily...loud noises bother me ect.....as i said thought maybe its my cns adjusting to the antidepressant taper.
I feel exhausted at times...
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