# Worsening of hypo symptoms after increasing Armour dosage



## hasenbraten (Apr 29, 2011)

I have been diagnosed with hypothyroidism. I finally found a doctor who increased my dosage to 4 grains of Armour a day. In addition he prescribed 25mcg of Cytomel. I felt great, for the first time in 3 years I wasn't depressed anymore. I couldn't believe it.

I did still have minor depression, and a lab test 6 weeks later revealed that my levels were still a little low, so my doctor increased the Armour once more to 5 grains. I don't know if this is coincidence, but all of a sudden I have hypo symptoms again...mainly fatigue and severe depression, to the point of feeling suicidal. Has anyone else ever experienced this? I feel so awful, I can hardly function.


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## Andros (Aug 26, 2009)

hasenbraten said:


> I have been diagnosed with hypothyroidism. I finally found a doctor who increased my dosage to 4 grains of Armour a day. In addition he prescribed 25mcg of Cytomel. I felt great, for the first time in 3 years I wasn't depressed anymore. I couldn't believe it.
> 
> I did still have minor depression, and a lab test 6 weeks later revealed that my levels were still a little low, so my doctor increased the Armour once more to 5 grains. I don't know if this is coincidence, but all of a sudden I have hypo symptoms again...mainly fatigue and severe depression, to the point of feeling suicidal. Has anyone else ever experienced this? I feel so awful, I can hardly function.


My goodness! Could we please see your most current thyroid labs and the ranges? Different labs use different ranges so please include them.

You can have fatigue and severe depression from being hyper too and symptoms can cross over. Need those labs!! Can't tell w/o them.

Also need to know your gender. It is important when looking at dose amounts and level of activity. Are you real active?

When were you diagnosed and have you had any antibodies' tests?










If you are having suicidal ideation, I do hope that you have hooked up w/a professional counselor (psychologist) and/or psychiatrist.

Keeping you in my prayers.


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## hasenbraten (Apr 29, 2011)

Thank you for the welcome. I do have my lab results, please see below. I am a 36-year-old female, usually very active (I work out 6 times/week), but as of lately i have not had the energy to do anything but sit around the house. I eat very healthy, and because I am very skinny I guess no-one ever tested me for thyroid issues. I did have an antibody test done, but I forget the results...I really like this doctor as he is the first one to bump my medication up despite "normal" results, and like I said I felt great on 4 grains. The increase to 5 was about a week ago...

TSH 0.02 L Ref. Range 0.3 - 1.5 uIU/ml
FT3 3.8 3.6 - 4.2 pg/ml
free T4 1.13 1.6 - 2.0 ng/dL

I should mention that these reference ranges are HIS preferred ranges. The value he was not happy with was the Free T4, which is why he increased the Armour.


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## lavender (Jul 13, 2010)

If you are on Armour and Cytomel, your T4 will be low because you are taking meds that are high in T3. I'm honestly concerned that your doctor may have overshot the mark and made you hyperthyroid. I am also concerned that your were increased an entire grain at once, rather than gradually. A jump of an entire grain is a pretty big shock to your system. I know that for myself, I felt really tired when I was hyperthyroid and my emotions were all over the place.


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## Andros (Aug 26, 2009)

hasenbraten said:


> Thank you for the welcome. I do have my lab results, please see below. I am a 36-year-old female, usually very active (I work out 6 times/week), but as of lately i have not had the energy to do anything but sit around the house. I eat very healthy, and because I am very skinny I guess no-one ever tested me for thyroid issues. I did have an antibody test done, but I forget the results...I really like this doctor as he is the first one to bump my medication up despite "normal" results, and like I said I felt great on 4 grains. The increase to 5 was about a week ago...
> 
> TSH 0.02 L Ref. Range 0.3 - 1.5 uIU/ml
> FT3 3.8 3.6 - 4.2 pg/ml
> ...


When taking Armour, FT4 is naturally lower than for those who do not take any T3. (Cytomel as well)

If you felt great on the 4 grains, I don't think you should have bumped up. Being over medicated can be as bad as undermedicated. You get very very tired w/hyper................very tired.

Consider this. When someone feels good, it is not wise to tamper.

Anyway, I would also suggest you get a ferritin test. Your ferritin should be 50 to 100; the closer to 100, the better.

Ferritin http://www.thewayup.com/newsletters/081504.htm

Are you still on the Cytomel as well? Your labs look really good to me.

My labs usually look pretty much like yours and I feel great also. I also used to work out 6 days a week, twice a day until they closed the Gold's Gym in my neighborhood. I went for 10 years. Now..................I have had to recon and really be self motivated here and I am pretty much but it is hard and not the same. Fast walk a lot, lift weights in the basement, do yoga and a lot of other exercises BUT..................it is not the same as going to the gym. I miss it badly.


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## hasenbraten (Apr 29, 2011)

Thank you for all your responses! I finally went in for testing, and my results speak for themselves-no wonder I feel like crap.

TSH <0.01 L Ref. Range 0.3 - 1.5 uIU/ml
FT3 5.7 Ref. Range 3.6 - 4.2 pg/ml
free T4 1.53 1.6 - 2.0 ng/dL
Reverse t3 424 Hf Ref. Range 90-350 (Doctor wants it below 220)

I feel at the end of my rope, like I will never feel better. I can't do this anymore. I have been trying for almost 4 years tp figure this out.


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## Andros (Aug 26, 2009)

hasenbraten said:


> I have been diagnosed with hypothyroidism. I finally found a doctor who increased my dosage to 4 grains of Armour a day. In addition he prescribed 25mcg of Cytomel. I felt great, for the first time in 3 years I wasn't depressed anymore. I couldn't believe it.
> 
> I did still have minor depression, and a lab test 6 weeks later revealed that my levels were still a little low, so my doctor increased the Armour once more to 5 grains. I don't know if this is coincidence, but all of a sudden I have hypo symptoms again...mainly fatigue and severe depression, to the point of feeling suicidal. Has anyone else ever experienced this? I feel so awful, I can hardly function.


Welcome to the board.









It would be very helpful if you could post your latest lab results for the thyroid with the ranges. We must have the ranges for different labs use different ranges.

You are on a huge amount of T3. 70 mcgs of T3 is practically unheard of.


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## hasenbraten (Apr 29, 2011)

I put my latest lab results in my latest post, the ones from 6 weeks ago are in my earlier post. The latest ones were pretty off the charts


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## hasenbraten (Apr 29, 2011)

Just out of curiosity, where do you get the 70mcg from? I am "only" taking 5 grains armour and was taking (not anymore) 25mcg of Cytomel. And thank you so much for your answer!


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## Andros (Aug 26, 2009)

hasenbraten said:


> Thank you for all your responses! I finally went in for testing, and my results speak for themselves-no wonder I feel like crap.
> 
> TSH <0.01 L Ref. Range 0.3 - 1.5 uIU/ml
> FT3 5.7 Ref. Range 3.6 - 4.2 pg/ml
> ...


According to the above, you are very hyperthyroid. Why does the doctor want you at this place, do you know?

Have you had your adrenals checked?

rT3, unlike T3, does not stimulate thyroid hormone receptors. However, rT3 binds to these receptors, thereby blocking the action of T3. Under stress conditions, the adrenal glands produce excess amounts of cortisol. Cortisol inhibits the conversion of T4 to T3, thus shunting T4 conversion from T3 towards rT3. As a consequence, there is a widespread shutdown in T3 binding across the body. This condition is termed Reverse T3 Dominance. It results in reduced body temperature, which slows the action of many enzymes, leading to a clinical syndrome, Multiple Enzyme Dysfunction, which produces the effects seen in hypothyroidism. Effects include fatigue, headache, migraine, PMS, irritability, fluid retention, anxiety and panic.

http://en.wikipedia.org/wiki/Reverse_triiodothyronine

I have wondered in past posts that I have read why your doc has you on any T4 at all ..............................

Reverse T3 is biologically essential to slow down metabolism as a natural compensation mechanism during times of starvation or famine. In fact, reverse T3 creates more powerful negative feedback on the production of T3 than vice versa. Under varying stressors such as extreme caloric restrictions, pregnancy, and emotional stress, the conversion of T4 to T3 can become unbalanced as the body produces excessive amounts of reverse T3. Reverse T3 exerts its negative feedback on T3 and ties up thyroid receptors. Reverse T3 must be displaced by the proper biologically active T3 if metabolism is to normalize. This is impossible, however, if a patient is being given synthetic T4 only. In these cases, there is no replacement source of the T3 that is needed to displace the excess accumulations of reverse T3 in the circulation and receptors. In the absence of adequate biologically active T3, symptoms of hypothyroidism remain, despite an adequate level of T4 in the serum and a normal TSH level. Since most of the conversion of T4 into T3 happens in the cells, serum levels of free T3 and reverse T3 may be normal even when T3 and reverse T3 levels are not in balance. It is as though the cells are starving for biologically active T3 in the midst of plenty. Unfortunately, the "plenty" is plenty of T4 and reverse T3 rather than the essential biologically active T3. I see many examples of this in my clinical practice. Many patients continue to suffer with hypothyroid symptoms even though they are taking T4100 µg (0.1 mg) per day. Their blood levels of TSH and T4 are normal, yet symptoms persist.

You are on 190 mcgs of T4 as each grain of Armour contains 38 mcg of T4. This is contraindicated to get that rT3 down and get things working right again.

http://www.townsendletter.com/FebMarch2007/hypothyroid0207.htm

Have you sat down and really discussed this w/your doctor? I think these 2 things need to be addressed. Taking T4 and the adrenals.

And just a little tip from me................mixing Cytomel (synthetic) with dessicated porcine............................is not a good idea. The 2 don't mix. Humble opinion. Like trying to mix oil and water.


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## hasenbraten (Apr 29, 2011)

Thank you so much for the great reply, all you say makes a lot of sense...my doctor fell ill today, but I was able to get my results and see one of his colleagues, but all he told me is to go back to 4 grains Armour and 25mcg Cytomel. He suggested some nutritional stuff for the reverse T3. I am so frustrated, because I don't even know what to ask. It would be great of I could depend on my DOCTOR to figure out the problem!

So you are saying that I should not be having any T4? Would that mean discontinuing the Armour? What else would I take? I tried some synthetic thyroid meds that did not do a thing...are there any alternatives?

I probably sound like a total moron, but I really know very little about all of this...well I thought I knew enough, but I actually have no clue. I don't know what to do anymore. I can't stand this depression much longer, I am at my limit.

Thank you again!


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## Andros (Aug 26, 2009)

hasenbraten said:


> Just out of curiosity, where do you get the 70mcg from? I am "only" taking 5 grains armour and was taking (not anymore) 25mcg of Cytomel. And thank you so much for your answer!


I thought you were still on the Cytomel. Armour has 9 mcg. of T3 per grain and 38 mcg. of T4 per grain.

45 mcg. of T3 is still a lot.


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## hasenbraten (Apr 29, 2011)

I really don't know what to do anymore. I am to the point of just accepting that I am never going to be fully functional. I mean it's been 4 years. I am back on 4 grains as of yesterday and feel even worse. Which could also be due to me freaking out every time I get even a little depressed.

Thank you very much for your help!


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## hasenbraten (Apr 29, 2011)

The doctor also told me to take 25mcg Cytomel in addition to the 4 grains, but as I said, he is just filling in for my regular doctor and doesn't specialize in thyroid treatment...seemed to me that he wasn't really sure what to do and put me on the old dose since I wasn't feeling "as bad."

Do you have any suggestions...? Sorry about all the questions, I just don't know how to make it 3 more weeks until my regular doctor comes back...


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## lavender (Jul 13, 2010)

1 grain is a big jump to make all at once. It may take your body some time to adjust to a dose. You are currently hyperthyroid. Lowering thyroid levels from hyperthyroid is not a pleasant experience and takes some time. When I was in thyroid storm, it took me 3 months to start to feel a little normal again. My levels were much higher than yours. But I can imagine the experience is similar at lower levels, just less intense.


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## lainey (Aug 26, 2010)

hasenbraten said:


> I have been diagnosed with hypothyroidism. I finally found a doctor who increased my dosage to 4 grains of Armour a day. In addition he prescribed 25mcg of Cytomel. I felt great, for the first time in 3 years I wasn't depressed anymore. I couldn't believe it.
> 
> I did still have minor depression, and a lab test 6 weeks later revealed that my levels were still a little low, so my doctor increased the Armour once more to 5 grains. I don't know if this is coincidence, but all of a sudden I have hypo symptoms again...mainly fatigue and severe depression, to the point of feeling suicidal. Has anyone else ever experienced this? I feel so awful, I can hardly function.


I am quoting your original post. Based on your most recent labs, you are way over-medicated. Of course, it is going to take some time for the excess T3 and T4 to clear your system after your dose has been reduced in order for you to feel better.

What are your other symptoms besides depression? Perhaps, using thyroid medication to treat depression is not the best strategy?


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## hasenbraten (Apr 29, 2011)

Makes sense that it would take a while to adjust...I guess I AM taking thyroid to treat depression, since being hypo is the cause o fit. I have a few other symptoms as well, the cold hands, constipation, hair falling out, dry skin, all that stuff.

I guess all I can do is wait. Thank you for your replies!


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## Andros (Aug 26, 2009)

hasenbraten said:


> Makes sense that it would take a while to adjust...I guess I AM taking thyroid to treat depression, since being hypo is the cause o fit. I have a few other symptoms as well, the cold hands, constipation, hair falling out, dry skin, all that stuff.
> 
> I guess all I can do is wait. Thank you for your replies!


There certainly is nothing wrong with treating the thyroid to relieve depression since that is a major symptom of thyroid disease. The limbic system in the brain definitely needs T3; that is a fact.

I think we are all worried that you may be over medicated. The symptoms don't always hold true and do cross over.

And I would like to urge you to get your ferritin checked; it should be 50 to 100. The closer to 100,the better. Please read the link below.

Ferritin http://www.thewayup.com/newsletters/081504.htm


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## lainey (Aug 26, 2010)

I guess what I am saying is, if your levels were good, then perhaps the depression is idiopathic--ie, independent of the thyroid problem.

Depression occurs in people without thyroid problems, and in people who are treated but euthyroid.

In that case depression should be treated in it's own right, with different therapy, because at that point it would be ineffective to add more thyroid medication, and as you can see, downright dangerous.

A licensed psychiatrist is your best bet for treating the depression.


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## hasenbraten (Apr 29, 2011)

Lainey, I certainly see your point-depression can have a multitude of causes besides high or low thyroid function. In my case I believe the depression is definitely due to thyroid issues, as I have treated it with antidepresssants, therapy etc. with only minimal improvement before. Once I started taking dessicated thyroid (no-one had ever tested me before since I was "skinny")I felt amazing-the depression was gone for the first time in years. It was the best feeling ever.

I really think it's a dosage problem-Andros, you are right, I am overmedicated and need to get that under control. I decreased the dosage a few days ago and already feel better. And I will get my ferritin checked! I very much appreciate everyone's input, thank you very much. It's hard not to panic sometimes, and that does not help.


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## hasenbraten (Apr 29, 2011)

Very interesting article, Andros! I did not know that athletes are at risk for low ferritin! Not that I am an athlete, but I do exercise a lot. I was tested a while back and found to be low, but once I took suplements and they ran out I stopped paying attention. I will definitely get retested.


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