# New Labs - At Crossroads for Treatment - Start Armour?



## Hypoman (Aug 7, 2010)

Hi All,

Just got new labs, and I'm at the crossroads for treatment. The discussion is whether to ditch the Synthroid and start Armour OR just increase Synthroid (again). I was given the choice to start Armour over a month ago, and opted for a Synthroid dose increase instead. Here are my labs after six weeks at 137mcgs Synthroid:

TSH *3.190 *0.450 - 4.500 uIU/mL

FREE T4 *1.58 * 0.82 - 1.77 ng/dL

FREE T3 *3.0* 2.0 - 4.4 pg/mL

I don't feel any better, and my labs haven't really budged with the increase. Same old symptoms: weight gain, puffiness, joint pain, headaches, lack of energy. I spent five years at 125mcgs Synthroid, and my labs were stable (TSH at 1.5) -- it wasn't until the last six months that they started going haywire, even though I haven't changed anything.

My options now are to bump up to 150mcgs of Synthroid and see if that helps, or start Armour. I have the Armour prescription ready to go. My ONLY concern is that I really can't afford to crash right now with the experimentation. Important and stressful things are happening in the career, and I really need to be "with it" -- problem is, I feel terrible as is. So I'm looking for opinions.

With the above labs and options, what would you do?

As always, any and all comments are greatly appreciated.

Best,

Hypoman


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## lainey (Aug 26, 2010)

I have had the experience of several dose adjustments over the years and for no particular reason either. Last December, my TSH turned up at 7.8 after 18 months or so around 2.5, and this has been a typical pattern for me, things will just pop out of whack for no reason periodically. On discussion with the doctor this is apparently typical--the idea that once you are titrated you will "stay" there is a bit of misnomer--periodic adjustments will always be necessary as you are experiencing.

I will add to that my frustration with those adjustments, they take a good bit of time to kick in after the numbers have moved. We'll go with, my TSH was back down in March, but the nagging issues of mild fatigue and losing those couple of pounds I had gained didn't really resolve until the end of April. If anything, this disease demands a cruel sort of patience.

Given the events in your life that you describe, if it were me, I would increase the synthroid. It's a known entity. You can increase it and it will either work or it won't, but you won't be adding any unknowns, which in the case of armour, is a different formulation including T3.

With armour, you basically have to go backward a bit and titrate up, with labs. Not everyone finds T3 medication to be just as wonderful as internet forums would have you believe--some people really struggle with it.

You know yourself, but if there is a lot going on you may wish to choose to muddle along as is, than risk the bigger change at the moment.


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## Hypoman (Aug 7, 2010)

Thanks for the response lainey. I'm leaning towards trying the bump in Synthroid first as well. As you said, it's a known entity. I've never been as high as 150, but my labs are calling for an increase.

I have been flirting with giving Armour a shot for over a year now. Every time I build up the courage and frustration to give it a go, I always fall back on "What if?" -- I do feel like I'll have to give it a shot at some point, just to know whether it's for me or not.

Any other thoughts folks?


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## bigfoot (May 13, 2011)

Ugh, I've been in this situation, too. Not an enviable place to be, and it's a hard decision to make. Ultimately, if you're able to do what you need to do while taking Synthroid, perhaps that's the best course. Especially if these events and stresses are temporary. On the other hand, if this feels like total rock-bottom and you're completely struggling anyway, Armour might be just the ticket. Or at least something to try in the near future. The beauty of desiccated combination T3+T4 drugs (Armour, Nature-Throid, West-Throid, etc.) is that when you adjust things, you get can get an early indication if the new dose might work out or not. This is because T3 is short-acting (hours, days) and T4 is long-acting (weeks, months). So there is some ability to tweak things if needed.

Just for giggles, you might want to look into getting Reverse T3 tested. It's possible that it is high, blocking the ability of your body to absorb and utilize the Free T3. If that's the case, then taking some T3 might benefit you, as piling on as much T4 as possible won't help. But, as Lainey pointed out, T3 is pretty potent. It's taken me years to get to the point where I can tolerate more than a few micrograms at any given time. The stuff is like jet fuel! Whatever you decide, go low 'n' slow if it involves T3.

Best wishes and positive thoughts headed your way.


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## bigfoot (May 13, 2011)

Hypoman said:


> I have been flirting with giving Armour a shot for over a year now. Every time I build up the courage and frustration to give it a go, I always fall back on "What if?" -- I do feel like I'll have to give it a shot at some point, just to know whether it's for me or not.


I did this with Nature-Throid, too. I was nervous and shied away from it for many months. Finally I had had enough and figured I had nothing to lose -- I changed over partially, and then fully, with the support of my doc. It wasn't the answer to all of my problems, but it certainly helped. My body seems to prefer it over synthetics. And many of the irritating signs & symptoms diminished or vanished altogether (joint pain / stiffness, rashes, neuropathy, poor sleep, etc.). Something to mention is that the desiccated products also contain the hormones T1 and T2, which are absent in synthetic levothyroxine. YMMV


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## Hypoman (Aug 7, 2010)

bigfoot said:


> I changed over partially, and then fully, with the support of my doc. It wasn't the answer to all of my problems, but it certainly helped.


This is one element that has been holding me back from giving Armour a shot -- *there doesn't seem to be a consensus on how to switch from Synthroid to Armour. *

Some say to stop Synthroid altogether and start low on the Armour and titrate up slowly. So start at 1/2 a grain and bump up over several weeks with labs. This seems to be asking for a hypo crash in my opinion. Who can afford to feel rotten for weeks before new labs and an increase?

Others have said to stop the Syntrhoid and start with a full grain, or even an equivalent dose of Armour, and not titrate at all.

Others still have said to keep some Synthroid in addition to the Armour, to achieve a more physiologic balance (somewhere around 98% to 2% T4 to T3).

So, it's a confusing switch, and my doctor doesn't seem to really know the best way to do it (though he is game to experiment within reason).


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## bigfoot (May 13, 2011)

To get the equivalent of the 137 mcg of Synthroid that you are taking now, you'd have to be taking about 1 3/4 grains of Armour. And that's just a guesstimate -- could be a little more, could be a little less. It all depends on how well your body absorbs the various thyroid hormones, what your level of activity is, etc.

Each grain has 38 mcg of T4 and 9.5 mcg of T3. Since T3 is roughly four times as potent as T4, there's an equivalency factor of 4x. The smallest you could go is to get 1/4 grain pills and split them into 1/8 grain pills. Here's a few examples below.

At 1/8 grain of Armour (splitting a 1/4 grain pill): 4.5 mcg T4 + (1.125 mcg T3 x 4) = ~9.5 mcg T4-only equivalent.

At 1/4 grain of Armour: 9 mcg T4 + (2.25 mcg T3 x 4) = ~18 mcg T4-only equivalent. [Corrected]

At 1 grain of Armour: 38 mcg T4 + (9.5 mcg T3 x 4) = ~76 mcg T4-only equivalent.

At 1.5 grains of Armour: 57 mcg T4 + (14.25 mcg T3 x 4) = ~114 mcg T4-only equivalent.

At 1.75 grains of Armour: 66.5 mcg T4 + (16.63 mcg T3 x 4) = ~133 mcg T4-only equivalent.

At 2 grains of Armour: 76 mcg T4 + (19 mcg T3 x 4) = ~152 mcg T4-only equivalent.

One thought would be to slowly decrease your dosage of Synthroid, while at the same time building up your equivalent dosage of Armour. So maybe this week you are taking 137 mcg of Synthroid. Next week perhaps you drop that down to 125 mcg of Synthroid, and make up the difference with 1/8 grain of Armour. And so forth.

Personally, I went from 1/2 grain of Nature-Throid and worked my way up to 1 grain pretty quickly (a week or two), then added in 1/4 grain at a time. If it got to be too much, I throttled back 1/4 grain and held there for a while. It wasn't the easiest transition, and I definitely felt it, but things got a little better as I took more and more Nature-Throid. It also helps to have multiple dose sizes on hand -- with some 1/4 grains (can split into 1/8 grain) and some 1 grains (can split into 1/2 grains), you can pretty much mix 'n' match for what you might need during titration.

On the plus side, your doctor is open to experimenting, and it might take a little trial & error at first. If he gives you a little bit of latitude, you can go up/down is small amounts as needed to adjust. Such as if your pulse creeps up over 100, you can throttle back a bit. And likewise, if all of a sudden your skin is cracking and hair starts falling out, you can go up a notch. I have also seen the reports of people taking a little bit of separate T4 to improve the ratio of T4 to T3, which is another idea to try.


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## Hypoman (Aug 7, 2010)

Thanks Bigfoot. That is really helpful information. Wow, I'm really unsure what to do next. My hunch is that I need the T3 from the desiccated, but I'm just not prepared to try the full switch yet. I'm scared of really hitting a wall.

I wish I could try 125mcgs Synthroid with a 1/4 grain of Armour, and just see how I feel. Wouldn't that put me in the ballpark of ~150 mcgs Synthroid - which is what the increase would be?


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## Lovlkn (Dec 20, 2009)

I've hear many times along the way that Armour / Synthroid combo don't work well together.

Is there any reason you will not add Cytomel to your current dose of Synthroid? I did not feel well until I added Cytomel - it was a slow journey and I quit the first time due to the jolt mys system experienced.

I think Bigfoot described it quite well...



> The stuff is like jet fuel!


I've referred to it as TNT rather than T-3. The stuff packs a punch but once you adjust to it all is good. Start off slow - ask for a trial 5mcg daily and ease yourself into it - it you feel effects back off until you can tolerate. I began with 1/4 of a 5mcg pill 2 x a day and tried easing up, then backed down and eventually gave up the 1st time. I suffered for a few more years and gave it another try and am so glad I did as it has made a HUGE difference in how I feel.

I take 12.5 mcg daily in addition to 125mcg of Unithroid


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## bigfoot (May 13, 2011)

Beware that there is a "conversion chart" from desiccated med. manufacturers floating around out there. The chart is a little on the weak side, and I suspect that is so doctors and patients don't unknowingly start on too high of a dose.

I made a mistake in my math above -- a 1/4 grain has 9 mcg of T4 and 2.25 mcg of T3, while splitting that into 1/8 grain results in 4.5 mcg of T4 and 1.125 mcg of T3 (so equivalent to roughly about 9.5 mcg of T4). Lemme go in and edit that...


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## Hypoman (Aug 7, 2010)

Lovlkn said:


> Is there any reason you will not add Cytomel to your current dose of Synthroid?


Thanks for your respone Lovlkn. I tried Cytomel for three months and gained 15 pounds. It threw my system for a loop. Not sure why I had such a bad reaction to it, but I did.

I'm basing my interest in using Synthroid in addition to Armour off of many case studies of doctors saying that the percentage of T4 to T3 in Armour is too high (at about 80 to 20) -- a closer physiologic dose would be 90 to 10 or 95 to 5. So I would be adding Armour to the Synthroid to get closer to the right balance of T4 to T3. I know this combination is used quite often (Synthroid and Armour) -- it may not be the most popular, but it is used safely.

Thoughts?


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## bigfoot (May 13, 2011)

[Just saw you replied and have already tried Cytomel, so you can skip the below response. Whoops!]

My experiences with mirrored Lovlkn's, too. At first I was taking levothyroxine (generic, then Levoxyl) only and wound up feeling awful. A couple of years later a doc let me add in 5 mcg of Cytomel (synthetic T3) to see how it worked. Holy smokes, powerful stuff. I split the pill into 2.5 mcg and that *still* seemed like a lot. I couldn't handle it and decided to stop the T3 trial. In hindsight, I probably should have stuck with it. But eventually, via another doctor, I wound up on Nature-Throid -- working my way up to 1 3/4 - 2 grains daily, split into morning and evening doses. Seems like my body prefers that instead.

Maybe if you have a stretch of vacation or a bunch of days off you could try a little bit of T3. After a couple of days it will have peaked in your system, since it has such a short half-life. Not the most scientific approach, but hey it's a step in the right direction.


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## Hypoman (Aug 7, 2010)

bigfoot said:


> [Just saw you replied and have already tried Cytomel, so you can skip the below response. Whoops!]


No worries bigfoot! So I started Synthroid 137mcgs plus Armour 1/4 grain today. My doctor said he was happy to have me try it. The plan is, if it feels like too much, I can back off to either 125mcgs Synthroid and keep the 1/4 grain, or I can try 1/8 grain with the current Synthroid dose.

The reasoning was, my labs didn't budge with the increase from 125 to 137 -- so adding ~18mcgs equivalent from Armour gets me pretty close to the 150 dose of Synthroid that would be the next step. My T3 is also pretty low, so that factored in as well. I know some folks here aren't fans of mixing Synthroid and Armour, but my doctor says that it's not unheard of at all. To be honest, I just want to feel better, and as long as it's safe and slow, I'm willing to do the experimenting.

I will report how I feel in this thread as the days move on. Any thoughts on this, based on my above labs? I like to get a discussion going so others can find these forums and see how diverse and individualized treatment for Hypothyroidism really is.


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## Andros (Aug 26, 2009)

Armour thyroid
http://www.armourthyroid.com/
(Copy and paste into your browser)

Full prescribing info
http://www.frx.com/pi/armourthyroid_pi.pdf
(copy and paste into your browser)

Synthroid and Armour are 2 different pharmaceuticals. There is no equivalent dosing. The patient is to start on a low dose of 30 mgs. and the doctor needs to work closely with said patient re the titration process every 8 weeks.

Information on all that above!


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## Hypoman (Aug 7, 2010)

Andros said:


> Armour thyroid
> http://www.armourthyroid.com/
> (Copy and paste into your browser)
> 
> ...


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## Hypoman (Aug 7, 2010)

Hi Andros,

Thank you so much for your reply. You are obviously very well respected on these boards, and rightfully so -- you are very helpful and knowledgable.

I know that mixing Synthroid and Armour is slightly unusual, but it is done. Clearly it is your opinion that it isn't the best treatment. I respect that. I'm just trying a few different options and experimenting. Look forward to hearing others opinions as well.


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## Dolly (Apr 24, 2013)

Once you switch over fully, you may find that Armour alone will do the trick. I was on Synthroid and Cytomel, and was OK, but still not right. Once I got switched over to Armour, I feel fantastic. It is like night and day. I did go against my doctor's wishes and went on 2 grains daily instead of 1, but I felt all but dead on just one.

Hope it works for you!!!


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## Hypoman (Aug 7, 2010)

Thank you for your input Dolly. Sounds like I should be asking my doctor about switching completely, and potentially adding Synthroid back in if extra T4 is needed.

Day two of Synthroid and Armour, and I definitely have more energy -- some of it is nervous energy -- but no heart palps or other hyper signs.


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## bigfoot (May 13, 2011)

That is good to hear! One thing to keep an eye on is your pulse. If you start zooming up over 100 bpm just sitting around, take notice. If it persists, you could be slightly over-medicated. If not, well, then it was your body temporarily adjusting to the higher dose of medication. I know that when I do a dose increase I'll feel a little revved for a few days, my pulse will be a little higher, then things settle back down.

Another indication can be your body temperature -- you might want to keep a daily logbook. I track my dosage, temperature, BP, weight, and any big improvements or hiccups during the day. After a long enough time you can spot trends and get an idea of where you stand. As far as the temps go, some recommend taking them between 9 a.m. and 3 p.m., then averaging them. This is because your body temps are naturally going to fluctuate during the whole day, and the peak of the day is what you want to measure. Still others suggest doing a basal body temp right when you wake up. Just a different approach in tracking the changes. See info on Dr. Broda Barnes: http://en.wikipedia.org/wiki/Broda_Otto_Barnes


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