# Trouble with FT4



## ashton (Sep 15, 2014)

Hi, I am new here and I was wondering if I could get some feedback on something that is making me uneasy about my treatment.

A short background: I was diagnosed hypothyroid a year ago this month. I was being treated by my GP who only ran TSH (13.1 at dx, never went below 9 during the time I was being treated by her) and put me on Tirosint. I dealt with palpitations for the entire time I was on Tirosint - from Sept 2013 until the beginning of Feb 2014 when I convinced my GP to let me try Armour. Unhappy with her treatment, I then sought out an Endo and found one in my town through the Thyroid Change recommended Drs list. I have since been diagnosed with Hashi's after my Endo tested for thyroid antibodies and also ran bloodwork for FT3 & FT4. My palpitations disappeared almost instantly with the start of Armour. I noticed that when my dosage isn't correct, they tend to come back along with my other symptoms until my Endo adjusts my dosage. As of the end of last week, I am on 1.5gr of Armour.

My Endo says that my T4 is too low (0.72) and if it doesn't increase to normal range within the next 7 weeks, she will be forced to put me back on synthetic T4-only medication. So, my question is: Do I have any other options? Is there anything I can tell her to let me stay on NDT? I'm terrified of going back to synthetic because I feel the best I have ever felt while on Armour. I'm scared of the palpitations coming back (I experienced them on even the lowest dosage of Tirosint) and I'm scared to feel as bad as I did between Sept 2013 and Feb 2014.

If anyone has any suggestions, I would be forever grateful! Thank you.


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## jenny v (May 6, 2012)

> My Endo says that my T4 is too low (0.72) and if it doesn't increase to normal range within the next 7 weeks, she will be forced to put me back on synthetic T4-only medication.


Do you have copies of your latest labs, with ranges? Do you know if your endo is talking about your T4 only or your Free T4? I would fight tooth and nail to stay on the Armour if it makes you feel well and I'm not sure why she would say you need to get off of it instead of raising it to try and raise your FT4.


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## ashton (Sep 15, 2014)

jenny v said:


> Do you have copies of your latest labs, with ranges? Do you know if your endo is talking about your T4 only or your Free T4? I would fight tooth and nail to stay on the Armour if it makes you feel well and I'm not sure why she would say you need to get off of it instead of raising it to try and raise your FT4.


Thanks for your reply, Jenny!

She did raise my dosage from 1gr to 1.5gr last Thursday when I saw her. She said if this increase doesn't push it into normal range, I'll have to go on synthetic. =\

I was under the impression she was talking about FT4. Here are my latest labs from 9/5/14:

TSH: 2.11 (0.45 - 4.50)

FT3: 2.8 (2.0-4.4)

FT4: 0.72 (0.82-1.77)


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## joplin1975 (Jul 21, 2011)

Ashton, you free t4 is suppose to drop when you take desiccated meds. In your case, you really want to focus on free t3, which, if you ask me, could stand to increase quite a bit. With your latest dose increase, your next labs will likely show a further decrease in free t4.

Is your doctor well-versed on prescribing and dosing Armour?


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## ashton (Sep 15, 2014)

joplin1975 said:


> Ashton, you free t4 is suppose to drop when you take desiccated meds. In your case, you really want to focus on free t3, which, if you ask me, could stand to increase quite a bit. With your latest dose increase, your next labs will likely show a further decrease in free t4.
> 
> Is your doctor well-versed on prescribing and dosing Armour?


From my last couple labs, I've seen small increases in my FT4 (before 0.72 it was 0.71 and before that, 0.70 - and that's when I was on Tirosint). Thanks for letting me know about FT4 being likely to decrease, I didn't know that. I really hope I can find some way to stay on Armour. =\ Since you think my FT3 needs to come up, do you think switching to T4-only would be a bad idea?

I'm not certain about how well-versed she is with prescribing Armour. Is that something I should ask her?

Thank you for your response! You've been very helpful so far.


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## joplin1975 (Jul 21, 2011)

Yes, switching to a t4-only med at this time would not be something I'd be considering. What likely was happening on t4-only meds is that you (your body, that is) were not converting t4 to t3. So there's a build up in t4 (causing the heart palps),

You need to more or less ignore TSH and free t4, and fine tune the free t3. Get it to minimally 50% of the range and then reassess from there.


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## ashton (Sep 15, 2014)

joplin1975 said:


> Yes, switching to a t4-only med at this time would not be something I'd be considering. What likely was happening on t4-only meds is that you (your body, that is) were not converting t4 to t3. So there's a build up in t4 (causing the heart palps),
> 
> You need to more or less ignore TSH and free t4, and fine tune the free t3. Get it to minimally 50% of the range and then reassess from there.


Wow! I never thought about the fact that I could have too much T4 with the Tirosint. Especially considering that my GP kept me on such a low dose because she thought I was being overmedicated. That definitely makes sense, thought, considering my palpitations. I did do a 24 hr holtor monitor as well as an echocardiogram which all came back normal.

I'm more than willing to ignore FT4 & TSH, but how will I convince my Doctor to only pay attention to FT3? I'm afraid I won't be able to properly advocate for myself at this point.

Thanks again for your reply!


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## Lovlkn (Dec 20, 2009)

Go to the pharmacy you got your Armour from and ask the pharmacist what doctors are writing prescriptions for it. Make an appointment with the doctor that prescribes the most.

Your doctor does not understand based on what he is suggesting and what your labs look like.


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## Andros (Aug 26, 2009)

http://www.frx.com/pi/armourthyroid_pi.pdf

Armour thyroid
http://www.armourthyroid.com/

http://www.frx.com/pi/armourthyroid_pi.pdf
(Copy and paste into your browser)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/
(Copy and paste into your browser)

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.

FREE T3 explained by Woliner
http://thyroid.about.com/cs/testsforthyroid/a/freet3.htm

Oh, Lord! Your Armour has 38 mcgs. of T4 per grain. And, 9mcgs. of T3 per grain. All she has to do is increase your Armour by small increments about every 8 weeks and do not expect the T4 to ever be that high when taking exogenous T3.

Armour is the "perfect" 4 to 1 ratio.

Information provided above. Going by TSH only is a bad idea also.


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## Andros (Aug 26, 2009)

You truly are undermedicated. I am on 3 1/2 grains of Armour and have been for over 20 years. I am a 71 year old very active woman.

I put links in another post for you.

Welcome to the board.


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## ashton (Sep 15, 2014)

Lovlkn said:


> Go to the pharmacy you got your Armour from and ask the pharmacist what doctors are writing prescriptions for it. Make an appointment with the doctor that prescribes the most.
> 
> Your doctor does not understand based on what he is suggesting and what your labs look like.


Thank you! That's a great idea, I will go there this week and speak with the pharmacist.



Andros said:


> http://www.frx.com/pi/armourthyroid_pi.pdf
> 
> Armour thyroid
> http://www.armourthyroid.com/
> ...





Andros said:


> You truly are undermedicated. I am on 3 1/2 grains of Armour and have been for over 20 years. I am a 71 year old very active woman.
> 
> I put links in another post for you.
> 
> Welcome to the board.


Thank you so much for your input, Andros! I will take a look at the links you've provided. I have felt undermedicated for the past 12 months - I've had a very rocky start to this whole thing. I'm hoping that with the information you've provided, I can figure out a way to convince my current Endo at my next appt (6 weeks from now) to keep me on Armour and steadily increase the dosages until I am feeling well again. If she doesn't comply, I will have to seek out another Dr based on Lovlkn's recommendation.

Thank you both for being so helpful!


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## Andros (Aug 26, 2009)

You are welcome and please do keep us in the loop! We "do" care...................very much so!


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## ashton (Sep 15, 2014)

Hello, it's been a while!

There was no luck going to the pharmacy about doctors prescribing Armour. They wouldn't tell me anything.

My T4 did increase to 0.74 while I was on the 1.5gr, but my TSH dropped to 0.08 and my doctor said that's not allowed because it could lead to osteoporosis, which I didn't know. She tried me on 1.25gr and of course the T4 dropped again. She looked at my previous lab work when I was on T4-only and realized I had a TSH of 9 when I was on 75mcg and agreed something was wrong there.

I told her I stopped birth control because it was hindering my weight loss program and she said we would leave things as-is until February to see if anything changes. She wants to try me on T4-only and T3-only next time. Is this something that might work for me?

Also, I noticed yesterday and today that my thyroid appears to be enlarging. I can feel it when I do my neck check and it's making me worried. Can this be from being under or incorrectly medicated?

Thanks again for all your help!


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## Andros (Aug 26, 2009)

Have you had an ultra-sound of your thyroid? If not, I urge you to do so!

And yes; T4 and T3 combo could work bearing in mind that when taking T3, the T4 will be lower which is a normal thing.


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## joplin1975 (Jul 21, 2011)

joplin1975 said:


> Yes, switching to a t4-only med at this time would not be something I'd be considering. What likely was happening on t4-only meds is that you (your body, that is) were not converting t4 to t3. So there's a build up in t4 (causing the heart palps),
> 
> *You need to more or less ignore TSH and free t4, and fine tune the free t3. Get it to minimally 50% of the range and then reassess from there.*


Just bolding my previous response. Without a free t3 test, there's no way to tell if you are being under or over medicated. On desiccated medications, you TSH will drop quite low as will your free t4. As such, those lab results are more or less useless.

The osteoporosis issue is real, but its only a concern if -- while on desiccated meds -- your free t3 is too high.


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## ashton (Sep 15, 2014)

Andros said:


> Have you had an ultra-sound of your thyroid? If not, I urge you to do so!
> 
> And yes; T4 and T3 combo could work bearing in mind that when taking T3, the T4 will be lower which is a normal thing.


I've had two; one in May 2014 and one in August 2014. The one in May revealed two small nodules on the left side that are too small to biopsy. The August one showed no change from the May scan, so it was advised I get my next scan in August 2015. That was before I spoke to my Dr today and she suggested I get one as soon as I receive the Rx from her in the mail.

I'm glad that T4+T3 appears to be an option for me. I didn't want to jump ship from NDT until finding out for myself if it is worthwhile.



joplin1975 said:


> Just bolding my previous response. Without a free t3 test, there's no way to tell if you are being under or over medicated. On desiccated medications, you TSH will drop quite low as will your free t4. As such, those lab results are more or less useless.
> 
> The osteoporosis issue is real, but its only a concern if -- while on desiccated meds -- your free t3 is too high.


I had your bolded portion in mind when she told me about the osteoporosis, but again, I never heard it before so I wasn't sure how to react. I've had FT3 tested multiple times in the past year, with the most recent being around 2.8 (2.0-4.4). I know it could come up, but my Dr will not increase my dosage at this point.

I made an appointment with a recommended Naturopath today. Between that and my Endo, this disease has become quite expensive as both Drs do not take insurances. I hope the Naturo has some answers for me.

I'm having a hard time finding a new Endo that will prescribe Armour in my area. =\

Thanks again for your responses.


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## Andros (Aug 26, 2009)

Your NDT is T4 and T3.


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## ashton (Sep 15, 2014)

Yes, I know. My doctor wants to be able to control the T3 and T4 dosages separately.


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## Lovlkn (Dec 20, 2009)

You need to start doctor shopping.

I went to 2 endocrinologists and 2 GP's prior to finding the DO that treats me with 1/2-3/4 range FT-4 and FT-3, I run little to no TSH due to stimulating antibodies.

Why would you stay with a doctor who does not know how to dose the medication they prescribed?


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## Andros (Aug 26, 2009)

Oh, thanks....................I wasn't clear on that. Have you started doing that yet and if so, how is it working out?

Hugs,


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## Lovlkn (Dec 20, 2009)

> There was no luck going to the pharmacy about doctors prescribing Armour. They wouldn't tell me anything.


 I've been thinking about this - you need to go to more pharmacies. Maybe someone will give you a name. Finding a doctor to prescribe Armour is hard enough - at least if you have a name to start it give you a better chance of finding someone who might treat you properly,


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## ashton (Sep 15, 2014)

Andros said:


> Oh, thanks....................I wasn't clear on that. Have you started doing that yet and if so, how is it working out?
> 
> Hugs,


I haven't, no. I see my endo again next month. I did however see a naturopath and he said that he doesn't believe T4+T3 would be a good route for me. He agrees that I should stay on Armour and that I should really be on the 1.5gr dosage rather than the 1.25gr that I am currently on. He is going to call my endo and try to work together with her to get me where I need to be.



Lovlkn said:


> You need to start doctor shopping.
> 
> I went to 2 endocrinologists and 2 GP's prior to finding the DO that treats me with 1/2-3/4 range FT-4 and FT-3, I run little to no TSH due to stimulating antibodies.
> 
> Why would you stay with a doctor who does not know how to dose the medication they prescribed?


I agree with you. I keep running into walls whenever I try to call around and find out information about other Endos in my area. I'm going to keep trying though!



Lovlkn said:


> I've been thinking about this - you need to go to more pharmacies. Maybe someone will give you a name. Finding a doctor to prescribe Armour is hard enough - at least if you have a name to start it give you a better chance of finding someone who might treat you properly,


I asked my mom to talk to her pharmacist (who was my pharmacist for over 25 years of my life) and she was also told that they can't give out that kind of information. My boyfriend's aunt asked hers as well as was told it's not a legal thing to do. I'm not sure where else to go from here.


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## Lovlkn (Dec 20, 2009)

I was going to direct you to the attached link to study and have a conversation with your doctor. Unfortunately - it does not say much and in my opinion is a bit slack on the testing they suggest.

http://pi.actavis.com/data_stream.asp?product_group=1924&p=pi&language=E

Now onto your doctors resistance to understand properly prescribing Armour. You are in a good place now - as you have an active prescription. If you were to go to a different doctor you are already on a prescribed dose of Armour. If you call a specific office, you might get some information out of the office staff as far as the doctor and what the doctors specialties are - like maybe thyroid issues?? You might also explain that you are on a medication that not alot of doctors feel comfortable or experienced with and can you tell me does Dr. X*** prescribe Armour?

I have had success in changing doctors and have them continue what I came to them on or tweak my meds upward or down. The hard part is done, you have the diagnosis and initial prescriptions. Walk in like you own the place and ask for what you want - it works!

Be sure to fill all open Armour prescriptions as soon as you are able and keep a supply while you doctor shop.


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## ashton (Sep 15, 2014)

Lovlkn said:


> I was going to direct you to the attached link to study and have a conversation with your doctor. Unfortunately - it does not say much and in my opinion is a bit slack on the testing they suggest.
> 
> http://pi.actavis.com/data_stream.asp?product_group=1924&p=pi&language=E
> 
> ...


Thank you SO much for this response. I wish I had checked this sooner, though. I saw my endo today and things are not so good.

She diagnosed me as pre-diabetes. She says this happened because I let my T4 remain too low. This seems weird to me. She tried again to switch me to T4-only and when I said no, she made me sign a waiver that states that she is not responsible for what happens to me or to any offspring I may have because I am refusing her recommendations for treatment. She also said the Endocrine Society published a study that Armour is no longer recommended for women who are to become pregnant. She couldn't show me the study online because she couldn't find it. I tried looking too and I can't find it. I am not presently trying to become pregnant, but I would like to once I am married and situated with my thyroid (years from now), so I would like to know if this is true anyway just as a precaution.

I am on a Paleo diet and am not one for over indulgence. I am also gluten and soy free. So I'm really confused about this pre-diabetes diagnosis.

On the other hand, some good things are that my ultrasound came back as stabilized. No changes since August 2014. Also, my antibodies have decreased by over 50%! They're still super high but the fact that they decreased made me happy.

So I'm stuck at 75mg of Armour, she won't increase my dose or anything. However, my TSH did go down from my last visit. My endo isn't happy about that, either.

As of 2/16/15:

A1C: 6.0 (4.8 - 5.5)

FT4: 0.79 (0.82 - 1.77)

FT3: 3.1 (2.0 - 4.4)

TSH: 0.126 (0.45 - 4.50) [Was 0.80 on 12/18, same dosage of Armour)

Antithyroglobulin Ab Thryroglobulin, Antibody: 17.8 (0.0 - 0.9) [Was 53.1 in 6/2014]

TPO: 600 (0 - 34) [Was 1300 1694 in 6/2014]


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## Lovlkn (Dec 20, 2009)

> A1C: 6.0 (4.8 - 5.5)
> 
> FT4: 0.79 (0.82 - 1.77)
> 
> ...


The fact your TSH is falling would indicate that you have stimulating antibodies kicking in.

Have you ever had a TSI test?

Your A1C is alarming - have they suggested any changes to your diet?


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## ashton (Sep 15, 2014)

Lovlkn said:


> The fact your TSH is falling would indicate that you have stimulating antibodies kicking in.
> 
> Have you ever had a TSI test?
> 
> Your A1C is alarming - have they suggested any changes to your diet?


Is it a good thing or bad thing that stimulating antibodies are kicking in?

I've not had a TSI test. What is it for?

My endo wasn't very helpful with the A1C/diabetes part of my visit. She gave me an AccuChek and pretty much sent me on my way. She handed me a pamphlet for a diabetic diet, but because of my gluten, soy, and goitrogen restrictions, I can't follow it. I am on a Paleo diet, so I don't know what else I should change.

My numbers before/after dinner last night were 88/96. My number at 11AM today was 94. Doesn't seem bad to me.

The exact name of that antibody test is: "Antithyroglobulin Ab Thryroglobulin, Antibody"

As I mentioned yesterday, it was 17.8, but I looked at my bloodwork from June 2014 and it was 53.1. Range is 0.0-0.9.

I am seeing another Endo today as a second opinion. Hopefully she will be able to help me since my current Endo won't work with me anymore unless I switch to T4-only.

Oh & I also found out that my initial TPO was 1694, not 1300. My Endo gave me the wrong number, but when I looked at my paperwork when I got home, it was 1694 in June 2014.

Thanks again


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## ashton (Sep 15, 2014)

Update: I drove all the way to the new endo's office only to find out they take all but 1 plan from Amerihealth and it just so happens to be the plan that I have. I have no idea why their office showed up on my search in my account on Amerihealth's website.  I didn't have $350 handy to self-pay. I'm really feeling down about this... I can't find a single endo within my network.


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## Andros (Aug 26, 2009)

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
(Copy and paste into your browser)

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.

OMG!!! Unbelievable............................; I am so sorry! Do hurry and try to find a better doctor than that. It is all poppycock.

T3 is what every woman needs for a successful uninterrupted pregnancy! LHM!!!


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## Lovlkn (Dec 20, 2009)

Have you had an ultrasound of your gland?


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## ashton (Sep 15, 2014)

Andros said:


> Understanding the Thyroid: Why You Should Check Your Free T3
> http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
> (Copy and paste into your browser)
> 
> ...


The list of Drs on my insurance's website is severely out of date. I have no idea what to do now. I'm on a waitlist to see a Dr that claims to take my insurance but I won't be able to see them for 3 months! I have no idea what to do now. I guess paying out of pocket is the only thing I can do.



Lovlkn said:


> Have you had an ultrasound of your gland?


Yes 3 times. I have 2 nodules on my left lobe that are too small to biopsy. They have grown in size just a little bit. The report says they are stable; I can get a follow up in 12 months.


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## ashton (Sep 15, 2014)

ashton said:


> As of 2/16/15:
> 
> A1C: 6.0 (4.8 - 5.5)
> 
> ...


Hello! I am back with an update. I am now seeing a new Endo - who is also a DO - that was recommended by my nature path. I am doing a 15 day yeast cleanse (I'm on day 9 today) and have removed dairy and yeast from my diet as of 4/27. (I'm also gluten, soy, caffeine, and alcohol free for 18+ months.)

As of 4/25/15:

A1C: 5.4 (4.8-5.6)

FT3: 6.4 (2.0-4.4) *

TSH 0.602 (0.450-4.500)

*Note: The Dr. told me to take my medication the morning of the blood test, I have always waited until after to take my meds, but she insisted I take it like I normally do each morning.

She is increasing my VitD3 from 5K/day to alternating between 5K and 10K every other day.

She also wants to switch me to a compounded medication from Armour. I'm willing to try it, but the compound pharmacy told me that I have to pay up front and submit the claim to my insurance company. She said it'll cost me $100. Does this seem right? I don't know anything about compounded medications and I'm not even sure if my insurance will cover it. I called them today and they said they won't know until I submit it to them. Any info on this would be greatly appreciated!


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