Are you still around, Norty1? Come back tell us your progress, if you could. thank you. Many people have problems. Hopefully no news is good news? Best.
I wouldn't bother testing for TSH. It means nothing when taking thyroid med. Just stay with the plan and get the doctor to continue increasing your thyroid med dosage.
Quite often hypothyroid patients report feeling no better, and sometimes even a bit worse, when increasing their med dosage until TSH becomes suppressed. After that , further increases in dosage will start raising your FT4 and FT3 levels. To get to a good level for you will most likely require your FT4 near mid-range and your FT3 in the upper half of its range. And don't forget that symptom relief tends to lag a bit behind reaching those levels. Are you supplementing for iron? Your B12 was good. Without looking back through everything do you have a test for Vitamin D?
In view of your symptoms I have no clue about the reduction. Small doses of thyroid med do not raise serum levels. Our bodies are used to a continuous low flow of thyroid hormone in the treated state. When taking thyroid med it causes the TSH to do down, thus reducing the output of natural T4 and T3. So only when TSH is basically suppressed will further increases in dosage start to raise your FT4 and FT3 levels.
You need a full replacement dose that relieves symptoms. Since an average thyroid gland produces about 94-110 mcg of T4 and 10 - 22 mcg of T3 daily, when you consider that absorption is only about 85% that means the average daily replacement dosage needs to be about 2 - 3.5 grains of desiccated thyroid med (120 - 210 mg). So you can see just how far your current dosage is from those levels.
I suggest that you stay with the plan and continue to increase your med dosage toward getting your FT4 around mid-range, and your FT3 into the upper half of the range, and adjusted from there as needed to relieve symptoms. And as mentioned previously, don't overlook the importance of supplementing for Vitamin D, B12 and ferritin as needed to optimize. One other thing to keep in mind is that symptoms typically lag behind changes in med dosages. So for the best overall result, patience is important to avoid unnecessary changes. .
Before further discussion please answer the questions about whether you took your thyroid med before the blood draw, and if so what was the amount?
I don't really understand why you would have felt any significant difference with only an increase of 15 mg of Armour; however since your FT3 was lower than optimal for most people, and your doctor is willing to increase your T3 dose, I'd go ahead and do that. You really want your Free T3 in the upper half of the range, and adjusted from there as needed to relieve symptoms. Which raises a question. Did you take any thyroid med before those last tests? If so, how much was taken?
Thyroid med will have little or no effect until the dosage is high enough to essentially suppress TSH. After that dose increases will start to raise FT4 and FT3 levels. Even with that the effect on symptoms lags behind changes in med dosage and you are a long way from anywhere near optimal dosage. I suggest you stay with the plan, Understanding the process will help you with the patience you will need.
A grain of Armour (60 mg) has 38 mcg of T4 and 9 mcg of T3. With that ratio of T4 and T3, a person taking Armour will typically end up with FT3 higher in range than FT4. so I don't see any need to also raise your T3 med.
Don't forget that you should delay your morning thyroid med until after the blood draw for thyroid testing, in order to avoid false high results that tend to confuse things. Also don't overlook the importance of supplementing for Vitamin D, B12 and ferritin as needed to optimize.
I know it is easy for me to say, but I'd stick with the plan I gave you on Feb. 9, that is used by an excellent thyroid doctor.
Yes, I think changing too soon is a problem. There is no way you would become hyper from such a small amount of cytomel. You need to commit to a plan for dosage and increases and stick with it unless there is some unforeseen reaction you cannot tolerate short term, which is not likely with your cortisol and ferritin levels.
That is a small amount of Cytomel. You could try to get the doctor to agree with increasing your dosage every two weeks, as mentioned, and you can tell if it is going well. You don't need labs any more often than 4 or 5 weeks at the earliest.
There are a lot of good iron supplements such as ferrous fumarate or ferrous bisglycinate. Another very good one is VitronC, which contains 65 mg of iron. With your ferritin level, I would not want to average more than about 25 mg daily and then test for ferritin again after a couple of months.
Self medication is not usually recommended. You need to get your doctor on board with med dosages. Just to be cautious, if it were me I would start with 30 mg of Armour, and drop the Cytomel to 2 1/2 mcg twice a day. I would also make appt. with doctor and get agreement for dose increases as mentioned above.
I don't think hair shedding is something that occurs in a short time as a result of a change like that. It is important to note that when you start on thyroid med, the dosage is not additive to your prior totals. The med causes TSH to go down, and as a result your output of natural thyroid hormone is reduced. This continues with dose increases until TSH becomes essentially suppressed. Then any further increases in thyroid med will start to raise your levels. People often find that their symptoms are no better, and maybe even worse, when starting on thyroid med, until the dosage is adequate to raise the prior FT4 and FT3 levels. You may be interested in this description of how an outstanding thyroid doctor doses his hypothyroid patients. " To initiate Thyroid Replacement Therapy with NDT in patients who are healthy and less than 50yrs. old, I start with 1/2 gr of NDT (30mgs) and increase by 1/2 gr every two weeks up to 1.5 to 2 grs, depending on body weight. In elderly or ill patients or those with suspected hypocortisolism, I start with just 1/4gr and increase by 1/4gr every two weeks up to just 1 to 1.5grs daily. " Then he extends the time between any further increases needed to relieve hypo symptoms, since symptom change tends to lag somewhat changes in med dosage.
If I haven't mentioned it previously you should make sure to always delay your morning thyroid med until after the blood draw for thyroid tests that day, in order to prevent false high results.
No, I see no current reason to go on Cytomel only.
With the symptoms you reported, your test results of FT4 at only 33% of its range and FT3 at only 29% of its range, along with your experience with the other desiccated type meds, I suggest that you need to stay with Armour and increase dosage until you get your levels high enough to relieve hypo symptoms. To achieve an average daily replacement dosage, this typically requires a dosage between 150 and 225 mg of Armour. The key is to increase your dosage enough to relieve hypo symptoms, without going too far and creating hyper symptoms. Along with that make sure to keep your Vitamin D at least 50, test and supplement for B12 to get it in the upper part of its range, and ferritin should be at least 100, so you could supplement a bit there also.
If your doctor is willing to do what seems to be needed, that is a huge for you. I would stick with that doctor and see if we can give you info needed to help with your issues.
The assumption that your reaction to raising your med dose is due to low cortisol is not confirmed by your cortisol tests. That doesn't totally ruld out inadequate cortisol effect, but I think you should look elsewhere for now. Reactions to raising T3 med can is reported to also be a possible effect of low ferritin?iron. Have a look at this link and you will see what I am talking about.
So I suggest that you get a full iron test panel: serum iron, TIBC, transferrin, and ferritin. Ferritin is a precursor to iron levels, so it shows up low iron early.
What is the answer for my question about the cause for your hypothyroidism?
First, I would really like to understand the cause for your initial diagnosis of hypothyroidism. What did the doctor say was the cause?
Next, I don't think your symptoms have are caused by the brand of med.
I think you have never been adequately medicated. Thyroid med is not directly additive to your prior levels. The reason is that when you start the med, your TSH level goes down in response. That results in less stimulation of the thyroid gland to produce hormone. The net result of doses like you have been taking is basically very little when the doctor is dosing you based on TSH. A person's TSH test compared to a group based reference range cannot reliably indicate a person's thyroid status, even in the untreated state. After starting thyroid med, TSH is basically a wasted test. A hypothyroid patient should be given thyroid medication as needed to relieve hypo symptoms, without going far enough to cause hyper symptoms. Typically , with desiccated med like Armour, this will require Free T4 around 35 to 50 % of its range, and Free T3 in the upper half of its range, and then adjusted from there as needed to relieve symptoms. Studies have shown that symptom relief was mainly associated with Free T3 levels, and less with Free T4. It is also important to note that the levels I mentioned for FT4 and FT3 are based on the patient not taking their morning thyroid med until after the blood draw, in order to avoid false high test results. So make sure to do that in the future.
Hypothyroid patients are also frequently deficient in Vitamin D, B12 and ferritin. If not tested for those, you should do so and then supplement as needed to optimize. D should be at least 50 ng/ml, B12 in the upper part of its range, and ferritin should be at least 100. Hair loss is often associated with hypothyroidism and/or low ferritin.
I am not optimistic that you can get the treatment needed from your doctors, based on your experience to date. If you want to try and persuade them to treat as I suggested, then you can click on my name and then scroll down to my Journal and read at least the Overview of a paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective. You can give a copy to your doctor and ask to be treated clinically, as described, to relieve symptoms, rather than based on TSH. If you have no hope that will work, then you will need to find a good thyroid doctor. If you will give us your location perhaps we can suggest a good thyroid doctor in your general area.
We need more info in order to try and answer questions. What was diagnosed as the cause for you being hypothyroid 7 years ago? When you switched to NatureThroid and then NP were those doses the same as the Armour. Also what was the Cytomel dose when you tried that? Please post your thyroid related test results and reference ranges shown on the lab report from when you were on Armour and any other test results since.
Please review the following list of typical hypothyroid symptoms and tell us which ones you had when on Armour, if any. Also which symptoms do you have now besides the ones you mentioned?
Increased sensitivity to cold (temp. below 98.6 which is considered normal)
Constipation ( have to use fiber or laxatives)
Dry skin (have to use moisturizer)
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Slowed heart rate
Enlarged thyroid gland (goiter)
What makes you think you may have an adrenal problem?