# going in circles



## sarah73 (Feb 17, 2017)

First of all, I am sorry this is so long. I have tried to gain all the information that I can from other posts and websites, but I am getting stuck on figuring out my lab results and a couple of other things.

I have been ramping up Armour over the past few months and have some lab results that are unusual, I think.

I was first diagnosed with hypothyroidism 4 years ago but I think I had some symptoms before then. I was given Synthroid but crashed - it made me so much worse but my endo at the time said he could not find anything else wrong with me and said I needed to go back on the Synthroid. I did not go back on it. I later went to a naturopath and some things he gave me worked, some made me worse, and I stopped going to him because I felt like I was on a rollercoaster. Also, my TSH has been 'normal,' so I had problems finding a PCP that would take my symptoms seriously. So I managed. I should also add that my antibodies seem to be low, so it doesn't seem to be Hashimoto's (anti-thyroglobulin was 18 with 0-115 range and TPO was 13 with range of <35); my doctor hasn't said that I have Hashimoto's but she hasn't said I don't have it either.

I started feeling significantly worse in August and realized I really needed to see an endocrinologist. I found a doctor who belongs to a practice that looks at T3 and T4, not just TSH.

Based on my history with the Synthroid (and history of steroid use for severe asthma in the past and family history of Type 1 diabetes which I guess elevates my risk of Addison's), the new endo had me take an ACTH stimulation test. My cortisol went from 12 to 24, which my doctor said indicates that I didn't have adrenal insufficiency. So, she started me on Armour.

My results since August:

0 mg Armour:

TSH: 3.98 (0.27-4.2)

T3 total: 0.71 (0.8-2.0)

Free T4: 1.09 (0.93-1.70)

15 mg Armour:

TSH: 4.07 (0.27-4.2)

T3 total: 0.8 (0.8-2.0)

Free T 4: 1.06 (0.93-1.70)

[I went to 30 mg dose, but I wasn't feeling any better, so she let me go up to 45 mg; therefore, I have no lab results from 30 mg)

45 mg Armour:

TSH: 1.56 (0.27-4.2)

T3 total: 1.15 (0.8-2.0)

Free T4: 1.13 (0.93-1.70)

60 mg Armour:

TSH: 0.726 (0.27-4.2)

T3 total: 0.92 (0.8-2.0)

Free T4: 1.07 (0.93-1.70)

I think some say the Armour should be ramped up pretty quickly (and Allergan says this too), like a new dose every 2-3 weeks, but I am being ramped up more slowly, like every 5 weeks or so.

As I ramped up the Armour to 60 mg, I didn't really notice big changes overall in how I felt. I had expected to gradually feel better. I would usually feel slightly better the first week of a new dose but then regress. And when I was on the 60 mg, I felt terrible, as bad as how I felt in August when I suddenly got significantly worse. My T3 and T4 actually declined on the 60 mg, so I guess this makes sense that I felt worse.

But that is one of my questions - does it make any sense that T3 and T4 would decline when I went from 45 mg to 60 mg of Armour? I know the TSH matters less, but it also went down. This seems strange to me.

Because I felt so bad on the 60 mg, and given my experience on the Synthroid, I started wondering if I maybe have a reverse T3 problem, possibly due to low iron. My iron tests were all towards low end of the ranges, so I have started taking about a teaspoon of blackstrap molasses every day (I have been doing this for almost two months). I may start taking more of this. I didn't want to take too much too fast or take an actual iron supplement since my intestines are backed up enough already. :-/ Anyway, at my appointment, my endo said that I don't have a reverse T3 problem, but she ran the tests anyway for me:

This is on the 60 mg:

T3 reverse 22.5 (9.0-27)

T3 Free 2.45 (2.0-4.40)

T3 total 0.92 (0.8-2.0)

Based on the Stop the Madness website calculator, the ratio is 10, which means that reverse T3 could be a problem. Which leads to my experience with iodine...

I now also wonder if I am/was iodine deficient. At my appointment, my blood pressure was something like 90/64, which is low for me (my normal is around 110/64). My endo recommended that I add more salt to my food. At first I added sea salt, which made me feel so much worse. Then on a whim, I changed to iodized salt (I have a friend who thinks it is poison, and maybe there are others out there who think so too, but please bear with me, lol). The following day, I woke up and felt my same exhausted self. But then something amazing happened in the afternoon - my brain fog slowly, slowly started lifting. And then it slowly, slowly came back. But during those three hours, I was clearer than I have been for years. I continued with the iodized salt, and felt clearer, stronger, calmer, and more pleasant to be around for more hours of the day over the next few days. I have regressed a bit since then, but I definitely feel a difference, and I think it has to be the iodine. I have stopped taking the iodized salt and am now taking a dilute iodine solution. I am also eating a couple of Brazil nuts every day for selenium. I am wondering if I do/did have a reverse T3 problem, maybe the iodine is now helping it, since I am feeling slightly better?

The next set of lab results I am concerned about. I haven't really seen a lot of information about B-12 and sex hormone binding globulin (SHBG), so maybe it doesn't come up very often. I am not sure if they are related but I put them together because they are both pretty significantly out of range:

0 mg Armour:

B-12 1638 (211-911)

SHBG 135.2 (24.6-122)

60 mg Armour:

B-12 975 (211-911)

SHBG 173.4 (24.6-122)

Why would these be high? I am not taking B-12 supplements. According to an internet search, it may indicate a liver problem. I have tested negative for Hepatitis C.

I am not sure what my next steps should be. Based on my T3 and T4, it seems that I need a higher dose of Armour, but I'm still slightly concerned about reverse T3 and also the fact that T3, T4, and TSH all dropped when I went up to the 60 mg dose. I have also thought about increasing the molasses and giving the iron and iodine a little more time to work.

The other thing is that my doctor wants me to see a neurologist for the weakness in my legs and arms. About a year before I was first diagnosed with hypothyroidism (so five years ago), I was diagnosed with some sort of rare form of muscular dystrophy. My PCP noted weakness in my legs at my annual exam and referred me to a neurologist. He said I did not have MS but something was going on, so he referred me to a neurophysiologist. He did an EMG (where they stick needles into your muscles), and said he thought I had muscular dystrophy (there are types that start and stop irregularly and don't continually progress). I did not get the genetic test or have the muscle biopsy done because of time and money. I also didn't really think that I had muscular dystrophy.

The thing is, on my best day after I started taking the iodine, I felt so strong. I also felt very strong during the first hours after I took the 15 mg of Armour. My legs were so strong that I could have run a mile. This makes me think that the weakness in my arms and legs from the 'muscular dystrophy' was actually early signs of hypothyroidism. Could this be the case?

I have asked the endo for the next higher dose of Armour and said I am reluctant to go to a neurologist when there are signs that the hypothyroidism is the cause of the weakness in my muscles but I haven't heard back from her.

I am sorry this is so long. When I started the Armour, I was so excited, and I thought my recovery would be in a straight line, but after reading everyone's experiences here, I can see that it can be a rollercoaster. I am just so frustrated right now, and I feel like my world has been revolving around figuring out what is wrong with me when I should be out there living my life. :-( I know I will get there.

I greatly appreciate any insight that anyone has for me. Thank you!


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## Lovlkn (Dec 20, 2009)

sarah73,

Welcome!

You mention steroids for asthma. I use a steroid nose spray and can tell you - I notice a huge difference in how I fee using it vs not using it, with that said, I would imagine beside any interaction with thyroid hormone - using a steroid affects how one feels day to day.



> My cortisol went from 12 to 24,


What sort of test was this? Please provide more detail.



> I was first diagnosed with hypothyroidism 4 years ago but I think I had some symptoms before then. I was given Synthroid but crashed - it made me so much worse but my endo at the time said he could not find anything else wrong with me and said I needed to go back on the Synthroid.


Do you have any labs from your initial diagnosis? Have you ever had an ultrasound of your thyroid?



> I later went to a naturopath and some things he gave me worked,


What worked? Ingredient only please, not name of supplement



> This is on the 60 mg:
> 
> T3 reverse 22.5 (9.0-27)
> 
> ...





> Free T4: 1.07 (0.93-1.70)


Based on these labs - I would consider you hypo. with that high of a Reverse T3 has your naturopath suggested any additional treatment paths? With such a low FT-4 I am surprised you have such a high RT3.



> But that is one of my questions - does it make any sense that T3 and T4 would decline when I went from 45 mg to 60 mg of Armour?


I noticed the crazy labs more on anti thyroid medication - Free labs and TSH seemed to do their own thing rather than react to the medication dosage. Eventually it calmed down.



> a teaspoon of blackstrap molasses every day


You think this is good idea with the diabetes that runs in your family?

Have you ever had liver function tests run?



> Which leads to my experience with iodine...


WOW...



> I am not sure what my next steps should be. Based on my T3 and T4, it seems that I need a higher dose of Armour, but I'm still slightly concerned about reverse T3 and also the fact that T3, T4, and TSH all dropped when I went up to the 60 mg dose. I have also thought about increasing the molasses and giving the iron and iodine a little more time to work.


Iron interacts with thyroid hormone supplement - you should probably avoid your blackstrap molasses 4 hours either side of your Armour. You might want to contact your doctor about taking Armour and iodine at the same time. Interesting comment about your changing B-12 levels - I have no experience. The only thing I know about lowering reverse T3 is high doses of T3 only. Because you did not have a high FT-4, I have no idea why your RT3 would be so high.


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## sarah73 (Feb 17, 2017)

Thank you so much for your reply, Lovlkn! I will try to answer your questions:

As for the steroids, I'm not taking anything right now. My asthma only flares up when I get sinus/bronchitis infections, and I haven't had anything serious for 4 years. I developed asthma during a mycoplasma infection about 20 years ago, and that was when I was on oral steroids and steroid inhaler for about 2-3 years to control the asthma. About 4 years ago, I did have to take oral prednisone and steroid inhaler for a severe bronchitis infection, but that was the last time. It was really after that infection that I felt off and felt like I never completely recovered from it, so I always mention it as part of my history when I see a doctor about the hypothyroidism, but I'm now thinking I had some symptoms before then, and maybe the bronchitis just accelerated it.

In the ACTH stimulation test, you are given an injection of ACTH (which is supposed to be made by the pituitary gland to tell your adrenal glands to make cortisol), and cortisol level is measured pre- and post-injection. Cortisol is supposed to double after the injection within an hour (I think). If it does, it rules out Addison's. If it more than doubles, I guess it means there could be a pituitary problem, but it seems this is less reliable.

When I was first diagnosed with hypothyroidism, my PCP went by TSH, which was around 6. He prescribed 50 mcg of Synthroid. Since I gradually felt worse over the subsequent two months, he referred me to an endocrinologist. My labs after about three months of being on the 50 mcg of Synthroid:

TSH: 1.84 (0.27-4.2)

Free T4: 1.22 (0.93-1.70)

At my first appointment, he told me to stop taking the Synthroid. So here are my labs after one month without the Synthroid:

TSH: 2.98 (0.27-4.2)

Free T4: 1.18 (0.93-1.70)

Free T3: 2.10 (2.0-4.4)

Total T3: 94 (80-200)

I wish he had tested the Free T3 when I was still on the Synthroid. It might have been useful.

I have never had a thyroid ultrasound done. No one has suggested it. I have a family history of hypothyroidism (dad, who also has Type 1 diabetes, his sister, and their mom). I have asked my dad if he has Hashimoto's and he says he doesn't know. I think because I have this family history, the initial PCP was quick to put me on the Synthroid rather than look at other possible causes.

Liver function test - I believe it was done in August (when I felt really bad), and I think everything was normal. My cardiologist also did liver function tests three weeks ago. She said everything was normal, but they are sending me the results, so I will take a look at those when I get them.

Iron/iodine - I'm taking the molasses about half an hour before I eat dinner and take my Armour in the morning on an empty stomach, but I will definitely check with my doctor on the iodine. I take that in the morning with food, but maybe it should be spaced out more. As for diabetes, I guess if I were going to develop Type 1, I would have developed it already (I'm 43.) My endo said my risk of Type 2 is very low, based on my blood work, I guess.

Naturopath - one of the things that worked was he suggested I take some sort of minerals (I ended up taking some sort of plant minerals solution). I noticed that my brain fog got a little better. Looking back, this kind of makes sense if I am deficient in some minerals. After some time, it didn't seem to make much of difference, though. At one point, he also recommended supplements for pituitary and hypothalamus support, and those made me feel worse. I can't really remember a lot of what he gave me. I'm using the term naturopath, but I'm not sure that is the correct term. He can't prescribe anything and can't request blood tests. Everything he gave me or recommended was over the counter. In fact, I have never seen a naturopath where I live who can do this. I am in one of the states where patients cannot order their own tests (not even saliva tests), so maybe there are limitations on blood tests and writing prescriptions for medical professionals as well? To find a more 'open-minded' doctor, I would have to find an endo (an MD) who does not take insurance. I'd like to continue working with my current endo.  She takes my insurance, and she is willing to run some blood tests at my request, even when she doesn't think I need them, like she did with the reverse T3. People say a good doctor is one who listens, but I think she's even better because she believes me when I say I don't feel well. So many other doctors have completely dismissed me over the past few years. But I also feel like some lab results are being ignored and my hypothyroidism is not being fully addressed before she refers me to other specialists (so far, cardiologist and neurologist).

With respect to the high T3 and low T4, one of my theories I came up with is this: T4 has four iodides while T3 has three. I wonder if I was iodine deficient, perhaps somehow, my body knew this and was converting lots of T4 to T3 for the iodide. For whatever reason, it was prioritizing the need for iodide over T4. But I am also low on iron, so that T4 was converted to Reverse T3, rather than usable T3. Then, since I was low on T4 and usable T3, my symptoms got worse when my dose was raised to 60 mg of Armour. Now that I am taking iodine, it doesn't need to convert as much T4 to get iodine and might explain why I am feeling slightly better. This might also explain why my T4 dropped when I raised the dose to the 60 mg of Armour, although I'm not sure if it really explains why the total T3 dropped. I have no idea if this makes any sense, but I am curious to see if my blood work has changed since I started the iodine. I have thought about buying a medical school endocrinology text book to try to learn about this stuff!

Lovlkn, I found your signature very interesting - my endo has said at some point, she might recommend supplementing the Armour with Cytomel. I will keep your experience in mind if she recommends adding Cytomel.

Thanks again. I wish you continued good health!


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## Lovlkn (Dec 20, 2009)

I would say that you have been under medicated based on the labs you provided. If you are taking Synthroid then your labs should be closer to 3/4 of range , yours were nowhere close.

Cortisol testing is also done by 4 point saliva testing. I actually never thought of someone listing it as result of ACTH test as so few are posted here.

I would suggest quitting the iodine and being tested for iodine deficiency.

Taking iodine and thyroid hormone replacement in my opinion is too many variables as both affect thyroid hormone in your system. One or the other and test is my suggestion.



> my endo has said at some point, she might recommend supplementing the Armour with Cytomel.


Not a good idea in my opinion. Have you had a reverse T3 run?


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## sarah73 (Feb 17, 2017)

Thank you!

I agree with you on the underdosing, and I'd like to get closer to an optimal level before I go to another specialist for symptoms that could be related to the hypothyroidism.

Her suggestion of the Cytomel was just if I needed a boost in the afternoon. I had mentioned to her that when I first started taking the 15 mg of Armour, I felt a difference in the morning but nothing in the afternoon, and she thought an afternoon dose would help. Didn't really matter, because after about a week, I evened out, and didn't feel much difference.

As for reverse T3, she ran them at my request at my last appointment. This was on the 60 mg of Armour, but before I started taking the iodine:

reverse T3: 22.5 (9.0-27)

free T3: 2.45 (2-4.40)

total T3: 0.92 (0.8-2.0)

I took another look at my lab results from my last appointment, and realized that I had additional tests that were out of range (but for some reason, they are not flagged as low):

free testosterone (calculated): 0.84 (1.4-15.6)

% free testosterone: 0.5 (0.59-2.01)

but my testosterone was: 16.9 (8.4-48.1) (normal, although maybe on the low end of the range?)

I think the two low results are related to my high sex hormone binding globulin (SHBG) which was 173.4 (24.6-122). I think SHBG binds free testosterone?

So, I have more questions for my endo.


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## Lovlkn (Dec 20, 2009)

> This was on the 60 mg of Armour, but before I started taking the iodine:
> 
> reverse T3: 22.5 (9.0-27)
> 
> ...


If you are taking Armour - your FT-3 should should fall closer to 3/4 of range. 3.2-3.8, you are only at 2.45. If it were me, I would push for an increase in Armour.


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## sarah73 (Feb 17, 2017)

I have a follow up question related to all of this. Lovlkn had asked if I had gotten a thyroid ultrasound, and at the time, I had not. But I got one done last week. And it was normal. Normal size, normal texture, no nodules (although I'm still waiting on the final report). The woman who did it, said my thyroid looked 'unremarkable.' I am now taking 90 mg of Armour, and still not feeling better. I'm due to go back for blood work in a few weeks.

With the normal ultrasound (and low antibodies), I'm starting to wonder if I even have hypothyroidism.

Also, in the past few weeks, I have noticed discomfort at my lower right rib cage (where my liver is) and my abdomen keeps getting bigger and bigger (I am thin and never gained weight in the 4+ years that I supposedly had hypothyroidism). I'm starting to wonder if I actually have a liver problem with the high SHBG and high B-12 (although my liver function tests have been normal).

Please let me know if you have any ideas, because I am lost. :-/


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