# starting new treatment



## loretta (Nov 18, 2010)

hi all, we are moving over from newbie to here to report on our treatment plan and ask a few questions. my daughter had her first appointment with our naturopath and we have a treatment plan. he re- ran her tests and started her on 30 mg or armour and adrenal supplements although her saliva adrenal test came out normal.

we found a few changes in her numbers. her THS has gone down from last summer from 4.36 to 1.69 and her reverses t3 is also lower. it went from 375 to 302. her ft4 is 1.21 and ft3 is 3.3.

however, her cholesterol is high @ 210 and HDL 64 and LDL 132. her B12 is good. everything else is is looking pretty middle of the road. we didn't retest those antibodies. we are going on those previous numbers since it was only a couple of months ago but she does have them...some. (MBH is 5.2, neutrophilis 62., lymphocytes 28.5, lymphocytes abs, 1.5. i don't know much about these last few...i don't know what they pertain to but i will look into it)

so we giving her adrenal support supplements 3 times a day and 30 mg of armour to start. she has been on them for about 7 days and is more exhausted then ever. we are assuming that the 30 mg is the lowest dose and may not do much. In a week he is putting her on a detox fast with lots of nutrients for 11 days which he hopes will get her metabolism kicking into gear. I am reading three books about thyroid treatment and i think that starting out with 30mg is reasonable but i'm wondering where we might go from here. i've heard so many different opinions about armour these days although he says that he has not had any problems with this one. We plan to meet with him after her fast to reassess which will have her on this dose for about four weeks. my guess is she will need more armour to feel better although with her numbers are improved for some reason and she no longer looks that much out of the normal range. I'm wondering if the adrenal support is making her feel worse or if a low does of armour could actually be making her more tired. 
any thoughts or opinions would be welcomed. thank you!


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## Andros (Aug 26, 2009)

loretta said:


> hi all, we are moving over from newbie to here to report on our treatment plan and ask a few questions. my daughter had her first appointment with our naturopath and we have a treatment plan. he re- ran her tests and started her on 30 mg or armour and adrenal supplements although her saliva adrenal test came out normal.
> 
> we found a few changes in her numbers. her THS has gone down from last summer from 4.36 to 1.69 and her reverses t3 is also lower. it went from 375 to 302. her ft4 is 1.21 and ft3 is 3.3.
> 
> ...


Hi there!!! I do know that 30 mg. is the ideal starting dose for Armour and as with any titration, sometimes the patient does not feel their best until such time as they are approaching the euthryoid state.

If your daughter's adrenal test was normal, I would not know why she is on adrenal support. I would give that some thought. If you don't need such, it could make one feel ill, I think?

I am not a doctor. Just conjecturing here.

In the future, ranges for the lab results would be ever so helpful as different labs use different ranges.

What antibodies did your daughter test positive for? Results and ranges would be appreciated.


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## loretta (Nov 18, 2010)

Thanks andros, here are the ref ranges
FT3-2.3-4.2
FT4- 0.75-2.00
RT3-90-350
THS-0.30-4.70

her antibody tests were -

thyroglobulin antibody-<20 range 0-40
thyroid peroxidase ab-<10 range 0-35

As for adrenal support: he gave it to her because even though her tests came out normal she still had many of the symptoms of adrenal fatigue so he thought he would treat the symptoms and see if that helped her. 
I'm wondering if there is any danger in keeping her on 30 mg. for a month?
thank you!


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## McKenna (Jun 23, 2010)

Hi Loretta,
I'm wondering if it would be more helpful to try only one thing at a time, so you can better see what works for your daughter. She started the Armour and adrenal supplements at the same time and is planning on a detox fast in the near future. I'm a big supporter of allowing the body time to adjust to each new treatment or supplement before making a new change.


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## loretta (Nov 18, 2010)

thanks all. we have cut back on adrenal support, however the doctor has scheduled her for a 9 day fast. A mid day meal and two shakes a day for 4 days interspersed with by 2 days of shakes only which apparently are chock full of amino acids and nutrients. i keep reading how fasting can inhibit thyroid even more and i'm wondering if anyone else has been put on a similar regime?
I realize in some cases when the writer is referring to fasting they are referring to starvation.
thanks!


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## Andros (Aug 26, 2009)

loretta said:


> Thanks andros, here are the ref ranges
> FT3-2.3-4.2
> FT4- 0.75-2.00
> RT3-90-350
> ...


Thank you for the ranges. Are these labs with or w/o Armour? They actually look good. FT3 is only a wee bit above mid-range and the target would be a bit higher than that and also to get that TSH down further.

Info on rT3

http://thyroid-rt3.com/whatis.htm

http://www.jci.org/articles/view/107795/files/pdf

http://www.mitochondrial.net/showabstract.php?pmid=900879

What did you mean about the 30 mg. of Armour for a month. What danger?


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## loretta (Nov 18, 2010)

Hi andros and everyone else,

I shall stick with this thread since I failed to see three weeks ago that andros last commented.
For convenience, I will repost my daughter latest lab work as well as include the ref. range for the thyroid antibody test that andros asked for. (see end of post)

My daughter has been on 30 mg, 1/2 grain of armour for one month we just returned to our Doctor after her proscribed 11 day fast. (she lost 6 pounds which the doctor said was a good sign.) Mainly she did not feel anymore energetic or rested on the 30 armour. the doctor was willing to double her dose to 60mg simply for symptoms sake however he told us this:

Looking at her current labs he feels as though he can not see enough evidence for hypothyroidism and that if she does not respond to the doubled dose of armour in the next several weeks he thinks that we should give up on this particular treatment all together. He thinks that she does not have a thyroid problem. I mentioned her High RT3- 302, it was 375, 6 months before as well as her THS had been at the top end of the range @ 4.35 and is now 1.69. I might add that these numbers came down before she received any armour.

My question is this: From the labs I've posted is this how it appears to you all and/or could there be a RT3 resistance issue possibly and how would we know this? it seems to me that Her THS and Rt3 must have been high for a reason, coupled with the fact that she wakes up exhausted every day, eats reasonably, diets some and still puts on the weight despite efforts and also a host or other symptoms. She does not have irregular periods or constipation or seem to have terribly low temperature.

If she is not hypo... great but i just don't want to give up on this if we just haven't hit it right. Looking at her labs would anyone else draw the same conclusion.
thank you!

reference ranges
FT3-2.3-4.2
FT4- 0.75-2.00
RT3-90-350
THS-0.30-4.70
ferritin-10-291
iron-40-150

ft4 - 1.21 
ft3 - 3.3.
Rt3-302
cholesterol is high @ 210 ref range-<199
triglicerides 71 (ref range <149
HDL 64 (ref r. -40-59
LDL 132- high (ref range-<=99)
B12 is good 
Adrenals tested normal
thyroglobulin antibody-<20 range 0-40
thyroid peroxidase ab-<10 range 0-35

her ferritin and iron have not been tested since last september but were low
ferritin-29 (10-291)
iron 59 (40-150)

thyroglobulin antibody-<20 range 0-40
thyroid peroxidase ab-<10 range 0-35


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## lavender (Jul 13, 2010)

Are these labs from before or after she was taking Armour? They look the same as the last ones that were posted a month ago. In order to monitor if the Armour is raising her levels, labs need to be done before she was on it, and then followed up 6-8 weeks after she starts a new dose.


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## loretta (Nov 18, 2010)

These labs are from before she was put on Armour. she has not been retested since she started armour a month ago and she has only been on the 60mg for about 5 days. so far she doesn't feel anything. I am just wondering though if it seems appropriate looking at her labs as they stand presently for the doctor to conclude that there is no evidence for even subclinical hypothyroidism. I guess to be subclinical you have to be slightly over the top end of the range...I don't remember exactly the numbers for that...


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## midgetmaid (Jul 22, 2010)

Is she on iron? Her ferritin is near the bottom of the range and may be causing her to feel tired.

Renee


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## loretta (Nov 18, 2010)

she took it for a while and then with this new doctor he didn't put any emphasis on it so she dropped it. I have read here that its important to get your iron in place before treatment but it seems as though that i've also read that iron can inhibit thyroid. sounds like you might think it a good idea for her to go back on it...? any idea how much and it should be taken away from thyroid, right?


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## midgetmaid (Jul 22, 2010)

Iron should be spaced 4 hours from thyroid meds so it won't interfere with absorption. Some people report feeling unwell at that level. Let the doc know if you decide to put her back on it.

Renee


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## Andros (Aug 26, 2009)

loretta said:


> These labs are from before she was put on Armour. she has not been retested since she started armour a month ago and she has only been on the 60mg for about 5 days. so far she doesn't feel anything. I am just wondering though if it seems appropriate looking at her labs as they stand presently for the doctor to conclude that there is no evidence for even subclinical hypothyroidism. I guess to be subclinical you have to be slightly over the top end of the range...I don't remember exactly the numbers for that...


Just so you know; low ferritin impedes the efficacy of thyroxine replacement.


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## loretta (Nov 18, 2010)

yes, I do, thanks. We are trying to figure out a way she can take it in the morning before school and still have time to have breakfast. I've read that you should wait an hour to eat and stay away from iron and calcium. the other option is to wait two hours and take it after breakfast...tricky with school age kids, however.

Andros, In your experience, have you seen labs like this where the person is hypo in spite of most of the labs being in range...also with regards to a high but still within range RT3? 
thanks you.


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## lainey (Aug 26, 2010)

>>In your experience, have you seen labs like this where the person is hypo in spite of most of the labs being in range...also with regards to a high but still within range RT3?<<

People are occasionally treated with borderline numbers in the presence of high antibodies. With the results that you have posted, even when her TSH was slightly high, her Free T4 and T3 were quite good, and your daughter's antibodies are not high.

Do you have current labs? Has anyone ever done a sonogram or uptake scan?

You should know, that RT3 is generally not used to treat and diagnose thyroid problems.
Most doctors do not even run it any more.


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## loretta (Nov 18, 2010)

Yes, thanks. the labs i have posted are current but they were taken just prior to taking armour and as I said she just doubled her dose and has not yet been re tested. the doctor said in a months time he will.
As for rt3? i thought that the more savvy doctors did look at that. Although as you said, i didn't realize that without the presence of high antibodies it was not an issue.

we have not done a sonogram or uptake scan...i'll have to look that up since i'm not quite sure about what they are.
thanks.


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## lainey (Aug 26, 2010)

If your are considering "T3 resistance" as being her problem, you should know that "Wilson's Syndrome" and it's treatment is considered spurious at best in most parts of the world.

IF your doctor were treating her for that, the proper course would be a short interval (several weeks) of T3 only therapy, and then re-test the blood.

These are copied from a post in this thread:
FT3-2.3-4.2
FT4- 0.75-2.00
RT3-90-350
THS-0.30-4.70

ft4 - 1.21 
ft3 - 3.3.
Rt3-302

All are well in range--and the second TSH I saw was 1.69, is that correct?

While those numbers are not "ideal" if there is such a thing, the doctor did say:
>>Looking at her current labs he feels as though he can not see enough evidence for hypothyroidism and that if she does not respond to the doubled dose of armour in the next several weeks he thinks that we should give up on this particular treatment all together. He thinks that she does not have a thyroid problem.<<

He has a valid point. I don't agree with increasing the dosage without running the lab work first. You have no idea what her levels are now, if the 30mg of Armour has made her hyper (as it very well could have because her numbers were pretty normal) she wouldn't be feeling any better, and the increased dosage wouldn't help. The only way to know is with a blood test.

If these are the labs BEFORE armour, she should have labs before increasing it to 60mg.

Has she had any GYN testing--full scale female hormone, sonogram for ovarian cysts (polycystic ovarian syndrome) and insulin resistance? They did a c-peptide earlier, but insulin resistance testing includes that with a glucose challenge.


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## Andros (Aug 26, 2009)

loretta said:


> yes, I do, thanks. We are trying to figure out a way she can take it in the morning before school and still have time to have breakfast. I've read that you should wait an hour to eat and stay away from iron and calcium. the other option is to wait two hours and take it after breakfast...tricky with school age kids, however.
> 
> Andros, In your experience, have you seen labs like this where the person is hypo in spite of most of the labs being in range...also with regards to a high but still within range RT3?
> thanks you.


Hypo, hyper and even cancer when the usual thyroid panel is in range. That is why "all" the antibodies' tests are so important as well as RAIU in a young lady. You never know.

There are binding, blocking and stimulating antibodies and autoantibodies. If they are running amok, they will skew the thyroid panel including the rT3.

While below the range, there is a smattering of both those antibodies which does indicate something is going on.

I can't remember if I provided this url to you? So here it is.

http://thyroid-rt3.com/whatis.htm

It would be good to run the TBII, TSI and ANA as well.

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/unders...s/thyroid.html


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## loretta (Nov 18, 2010)

Lainey, yes the second TSH was 1.69.
as for T3 resistance : 
you say :"you should know that "Wilson's Syndrome" and it's treatment is considered spurious at best in most parts of the world."

thank you for that. i have reading about it and I also see that most think wilsons syndrome is bogus but i didn't realize that it was one and the same, so that is helpful to know.

Then you say, "He has a valid point. I don't agree with increasing the dosage without running the lab work first. You have no idea what her levels are now, if the 30mg of Armour has made her hyper (as it very well could have because her numbers were pretty normal) she wouldn't be feeling any better, and the increased dosage wouldn't help. The only way to know is with a blood test. If these are the labs BEFORE armour, she should have labs before increasing it to 60mg."

I understand, however we had just done the lab work before we put her on 30mg. starting dose, after 4 weeks he raised it to 60 mg. he plans to test her in three weeks or so. she has not had any ill symptoms yet on 60mg. no hyper symptoms either.

Andros and lainey:
as for antibody testing initially she had thyroglobulin Ab and thyroid peroxidase antibody done. When i suggested that she be tested for the other antibody tests, ie.,TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin) ANA (antinuclear antibodies), both doctors we were seeing said those are very expensive and i don't see that we need to do those. I recently ask again about her low levels of antibodies and he said that they were not high enough to be an issue...

her C-peptides were high when we first tested them last august. 4.8 (1.0-4.0). as i mention earlier also high cholesterol and LDL.
And lastly fasting glucose was 92 (60-99)

"Has she had any GYN testing--full scale female hormone, sonogram for ovarian cysts (polycystic ovarian syndrome) and insulin resistance?"

not really, They did a c-peptide earlier.

" but insulin resistance testing includes that with a glucose challenge."
no, I don't think so. that's when they give you something to drink and then check your sugar levels, right?

She has not been tested for polycystic ovarian syndrome because she doesn't seem to have any of the symptoms that go with it. but maybe its time to go to a gyno and have that checked out.

As for the insulin resistance? I keep asking about it i i get a no, although I don't really get why. my understanding is that is because they said that her triglyicerides would be higher and her HLD would be down. I'm still trying to understand why her cholesterol and LDL are high and where that fits in.

thank you for trying to point us in the right direction and help. it is a mystery though..something is not right, we just don't know what it is exactly.
Our doctor wants her to do another cleaning fast for 30 days to see if that will shake something loose but that might not be in the cards for a 17 year old not to mention the expense.
thanks again


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## lainey (Aug 26, 2010)

>>I understand, however we had just done the lab work before we put her on 30mg. starting dose, after 4 weeks he raised it to 60 mg. he plans to test her in three weeks or so. she has not had any ill symptoms yet on 60mg. no hyper symptoms either.<<

Loretta, I have to repeat myself here, because I feel so strongly, that titrating the dosage up should only be done with lab work in hand that indicates that it should be so.

Symptoms, as you can see, are not the best measurement of disease or it's treatment.

Thyroid medication is very powerful, especially that containing T3, and dangerous in the sense that too much can cause, among other things, heart rhythm disturbances.

If it were my child, I absolutely wouldn't give her the medication without the supporting lab work. By the time she has symptoms, it is too late in this instance.


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## lavender (Jul 13, 2010)

Thyroid medications should NEVER be increased without first running a thyroid panel including TSH, Free T3 and Free T4. It could be dangerous to increase meds without knowing what her current levels are because too high of a dose will make your daughter hyper.

Thyroid meds have a very small range in which they are effective for any individual. Too little makes someone hypo and not well. Too much makes someone hyper, and could be lethal.

As fatigued as hypothyroid makes someone, being hyperthyroid can be a terrifying experience when it starts to affect one's heart. I have been there. When I was hyperthyroid, there was nothing I could do to calm myself down. Hyperthyroid symptoms can come on suddenly without warning. It took months for my body to heal from being hyperthyroid. I would hate to see someone go through that unnecessarily.

Just the process of switching doses and changing homone levels is very taxing on the body. Not to mention adding a fast on top of that. The thyroid is a very slow gland, and requires patience to treat. There are no quick solutions. It may take a few weeks for your daughter to tell if her current dose is effective. I myself am hesitant to increase my armour dose until I have been on it for at least 6 weeks and have had labs to see what my levels are.

Not testing before putting your daughter on a higher dose of Armour could seriously affect her heart and her overall health. That's not a risk I would take with myself, let alone with a 17 year old.


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## loretta (Nov 18, 2010)

Thank you all for your heart felt concern. As i said she was tested and and given 1/2 grain. four weeks later she was given 1/2 more. Calling it a fast was misleading on my part.. she wasn't fasting, it was a very healthy diet with lots of specially formulated shakes, salads and lots of protein and fruit. she was never hungry.

As to your concern about changing her dose before she was retested...I hear you both loud and clear. The doctor made this decision and assured us that it was just a very small increase and if she felt any hypo effects we would immediately back her off of it. I hear that you are saying that he shouldn't have made the increase without retesting. I thought he did so because he felt that he has just tested her but now you have raised my concern. I have to say that he has been practicing for many yeas and that he is well regarded as to thyroid treatment. Also I wanted to add that she hasn't felt a thing and she has been on it for 6 days now and before that 1/2 grain for a month.
Still no new symptoms.

Here is the big question: Is it possible to have it build up after weeks and then all of a sudden go hyper?

I have been extremely hesitant about this process of medication and now i'm very nervous. I shall call him and ask if we should continue without further testing


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## northernlite (Oct 28, 2010)

I could not agree more with the last posts. Your daughter could get in serious trouble increasing meds without checking her blood levels. This is not a doctor I would want for my child.

Fasting and cleansing are not for ill teenagers. Losing 6 lbs in 11 days means her body was not taking in enough calories. This throws the body in to starvation mode and her body begins to burn muscle not fat. This loss of muscle lowers the metabolic rate even further. This is not healthy in a well person let alone someone that is ill.


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## Andros (Aug 26, 2009)

northernlite said:


> I could not agree more with the last posts. Your daughter could get in serious trouble increasing meds without checking her blood levels. This is not a doctor I would want for my child.
> 
> Fasting and cleansing are not for ill teenagers. Losing 6 lbs in 11 days means her body was not taking in enough calories. This throws the body in to starvation mode and her body begins to burn muscle not fat. This loss of muscle lowers the metabolic rate even further. This is not healthy in a well person let alone someone that is ill.


I most certainly agree with your input! Well said.


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## loretta (Nov 18, 2010)

Okay, so please tell me if this is what you recommend now.
make an appointment to have a new panel done and on the day she is to have the test have her skip her meds to see more accurately what her body is doing?
Or what?

And then what? if the numbers are the same or better keep going with the 60mg for another month or so and then retest? 
If the THS is too low obviously we go back to 1/2 or do we slowly come off of it all together?

what other things should i look for in the numbers?
she is not feeling anything negative effects what so ever...

advice please?


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## lainey (Aug 26, 2010)

Why would you skip the meds on the day of the test?

If you want to see what her body is doing, you need to measure what is happening when she takes it, not when she isn't. You wouldn't want to make the T3 appear lower than it actually is when she is taking the medication, would you?

Do the bloodwork.

It is not just the TSH that you need to measure. Armour, by it's very nature, will tend to suppress the TSH and the free T4 (which you need measured also) because of it's high ratio of T3. It's the free T3 that is critical and is what must be run while she is on this type of medication.

Once you know where she is, you can make an informed decision based on the results.


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## lavender (Jul 13, 2010)

This is what I do for myself:

Take the same dose of Armour (or whatever thyroid med I am taking) for 4-8 weeks. Take my normal dose of meds in the morning. Get bloodwork (TSH , Free T3, Free T4). After my labs are back, discuss med changes with my doc based on test results and my symptoms.

Make one change at a time. That being, thyroid meds, other meds, dietary changes, vitamins, supplements, etc. Otherwise, I run the risk of overloading my system. If I change too much at once and something is working, there will be too many factors to determine what is working. If I suddenly get worse, I won't know the cause either.

When making a bunch of changes all at once, it may be possible that I am doing one thing that improves my condition and something else that makes it worse, leaving me feeling the same and unable to sort out what is what.

For example, when I saw my doctor recently, we discussed trying a gluten free diet. However, she was just starting me out on Armour at that appointment. She told me to wait a while to go gluten free so that I could see what was helping and what wasn't.

Also, if I try to many changes at once, at some point I will just get overwhelmed and frustrated and give it all up, going back to what I was doing before and not doing my body any good in the long run.


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## loretta (Nov 18, 2010)

Thank you. i understand that changing too many things can confuse results...we are on board with that.

Lainey, the reason i asked about whether she should skip her doses before she does the blood work is because I read in one of the many books that I have been reading...Here it is, from mary shomans book, Living Well with hypothyroidisn, page 117.

the heading: 
Timing Of When to Take Your Pill on Test Day

she says this:

[While when you take levothyroxine pill doesn't typically have an effect on your over all THS levels, the timing of a T3 drug can. So ideally, on the day you have your blood test, you should try to avoid taking your thyroid hormone until after you've had your blood taken. this is particularly important if you are having T# and Free T3 levels measured.}

So, thats where i got that idea.
Having said that Lainey, I see what you saying. you are saying that if you want to know how her system is handling what she is on then test while she has the daily thyroid in her blood stream. Is that right?
thank you.


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## Andros (Aug 26, 2009)

loretta said:


> Okay, so please tell me if this is what you recommend now.
> make an appointment to have a new panel done and on the day she is to have the test have her skip her meds to see more accurately what her body is doing?
> Or what?
> 
> ...


My experience says do not skip meds (Armour) but do get her labs 5 or 6 hours away. Armour peaks in 4 hours so if she takes her Armour in the morning (early), I would advise afternoon labs.

If that cannot be done, I do advise skipping for morning labs because the new Armour absorbs very fast and could give a very high FT3. I had this happen to me recently on the new Armour. They changed the filler so it would absorb better and faster which is fine by me.

But, I take @ 5:30 AM and got my labs @ 9:30 AM. OMG!! FT3 was 705! LHM!!! No way did I present clinically hyper on that day. Doc scrutinized me carefully.

So, since I am a morning person for almost all things I do, I do skip my Armour prior and take it right after my blood is drawn.

The main criteria here is consistency. You don't want to lab in the mornings sometimes and you don't want to lab in the afternoons sometimes. Staying the course is vitally important.

Hope my experience is helpful to you.


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