# ok, here's my latest



## cookfan56 (Oct 26, 2011)

Hey everyone. I was diagnosed with hashis in 2009. Have been up, down and all around. But 2011 has been especially bad since the spring.

Note: very limited blood results from 2/11. This doctor (I since left him) ran a long CBC panel (normal) but rather incomplete thyroid panel:

Free T4: 1.56 (.82-1.77) range
TSH: .316 (.45-4.5) range

I could not believe he didn't run antibodies since I had already been diagnosed with hashis, didn't run Free T3, or any other thyroid tests.

But, I felt much better then than I do now. I was on Synthroid 112 mg and 5 mcg cytomel then, and now I am only two weeks on 75 mg Armour Thyroid because of the following results in Sept. 2011: (note, this results were with a new doctor, because even though I felt ok back in february, I felt this doc didn't test enough levels and so now these new results are with doc #2)

Sept. 2011

Free T4: 1.4 (.82-1.77)
TSH 2.460 (.45-4.5)
TPO Ab 372 (0-34)
Triiodothyronine (T3) Free Serum 3.4 (2.0-4.4)

Since the first doc didn't test antibodies, and looking back at all my labs for 2 1/2 years, the only docs who did were the first one who diagnosed me, then this last one. Complicating my situation was that I was diagnosed in a different city than I'm in now. So I was diagnosed in early 2009 with high antibodies (and I do not have those numbers) put on 112 synthroid and 5 cytomel then, but have had labs that bounced all over the place since then.

Now, I feel like total crap. No energy, poor sleep. Mental depression, very bad depression. Not wanting to leave the house or even walk outside. If I do mild exercise I can only do a few minutes.

Ok -- so doc #2 (here) switched me to Armour Thyroid, 75 mg, two weeks ago. How long should it take to start feeling different? I am also on antidepressants, and nothing helps the depression or fatigue. And I also sit by a blue light box each day, and I take Omega-3's, biotin and vitamin D 10000 units per day.

I don't smoke or drink. I probably should have asked new doc for a change to Armour back in September, but was very hesitant to take it, which is why I've only been on it for two weeks.


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## lainey (Aug 26, 2010)

> Since the first doc didn't test antibodies, and looking back at all my labs for 2 1/2 years, the only docs who did were the first one who diagnosed me, then this last one.


After you are diagnosed, it is really not necessary to run antibodies. They are used to make a diagnosis, and are generally not affected by treatment. These tests are also quite expensive, which is probably why subsequent doctors have not run them.

You post is confusing.

Which set of labs goes with which medication/dosage?



> Sept. 2011
> 
> Free T4: 1.4 (.82-1.77)
> TSH 2.460 (.45-4.5)
> ...


Even if your TSH is over 2, your free T4 is in the upper third, and free T3 is in the upper half of the range. This can't come much closer to ideal. What dose/medication was this, and what was the problem here?

Perhaps changing to Armour will help, perhaps not. Presently, 75 mg of Armour is the equivalent of approximately 40 mcg of T4 and 10mcg of T3--a dose reduction from 112mcg of levothyroxine and 5 mcg of cytomel. This is going to have to be tritrated the same as any other medication change.

Have you had other vitamins and minerals tested such as ferritin, vitamin D and B as well as other hormones? There are a lot of other conditions whose symptoms mimic thyroid problems.


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## cookfan56 (Oct 26, 2011)

lainey said:


> After you are diagnosed, it is really not necessary to run antibodies. They are used to make a diagnosis, and are generally not affected by treatment. These tests are also quite expensive, which is probably why subsequent doctors have not run them.
> 
> You post is confusing.
> 
> ...


In *both* labs, I was on Synthroid 112, and cytomel 5. To me, that just shows that your TSH, as well as how you feel, can change drastically even if your meds remain the same. It is only two weeks ago that I went on Armour. Those new labs will be done in about 3 weeks.

As well as other labs, my vitamin D is good (I take it), B also good (I also take the liquid). I do realize that my Armour will have to be titrated. But I've been on synthroid for so long, and with years of "up and down labs" (up and downs on TSH as well as other values) that I thought it was time to change, because frankly I just feel like s**t.

As for antibodies, many authors (I believe Mary Shamon is one of them) state that even if your other numbers are "in range", having raging antibodies is not a good thing and means your body is in an inflamed state. And I know you probably don't agree (that is fine), I *feel* inflamed right now. very inflamed. So it makes sense my antibodies are high. Personally, I want to know if there are high levels of T-cells in my body, because they inflame other parts of your system, not just your thyroid.

But also, my TSH jumped almost 2 full points in 7 months with no med change. So that also proves something I would think.


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## cookfan56 (Oct 26, 2011)

I wanted to add that when my endocrinologist calculated my armour dose based on my dose of synthroid and cytomel, she did it twice for accuracy, and came up with 75 mg Armour. So actually maybe she converts differently than you. I don't know. I do know that if chronic fatigue, depression, lethagy, mental fog, and achiness doesn't improve within a month or so on Armour I'll be very disappointed. Since obviously I wasn't well over the past few months on Synthroid either.


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## lainey (Aug 26, 2010)

Regarding Armour:

One grain is 60 mg and contains 38 mg of T4 and approximately 9 mcg of T3. This information is available in their website.

There is nothing wrong with my math. You were put on 75mg of Armour and the dose of T4 is less than half of the 112mcg you were on. The problem with Armour is that it contains an unnatural amount of T3, which many people cannot tolerate. In addition, it produces deviations in the labs--low TSH and free T4, with elevated T3. With Armour, the dosing is based on the free T3. That 112/5mcg of synthroid/cytomel would yield much closer to 3 grains of Armour total on the T4, giving you closer to 30 mcg of T3 which would be way too much of a starting dose with your free T3 already well into the range as it is.



> As for antibodies, many authors (I believe Mary Shamon is one of them) state that even if your other numbers are "in range", having raging antibodies is not a good thing and means your body is in an inflamed state.


That may be. If you are not tolerating a T4/T3 combination due to fluctuating antibodies, there is a similar line of thought (and writing, although little of it is actual research) that believes that combination products such as Armour will produce worse results for those people. Only you can be the judge of that.

TSH can fluctuate, and pretty widely, for a variety of reasons--other medications, general health, levels of other hormones to name a few. Even minor changes in bioavailability due to the shelf life of the drug can affect some people.

Have you ever had TSI run? People who are not stable on a particular dose often have competing antibodies.


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## cookfan56 (Oct 26, 2011)

lainey said:


> Regarding Armour:
> 
> One grain is 60 mg and contains 38 mg of T4 and approximately 9 mcg of T3. This information is available in their website.
> 
> ...


I do appreciate your explaining the calculation to me. It makes sense, however, I'd have to be very careful in going to my doc and telling her that I figured out myself that the dosage of Armour she put me on was wrong. Or that someone from the internet told me, you know? I'm not saying you're wrong -- you very well may be right -- but how do you tell a doc they did a calculation wrong?

I'm learning lots from these boards, but also, I'm very aware that doctors can "fire patients" for going against medical advice, thinking they know more than the doc does, etc. And it takes 2-3 months to even *see an endo around here. So I have to watch my step.

And yes, I think I can ask to have the TSI run. It's never been run before. Thanks for your response.


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## lainey (Aug 26, 2010)

I am not in any way saying that the doc calculated the dose incorrectly.

I was just making you aware that it was not equivalent to your previous dosage and that you should expect to need to titrate it in the same way as any T4 medication.

In fact, it would have been downright dangerous to start you on an "equivalent" dosage of Armour, as T3 medication is very powerful and that would have been a six times increase. As it is you are getting about twice as much T3.

Additionally, you may experience some regression of symptoms, as many people often do when changing doses or medications.


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