# How did you feel as you titrated up on Armour?



## Zugora

How did you feel as you titrated up on Armour? Did you feel worse with each dose increase? Did you slowly see improvements as you titrated up?

I started Armour (30 mg or 1/2 grain) about 4 weeks ago. Immediately upon taking, I got intense heart palpitations...not totally unusual for me, since vitamins can even make my heart race. Plus, I know I'm just ultra sensitive to medication. Called doc and he said to take 1/2 (15 mg) instead.

So, for 2 weeks I took 15 mg (1/4 grain), as directed. There was less heart racing initially and they slowly subsided over the 2 week period. Yay! However, I felt like I was swinging between hypo and hyper the entire time. When heart palps were gone, doc said to raise the dose again to 30 mg (1/2 grain)..that was about 1 week ago. Again, experiencing heart palps with the increased dosage, but less severe than the first 2 weeks. I'm also experiencing crazy insomnia/mind racing, and then I crash with fatigue. The good news is, despite the "swinging" feeling, I am noticing a difference in energy level.

Doc wants me to continue raising the dose by a 1/4 grain every two weeks or so (if sxs allow) until I reach 1 grain. Then, to slowly increase every 8 weeks after that. Does this sound right?

I know I'm very sensitive to medication, but what has been your experience with titrating up on Armour? This not sleeping/mind-racing business is pretty awful. Thanks so much.


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## McKenna

Hi there, 
Well, it sounds like your doctor is right on the ball with increasing 1/4 grain at a time. Armour definitely packs a punch and it does take time to get used to it. If you try to bump it up too fast it can backfire and the you might not be able to handle it down the road.

I felt every dose increase but any symptoms went away after a few days. There are some things that I have found work better for me when taking Armour. I take it first thing in the morning when I get out of bed and I chew mine. It seems to absorb better for me that way. I have my coffee after about 20 minutes. I also have to eat after one hour because it seems to keep the absorbtion or the effects more steady. I don't know why it works like that for me, but I've tried several different ways and that's what seems to work the best.

And depending on how much I eat or how active I am on a particular day, I will feel the peak of Armour anywhere between 4 and 5 hours after taking it. It's usually a burst of energy or slightly flushed feeling that lasts for about 20 minutes. It's not a hyper feeling but feels sort of like I drank a cup of coffee. That is if I'm not doing much or if I didn't eat much. Otherwise I don't notice it.

As for feeling better with each increase, I suppose I felt small improvements, but honestly it took until my dose was consistant for a few months before feeling back to myself again, and that was around one year after my TT. Your symptoms sound like your body is trying to adjust to this new change and it takes time.

I feel I'm extremely sensitive to meds also and I always feel every change in dose.

HTH and good luck.


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## I DClaire

I've only been on 60 mg Armour since the end of December but I don't feel like the results are stable. Some days I feel relatively normal - other days, like today, I literally could not function, I stayed in bed almost all day too fatigued to even try to do anything.

I'm not totally discouraged but I am somewhat worried and frustrated. One thing I find is if I push myself when I honestly don't feel well THEN my blood pressure will escalate, my heart rate will increase and I feel breathless.

After surgery I first took 125 mcg Synthroid and I don't know how 60 mg Armour compares in strength but I'm really just out of energy most of the time.


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## Andros

Zugora said:


> How did you feel as you titrated up on Armour? Did you feel worse with each dose increase? Did you slowly see improvements as you titrated up?
> 
> I started Armour (30 mg or 1/2 grain) about 4 weeks ago. Immediately upon taking, I got intense heart palpitations...not totally unusual for me, since vitamins can even make my heart race. Plus, I know I'm just ultra sensitive to medication. Called doc and he said to take 1/2 (15 mg) instead.
> 
> So, for 2 weeks I took 15 mg (1/4 grain), as directed. There was less heart racing initially and they slowly subsided over the 2 week period. Yay! However, I felt like I was swinging between hypo and hyper the entire time. When heart palps were gone, doc said to raise the dose again to 30 mg (1/2 grain)..that was about 1 week ago. Again, experiencing heart palps with the increased dosage, but less severe than the first 2 weeks. I'm also experiencing crazy insomnia/mind racing, and then I crash with fatigue. The good news is, despite the "swinging" feeling, I am noticing a difference in energy level.
> 
> Doc wants me to continue raising the dose by a 1/4 grain every two weeks or so and when I feel like I have "settled into" each new dose. Does this sound right?
> 
> I know I'm very sensitive to medication, but what has been your experience with titrating up on Armour? This not sleeping/mind-racing business is pretty awful. Thanks so much.


Does not sound right to me. One should start on 1/4 to 1/2 grain and titrate by 1/4 grain (or 1/2 grain but my doc did 1/4 grain) every 8 weeks.

Too much too soon for you, I believe. Also, have you checked your adrenals and your ferritin?

Are you taking after a light meal as previously suggested? You are taking Armour brand by Forest Pharmaceuticals?


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## Zugora

Andros said:


> Does not sound right to me. As per the Rx info on the Armour site; one should start on 1/4 to 1/2 grain and titrate by 1/4 grain (or 1/2 grain but my doc did 1/4 grain) every 8 weeks.
> 
> Too much too soon for you, I believe. Also, have you checked your adrenals and your ferritin?
> 
> Are you taking after a light meal as previously suggested? You are taking Armour brand by Forest Pharmaceuticals?


Thank you all for your replies. Every 8 weeks titrate up? That's quite a bit different that every 2 weeks. I guess I've heard conflicting info about how often to titrate up: I've heard some say 2 weeks until you reach 1 or 2 grains (then slowly raise every 6-8 weeks), and othes say raise every 8 weeks from the very beginning of starting Armour. I guess it depends on how well an individual adjusts to it and levels out, I guess. I'm definitely not feeling level yet, so I will stick with 1/2 grain for a while.

Haven't checked adrenals and ferritin in a while. Last I checked (about 1 year ago), ferritin was great, adrenal levels were low per the 24-hr saliva test.

Tried taking Armour after a light meal for a few days. Didn't notice a difference, so I went back to taking it immediately upon waking, then eating breakfast (no caffeine) about 45min-1hr later.


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## lainey

Titration should properly be done over 8 week intervals, as Andros indicated. There is T4 in Armour, and over time it will build up in your system, so it needs to be accounted for.

Not everyone tolerates medications with T3 in them well, especially when their labs are borderline--as you are experiencing.

Perhaps a low dose of T4 only medication would have been a better place to start.


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## miltomeal

i agree with Andros and Lainey that 2 weeks is just too short of time to titrate the Armour, 8 weeks sounds much better.

You will be giving your body a chance to adjust after each increase, its also a good time to get another set of blood results to see where you are at. Remember that on Armour, your FT4 will be a little lower because you are getting some of the T3 from the meds.

Good luck!!! and i do think patience is the key with this


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## Zugora

lainey said:


> Perhaps a low dose of T4 only medication would have been a better place to start.


Thank you, everyone, for the titration advice. I'll be sure to slowly increase by a 1/4 grain every 8 weeks then, (or longer if needed) and get labs done at that time. New doc did say, "this would take some time with me, but its okay --we'll just have to go slow."

Old doc gave me Synthroid about 1 year ago (25 mcg, but I took half, so... 12 1/2 mcg). Heart racing and side effects were terrible for me (much worse than Armour has been), even at that small dose of Synthroid. I only took it for a couple of days, ....absolutely could not handle it. My doc at the time didn't know what to tell me, but he seemed pretty thyroid-clueless, in general.

Hopefully, Armour will be good for me. Since starting it, I feel *slight* improvements in sxs (despite the waves and start-up reactions to it). Every day seems to be a little better with the heart racing and the ups and downs.


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## Zugora

miltomeal said:


> Remember that on Armour, your FT4 will be a little lower because you are getting some of the T3 from the meds.


Miltomeal (or someone): Could you explain how the FT4 levels will be lower in the bloodwork by taking Armour with both T4 and T3 in it? I thought it would be raising my FT4 (which is at the bottom of the barrel).


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## miltomeal

Zugora~
Your FT4 level will increase by taking Armour, but not to the extent it would if you were taking a T4 only med. This is normal when you are taking Armour. Maybe one of the mods/or someone with more knowledge can help explain this better.

Sounds like you will give the titration period some time. I think that is great and your body will react much better to the meds. this thought is from experience

Best wishes!


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## McKenna

McKenna said:


> Hi there,
> Well, it sounds like your doctor is right on the ball with increasing 1/4 grain at a time. Armour definitely packs a punch and it does take time to get used to it. If you try to bump it up too fast it can backfire and the you might not be able to handle it down the road.


I feel I should clarify what I wrote here...I'm not agreeing with the doc wanting to increase after 2 weeks, but agreeing in the small increment increases. Some doctors start patients at way too high or increase too much.

All my increases were 8 weeks apart.


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## lainey

> Remember that on Armour, your FT4 will be a little lower





> Could you explain how the FT4 levels will be lower in the bloodwork by taking Armour with both T4 and T3 in it? I thought it would be raising my FT4 (which is at the bottom of the barrel).


You will not raise your FT4 on Armour. It will likely go down.

This is because Armour contains T3 at a higher ratio than is found in the body. 
T3 is the active hormone, and there is little need for the body to store T4 to convert to T3, if exogenous T3 is readily available.

The results are labs that show suppressed TSH and free T4.



> Doc wants me to continue raising the dose by a 1/4 grain every two weeks or so (if sxs allow) until I reach 1 grain. Then, to slowly increase every 8 weeks after that. Does this sound right?





> Old doc gave me Synthroid about 1 year ago (25 mcg, but I took half, so... 12 1/2 mcg). Heart racing and side effects were terrible for me (much worse than Armour has been), even at that small dose of Synthroid. I only took it for a couple of days, ....absolutely could not handle it.


One grain (60mcg) of Armour contains approximately 38mcg of T4 and 9 mcg of T3. If you could not handle 12.5 mcg of T4 the first time around, I'm thinking you are getting ahead of yourself thinking you'll need more than 1 grain.


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## HeidiBR

Are you sure you need thyroid med? If you are having this reaction on 15 mg, that seems like your body is telling you it is too much. And you can't go any lower than what you are on.


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## Zugora

lainey said:


> You will not raise your FT4 on Armour. It will likely go down. This is because Armour contains T3 at a higher ratio than is found in the body. T3 is the active hormone, and there is little need for the body to store T4 to convert to T3, if exogenous T3 is readily available. The results are labs that show suppressed TSH and free T4.


I'm a little concerned. My doc told me that he would like to see my FT3 and FT4 in the upper third of the range and then prescribed Armour. He did not mention that it would LOWER my FT4. Does anyone else have experience with the lowering of raising of FT4 on Armour?



lainey said:


> One grain (60mcg) of Armour contains approximately 38mcg of T4 and 9 mcg of T3. If you could not handle 12.5 mcg of T4 the first time around, I'm thinking you are getting ahead of yourself thinking you'll need more than 1 grain.


I have no idea what I will need or if this will even work for me. Wish I did.



HeidiBR said:


> Are you sure you need thyroid med? If you are having this reaction on 15 mg, that seems like your body is telling you it is too much. And you can't go any lower than what you are on.


HeidiBR, I've been at 30 mg this past week. The initial effects of 15mg went away after 2 weeks, so doc said that I could raise. This is all a big experiment because by textbook standards, I'm "normal" and should be feeling fine. Doc doesn't think so because of my increasing TSH, low-end FT3 and FT4, and extremely strong family history of hypoT and Hashi's. I know I'm also just super sensitive to ANY med. Despite the labs, he suspects Hashi's is at work here and possibly other autoimmune issues. I have positive ANA antibodies, but all other specific AI tests have been "normal" numerous times. One day at a time, I guess...


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## lainey

> I'm a little concerned. My doc told me that he would like to see my FT3 and FT4 in the upper third of the range and then prescribed Armour. He did not mention that it would LOWER my FT4. Does anyone else have experience with the lowering of raising of FT4 on Armour?


"Classic" labs on Armour result in suppressed T4 and TSH numbers. It happens this way also if the patient is supplementing T3 such as cytomel with T4 medication, if the the T3 is an excess ratio.

The way to raise your T4, and indirectly your T3, is with T4 only medication. In that way, the body controls the conversion itself, and maintains a healthy T3/T4 ratio. Once you introduce T3 medication to this, you circumvent the process. This can result in altered labs.

I am a little concerned also, as your doc should know this when they prescribe the medication. But, considering your history, the doc is a little "off" on their titration recommendations among others in my mind. More reason to be concerned.


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## HeidiBR

Yes, my T4 decreased on Armour. That is normal. I am also taking a small dose of Synthroid with the Armour, which is not conventional but seems to work for me.


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## miltomeal

I have been on Armour since last August. My thyroid is still dying off after RAI last May. And on Armour, my FT4 lab results have seen a rise with each meds adjustment. The FT4 is not moving up as much as it would on T4 only meds, and it is not moving up as much as my FT3 results, but my body is finding what works best for me on Armour.

You will need to find what works best for you. As HeidiBR does by adding a little T4 to armour. All of our symptoms are different, are bodies are different and handle the meds differently, so give this a little time to see how your body reacts and then go from there.

Good luck


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## I DClaire

Somehow I missed following this discussion. I ended-up having a bad night last night with my cold symptoms and didn't fall asleep until around 5:00 this morning. My mother called at 6:30 hallucinating or having a nightmare and nearly scared the wits out of me and I totally forgot to take my Armour. It did not cross my mind until mid-morning.

Today I have had NO sensation of being breathless, no racing heart and no palpitations.

_Velly in-te-res-tink!! :confused0024:_

I'm going to have to hang a chart on the wall to try to figure out or keep track of exactly what seems to trigger problems and what leads to less symptoms.


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## Octavia

I DClaire said:


> I'm going to have to hang a chart on the wall to try to figure out or keep track of exactly what seems to trigger problems and what leads to less symptoms.


That's a great idea, IDC. Include as many variables as you can, without making it too cumbersome...meds, times, stressors, activity level, sleep, etc. This will give you something "hard" to show your doc in a couple weeks. Great idea!


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## I DClaire

I know we need to follow our doctor's recommendations as faithfully as possible but I can't help wondering, at the rate I'm going (5 months post-surgery), if I'll live long enough to get all this stabilized?

I read something in the newspaper yesterday about supplements (along with certain prescription drugs) sometimes causing A-Fib and palpitations...so I worry now that maybe my few supplements are involved? It's like everything either influences or possibly influences everything else regarding my thyroid hormone. I can't find the right combination!!

Patience has never been my strong suit!:anim_03:


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## daisydaisy

I didn't do well on cdn pig thyroid brand I tried and suffered badly. too much energy and heart palps and anxiety...no relief. I think I didn't need the t3 . when I switched to synthroid I slowly got relief with just the t4 med. Aldo note if your adrenals are sluggish and there isn't a real test for this for the in between stages that higher doses of thyroid meds may make you feel worse as your adrenals can't keep up.


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## I DClaire

If I live to be 100, I'll never really understand or be as familiar with all the lab numbers as so many here are. I feel like I'm braindead when I try to think about how my symptoms correlate to my medications.

Dumb question #1: Is it possible to feel woefully hypothyroid and presumably be hypothyroid but be having all the heart-related symptoms I experienced when I was hyperthyroid - feeling breathless, elevated heart rate, palpitations?

Is it conceivable that my body is suffering from lack of thyroid hormone (in my case Armour) to the extent that I'm experiencing the heart-related symptoms?

OR...(and this is what throws me) are those symptoms strictly related to hyperthyroidism?

I'm only taking 60 mg Armour so I have to believe I'm not getting enough - yet my breathlessness, elevated heart rate and palpitations make me feel like I'm over-medicated.

It doesn't seem logical to me that a grown woman without a thyroid would feel better with anything less than 60 mg Armour...but am I mistaken? I worry and at the same time somewhat hopefully anticipate getting my dosage increased after my next labs the end of February wondering if more Armour won't mean even worse heart symptoms.

I feel haunted by my cardiologist's words the day I had a total heart evaluation. He said my heart was strong, I'd blown the top off a nuclear stress test and everything else was normal and he thought my blood pressure, elevated heart rate and palpitations would resolve themselves once I got my thyroid problems under control.

Is it reasonable to think or try to accept that if/when my heart symptoms are more stabilized that that will mean my thyroid is as good as it's going to get OR what if my thyroid lab numbers eventually improve but my heart symptoms don't?

My main thyroid problem since day #1 has been how my hyperthyroidism originally effected my heart. Now, I cannot help assuming that because I still have the same basic heart symptoms, I'm hyperthyroid again...only now with Armour and previously with Synthroid.

So confusing!!


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## Andros

I DClaire said:


> If I live to be 100, I'll never really understand or be as familiar with all the lab numbers as so many here are. I feel like I'm braindead when I try to think about how my symptoms correlate to my medications.
> 
> Dumb question #1: Is it possible to feel woefully hypothyroid and presumably be hypothyroid but be having all the heart-related symptoms I experienced when I was hyperthyroid - feeling breathless, elevated heart rate, palpitations?
> 
> Is it conceivable that my body is suffering from lack of thyroid hormone (in my case Armour) to the extent that I'm experiencing the heart-related symptoms?
> 
> OR...(and this is what throws me) are those symptoms strictly related to hyperthyroidism?
> 
> I'm only taking 60 mg Armour so I have to believe I'm not getting enough - yet my breathlessness, elevated heart rate and palpitations make me feel like I'm over-medicated.
> 
> It doesn't seem logical to me that a grown woman without a thyroid would feel better with anything less than 60 mg Armour...but am I mistaken? I worry and at the same time somewhat hopefully anticipate getting my dosage increased after my next labs the end of February wondering if more Armour won't mean even worse heart symptoms.
> 
> I feel haunted by my cardiologist's words the day I had a total heart evaluation. He said my heart was strong, I'd blown the top off a nuclear stress test and everything else was normal and he thought my blood pressure, elevated heart rate and palpitations would resolve themselves once I got my thyroid problems under control.
> 
> Is it reasonable to think or try to accept that if/when my heart symptoms are more stabilized that that will mean my thyroid is as good as it's going to get OR what if my thyroid lab numbers eventually improve but my heart symptoms don't?
> 
> My main thyroid problem since day #1 has been how my hyperthyroidism originally effected my heart. Now, I cannot help assuming that because I still have the same basic heart symptoms, I'm hyperthyroid again...only now with Armour and previously with Synthroid.
> 
> So confusing!!


Number 1 answer coming your way! YES! Hypo and hyper both cause heart palps and arrhythmia.


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## lainey

> Is it conceivable that my body is suffering from lack of thyroid hormone (in my case Armour) to the extent that I'm experiencing the heart-related symptoms?


Yes. While generally associated with hyper, they are also part of hypo--just further down on the symptoms list if you look on any good website.

And yes, they usually do resolve, or at least diminish when your levels are right.

If they do not, there may be some finger pointing regarding T3 medications, as they are often associated with it. Sometimes doctors will suggest low doses of anti-anxiety medications or low doses of beta blockers to take the edge off if the palpitations continue, especially if your heart rate remains a little elevated.

At this point it comes down to seeing where your levels are.


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## I DClaire

I think I mentioned previously that I'd read somewhere that supplements taken with certain prescription drugs could cause what I call "heart symptoms" - elevated blood pressure, racing heart, palpitations, etc. I haven't taken anything except my Armour, Vitamin D and Toprol XL for several days now and I can honestly say my "heart symptoms" have been wonderfully less problematic...and it has been nice!

If my energy level was any less I doubt I could get out of bed but I'm O.K. Everytime I think I've done something that leads to a positive change it seems to bolster my faith that sooner or later I'll get it all right.

I've actually taken two different beta blockers and two different blood pressure drugs in the past but I cannot remember which ones. I used to take my beta blocker and a blood pressure drug separately but then was prescribed Toprol XL which is supposed to help both problems.

I am really looking forward to my next labs. I wish someone would invent a do-it-yourself blood testing kit for thyroid patients.


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## I DClaire

I intended to ask about this in the previous post but maybe it's just as well to separate my thoughts. One of the supplements I have not taken since the weekend is my Citracal calcium which contained 500 IU Vitamin D.

My doctor has me taking 2,000 IU Vitamin D-3 and I thought maybe I was overdoing it a little bit. I'm just trying different combinations.


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## Octavia

I DClaire said:


> I'm just trying different combinations.


Good thinking...process of elimination to see what might be the cause.


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## lainey

It is generally considered to be beneficial to take the vitamin D with the calcium--you need to keep track of your total vitamin D intake. D is a stored vitamin, so hopefully you are getting follow up testing to keep track of those levels so that you do not get too much.

Beta blockers can make you feel tired, although it is not as pronounced in the extended release ones like Toprol XL. A good solution to this is to take them in the evening. While you can take them as needed, when taken regularly, beta blockers are also not to be stopped suddenly. After you have taken them for a while, you need to taper off with a doctor's guidance if you are going to stop them.

I'm glad your getting relief from the "heart" symptoms. It certainly does help.


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## Zugora

I DClaire said:


> Is it possible to feel woefully hypothyroid and presumably be hypothyroid but be having all the heart-related symptoms I experienced when I was hyperthyroid - feeling breathless, elevated heart rate, palpitations?
> 
> Is it conceivable that my body is suffering from lack of thyroid hormone (in my case Armour) to the extent that I'm experiencing the heart-related symptoms?
> 
> OR...(and this is what throws me) are those symptoms strictly related to hyperthyroidism?
> 
> I'm only taking 60 mg Armour so I have to believe I'm not getting enough - yet my breathlessness, elevated heart rate and palpitations make me feel like I'm over-medicated.
> 
> It doesn't seem logical to me that a grown woman without a thyroid would feel better with anything less than 60 mg Armour...but am I mistaken? ....


I DClaire- I feel like this thread has gone off-topic some and you might get more views and responses if your questions were labeled in a separate thread. Thanks for understanding.


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## Zugora

Andros said:


> Does not sound right to me. One should start on 1/4 to 1/2 grain and titrate by 1/4 grain (or 1/2 grain but my doc did 1/4 grain) every 8 weeks.


Regarding the initial titration process, I was reading some information about a possible "feedback loop" that can happen as you start thyroid meds and stay at these start-up low doses longer than 2 weeks. Apparently, your hypothalamus gland senses the addition of low dose thyroid medication (thinking the thyroid sent it), then sends a message to the pituitary gland, which in turn sends a message to the thyroid gland to stop producing, making you even more hypothyroid than you began. I'm wondering if anyone has heard of the "feedback loop"?

So far, the two increases I have had with Armour (0 grains to 1/4 grain, and 1/4 grain to 1/2 grain) really packed a punch, and the initial "start up" side effects of each dose increase took about 2 weeks to level off.


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## lainey

> I'm wondering if anyone has heard of the "feedback loop"?


Almost all endocrine function works on this basis. It is part of the essential understanding of how the thyroid (or pancreas, or parathyroid) works--and most of it is masterminded by the pituitary.

This is also why patients get confused when they don't see instant results, especially from thyroid medication. This process can't work quickly, it takes time for the hormone levels to change enough in the blood to trigger feed back--this goes for medication increases as well as decreases.

This is also why patients become confused that they can't maintain "set" thyroid levels. The levels fluctuate naturally, as a pendulum, in response to many internal and external factors.


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## Andros

Zugora said:


> Regarding the initial titration process, I was reading some information about a possible "feedback loop" that can happen as you start thyroid meds and stay at these start-up low doses longer than 2 weeks. Apparently, your hypothalamus gland senses the addition of low dose thyroid medication (thinking the thyroid sent it), then sends a message to the pituitary gland, which in turn sends a message to the thyroid gland to stop producing, making you even more hypothyroid than you began. I'm wondering if anyone has heard of the "feedback loop"?
> 
> So far, the two increases I have had with Armour (0 grains to 1/4 grain, and 1/4 grain to 1/2 grain) really packed a punch, and the initial "start up" side effects of each dose increase took about 2 weeks to level off.


This is true for those of you who still have your thyroid.

Here is a good chapter on the subject.
http://www.thyroidmanager.org/chapter/physiology-of-the-hypothalmic-pituitary-thyroidal-system/


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## miltomeal

The Thyroid really does throw the entire endocrine system off balance and as we balance out and titrate our thyroid meds, we are working to balance the entire endocrine system, which has a lag time compared to the thyroid.

This is why it is a good idea to take your time during the titration process and not rush ahead too fast, especially when we have some thyroid organ left.


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## Zugora

The feedback loop, I believe, is the theory behind increasing the starting doses of Armour every 2 weeks by 1/4 or 1/2 grain (or as tolerated) until you reach a more "therapeutic" dosage of 1 or 2 grains, at which point you would assess labs, your sxs, and initiate further titration every 6-8 weeks, if needed. I see on realthryoidhelp.com, STTM website, and other sources that advise this titration method. This is where I'm confused, then. See below from realthryoidhelp.com:

"When you start on Armour, you start out low, 1/2 to 1 grain once a day, and ramp up by 1/2 grain every 2 weeks until you are at 2 1/2 grains, then slow the raises down to 1/4 grain every 6 weeks. I am assuming here that you will not start on Armour until you have confirmed you have healthy adrenals (read Adrenal FAQ's completely)."

These sources say that its okay to titrate up every 2 weeks in the beginning, but other sources say to wait 8 weeks for every dose increase. I've been at 30 mg (1/2 grain) for 2 weeks. Should I still wait another 6 weeks before increasing?


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## Octavia

I don't know much about Armour and have never taken it, but if the "standard" dose is 2 grains, then it makes some sense to me to titrate up from 1/2 grain faster than every 6 to 8 weeks, but to slow down once you get close to 2 grains so you don't overdo it. Curious to see what the Armour takers in our group think.

To me, it sounds like the equivalent of purposely starting out low on Synthroid and titrating up to 125 fairly quickly, as that seems to be around the minimum therapuetic dose after a total thyroidectomy....as opposed to starting out low and waiting every 6 weeks, when it's exceedingly obvious that the patient will need an increase. I know this is not standard practice, but I'm just saying it makes sense to me personally.


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## lainey

> "When you start on Armour, you start out low, 1/2 to 1 grain once a day, and ramp up by 1/2 grain every 2 weeks until you are at 2 1/2 grains, then slow the raises down to 1/4 grain every 6 weeks. I am assuming here that you will not start on Armour until you have confirmed you have healthy adrenals (read Adrenal FAQ's completely)."


I am quoting a quote, not good.

I will state once again, that STTM is not considered a most authoritative source, like any other that has an underlying marketing plan.

In all cases, titration should be based on blood work. This quote makes it seem as if everyone should be taking 2 1/2 grains of Armour, which is not the case. Titration rates are individual and should be based on thyroid levels as measured by laboratory results.

A lot of what you are reading is assuming that the patient is clinically hypothyroid. Medication requirements are individual, and patients should not have "dosage expectations", as this will vary based on the person's underlying metabolism and absorption, hormone balance, over all size and other factors.

Labs are done at approximately 6 to 8 week intervals for the duration of the titration period, until the patient has euthyroid labs. This is pretty much the standard of care for any thyroid medication.

The reason for this is because with medication containing T4, the half life is a consideration, i.e. it is about 7 days for T4 and about 10 hours for T3. Given this, it takes a period of time for T4 to build up in the system while T3 is used much more quickly. Laboratory results taken too early after a dose change may not accurately show its full effect.

"Low and slow" is always an excellent strategy. Too much too soon can easily backfire, especially where T3 medications are concerned, and especially for someone such as your self--having normal labs to begin with, it should not take a lot of medication to move them.


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## lainey

> I don't know much about Armour and have never taken it, but if the "standard" dose is 2 grains, then it makes some sense to me to titrate up from 1/2 grain faster than every 6 to 8 weeks, but to slow down once you get close to 2 grains so you don't overdo it. Curious to see what the Armour takers in our group think.
> 
> To me, it sounds like the equivalent of purposely starting out low on Synthroid and titrating up to 125 fairly quickly, as that seems to be around the minimum therapuetic dose after a total thyroidectomy....as opposed to starting out low and waiting every 6 weeks, when it's exceedingly obvious that the patient will need an increase. I know this is not standard practice, but I'm just saying it makes sense to me personally.


In Zugora's case, her TSH is low and she has no antibodies. Her starting dose as a trial would likely be, as she has indicated she has taken, 25 mcg of T4 or half a grain of Armour. Her situation does not compare to someone who has no thyroid or full blown hypothyroidism--her thyroid is still working, she is looking to supplement it, which is a different situation from someone who requires full replacement dosages.


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## Octavia

lainey said:


> In Zugora's case, her TSH is low and she has no antibodies. Her starting dose as a trial would likely be, as she has indicated she has taken, 25 mcg of T4 or half a grain of Armour. Her situation does not compare to someone who has no thyroid or full blown hypothyroidism--her thyroid is still working, she is looking to supplement it, which is a different situation from someone who requires full replacement dosages.


Yeah...that was a pretty bad/ineffective connection I was trying to make there. Your explanation is much better informed than mine.


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## Zugora

lainey said:


> In Zugora's case, her TSH is low and she has no antibodies. Her starting dose as a trial would likely be, as she has indicated she has taken, 25 mcg of T4 or half a grain of Armour. Her situation does not compare to someone who has no thyroid or full blown hypothyroidism--her thyroid is still working, she is looking to supplement it, which is a different situation from someone who requires full replacement dosages.


I appreciate your input, Lainey, but unless you have x-ray vision, I don't believe you can comment on how well my thyroid is working. As I have said before, there are others in my family who have had "textbook normal" labs, but clearly had malfunctioning thyroids and once placed on proper thyroid medication doses, they began feeling well again. I believe I am in a similar situation. You have some valuable information that you lend on these forums, but your arrogance in your delivery is very off-putting. Please refrain from commenting on any of my further posts.


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## lainey

> I appreciate your input, Lainey, but unless you have x-ray vision, I don't believe you can comment on how well my thyroid is working.


Thyroid function is measured by laboratory results.

Those are clearly in your signature, and all assessments are based on the information that you provide:



> -TSH: 2.97 (range: .45-4.5)
> -FT4: .98 (range: .82-1.77)
> -FT3: 2.6 (range: 2.0 - 4.4)
> -Anti-TPO: "normal" <10.0 (<35)
> -Thyroglob AB: "normal" <20 (<40)


If your thyroid were not functioning at all, you would be clearly hypothyroid, with hypothyroid labs. This makes a significant difference in medication requirements and the titration process, which is what you have been asking about.



> Please refrain from commenting on any of my further posts.


This is an open forum.


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## Zugora

lainey said:


> Thyroid function is measured by laboratory results.


And this mentality is EXACTLY why we still have people very sick. Thyroid function is not just based on numbers, but also symptoms. Numbers are merely a guide.



lainey said:


> This is an open forum.


Then you will be the first person in my "ignore list" under "settings and options". Congratulations.


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## I DClaire

I was on 60 mg Armour for 8 weeks before being retested and then the dosage was raised to 90 mg Armour. I'm scheduled for new labs next Wednesday.

That being said, I have never felt worse in my life and I am light years beyond frustrated and disappointed. I may have initially felt a slight bump in energy when I first started taking 90 mg but right now I feel as tired and depressed as ever...so much so that a new attitude is entering the picture - a sense of hopelessness.

I'm now almost 6 months post-surgery and my energy level is practically zero. I've tried everything I read about or hear to help but I'm not gaining any energy, I actually feel like I'm steadily losing ground.

We've often talked about "thyroid fog" - I don't believe I could function whatsoever if I felt anymore lost in space. I cannot stay focused on anything, I have no real interest in anything, I'll start something then walk off and leave it. I'm not alert, I feel anxious, and I KNOW people are sick and tired of me always complaining about how tired I feel.

I feel like I've been inflated. My tongue is swollen or feels swollen. I have no real appetite...but I'm gaining weight.

This past week I've had a headache that all but makes getting online unbearable. I haven't really had headaches in probably 25 years...this one defies going away. It's like the worst imaginable tension headache. It'll ease up toward the end of the day but kick back in the next morning.

I just cannot continue complaining all the time. I try to make myself do things normally but even that seems weird. I went to a party last night thinking it would do me good to get out and be with a group of old friends but I felt so horrible I left early feeling like Cinderella in a panic to get back home. When I got home my blood pressure was low but my heart rate was elevated. I put on my nightgown and went to bed - it was 8:00 P.M. and I didn't even wash my face, I fell asleep so quickly that I never knew when my husband came to bed.

I am at my wit's end! Synthroid made me feel like I was going to literally jump out of my skin but Armour doesn't seem to be doing anything. I have never been so discouraged in my life!


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## webster2

I DClaire said:


> I was on 60 mg Armour for 8 weeks before being retested and then the dosage was raised to 90 mg Armour. I'm scheduled for new labs next Wednesday.
> 
> That being said, I have never felt worse in my life and I am light years beyond frustrated and disappointed. I may have initially felt a slight bump in energy when I first started taking 90 mg but right now I feel as tired and depressed as ever...so much so that a new attitude is entering the picture - a sense of hopelessness.
> 
> I'm now almost 6 months post-surgery and my energy level is practically zero. I've tried everything I read about or hear to help but I'm not gaining any energy, I actually feel like I'm steadily losing ground.
> 
> We've often talked about "thyroid fog" - I don't believe I could function whatsoever if I felt anymore lost in space. I cannot stay focused on anything, I have no real interest in anything, I'll start something then walk off and leave it. I'm not alert, I feel anxious, and I KNOW people are sick and tired of me always complaining about how tired I feel.
> 
> I feel like I've been inflated. My tongue is swollen or feels swollen. I have no real appetite...but I'm gaining weight.
> 
> This past week I've had a headache that all but makes getting online unbearable. I haven't really had headaches in probably 25 years...this one defies going away. It's like the worst imaginable tension headache. It'll ease up toward the end of the day but kick back in the next morning.
> 
> I just cannot continue complaining all the time. I try to make myself do things normally but even that seems weird. I went to a party last night thinking it would do me good to get out and be with a group of old friends but I felt so horrible I left early feeling like Cinderella in a panic to get back home. When I got home my blood pressure was low but my heart rate was elevated. I put on my nightgown and went to bed - it was 8:00 P.M. and I didn't even wash my face, I fell asleep so quickly that I never knew when my husband came to bed.
> 
> I am at my wit's end! Synthroid made me feel like I was going to literally jump out of my skin but Armour doesn't seem to be doing anything. I have never been so discouraged in my life!


IDC, I am sorry you are not feeling well. Miseery loves company, so thank you for being here with me. I am at 1.5 grains too. I have no energy. Today the hubby & I took a little day trip...I cannot find the correct words to say nor type. You would not believe how long it takes me to say/ fine to correct word.

I think our titration process is being drawn out too long. Getting the doctor on board with that may be a little challenging. I am happy with my doctor. I do believe I am her only "thyroidless" patient. I am guessin that 3 grains might do the trick. I also know we can't go there in one shot.

Your labs were similar to mine. I will pm you some info, you can see if it might help you state your case.

BLL my grnadboy just arrived!


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## Octavia

webster2 said:


> IDC, I am sorry you are not feeling well. Miseery loves company, so thank you for being here with me. I am at 1.5 grains too. I have no energy. Today the hubby & I took a little day trip...I cannot find the correct words to say nor type. You would not believe how long it takes me to say/ fine to correct word.
> 
> I think our titration process is being drawn out too long. Getting the doctor on board with that may be a little challenging. I am happy with my doctor. I do believe I am her only "thyroidless" patient. I am guessin that 3 grains might do the trick. I also know we can't go there in one shot.
> 
> Your labs were similar to mine. I will pm you some info, you can see if it might help you state your case.
> 
> BLL my grnadboy just arrived!


First, a big congrats on the new grandbaby!!!! Certainly something to celebrate!

Second, I am so sorry both of you are feeling this bad. I agree - your titration processes are taking forever, and that's coming from someone who's just "watching" from the sidelines, not experiencing any of what you're experiencing. Is there anything that can be done to speed things up? (I'm sure you've asked that a million times...)


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## scottyg354

Octavia said:


> First, a big congrats on the new grandbaby!!!! Certainly something to celebrate!
> 
> Second, I am so sorry both of you are feeling this bad. I agree - your titration processes are taking forever, and that's coming from someone who's just "watching" from the sidelines, not experiencing any of what you're experiencing. Is there anything that can be done to speed things up? (I'm sure you've asked that a million times...)


Was just reading through this. I just switched from Levo to Armour. I was on .225 of Levothyroxine (thyroid still intact) and was switched to 90 mg of Armour or 1 1/2 Grains. Anyways, the first four day were pretty rough, heart palps and chest tightness, anxiety and aggitation. The past 3 days it has been calming down. I am still getting the occasionaly chest tightness and anxiety but it seems and I quote "seems" to be gradually getting better.

I definetely think it was the initial blast of T3 I am getting since my FT3 was pretty much bottom of the barrel along with my Total T3.


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## I DClaire

I have been doing everything humanly possible to try to feel better and get my mind off my various complaints. My grandmother used to say the worse you feel the busier you should get to get your mind off your problems but it honestly isn't working in this case.

I thought I'd push to keep going when I didn't feel like I had much energy but I don't think that works either with a thyroid problem. I took my 90 mg dose at 7:00 this morning and now, at 2:00 P.M., I have no sense whatsoever that I have any energy.

People say maybe I should try taking a nap. I'm not sleepy - I'm tired. I slept until 9:00 this morning.

I am living for the new labs this coming Wednesday and hoping changing the timing between taking my Armour and having blood drawn will produce a better picture of how I feel.


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## webster2

Me too, IDC. I am still tired. I have to push myself to get anything done. On the up side, my GP and the ENT both said last week that I am way undermedicated but they aren't the ones writing the script for NDT.


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## Zugora

Zugora said:


> Thank you, everyone, for the titration advice. I'll be sure to slowly increase by a 1/4 grain every 8 weeks then, (or longer if needed) and get labs done at that time. New doc did say, "this would take some time with me, but its okay --we'll just have to go slow."


*Update*: I'm holding at about 6 weeks on 3/4 grain (after doctor was titrating 1/4 grain every 2 weeks, starting at 1/4 grain [15mg] of Armour).

The "ups and downs" and heart palps leveled out some and I was left with feeling just crushing fatigue (could barely lift a laundry basket or shower sometimes). My doc suspects adrenal issues (waiting for some tests to come back). In the meantime, I have been taking the following basic supplements this week that are supposed to be good for adrenals:

- Vit B Complex (Twin Labs B-100 Caps, 1/2 capsule in morning)
- Pantothenic Acid (250 mg - 1 in a.m., 1 at lunch)
- Vit C (500 mg - 1 in a.m., 1 at lunch)

This is really strange, but I feel so much more energy! It's actually unbelievable!! However, I do feel sort of "manic". Here is what I've noticed within 1 week of taking the supps:

- Definite increased energy and motivation (sort of revved, though)
- Increased strength
- More focused (less brain fog)
- Manic-type feelings (feels like sort of like a "high" or something)
- Crushing fatigue GREATLY reduced. There were times when I tried to nap, but I couldn't sleep.
- Depression greatly reduced this week. Happier, like a weight has been lifted.
- Feel more like myself, despite the manic-feeling and other weird sxs

*Questions: Did the supps give me a "thyroid dump"? Is it just the b-complex?* I don't really think it's just the b-complex because I had this "up" feeling before when I increased from 1/4 grain to 1/2 grain (but not to this extent). Also, I'm feeling a crash again now, and I'm still taking the supplements. Whatever it is, I feel like I'm swinging from hyper to hypo.

*Also, do you think I should keep holding on 3/4 grain or should I drop down to 1/2 grain, since I initially rose 1/4 grain every two weeks?* Someone mentioned that if I rose too fast to 3/4 grain, then the thyroid issues may ever not resolve by themselves (??).

Any thoughts on any of this would be GREATLY appreciated!! Thx.


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## McKenna

JMHO, I don't think you should make any dose changes without getting labs done. It really does take a good 6 - 8 weeks to adjust to a new dose. Even after that time and once you finally reach an optimal dose, it takes even more time to repair the damage done and for everything to begin to work properly.

Thyroid movement, changing numbers, can cause symptoms too.

B vitamins are known to be stimulating to some people.


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## I DClaire

webster2 said:


> Me too, IDC. I am still tired. I have to push myself to get anything done. On the up side, my GP and the ENT both said last week that I am way undermedicated but they aren't the ones writing the script for NDT.


You and I may end-up like a local friend who told me it took something like 20 years to ever get her medications to the point where she honestly felt good and then some test result compelled her doctor to change the formula. :anim_55:

I've mentioned before my neighbor who is in her 80's (but you'd think she was much younger) who had the walnut size nodule (non-malignant) removed approximately a year ago along with her thyroid. Her husband died February 13 and last week she went for a yearly checkup with her cardiologist.

The cardiologist told her he was doubling her dose of Synthroid. Shocked, she asked why and he said she was under-medicated and it was putting a terrible strain on her heart.

She is the one who recommended the endocrinologist I see - she sees the same doctor but only sees the P.A. now (to her total disappointment) because she didn't have cancer. Non-cancer patients see the P.A. for medication tests, etc. but patients who were diagnosed with cancer continue seeing the endocrinologist.

My neighbor went from 125 mcg Synthroid to 175 mcg and said she felt better almost immediately.


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