# I need someone to check my math!



## I DClaire (Jul 31, 2011)

This exact same chart is all over the Internet. I have been on 137 mcg Synthroid for exactly 17 days. Before that, I was on 105 mg Armour for over a year. My endocrinologist, on several occasions, suggested I try for 120 mg Armour but I couldn't do it, the #1 reason would be my heart rate would elevate too much AND I was beginning to suspect Armour was causing horrible anxiety attacks that on two occasions sent me to the ER.

Seventeen days on Synthroid have me more convinced than ever of a correlation between the anxiety attacks and Armour OR the dosage of Armour as I have not had so much as a hint of that problem on Synthroid. But I do have a new problem - I cannot stay awake! :indifferent0023:I feel rather well actually, but I simply cannot keep my eyes open! I'm sleeping all night, sleeping late every morning, and taking naps all day.

My vital signs are good and I've totally stopped the horrible nightmares I was having for months but this degree of lethargic fatigue is hard to endure! I haven't had anymore stomach symptoms and decided when I started taking Synthroid to do a little test - I am not consuming ANYTHING, no other drugs nor supplements, except the Synthroid and Metroprolol ER which is generic for Toprox XL, a blood pressure drug I've taken for several years, and I'm still using Restasis. I did not want anything to confuse my results with Synthroid.

I cannot 100% equate 105 mg Armour with 137 mcg Synthroid but am I wrong in thinking the amount of Synthroid I'm taking is roughly equivalent to 80 mg Armour _or does it not work that way?_

I know I'm confusing myself but this is how I do the math to compute the approximate equivalent of 105 mg Armour:

90 mg Armour = 150 mcg Synthroid
15 mg Armour = 25 mcg Synthroid (closest number to 37)
105 mg Armour = 175 mcg Synthroid

My point is, taking 137 mcg Synthroid am I tremendously undermedicated OR am I totally lost trying to compute the values? It seems to me that this chart is suggesting I'd need 175 mcg Synthroid to be where I was with 105 mg Armour?

My doctor wants me to stay with 137 mcg Synthroid for two months before being re-tested. I'm wondering if I'm so dang lethargic because I'm undermedicated?

*Approximate Equivalent Strengths of Various Thyroid Preparations*
*Drug →**Thyroid Tablets, USP*
*(Armour® Thyroid)**Liotrix Tablets, USP*
*(Thyrolar™)**Liothronine Tablets, USP*
*(Cytomel®)**Levothyroxine Tablets, USP*
*(Unithroid® , Levoxyl® , Levothroid® , Synthroid® )*Approx. Dose Equivalent1/4 grain 
(15 mg)1/425 mcg (.025 mg)Approx. Dose Equivalent1/2 grain 
(30 mg)1/212.5 mcg50 mcg (.05 mg)Approx. Dose Equivalent1 grain 
(60 mg)125 mcg100 mcg ( .1 mg)Approx. Dose Equivalent1 1/2 grains (90 mg)1 1/237.5 mcg150 mcg (.15 mg)Approx. Dose Equivalent2 grains
(120 mg) 250 mcg200 mcg (.2 mg)Approx. Dose Equivalent3grains 
(180 mg)375 mcg300 mcg (.3 mg)
_United States Pharmacopoeia - Drug Information 2000, 20th Edition, Drug Information for the Health Care Professional_; Vol. 1, pp. 2980-2986. World Color Book Services, Versailles, KY.


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## I DClaire (Jul 31, 2011)

Disregard! This thread won't make sense without the chart.


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## Octavia (Aug 1, 2011)

IDC, can you provide a link to the chart?


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## Andros (Aug 26, 2009)

I DClaire said:


> This exact same chart is all over the Internet. I have been on 137 mcg Synthroid for exactly 17 days. Before that, I was on 105 mg Armour for over a year. My endocrinologist, on several occasions, suggested I try for 120 mg Armour but I couldn't do it, the #1 reason would be my heart rate would elevate too much AND I was beginning to suspect Armour was causing horrible anxiety attacks that on two occasions sent me to the ER.
> 
> Seventeen days on Synthroid have me more convinced than ever of a correlation between the anxiety attacks and Armour OR the dosage of Armour as I have not had so much as a hint of that problem on Synthroid. But I do have a new problem - I cannot stay awake! :indifferent0023:I feel rather well actually, but I simply cannot keep my eyes open! I'm sleeping all night, sleeping late every morning, and taking naps all day.
> 
> ...


Armour contains 38 mcgs of T4 per grain. 90 mgs. of Armour which is 1 & 1/2 grains equals 57mcg. of T4 (Synthroid or whatever.)

In my humble opinion, the equivalency charts are of no value. No matter what thyroxine replacement the patient is on, one has to start at the bottom and work up if the plan is to work effectively. It would have been prudent to have started you on 50 mcgs. of Synthroid and titrate as indicated by labs and clinical evaluation every 8 weeks.

And I would like others to give their input on my comment.


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## Octavia (Aug 1, 2011)

ooohhhh....starting out at 50 mcg of Synthroid seems way too low to me, but I agree with Andros about scrapping the conversion chart.

Per the Synthroid website:
The average full replacement dose of levothyroxine sodium is approximately 1.7 mcg/kg/day (e.g., 100-125 mcg/day for a 70 kg adult). Older patients may require less than 1 mcg/kg/day.

1 kg is roughly 2.2 pounds. So if you weigh 150 pounds (and I have no idea what you weigh), that's around 70 kilograms. 100 to 125 micrograms would be a good starting point (although, based on this board's posters/members, it seems a bit low).

137 isn't a bad place to start. You've been so patient already, I know, but I think you're going to need to let your body catch up. Your body is adjusting, and believe me, I know exactly the kind of tired you're talking about, and it's difficult to deal with. Hang in there.


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## lainey (Aug 26, 2010)

I agree with Andros that the chart has little value--the two drugs have different bio-availablities, so there really is no direct comparison. It's a lot like saying that T4 is dosed on weight but in practice, it varies considerably among individual patients due to a variety of factors.

I think 137 mcg was a fine place to start, actually.

What time of day do you take the metoprolol and what is the dose? That has been known to cause fatigue.


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## I DClaire (Jul 31, 2011)

Call nasdaqphil - Andros is trying to kill me! :anim_63: I don't think my heart could beat with only 50 mcgs of Synthroid, especially not after a year on Armour.

I'll find a link to the chart - I'd tried to Copy & Paste the chart I had last night from a physicians' website but I've seen the identical chart on many websites. I was just too, you know, SLEEPY last night to dive back in!!

lainey, I take 50 mg Metoprolol ER (Toprol XL) every night at bedtime and I've been doing that since I was initially diagnosed with hyperthyroidism. Last July and August I went through a complete battery of heart tests and the cardiologist said continue on. This same doctor, someone I have known for at least 25-30 years, told me when I was initially diagnosed with hyperthyroidism that IF/WHEN I ever got my thyroid under control, my cardiac symptoms would resolve themselves...but I've never gotten there! It was heart symptoms that sent me to the doctor in the first place when I was initially diagnosed AND, to this day, I can run anything from perfect vital signs to numbers you wouldn't believe! I started out on another beta-blocker but was switched to Metroprolol a long time ago.

My plan at the moment is to try to endure this Rip Van Winkle stage as requested by my endocrinologist for 2 months and see what the test results reveal. I want to have a talk with my cardiologist about the Metroprolol BUT I'm always so unstable with my thyroid hormone replacement that I don't think changing anything would be prudent.

I definitely, beyond a shadow of a doubt, feel calmer on Synthroid (obviously) but other changes have been pretty dramatic - the most amazing has been the cessation of the anxiety attacks. THAT was the hardest time I've ever known with my health and neither I nor any of my doctors ever seemed to associate it with the Armour. I decided to try Synthroid again for one reason, the fact that no doctor other than my endocrinologist seemed to know anything about it OR be willing to work with me about it; I honestly was pleasantly surprised that the anxiety attacks stopped immediately.

Let me find a link somewhere to the chart. It must be printed with invisible ink! Someone Emailed me a copy and when I went back to look at it again yesterday, it too had disappeared and there was a little red x!


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## I DClaire (Jul 31, 2011)

I grabbed the first listing on Google. http://thyroid.about.com/library/drugs/blconversionchart.htm


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## joplin1975 (Jul 21, 2011)

Yeah, I think starting at 50 would be darn near catastrophic (says the gal who, when on 50, had a TSH of 121!!)...but, I also think the way your body uses and converts the t4 isn't going to be an exact science. 137 sounds like a good starting point, but I wouldn't be surprised if you needed to bump up. Good luck!


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## bigfoot (May 13, 2011)

Yeah, those conversion charts seem kinda off to me, too. For example, Naturethroid (similar to Armour) at 1 grain has 38 mcg of T4 and 9 mcg of T3. Since T3 is roughly four times as effective as T4, let's multiply the 9 mcg * 4 = ~36 mcg equivalent to T4 for conversion.

So, if my math is correct, 38 mcg T4 + the 'converted' 36 mcg = 74 mcg total equivalent to T4 in one grain. This is way, way off from the 100 mcg Synthroid equivalency the Naturethroid chart claims. My hunch is that the desiccated thyroid medications are a little weak if you're comparing apples to apples. And my own labs seem to bear this out.


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## Andros (Aug 26, 2009)

Chiming in here lest we forget that IDC has hypersensitivity to thyroxine replacement so my thought pattern was low and slow!!

Ssssssssssssssssssssssssssssh! Don't anyone tell Nasdaqphil!!








and I shall give this some further thought!!! LOL!


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## bigfoot (May 13, 2011)

Naah... we'd have too much trouble filling yours and the rest of the mod's & resident experts shoes!


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## Andros (Aug 26, 2009)

bigfoot said:


> Naah... we'd have too much trouble filling yours and the rest of the mod's & resident experts shoes!


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## I DClaire (Jul 31, 2011)

Hey guys,

Sorry to be AWOL the past couple of weeks. I've been dealing with two major concerns - Mother is woefully sick again with yet another UTI that I guess miraculously presents no urinary symptoms but sadly causes every imaginable mental/emotional problem...not the least of which is refusing to cooperate with her doctor whose only request is that she drink large amounts of water or tea to make her antibiotics work. She has had two rounds of tests, three different antibiotics, another test on the horizon and probably fixing to find herself hospitalized again!

Secondly, my computer is terminally ill! Yes, I'd beat it to death right now if I weren't afraid I'd get electrocuted! It is on its way out later today.

Before I vaporize off the Internet, I wanted to share the new lab results I received this morning - the labs I was so hoping would indicate a vast improvement getting back on 137 mcg Synthroid after being on Armour for one year. I can't say that the numbers are a vast improvement but I do feel somewhat better - still no anxiety attacks and no more excruciating nightmares since the day I stopped taking Armour. I'm also more able to help Mother, something I honestly could not do back in January when she and I were both hospitalized.

T4 Free in February (on Armour) was 1.0 - yesterday (on Synthroid) it was 1.4 
Range being 0.8-1.5

T3 Free in February (on Armour) was 3.1 - yesterday no change whatsoever
Range being 2.0-3.6

TSH in February (on Armour) was 0.005 - yesterday it was .013 on Synthroid
Range being 0.37-4.55

The doctor said to continue with 137 mcg Synthroid Monday through Saturday, take half a dose on Sunday.

As usual, I expected I'd be told I was hugely under-medicated...I guess my cross to bear from now on is low energy, little stamina, and aggravating daytime lethargy. At least I'm sleeping relatively well at night and my weight is stable.

I would give my kingdom to truly feel good again but I am thankful to have left the anxiety attacks and nightmares behind me.

Ann


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## jenny v (May 6, 2012)

Your thyroid numbers actually look really good, but it stinks about the symptoms you're still having. Have you ever had your Vitamin B12 or D levels checked?


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## I DClaire (Jul 31, 2011)

jenny v said:


> Your thyroid numbers actually look really good, but it stinks about the symptoms you're still having. Have you ever had your Vitamin B12 or D levels checked?


I'm deficient with both, Jenny. I take supplements daily but those were not checked yesterday - they'll both be rechecked in June. I generally can get mid-range with the B-12 (which I've been told is not optimum) but my D levels stay low in spite of prescription level dosing.

I didn't expect to be back online tonight. My computer is limping along with an integral part out of another computer, hoping to make it until a new computer is delivered around May 1. My computer and I function about the same speed - slow!! :anim_63:

Several people have told me today that I seem to feel better. Maybe I am better but stay so bogged down in my mother's problems that I can't really enjoy much of anything.


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