still have hypo symptoms, could I be hyper?

[arianna35]

I've been on 90 mg of Armour thyroid for 4 years now.  Felt better initially, but have been feeling progressively worse for 2 years -- really, really bad right now.

Hair loss, sensitivity to cold, terrible lethargy, aches and pains, weight gain, hormonal imbalance.

My recent test results

TSH .78
T4 1.06
T3  3.33

If anything they seem more on the "hyper" side than hypo.  My doctor said that hyperthyroidism could mimic the symptoms of hypothyroidism . . still, she advised me to increase my dose to 120 mg of Armour.  Is this safe?  I don't want to overmedicate, but I'd do about anything to feel better.  

This is making every day life nearly impossible, I never feel good anymore.

Many, many thanks for any insight, I'm so confused :-/

[arianna35]

Maybe not quite so nervous about it after what I've learned here.  I was basing my fears mostly on what I thought my numbers should be, but I really didn't understand them.

You all have helped me out tremendously!

I'm going to give it a try and see what happens, I just don't think I would be this lethargic if I was hyper.

[ahmee]

Great advice here. You will know if you are getting too much thyroid because your symptoms will turn into hyperthyroid symptoms: pounding heart, anxiety, diarrhea, feeling overheated all the time, excessive weight loss. Splitting the Armour into two doses will help a lot, but chances are if you are feeling as awful as you indicate you will need to raise the dosage as well. If you are nervous about raising too high, buy a pill splitter and start out by adding an extra 1/4 grain at a time.

[flyingfool]

TSH is a pituitary hormone.  The pituitary is in the brain.  It basically is supposed to test the blood and determine if you have enough thyroid (among other duties).  If the pituitary doesn't think there is enough thyroid hormone in the blood. It secretes TSH (Thyroid Stimulating Hormone)  TSH hormone is thus supposed to stimulate or tell your thyroid gland to produce more hormone.  This is why a high TSH value means that you are low thyroid as the pituitary is trying to tell the thyroid gland with more and more TSH to turn on and crank out more thyroid.  If your thyroid can not produce the hormone, the pituitary doesn't know that and keeps putting more and more TSH in an attempt to kick the thyroid gland into gear.  Obviously the opposite occurs if the pituitary thinks there is too much thyroid hormone and it shuts off or lowers production of TSH in an attempt to shut the thyroid gland down from producing hormone.

The problem is everything doesn't always work correctly.  Either the pituitary can be messed up and not sensing correctly and/or the thyroid gland may not be able to produce enough or too much hormone or doesn't listen to the TSH and the pituitary.

TSH varies significantly throughout the day.  I've read by as much as 70% variation within a day.  This is part of the reason why TSH is such an unreliable indicator.  Not to mention the ranges used are not the best which causes many people to not be treated for thyroid and left feeling terrible.

This is why it is so important to get the two thyroid hormones tested directly. This is the Free T4 and Free T3 hormones.  Again the ranges used are really far too broad and people often report feeling poorly when below the 50% level of the ranges.  To be more specific the better rule of thumb is for people who are feeling terrible they seem to find needing to have BOTH of the following in order to feel well.

1) Free T4 to be 50% of the range or slightly higher

AND - that means in addition to

2) Free T3 to be in the UPPER 1/3 of the range (66.7%)

Notice that Both of these are WELL up into the reference ranges that you will commonly find.  Do NOT let a Dr tell you that you are perfectly fine when your ranges are towards the bottom of the scale and you feel like crap.

If a Dr is ONLY using the TSH test RUN, do not walk away to find another Dr.

Furthermore in my opinion a Dr who is treating a patient with a medication that has T3 in it borders on malpractice if they do not test for Free T3.

So for you taking Armour which has a lot of T3 in it.  As stated above I would basically ignore TSH as it is unreliable to start and even further unreliaable when taking a T3 med.  Also it is imperrative to get tested for Free T3 every time and of course Free T4.  Splitting the dose is also I'd say a good thing to do.  It helps regulate the levels of T3 in your blood as the T3 level after taking medication is about the highest about 3 hours after taking it.  So by taking half in the morning and half mid afternoon it will help you not "sag" so much towards the end of the day.  You may still have yet a ways to go to actually optimize your dosage.

If you want more info on thyroid system, I've written a long while ago while I was learing what I call a tutorial.  it is several pages long in MS Word format.  I'd be happy to send it to you if you'd like.  Just private message me with your off line e-mail as it is too long to post here or even on the PM system.

[arianna35]

Good to know, I probably would have taken it at bedtime.

Thanks so much for your time and advice, I'll keep you posted :-)

[goolarra]

Thyroid meds, especially those with T3 in them, can suppress TSH.  TSH usually becomes unreliable once on meds.

Because of the high T3 content in Armour and because T3 is so fast acting, most people split the dose.  Usually, they take part first thing in the morning and part late morning to early afternoon.  On a "normal" sleep schedule, it's often best to avoid taking it after about 3:00 pm so that it doesn't interfere with sleep.  You can experiment with what time works best for you and how best to split it (it doesn't necessarily have to be 50/50).

B-12 deficiency can also cause debilitating fatigue.

Best of luck...let us know how you make out.

[arianna35]

you're totally right - don't know how I did that but the second results are correct.

Thank you SO MUCH for your comments.  I've been googling like crazy and haven't been able to sort it out, this is the first information that makes sense to me.  Knowing about the different lab methodologies helps a lot, it's no wonder I was confused.

So on Armour it's okay to have low TSH?  
I feel much safer increasing the thyroid dose now, I just didn't want to make the symptoms worse if I already had too much thyroid.  But I agree, the symptoms scream hypo.

I haven't split doses yet, but I read that it was a good idea with Armour, so I'll start.  Just need to avoid calcium at both ends of the day.

Will also have the iron, Vit D checked, surprised my doc didn't order that since I'm so tired.

I can't thank you enough for shedding light on this, it has helped me tremendously!

[goolarra]

I just noticed that from your first posting of your labs to your second, the TSH and FT4 results were transposed.  My comments were based on the second posting.  Is that the correct one?

[flyingfool]

Also with the T3 content of Armour, don't be surprised if your TSH goes WAY low (suppressed) it is quite common for TSH to be suppressed when taking a medication with T3 in it such as Armour.

your symptoms are consistent with Hypo.  While it is true that some symptoms can be present when hypo or Hyper.  When all of them are in one direction it is almost always use the theory that if it walks like a duck and quacks like a duck.  Its a darn good bet that it is a duck!

[goolarra]

Yes, they vary because different labs use different methodologies, which can yield slightly different results.  In fact, your FT4 range is a prime example.  Usually FT4 range is closer to 0.8-1.8, so yours is scaled way down.  Your FT3 range isn't bad on the low end, but the upper end usually goes to 4.2 or above.

Your FT4 is a little low at 42% of range (50% is rule of thumb).  However, due to the high T3 content in desiccated, it's not unusual for someone on Armour to have even lower FT4.

Your FT3 is at 71% of range, and the rule there for people on desiccated is upper half to upper third of range.  So, you're barely into the upper third.

I think your doctor is right to increase your meds.  You are still having hypo symptoms, and you have plenty of room to increase and still stay in range.  

Do you split your dose into two half doses?

If this increase doesn't resolve your symptoms (it may not be immediate), you might look into your vitamin D and B-12 levels along with iron an ferritin.  All are necessary for the metabolism of thyroid hormones, and deficiencies of each can mimic hypo symptoms.

If you're nervous about the increase, you might ask your doctor if you can do it in two steps...half now and half if that's tolerated well.

[arianna35]

interesting, I had no idea the varied.  Here are the ranges and results:

TSH         ( 0.34 - 5.66 uIU/mL) 1.06
T4 free      (0.52 - 1.21 ng/dL)   0.78
T3 free     (2.20 - 3.80 pg/mL)   3.33

It would seem like the numbers are where they should be . .   yet I'm having all these symptoms.

Thanks!

[goolarra]

Please post the reference ranges for your FT3 and FT4.  Ranges vary lab to lab, so tthey have to come from your own lab report.