# hypo recovery - some symptoms improve, others worsen??



## Jmobie (Jan 12, 2013)

This past week has been sort of weird for me, but very pleasant. I just had my most productive work week in many months, so I'm ecstatic about that. Ten weeks after starting Acella, and 3 weeks after my increase to 90 mg, it feels like I smashed through a mental brick wall. I have been able to give ideas more thought, just think deeper, and make sounder decisions more quickly. It feels great! Not a big improvement, but noticeable. However, it seems like my fatigue and facial edema have worsened. Does this happen? It's like my body is saying "Hey Energy and Face! Brain is finally willing to accept this thyroid med. So, it's going to be taken care of now, and you guys can wait until Brain is healthier." Is this how recovery goes? I know my Free T3 level is low (261, 230-420 tested 3 weeks ago), but is this a sign I need a higher dose? Is it true that as your organs and cells begin accepting the T3, there is less to go around for general energy?

Thanks!


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## Andros (Aug 26, 2009)

Jmobie said:


> This past week has been sort of weird for me, but very pleasant. I just had my most productive work week in many months, so I'm ecstatic about that. Ten weeks after starting Acella, and 3 weeks after my increase to 90 mg, it feels like I smashed through a mental brick wall. I have been able to give ideas more thought, just think deeper, and make sounder decisions more quickly. It feels great! Not a big improvement, but noticeable. However, it seems like my fatigue and facial edema have worsened. Does this happen? It's like my body is saying "Hey Energy and Face! Brain is finally willing to accept this thyroid med. So, it's going to be taken care of now, and you guys can wait until Brain is healthier." Is this how recovery goes? I know my Free T3 level is low (261, 230-420 tested 3 weeks ago), but is this a sign I need a higher dose? Is it true that as your organs and cells begin accepting the T3, there is less to go around for general energy?
> 
> Thanks!


Absolutely. If your doctor agrees and I sure hope so, titrate by small increments every 8 weeks so you don't bypass your euthyroid state.

Please read.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

See; as you start to feel better, you increase activity. Sometimes this is very insidious but normal and necessitating further titration.


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## Jmobie (Jan 12, 2013)

Thanks, Andros. My next appointment and lab tests are in about 2 weeks. On a side note, I started splitting my 90 mg into 2 doses- 45 at 8 AM, and 45 at 8 PM. It has helped immensely with getting started in the morning. I do get a little boost before bed, but because everything is working much more quickly, I am also falling asleep more quickly and sleeping better, I think.

One symptom that is getting out of control is sweating. I have had armpit sweating during the day and heat sweating at night maybe a bit more than the normal person these last several years. Now that I think about it, the way this has been worsening with my brain fog over these past years, it seems like another hypothyroidism symptom. But even with better NDT treatment that has improved many of my annoying symptoms like brain fog, cold hands and feet, my sweating has worsened. I bought clinical strength, weekly antiperspirant swabs to control my armpits. My face's T-zone area is now always oily during the day. This oily face thing is new and started after beginning NDT. Astringents have not worked. My nose has had very large pores for a while because of being hypothyroid probably, but now it's like they've been activated to release oil.

Is this normal for the transition from hypothyroidism to euthyroidism? Has anyone else experienced this sweating roller coaster? I am beginning to no longer be surprised if a new symptom appears on this journey to good health. Any new symptom is fair game, and if it's raining now, it might be pouring later. I am kind of encouraged though that these new symptoms have not appeared until I have been on 90 mg. Hopefully that means this dose is strong enough to be making a difference, like a wrecking ball to an abandoned house, even though I need to be on a stronger dose long-term.

Thanks!


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## Andros (Aug 26, 2009)

Jmobie said:


> Thanks, Andros. My next appointment and lab tests are in about 2 weeks. On a side note, I started splitting my 90 mg into 2 doses- 45 at 8 AM, and 45 at 8 PM. It has helped immensely with getting started in the morning. I do get a little boost before bed, but because everything is working much more quickly, I am also falling asleep more quickly and sleeping better, I think.
> 
> One symptom that is getting out of control is sweating. I have had armpit sweating during the day and heat sweating at night maybe a bit more than the normal person these last several years. Now that I think about it, the way this has been worsening with my brain fog over these past years, it seems like another hypothyroidism symptom. But even with better NDT treatment that has improved many of my annoying symptoms like brain fog, cold hands and feet, my sweating has worsened. I bought clinical strength, weekly antiperspirant swabs to control my armpits. My face's T-zone area is now always oily during the day. This oily face thing is new and started after beginning NDT. Astringents have not worked. My nose has had very large pores for a while because of being hypothyroid probably, but now it's like they've been activated to release oil.
> 
> ...


I don't think I have the answer for you but I do know that this is hormonal and the transition to NDT may be bringing the toxins out. I did have a similar experience when I started Armour (dessicated porcine thyroid.)

Have you talked to the doctor about this? Do you think it is your growth hormone?


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## I DClaire (Jul 31, 2011)

My temperature has been wildly erratic since I went back on Synthroid recently. My husband has been sleeping in our guestroom because he says my constant pulling on the covers, then throwing them off, then pulling them on me again is driving him crazy! I'm sleeping soundly and am not terribly aware of how disruptive my actions are but our bed looks like a tornado hit it every morning!

During the day I'm extremely colder than I have ever been.


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## CA-Lynn (Apr 29, 2010)

Are you menopausal?


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## I DClaire (Jul 31, 2011)

CA-Lynn said:


> Are you menopausal?


Me? :ashamed0003: I had a emergency total hysterectomy when I was 40 years old...I'll be 67 this coming summer. The problems I've had with thyroid hormone replacement pales in comparison to what I endured for several years because I never could tolerate estrogen replacement drugs. And, all the buzz back then was the relationship between estrogen and breast cancer and with that particular cancer rampant on both sides of my family, my doctors didn't want to even try options like compounded estrogen. I tried multiple estrogen and estrogen/combination drugs with horrible side effects. Eventually I worked my way through my instant "menopause" but I think perhaps that was the beginning of my ensuing years of health problems.

Even after all these years though, I will sometimes have a _power surge_ when something unexpectedly throws me for a loop.


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## Jmobie (Jan 12, 2013)

Andros said:


> I don't think I have the answer for you but I do know that this is hormonal and the transition to NDT may be bringing the toxins out. I did have a similar experience when I started Armour (dessicated porcine thyroid.)
> 
> Have you talked to the doctor about this? Do you think it is your growth hormone?


It's good to know this is somewhat normal then. It makes sense that hormonal changes would affect the sweat and sebaceous glands. Is it because these glands had been so dried up due to hypothyroidism and now they're adjusting to working again with treatment? I gave my doctor a list of symptoms, including one being an oily face, during my visit last month. It has since worsened as has my sweating. I'll mention this for sure during my next visit in 2 weeks. It could be the growth hormone, but I think it's the thyroid treatment, since the oily skin started after I began NDT and before I went back on GH.

Thanks!


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## Andros (Aug 26, 2009)

Jmobie said:


> It's good to know this is somewhat normal then. It makes sense that hormonal changes would affect the sweat and sebaceous glands. Is it because these glands had been so dried up due to hypothyroidism and now they're adjusting to working again with treatment? I gave my doctor a list of symptoms, including one being an oily face, during my visit last month. It has since worsened as has my sweating. I'll mention this for sure during my next visit in 2 weeks. It could be the growth hormone, but I think it's the thyroid treatment, since the oily skin started after I began NDT and before I went back on GH.
> 
> Thanks!


Please let us know what the doctor's input is and how you are feeling in a few weeks.

Yes; the body holds on to those toxins. Especially when hypo as all motility for bodily functions have severely slowed down. Drink plenty of water when you can to speed up the process. That might help!

And work out hard! LOL!!!


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## Jmobie (Jan 12, 2013)

Andros said:


> Please let us know what the doctor's input is and how you are feeling in a few weeks.
> 
> Yes; the body holds on to those toxins. Especially when hypo as all motility for bodily functions have severely slowed down. Drink plenty of water when you can to speed up the process. That might help!
> 
> And work out hard! LOL!!!


So I saw my endocrinologist today and told her that all my symptoms have been improving still. I've been on the 90mg dose for six weeks, and it is definitely making a difference. Three weeks ago my brain fog began lifting noticeably, and my energy and hairline have been returning since starting NDT in January. I just feel better. However, she didn't test my levels today and wants to see me again in 6 months and test me then. I was kind of bummed at first when the lab receptionist told me I couldn't have my labs done today. My endo does look at all three levels together- TSH, FT4, and FT3- as well as symptoms, but it sounds like she's taking the conservative approach in letting my GH levels rise and the 90mg dose do as much as it can. I guess the plan is if I still show symptoms in October, then maybe another dose increase can be made. I can see where she is coming from. I'm not quite back to normal, but I am slowly returning. My thyroid itself is fine- it's just not getting the instructions from my pituitary to release the sufficient amount of hormones. So I probably won't need to be on a full dose like 150 or 180mg of Armour or NDT long term. I would like to see how I feel on 105 or 120mg. Working on my ferritin levels in the meantime will also continue to help the fatigue. I have upped my water intake because the oily skin and facial edema may be partly related to dehydration.

What do you guys think? Does all this make sense? Is 90mg high enough to be on for over 6 months? I don't really feel like switching doctors again. She is really nice and sensed the urgency during my last appointment unlike my previous endo.

Thanks!


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## Jmobie (Jan 12, 2013)

Hi everyone. I've been thinking about my doctor's decision to wait things out, and if someone could please answer these questions, that would help me a great deal. If a person is on a less-than-optimal dose of natural dessicated thyroid, containing both T3 and T4, does that person's symptoms generally remain the same? I can certainly understand how that person may never feel his or her best, but would the person ever begin to gradually feel worse over time? I've read about a number of patients, like me, who had been on a constant dose of Synthroid and felt worse over time. Please correct me if I'm wrong, but I would think that continuing to receive exogenous T3 as well as T4 would prevent symptoms from worsening. What about symptoms actually improving? Does repairing damaged cells and regrowing hair use up more T3 than maintaining cells and hair health? I know my 90mg dose has been working for me, and I hope it continues. As I am continuing to feel better, slowly moving from repair mode to maintenance mode, will there be more T3 to go around for more energy?

Thanks!


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## bigfoot (May 13, 2011)

Interesting technical questions, and ones I don't really know much about, other than to relate my own experiences. For me, I've been on a roller coaster of different thyroid meds over recent years, as well as adjusting other hormones (testosterone). At certain points I have definitely noticed far, far more sweating than I was used to. Same goes for acne and the oily face. Right now, likely somewhat under-medicated on NT, I am not having a lot of sweating or acne (thankfully). Hormones, thyroid and otherwise, are a total PITA to balance.

For you, on the plus side, your brain fog is much better and energy improved, amongst other things. If you aren't comfortable waiting six months, I'd call the office back and ask for an appoint in, say, three months. To me, waiting six months to monitor things that have been bothering you seems like a little much. Keep track of trends you notice, which it sounds like you are already doing, and maybe ask for labs to be done prior to your appt.


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## Jmobie (Jan 12, 2013)

bigfoot said:


> For you, on the plus side, your brain fog is much better and energy improved, amongst other things. If you aren't comfortable waiting six months, I'd call the office back and ask for an appoint in, say, three months. To me, waiting six months to monitor things that have been bothering you seems like a little much. Keep track of trends you notice, which it sounds like you are already doing, and maybe ask for labs to be done prior to your appt.


Thanks for the suggestion, bigfoot. I'm seeing my PCP next week, and asked my endo if I could have my TSH, FT3, FT4 tested then to see if my dose could be increased. I was also able to schedule an appointment with my endo in July. So hopefully, I can finally get my FT3 into a good range this summer rather than next year. I told her in my message (through the hospital system) that, in March, each one of my symptoms individually would vanish for a day or so, but they could never vanish altogether. It felt great to think extremely clearly, even though I was a little tired. So, it's encouraging. Lately, things have been much more stable, about 7 weeks after the increase to 90mg. I feel good, better than in January, just not as good as I could possibly feel. The 90mg must have ran its course.

Thanks!


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## Jmobie (Jan 12, 2013)

Ok, now I'm really confused. I just received my lab test results after having been on 90 mg of Acella NP Thyroid for about 8 weeks. My Free T3 dropped, and my Free T4 stayed the same. I'm afraid my endocrinologist won't increase my dose anymore because of my low TSH. I feel better than I did in January, before starting NP Thyroid, but I really feel that I could use an increase to 105mg. I know it's a silly reason, but ending up at 120 mg would be ideal, so I could take 2 doses of 60 mg daily. I'm really getting tired of using a pill cutter.

5/10/2013 (most recent, after 2 months on 90mg)
FREE T3	245	230 - 420 PG/DL
FREE T4	0.8	0.8 - 1.7 NG/DL
TSH 0.09	0.40 - 4.60 UU/ML

3/6/2013 (after 1 month on 75mg)
FREE T3	261	230 - 420 PG/DL
FREE T4	0.8	0.8 - 1.7 NG/DL
TSH 0.41	0.40 - 4.60 UU/ML

2/8/2013 (after 1 month on 60mg)
FREE T3	248	230 - 420 PG/DL
FREE T4	0.8	0.8 - 1.7 NG/DL
TSH 0.53	0.40 - 4.60 UU/ML

What do you guys think? Is my low TSH irrelevant now that I'm on natural dessicated thyroid? I hope she pays attention to my FT3. Could my FT3 be lower because I had my blood tests taken around noon, about 24 hours after my 2nd half-dose the day before? I was feeling somewhat hypo at the time of my blood tests because of essentially skipping my 1st half-dose in the morning. (I took my 1st half-dose immediately after my tests and the my 2nd half-dose at 4 pm.) I thought for sure my FT3 would come back around 280-300 the way I feel now compared to February. I would be ecstatic if I could get my FT3 above 320, and my FT4 up to 1.0. Also, I read something about taking NDT, which suppresses TSH, which in turn suppresses natural T4 production and conversion to T3? Could this be what is happening? Although my thyroid gland is fine likely, it's not doing its job because my pituitary is not doing its job.

I certainly have no hyper symptoms. My hair continues to shed, yet it's thicker, which is amazing. I still have trouble metabolizing alcohol, and I'm going through an oily face phase. I usually feel drowsy around 2 to 3 PM and feel a little better around 6 PM. I heard this is a hypo symptom, as the body isn't making enough energy to keep itself active throughout the day.

Any advice would be very much appreciated. I'm not sure what my plan of attack is now.

Thanks!


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## Jmobie (Jan 12, 2013)

So I received a call from my endo's nurse that she wants to increase my Acella NP Thyroid to 120 mg! arty0006: I think my numbers are so low, that I should not have to worry about going hyper. Maybe for these first few days, haha! I'm glad she's ignoring my TSH. The last two times I saw her, she was was concerned about it getting too low, but apparently she places a higher value on FT3 and FT4. Besides maybe a faster heart rate, what else should I pay attention to as I adjust to the stronger meds?

Thanks!

UPDATE: Apparently, Acella NP Thyroid 60 mg is out of stock everywhere. So I wouldn't be able to take this twice a day. My options are 2 grains Armour or 2 grains Nature-Throid. Is one better than the other? I guess now is the best time to make the switch, at the time of a dose increase. As well as I respond to Acella, I am really getting tired of hunting it down. Armour is always available. I've gone a few stretches taking Armour because of my pharmacy filling my Acella with Armour. I felt my hypo symptoms return, so I'm a little hesitant about switching to Armour. Would I feel a good boost if I went from Acella 90 mg to Armour 120 mg?


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## Jmobie (Jan 12, 2013)

Could someone please answer these questions? Please??

Do some people just not respond well to the reformulated Armour no matter how high the dose? I took 1 grain of Armour twice today and feel like crap. I didn't expect this going from Acella 90 to Armour 120 mg. Is the T3 effect muted because it really isn't absorbed sublingually?

How different is Nature-Throid from Armour? It looks like it was reformulated, too.

Thanks!


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## Andros (Aug 26, 2009)

Jmobie said:


> Ok, now I'm really confused. I just received my lab test results after having been on 90 mg of Acella NP Thyroid for about 8 weeks. My Free T3 dropped, and my Free T4 stayed the same. I'm afraid my endocrinologist won't increase my dose anymore because of my low TSH. I feel better than I did in January, before starting NP Thyroid, but I really feel that I could use an increase to 105mg. I know it's a silly reason, but ending up at 120 mg would be ideal, so I could take 2 doses of 60 mg daily. I'm really getting tired of using a pill cutter.
> 
> 5/10/2013 (most recent, after 2 months on 90mg)
> FREE T3	245	230 - 420 PG/DL
> ...


You are undermedicated. Mid-range of the range for FT3 is 325. Most of us feel best when the FREE T3 is in the 75% range of the range supplied by your lab.

You may have to go doctor shopping. Here is some info which may help you.

TSH is no longer relevant and nor is the FT4 really regarding titration upward.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

I take 3 1/2 grains of Armour and I am a 70 year old woman.


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## Jmobie (Jan 12, 2013)

Not sure if you read my later posts, Andros, but my doctor seems to get it. She just raised my dose from 90 to 120. Now I just have to find a drug brand I can absorb. This Acella is wonderful, but it's hard to find nowadays.


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## bigfoot (May 13, 2011)

Jmobie said:


> Do some people just not respond well to the reformulated Armour no matter how high the dose? I took 1 grain of Armour twice today and feel like crap. I didn't expect this going from Acella 90 to Armour 120 mg. Is the T3 effect muted because it really isn't absorbed sublingually?
> 
> How different is Nature-Throid from Armour? It looks like it was reformulated, too.
> 
> Thanks!


I think Nature-throid and Armour are supposed to be pretty comparable. My understanding is that Nature-throid has different fillers, or something to that effect. So that could be affecting your absorption.

Edit: So are you taking Armour sublingually? I had read about that on the STTM website, but have never tried it myself.


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## Jmobie (Jan 12, 2013)

bigfoot said:


> I think Nature-throid and Armour are supposed to be pretty comparable. My understanding is that Nature-throid has different fillers, or something to that effect. So that could be affecting your absorption.
> 
> Edit: So are you taking Armour sublingually? I had read about that on the STTM website, but have never tried it myself.


For my morning dose, I chewed up a grain of Armour, but when I do that I cannot avoid swallowing the crushed parts, stuck to my back teeth. For my late morning dose, I crushed it with a mortar and pestle, just wiped the mortar clean with my finger, and let the powder dissolve a bit under my tongue. I think this is the best way to go, and might give this a few more days. Not sure if this fully takes care of the cellulose filler. I've heard doing this with a drop of honey improves absorption, but I don't understand why. It seems almost impossible to take Armour sublingually without chewing or crushing it.


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## Jmobie (Jan 12, 2013)

So I cannot take the new Armour. It's no use. Until I get a prescription for an additional 30mg of Acella NP Thyroid from my endo for a total of 120mg/d, I'm going to take 90mg one day and 135mg the next day, for a two-day average of 112.5mg.

I read an interesting post on another site about TSH and T3/T4 when first starting natural dessicated thyroid. The person said that once your TSH is fully suppressed, e.g. around 0.01, then you'll will finally start to see your FT3/FT4 numbers increase after dose increases. It takes a while for your pituitary to get with the program and realize the TSH is no longer needed. It's as if part of a person's optimal dose is for suppressing the TSH and the other part is for actually optimizing your FT3/FT4. Very interesting. It looks like my pituitary has finally gotten the memo.

Thanks!


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