# Titrating Armour thyroid questions



## earlyapex (Feb 17, 2014)

I was diagnosed hashimotos recently. Doc is starting me on 1/4gr of armour. I've done a lot of research online and i'm getting conflicting information on the rate of increases. Armour's website say raise every 2-3 weeks. STTM says 1/2 gr every 2 weeks. I noticed many of you all preach 1/4gr every 4-8 weeks. What's the deal with that? I'm a bit worried my body will sense the exogenous thyroid and shutdown total production and i'll go extremely hypo. Does that happen, or will my thyroid just back off a little to compensate for the additional input? Thanks.


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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)

It is my experience and humble opinion that Armour should be titrated upward as needed based on the FREE T3 results by 1/4 grain every 6 to 8 weeks. 8 weeks is better. You want to give your body time to adjust to the "news!"

This is a case where haste makes waste.

Welcome to the board.


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## Swimmer (Sep 12, 2013)

Well put Andros 

Here's how my endocrinologist helped me - first he put me on synthroid - because of an adverse reaction he put me on tirosint - because of an adverse reaction he took me off of everything -- THEN switched me over to armour (everything was clearly out of my system when the armour started) because of the adverse reactions to synthetics, he wanted this one to take... So he started me out very slowly (this is on the armour dosing page on their website).

Here's how it went down: My tablets were 30mg

1/2 a pill for two weeks as tolerated.

1 pill for two weeks as tolerated

1 1/2 pill for two weeks as tolerated

2 pills as tolerated until I see him (I saw him) and because of my current labs, I am only on 2 pills per day.

Now I have backed those up to 3 am for the past few days and MAN DOES that make me feel even better -- and I was feeling good already! Just a few down days/rest days needed here and there.

Some people have certain health conditions (mentioned on the armour dosing page) and if you have any of those conditions, your doc may be introducing this very carefully to you.

The good thing to keep in mind is that you are upping your doses until the doc finds that your labs are reflecting what he/she is looking for,


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## earlyapex (Feb 17, 2014)

Swimmer said:


> Well put Andros
> 
> Here's how my endocrinologist helped me - first he put me on synthroid - because of an adverse reaction he put me on tirosint - because of an adverse reaction he took me off of everything -- THEN switched me over to armour (everything was clearly out of my system when the armour started) because of the adverse reactions to synthetics, he wanted this one to take... So he started me out very slowly (this is on the armour dosing page on their website).
> 
> ...


What do you mean "backed those up to 3am"?


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## Swimmer (Sep 12, 2013)

Hi -- I mean that I was taking them at 5 am -- but I've changed the time to take it earlier  I now take the armour at 3am


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## earlyapex (Feb 17, 2014)

Swimmer said:


> Hi -- I mean that I was taking them at 5 am -- but I've changed the time to take it earlier  I now take the armour at 3am


You take the whole 1gr. at 3am? Can you explain why? thanks.


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## earlyapex (Feb 17, 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)
> 
> ...


If you were to wait 8 weeks on 1/4 and 1/2gr wouldn't you go extremely hypo due to the feedback loop? This is all new to me. Maybe I can just go by how my body feels? thanks.


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## Swimmer (Sep 12, 2013)

Hi, I don't know how much 1 grain is But -- I take both pills (totalling 60 mg) at 3am -- and wow do I feel great. I mean super duper.

LIke - dance, swim, play, laugh.


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## Airmid (Apr 24, 2013)

earlyapex said:


> I was diagnosed hashimotos recently. Doc is starting me on 1/4gr of armour. I've done a lot of research online and i'm getting conflicting information on the rate of increases. Armour's website say raise every 2-3 weeks. STTM says 1/2 gr every 2 weeks. I noticed many of you all preach 1/4gr every 4-8 weeks. What's the deal with that? I'm a bit worried my body will sense the exogenous thyroid and shutdown total production and i'll go extremely hypo. Does that happen, or will my thyroid just back off a little to compensate for the additional input? Thanks.


No that shouldn't happen.You already don't have enough so putting in more into your body does two things depending on what the issue is:

1. Compliment remaining natural thyroid function so that you have enough hormone between the pills and your thyroid

2. Suppress your natural thyroid function, i.e. in the case of Hashimoto's to slow or stop the body's attack and to bring you to a euthyroid state.

Shock and awe is never a good approach to balancing a thyroid and will just make you feel bad. Why so many talk about going slow here is that there is a risk of going hyper on medications if you go too fast. Those of us that have gone hyper while on thyroid meds will tell you it's not a fun place to be - you have to stop everything, wait and then start it again. Why go through that when going slower will pretty much prevent that?

While STTM does have a lot of good information I think she is too pushy about how fast to go up along with telling patients that they should be upping their own thyroid dose. Don't do that. Labs are what's needed especially on something on Armour that has T3 in it along with the fact that it has a higher ratio of T3:T4 then found in the human body. Monitoring where you are at while increasing your dosage is really the way to go here. Six weeks per dose increase is actually fast compared to what many of us went through to get to our doses and some of us do take some whooping doses.


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## earlyapex (Feb 17, 2014)

Airmid said:


> No that shouldn't happen.You already don't have enough so putting in more into your body does two things depending on what the issue is:
> 
> 1. Compliment remaining natural thyroid function so that you have enough hormone between the pills and your thyroid
> 
> ...


Thank you very much for your answer. The impression I got from STTM is that once i introduce some exogenous hormones, my feedback loop completely shuts down and that is the reason for the rapid titration. To be honest with you, this isn't my first time titrating Armour. I recently overmedicated myself following the 2-3 week raises that Armour and STTM recommend. I only made it to 3/4gr before all hell broke loose. I have been off meds for a little over a week now and still feel hyper. (insomina, racing mind, cant sit still, yet I feel cold, depressed and anxious as well. I told myself this is the last time I will put myself through this kind of hell and so I am determined to go extremely slow this time around. Here were my labs when I was diagnosed before any medication at all.

*Test Description* *Result* *Range* *Units*

TSH004264







31.66 0.450-4.500 uIU/mL

Triiodothyronine,Free,Serum010389 3.1 2.0-4.4 pg/mL

T4,Free(Direct)019745 0.87 0.82-1.77 ng/dL

Based on these labs is there any advice or insight you can provide? I notice my FT3 is actually not all that bad, Is this why starting on 1/4gr I feel pretty hyper for quite some time?

One final question, so as i titrate up, will I reach a point where my Frees are happy and my thyroid is picking up the rest of the slack, or will I have to completely suppress TSH and be fully replacing my thyroids own output? I'm a bit confused on that. My doc mentioned that I will probably need about 1.75gr of armour. Yet when I research online, everyone swears that we need a min of 3.5gr of armour. Thanks for the advice.


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## Airmid (Apr 24, 2013)

Wow you have labs like mine when my thyroid decides to do interesting things. Like you my T3 is normal and mine has actually been at the max end of normal before with my TSH and T4 in gutter. I was on 250 mcg of Synthroid then went hyper a few weeks ago. You can imagine how that felt. The tremors and hives were the best parts of that, along with the heart issues being exacerbated. While not a lot could have prevented that, it's why as you learned you must be so careful. And I was on that dose for 8 months by the way, pushed up from 200 mcg. It does take a while for the hyper issues to go away too, to be honest. T4 has a half life of 7 days and it may be wise to wait till some of the issues subside more before attempting again with a T3 containing medication.

I'm sorry that I'm unaware of your history. Did you ever try just a T4 medication or did you and your doctor decide for Armour as first go? Don't get me wrong, it's not that i think Armour is bad medication. I think it works for a lot of patients and can give them their lives back. It may on the other hand not be a good fit for you. Which is why I ask if you've tried something like Synthroid first. If you have T3 issues on it (which I don't think you will) Cytomel, a T3 medication can be added in a low dose. You may feel better if you haven't tried it yet. Sorry in advance if you have.

As for your last question, with Hashimoto's you'll probably end up aiming for suppression. As for how much you'll need, everyone is different. It really depends on how your body responds to the medication, how much thyroid function is left and also keep in mind that it is progressive disease and your needs may change over the years and you will probably end up needing more in 5-10 years then you do now. We all have different requirements and our bodies all respond differently. I was taking more hormone then people who don't have thyroids and we still struggled for some type of control while other's can be fully controlled at 75 mcg for years. There's no one size fits all dose of anything, and anyone who tells you that is trying to sell you something that just isn't true.


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## earlyapex (Feb 17, 2014)

Airmid said:


> Wow you have labs like mine when my thyroid decides to do interesting things. Like you my T3 is normal and mine has actually been at the max end of normal before with my TSH and T4 in gutter. I was on 250 mcg of Synthroid then went hyper a few weeks ago. You can imagine how that felt. The tremors and hives were the best parts of that, along with the heart issues being exacerbated. While not a lot could have prevented that, it's why as you learned you must be so careful. And I was on that dose for 8 months by the way, pushed up from 200 mcg. It does take a while for the hyper issues to go away too, to be honest. T4 has a half life of 7 days and it may be wise to wait till some of the issues subside more before attempting again with a T3 containing medication.
> 
> I'm sorry that I'm unaware of your history. Did you ever try just a T4 medication or did you and your doctor decide for Armour as first go? Don't get me wrong, it's not that i think Armour is bad medication. I think it works for a lot of patients and can give them their lives back. It may on the other hand not be a good fit for you. Which is why I ask if you've tried something like Synthroid first. If you have T3 issues on it (which I don't think you will) Cytomel, a T3 medication can be added in a low dose. You may feel better if you haven't tried it yet. Sorry in advance if you have.
> 
> As for your last question, with Hashimoto's you'll probably end up aiming for suppression. As for how much you'll need, everyone is different. It really depends on how your body responds to the medication, how much thyroid function is left and also keep in mind that it is progressive disease and your needs may change over the years and you will probably end up needing more in 5-10 years then you do now. We all have different requirements and our bodies all respond differently. I was taking more hormone then people who don't have thyroids and we still struggled for some type of control while other's can be fully controlled at 75 mcg for years. There's no one size fits all dose of anything, and anyone who tells you that is trying to sell you something that just isn't true.


I was on synthroid and cytomel for a while in the beginning and wasnt doing too well. I eventually became overmedicated when i started self medicating. Then I stupidly came off all thyroid for about a month. During that time my thyroid began producing again. Then after a couple rounds of trying to ramp up the armour every 2-3 weeks and that not working, brings me to where i am today. I will wait a bit longer before reinstate on armour. Should I start of 1/4gr and raise by 1/4gr every time? I'm so bummed that I threw all that time away when I originally became overmedicated and came off. Is it necessary to do labs after every increase or can I wait until I get up to around 1gr before I do them?


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## Airmid (Apr 24, 2013)

What were the issues on the Sythroid and Cytomel? Was it just not controlled?

I would definitely start out slow at 1/4 and go for labs at every 1/2 grain mark you hit. When you add more keep in mind you don't have to take the full thyroid dose at once, you can take it at different times of day. Due to the short half life of T3 and it's strength compared to T4 you may feel better.

Patience is the key here. While T4 itself does have a week long half life and you should start feeling better at that mark, it will take a little while longer for your body's feedback loop to normalize again at whatever was normal before the over medication issue occurred, usually a few weeks (this is where I've seen people get confused, it's not that Synthroid lasts so long it's that it takes that long for your body to become unaccustomed to not having extra hormones being added). It might be wise to get labs before reinstating the Armour to see where things stand and work from that.


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## Swimmer (Sep 12, 2013)

Hi early apex -- question - do you have a doctor that is prescribing your armour doses? I wouldn't recommend making *any* changes to what your doctor has suggested as they run labs to see how your body reacts to the small dosage, and if I understand right, aren't you coming off of some other synthetic thyroid hormone - if so, if that is left in your body at all, might be why the doc is starting you where you are, also if you have any underlying issues, also be careful about STTM - even though they have helpful information, when I was on a yahoo group that appeared to be theirs (I could be wrong) -- it seemed like they doled out info and suggestions in a "one size fits all" manner, they haven't seen your charts or even taken your pulse, they don't know your medical history - when compared with your doctor - I'd say - be patient and allow your doctor to care for you, and if you're not feeling well, call the nurse and have her pass that on, and allow your doctor to properly carefully take care of you and get you on level ground. Your doc may have some important medical reasons for what he/she is doing -- a simple phone call to the nurse -- and you might get a call back with an explanation.


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## earlyapex (Feb 17, 2014)

Airmid said:


> What were the issues on the Sythroid and Cytomel? Was it just not controlled?
> 
> I would definitely start out slow at 1/4 and go for labs at every 1/2 grain mark you hit. When you add more keep in mind you don't have to take the full thyroid dose at once, you can take it at different times of day. Due to the short half life of T3 and it's strength compared to T4 you may feel better.
> 
> Patience is the key here. While T4 itself does have a week long half life and you should start feeling better at that mark, it will take a little while longer for your body's feedback loop to normalize again at whatever was normal before the over medication issue occurred, usually a few weeks (this is where I've seen people get confused, it's not that Synthroid lasts so long it's that it takes that long for your body to become unaccustomed to not having extra hormones being added). It might be wise to get labs before reinstating the Armour to see where things stand and work from that.


My plan was to give it another week or so and once I begin sleeping again and my mind is no longer racing, I would reinstate on 1/4gr. Even if I go slightly hyper for a little bit, im sure I could handle it until things get balanced out again.

Once I'm on 1/4gr for say 8 weeks, do hypo symptoms always return after each dose increase? Or do you feel pretty good after 8 weeks and just have to force another increase, assuming labs say you're ready for another. Thanks.


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## earlyapex (Feb 17, 2014)

Swimmer said:


> Hi early apex -- question - do you have a doctor that is prescribing your armour doses? I wouldn't recommend making *any* changes to what your doctor has suggested as they run labs to see how your body reacts to the small dosage, and if I understand right, aren't you coming off of some other synthetic thyroid hormone - if so, if that is left in your body at all, might be why the doc is starting you where you are, also if you have any underlying issues, also be careful about STTM - even though they have helpful information, when I was on a yahoo group that appeared to be theirs (I could be wrong) -- it seemed like they doled out info and suggestions in a "one size fits all" manner, they haven't seen your charts or even taken your pulse, they don't know your medical history - when compared with your doctor - I'd say - be patient and allow your doctor to care for you, and if you're not feeling well, call the nurse and have her pass that on, and allow your doctor to properly carefully take care of you and get you on level ground. Your doc may have some important medical reasons for what he/she is doing -- a simple phone call to the nurse -- and you might get a call back with an explanation.


Yes i have a doctor who i am working with. He goes by the Frees and more importantly symptoms. I feel he will be the one to get me 100%. He pretty much told me to titrate myself based on feelings/symptoms. Which unfortunately has been a bit of a curse for me since I am very impatient. I want to work my way up to around 1gr. before I go back to see him, because its been over 6 months now and I'm back at square one, i'm pretty embarrassed about it to be honest. I was on the synthetics about a year ago and was very undermedicated. I ditched that doc because he was treating me by TSH. When I found this new doc, we added a small amount of armour to my Synthroid/cytomel mix and I felt great for a bit. But i got over zealous and overmedicated myself , that is when I came off meds completely. His plan was to ween me off the synthetics and onto 100% armour but I blew it. So he told me just to titrate back up on just armour.

I never want to be overmedicted again. It's simply awful. I simply can't put myself through that again.


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## Swimmer (Sep 12, 2013)

That's really neat that your doctor cares about your symptoms. That's super. I think you should just give them a call, tell them how you're feeling, make an appointment to go see them -- and just go ahead because then they'll know you need help and either make a change, or comfort you/explain - and that can help you get through this time as well.

Take care now & hope you're feeling better soon


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## earlyapex (Feb 17, 2014)

I just realized i've been hypo this entire time. Oh boy this thyroid stuff is so confusing. When I adjusting to 1gr recently I was only about 6 days into it and backed down to .75 because of the anxiety and insomina. That is when everything began going downhill. I went very hypo, but I thought I was hyper due to the insomina, anxiety, racing mind ect. But in reality, it was the adranline compensating for the lack of hormones. I put the pieces of the puzzle together today when I woke up with a pulse in the 50s, have been rather cold lately, but when the adrenaline kicks in I get hot and sweaty. When I am hypo, I have a very low resting pulse, but as soon as I get up and move around it sky rockets. During my hypo times, i also get a buzzing feeling throughout my body as well as a very minor tremor in my hands, I wish this stuff was black and white. Now I'm depressed that i wasted all that time titrating up. Oh well, at least I know now that I can in fact go a bit quicker than I thought. I do plan to take it very slow once I get to 1gr. just to play it safe.


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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)

The best protocol would be to start on 1/4 grain of Armour and for titration purposes; go up by only 1/4 grain every 8 weeks based on where your FREE T3 is at. Most of us shoot for FREE T3 to be at about 75% of the range provided by your lab.

You will find info enclosed.


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## burdette2004 (Oct 29, 2013)

Swimmer said:


> Hi, I don't know how much 1 grain is But -- I take both pills (totalling 60 mg) at 3am -- and wow do I feel great. I mean super duper.
> 
> LIke - dance, swim, play, laugh.


So you don't split your dose at all. Do you feel a crash later in the day? I am currently taking 30 morning and night.


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## Swimmer (Sep 12, 2013)

My dose has just been upped to 75, so now I'm taking one sixty, and then splitting a 30. I just bought a new pill splitter from Costco -- it is WAY better than the blue one from safeway. About the afternoon crash, taking armour thyroid has actually made my life so much better that I don't always have those anymore. In fact, I'd say it's more likely that I won't have an afternoon crash whereas before taking armour, I frequently had afternoon crashes.


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