# I am beyond confused...have I been off in left field all along?



## I DClaire (Jul 31, 2011)

On December 6, 2012, my T4 Free was 0.9 (normal is 0.8-1.5). My T3 Free was 2.7 (normal is 2.0-3.6). My test results seem low to me and I've been on 105 mg Armour for several months. Last November, the last time I saw my endocrinologist, she told me to "experiment" with 120 mg Armour but that dose makes my heart race.

So, I live haunted by the idea that I'm under-medicated with the 105 mg dose and over-medicated with the 120 mg dose.

For as long as I've been dealing with Armour and Synthroid, I've had one thought in mind - that Armour, maybe even regardless of the dose, was a weaker medication than Synthroid. When my endocrinologist took me off Synthroid, it was my understanding it was because I was over-medicated and I've assumed ever since that Armour is a weaker medication by its nature.

UNTIL TODAY!

Today someone sent me a chart that indicates the approximate equivalent strengths of several thyroid hormone replacement drugs and I'm a bit dumbfounded right now.

I've been on 105 mg Armour. 90 mg Armour is equivalent to 150 mcg Synthroid. The 120 mg Armour dose that my doctor wanted me to "experiment" with is equivalent to 200 mcg Synthroid.

I don't get it!

If my T4 Free and T3 Free test results are low on 105 mg Armour, and that much Armour is equivalent to between 150-200 mcg Synthroid, why aren't my test results much higher? It seems like if I was over-medicated with 125 mcg Synthroid months ago, I'd be bouncing off the walls on 105 mg Armour instead of lethargic, always tired, moody, achy, etc.

Now I'm thinking do I need to take less Armour (perhaps 90 mg) to feel more energetic, less sleepy, more normal?

I am beyond confused!


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## lainey (Aug 26, 2010)

> I've been on 105 mg Armour. 90 mg Armour is equivalent to 150 mcg Synthroid. The 120 mg Armour dose that my doctor wanted me to "experiment" with is equivalent to 200 mcg Synthroid.


Not quite. There are 38mcg of T4 and 9 mcg of T3 in one grain of Armour. Your 105mg dose then has about 66.5mcg T4 and 15.75 T3. T3 is about 4 times more potent alone--25mcg of T3 is considered equivalent to 100mcg T4. SOOOO, your present dose is appoximately 130mcg of straight T4.

The higher dose--2 grains of Armour, works out to about 148 mcg of T4.

Patients who have had their thyroid removed generally need higher doses than patients who still have the gland. You are not on a very high dose yet.


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## StormFinch (Nov 16, 2012)

The real question IDClaire, is what do your Free T3 and Free T4 say? If you feel hypo on 105 mgs and your Frees are near the lower end of the ranges then an even lower dose isn't going to do you any good.

I might have asked this before, not sure, but have you tried splitting your 120 mg dose so that you're taking 60 mgs in the morning and 60 in the mid afternoon?


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## bigfoot (May 13, 2011)

I noticed this, too. Naturethroid has a conversion chart floating around out there and it doesn't match up to what's actually in each dose. Their literature says it's "due to higher bio-availability". Not sure if I really believe that or not.

One thing that I wonder about is the short half-life of T3 present in Armour / Naturethroid / etc. So, let's say you take 1 grain (38 mcg T4 / 9 mcg T3) in the early morning and that's your regular daily dose...

As has been mentioned here on the forums, within 3-4 hours 95% of that short-acting T3 is gone and used up. So, does it figure that for the _rest_ of the day you are essentially walking around with only 38 mcg of T4 on board until the next morning?


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## I DClaire (Jul 31, 2011)

The chart I have, Thyroid Hormone Replacement Drugs Approximate Equivalent Strengths Chart's source is from United States Pharmacopoea. It compares Armour Thyroid with Thyrolar (Liotrix), Cytomel (Liothyronine) and Levoxyl, Levothroid, Synthroid (Levothyroxine).

This chart says 1 1/2 grains (90 mg) Armour is approximately equivalent to 1 1/2 Thyrolar, 37.5 mcg Cytomel and 150 mcg (.15 mg) Levoxyl, Levothroid, or Synthroid.

2 grains (120 mg) Armour is approximately equivalent to 2 Thyrolar, 50 mcg Cytomel and 200 mcg (.2 mg) Levoxyl, Levothroid, or Synthroid.

The half-life differences were a huge shock to me. This information is from Dr. Nicole Evans' "How to treat hypothyroidism using Armour Thyroid" and she says that due to the rapid gastrointestinal absorption and short half-life (one day) T3 tends to have a more unpredictable serum concentration than T4 replacement which usually reaches and maintains a stable concentration due to it's long half-life of 7 days.

I'm not arguing with anyone - I'm just surprised with new things I've been reading. Today, just kinda' beginning my own little test, I only took 90 mg Armour (instead of 105 mg) and I've had the best day I've had in weeks. Is it a fluke? I dunno' but I absolutely have not spent the day napping in my recliner.

In reading back through stuff I document myself from various doctors' appointments, I actually found a note I'd written to myself saying my doctor wanted me to try 135 mg Armour, which I never did. I dated that note July 13, 2012 - on July 16, I was in the ER thinking I was having a heart attack! To this day, if I take 120 mg, my blood pressure and pulse will elevate dramatically.


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## bigfoot (May 13, 2011)

Hey, whatever works for you! Just for giggles you could even try alternating between 90 mcg and 105 mcg every other day and see how you fare. hugs3

My doc and I are still trying to figure out why, when I do a dose increase, I feel good for a few days and then immediately am down in the dumps. This stuff will make you pull whatever remains of your hair out, LOL. It doesn't help that being over- and under-medicated share some of the same signs & symptoms, lab work aside.


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## lainey (Aug 26, 2010)

People get to reading on the internet about the "miracle" that are combination medications, and fail to ponder why it may have been in the first place that synthetic T4 medications were developed--perhaps because they produce more stable and reliable results and are better tolerated in a larger population of people?

I think the t3 is the problem for you and has been all along. Some people just don't tolerate it, period. It makes no sense to chase numbers taking it if it doesn't make you feel well in the first place.


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## Andros (Aug 26, 2009)

bigfoot said:


> I noticed this, too. Naturethroid has a conversion chart floating around out there and it doesn't match up to what's actually in each dose. Their literature says it's "due to higher bio-availability". Not sure if I really believe that or not.
> 
> One thing that I wonder about is the short half-life of T3 present in Armour / Naturethroid / etc. So, let's say you take 1 grain (38 mcg T4 / 9 mcg T3) in the early morning and that's your regular daily dose...
> 
> As has been mentioned here on the forums, within 3-4 hours 95% of that short-acting T3 is gone and used up. So, does it figure that for the _rest_ of the day you are essentially walking around with only 38 mcg of T4 on board until the next morning?


It is not gone; T3 "peaks" in 4 hours. If the patient is consistent and taking replacement in a timely manner, the T3 also levels out and stabilizes, remaining in your system at a steady flow. You should always have the energy you need to get through the day "provided" you are on the right dosage amount for your particular needs and life-style.

Many things peak; glucose, cortisol, estrogen, testosterone etc.. to name a few!


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## I DClaire (Jul 31, 2011)

Andros said:


> It is not gone; T3 "peaks" in 4 hours. If the patient is consistent and taking replacement in a timely manner, the T3 also levels out and stabilizes, remaining in your system at a steady flow. You should always have the energy you need to get through the day "provided" you are on the right dosage amount for your particular needs and life-style.
> 
> Many things peak; glucose, cortisol, estrogen, testosterone etc.. to name a few!


Well, doh... There's another word I've somehow overlooked for over a year - "*peaks".* It has taken me all these months to even begin to absorb a lot of this.

I thought the same thing as bigfoot, that most of my Armour was depleted after 3-4 hours. bigfoot and I definitely seem to share a lot of the same issues. I've even begun trying 90 mg Armour one day and 105 the next (for three days now) - I don't know whether it's the medication or not but on 105 mg, I stay more "crashed" than the two days I took the 90 mg. For me, not only do under-medicated and over-medicated, test results, etc., play into the equation but also my own imagination. I'd probably be one of those people in a blind pharmaceutical study who'd think they were better with the sugar pill! :anim_63:

I still occasionally think about something my endocrinologist said a LONG time ago and I don't remember if she was talking about Synthroid or Armour, but she said "theoretically" a person should be able to take a week's worth of whichever drug she was talking about and their body would utilize it as it needed it. I've never figured that one out! I know you can forget or skip a dose of Synthroid without the result that missing a dose of Armour would cause.

My brain just absolutely does not want to comprehend so much of this; I stay confused! Every once in awhile a light comes on and things make more sense to me but then I can't hold onto that flash of insight long enough to build on it!

I know I'm not the only one though. When two ER doctors tell me on two different occasions that they've quickly run TSH tests and my results are "absurd" (even though they tell me they can't test T4 Free and T3 Free), that I'm in the ER is because of either too much or too little thyroid drug, I don't think they know as much about it as I do!! I'm worried about being in the ER someday and not physically able to _try_ to explain what little I know about Armour!!

The last time I was in the ER, on New Years Day, I was in such excruciating abdominal pain that I was sedated through an IV. I remember barely comprehending it when I heard the doctor say my TSH results were so bizarre and somewhere in the room I heard my husband tell the doctor I take Armour. Had the ER doctor known my T4 Free and T3 Free results from December, he'd have known that I wasn't writhing in pain because of Armour and maybe he'd have picked up on something else to pursue.

When I went to the ER last July, same symptoms, everyone thought it was my heart so I was never totally sedated and I gave them my little speech about Armour - then the hospital pharmacist told me, when I was admitted, that I'd have to supply my own because the hospital didn't stock any "natural" products.


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## lainey (Aug 26, 2010)

Some cells do not use exogenous T3, but make their own from exogenous T4. This why it's not recommended to take T3 only, because T4 is needed by the body as well. The "lift" that people get from combination medications is from the T3, yes--but you have to understand "half life" ie, if you have taken 10mcg of T3, that under the rules of half life, that in the 4-7 hours half of it will be used, but then 5mcg will be remaining, and then half of that will be used, etc. You may remember the basic math "riddle", but by taking half of a half, technically you will never have the situation where "none" is left (this produces a curve if you graph it that approaches zero but never reaches it). This is why many people will split the dose into morning and after noon, and also why they won't take T3 too late in the day, because you don't want that burst of energy right before it is time to sleep.

And yes, once you have reached an appropriate medication level, these values should be approximately stable. However, T3 will vary quite a bit more than T4, depending on when the last dose was taken, and patients are more likely to notice a missed T3 dose--you certainly couldn't take all of your Armour for the week at once, but yes technically you could take a T4 medication that way.

The distorted labs that combination medications tend to produce are going to put you on the defensive any time you are in the situation of explaining symptoms that "may" have their root in low TSH--just like if you are overweight, a doctor may assume that all of your problems stem from that. This becomes part of anyone's risk/benefit analysis.


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## bigfoot (May 13, 2011)

Hmm... you have had a green-light on liver tests and whatnot, right?


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## I DClaire (Jul 31, 2011)

bigfoot said:


> Hmm... you have had a green-light on liver tests and whatnot, right?


Yep! Ultrasound on gallbladder, liver, etc. Then, later, CT scan of entire abdominal/pelvic area (this test revealed an abnormality on my pancreas), then most recently what was to be a third endoscope procedure, this one with an attached ultrasound, indicated the abnormality on my pancreas is a birth defect, a fold or wrinkle.

The pancreas specialist had intended to do a FNA guided by the endoscope-ultrasound but when he saw what it was, he decided not to do the biopsy. He plans to re-do the CT scan in six months to be sure but the general concensus has become that I had several really acute attacks of abdominal spasms and I'm now on Librax before each meal and have not had anymore pain.

lainey mentioned a burst of energy. As God is my witness, I don't believe in the 15-16 months I've been on Synthroid and then switched to Armour that I've ever had a "burst of energy". The closest I've ever come to that feeling was the first day I took Armour. I'd been taking 125 mcg Synthroid, then I switched to Armour with no break in between the two drugs and I absolutely felt like myself for a day...but that was it.

I was thinking this afternoon, before coming back to the computer and reading this, that when Andros speaks about "half life" and a thyroid hormone replacement "peaking", if I've ever felt that, I swear I do not remember it.

I take my Armour around 5:30-6:30 most mornings, I usually take a bath or shower, then I fix breakfast at which time I drink one cup of Instant Folgers coffee...then, more likely than not, I sit down in a recliner, pull a throw up over me and go back to sleep.

I do not take any other drugs in the morning except the low dose of Librax before I eat and I don't think my lethargy is related to that because I've been doing the morning nap routine for months - I just started the Librax a few weeks ago.

After I sleep all morning, I usually do whatever I'm going to do for the day and it's never much. I used to be a good housekeeper - now I barely keep things relatively picked up and my husband does more cooking than I do.

Around 5:00 P.M., I slowly walk my dog around the block...and I think THIS is where my daily routine takes an odd twist - generally speaking, I feel better between 6:00 P.M.ish and 10:30ish than any other time of the day but still nothing one would consider a burst of energy. Then I go to bed and I'm usually asleep by the time my head hits the pillow and I usually sleep soundly all night.

If I ever felt a "burst of energy", I swear I'd go outside and turn a cartwheel! That simply never, ever happens for me. I push myself all day if there is something that demands I not sleep, like doctors' appointments, etc. In all sincerity, I almost feel like I'm taking a sleeping pill every morning instead of something someone might get a burst of energy from taking.


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## I DClaire (Jul 31, 2011)

This morning something happened that brought my #1 anxiety over Armour into full focus. I worry, because it has happened this past year, that my husband could get into some kind of cardiac crisis in the night and I wouldn't be able to help him. I never gave anxiety attack a second thought until this past summer when I began having them and whether or not they're related to my thyroid hormone replacement I don't know...but my gut feeling is they are.

We've been discussing the half life of drugs, the fact that Armour "peaks" 4-5 hours after someone takes it, etc. I take my Armour around 5:30-6:30 every morning. It wasn't my husband who had a medical crisis this morning, it was my dog and he is now doing O.K., but at 4:00 A.M., when Jimbo began vomiting so fast and so much we couldn't manage at all for a couple of hours, I felt like I didn't have any reserve energy to fight with, I was so weak I kept thinking I was going to faint - what I fear was happening, in an emergency, I was little more than a second demand for help myself.

I finally managed to swallow my Armour but it never has done much today and there certainly hasn't been any burst of energy.

This is relatively new to me - my husband used to say I dealt with emergencies calmer than anyone he knew. I worked in a huge public high school - I had to! He teased that he'd married someone younger than himself (47 years ago now) to have someone to take care of him in his old age but I suspect he's rethinking that plan now. I am very uncomfortable with the realization that I do not believe I'm physically able right now to deal with any emergency in the night or early morning in particular.

I feel like maybe something is trying to tell me to give Synthroid a second chance. It's also become pretty clear what my endocrinologist said about my liver grabbing onto Synthroid and not letting go BUT that same liver didn't seem to pay any attention to Armour. Synthroid hung around too long - Armour, if it does anything, makes a mad dash for the door!


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## bigfoot (May 13, 2011)

I DClaire said:


> Around 5:00 P.M., I slowly walk my dog around the block...and I think THIS is where my daily routine takes an odd twist - generally speaking, I feel better between 6:00 P.M.ish and 10:30ish than any other time of the day but still nothing one would consider a burst of energy. Then I go to bed and I'm usually asleep by the time my head hits the pillow and I usually sleep soundly all night.


Funny, I literally experience the *exact* same thing. I have been puzzled all these last few years as to why I feel better in the evening than in the morning & afternoon. Adrenal fatigue is something that we've extensively tested for and looked into, but I don't quite match up to. Same for sleep apnea, no dice there. I'm guessing they checked into this for you, too?

Have you tried taking your Armour at night at all? I know that sounds counterintuitive, especially with the T3 in it, but I have to wonder. I'm about to that point myself. Maybe we can draw straws and see who goes first. :tongue0013:

And howzabout Reverse T3? I know most endos and docs poo-poo the very words, but if your body is shunting the T3 into Reverse T3, you could take all the Armour you wanted with little positive benefit. I don't know what to say about going onto straight Synthroid -- I suppose if your body isn't shunting to Reverse T3, that your liver is happy & healthy (thus good T4->T3 conversion), it might be worth a try.

Since I'm heading this route I might as well ask: have you seen an infectious disease doc? Been tested for neurotransmitters or any of the more specialized stuff?


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## bigfoot (May 13, 2011)

I DClaire said:


> It wasn't my husband who had a medical crisis this morning, it was my dog and he is now doing O.K., but at 4:00 A.M., when Jimbo began vomiting so fast and so much we couldn't manage at all for a couple of hours, I felt like I didn't have any reserve energy to fight with, I was so weak I kept thinking I was going to faint - what I fear was happening, in an emergency, I was little more than a second demand for help myself.


Hmm... in my humble layperson opinion, that sure sounds like an adrenal issue. And then I wonder about other hormones besides cortisol, like estrogen, testosterone, DHEA, etc.


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## I DClaire (Jul 31, 2011)

bigfoot, I feel like I've been tested for everything in the past few weeks...and some things multiple times. I THINK I have an adrenal issue but my doctor absolutely poo-poos adrenal fatigue, even to the point of sending me an envelope full of printouts saying there is no such thing. She says there is adrenal insufficiency but it is diagnosed by a blood test, not a saliva test.

I have not seen an infectious disease specialist but the ER doctor (on 1/1/13) told me my adrenal situation was normal, per a blood test.

If I ever find out what's making me a lazy, anxious, :anim_63:dopey-feeling nutcase, I'll sell you the information for $10,000!!

Seriously, I've had everything about me tested AND I feel blessed to have access to so many tests. The results are usually the same, I'll be low on B-12 and D3, which I take.


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## bigfoot (May 13, 2011)

And I'll be happy to give you $20,000 for that info!! hugs3

There is one hell of a gray area between "adrenal insufficiency" and "adrenal fatigue". That's like saying your car has gas in it, but they can't tell you if it's a full tank or 1/8th. If the doc won't do a saliva test, maybe ask for a 24-hour urine test of free cortisol. That is something they shouldn't have a problem with.

I am trying to get lined up with a good infectious disease doc. I'm not expecting much, but it's better to be pleasantly surprised instead, LOL. :tongue0013:


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## I DClaire (Jul 31, 2011)

I honestly love my endocrinologist! She treats me as much like a good friend as a physician and I guess she'd patiently sit and listen to me all day to answer my concerns.

I saw her this morning and she is switching me back to Synthroid (137 mcg). She said she has been worried about me for months and honestly was pleasantly surprised when I asked about switching back.

So...

Tomorrow I'll be a scout on a new route - hoping to feel better. My last set of labs were identical to the ones in December, still low on 105 mg Armour.


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## bigfoot (May 13, 2011)

Will be interesting! Glad she actually takes the time to listen, too. hugs4


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## Octavia (Aug 1, 2011)

Good for you, IDC. Fingers crossed...


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## I DClaire (Jul 31, 2011)

I woke-up at 4:00 this morning and decided to go ahead and take my first 137 mcg Synthroid. I snuggled back under the covers and slept until 6:00 A.M.

When I awoke at 6:00, my first thought was had my heart stopped? :scared0011: I cannot even remember when I've awakened in the morning without noticeable palpitations and that sickening feeling of anxiety.

I know taking one's blood pressure that early, in bed, etc., is pointless but my heart rate was beautifully normal - something else I haven't known in a long time.

It's almost 11:00 now and I feel calm. I also almost feel dazed because I've all but forgotten what it feels like to feel calm.

I'm honestly afraid to think about it too much for fear of jinxing the change!


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## Octavia (Aug 1, 2011)

Don't think about it!


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## jenny v (May 6, 2012)

I say this with love, STOP OVER THINKING IT!!! :tongue0013:

Just kidding! I'd say enjoy the normal feeling. Maybe the Synthroid is exactly what your body needed.


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## I DClaire (Jul 31, 2011)

jenny v said:


> I say this with love, STOP OVER THINKING IT!!! :tongue0013:
> 
> Just kidding! I'd say enjoy the normal feeling. Maybe the Synthroid is exactly what your body needed.


This morning I've taken everything out of the refrigerator and freezer, cleaned all that out, made several trips outside in the rain to the garbage bin, straightened up one dish cabinet that had maybe 8 plates in it and 250 outdated prescription bottles and every imaginable supplement. I'm on a roll!!

As God is my witness, my house has not really been cleaned well since the weeks before my thyroidectomy. I'll be a happy camper if my long lost energy will just hang-on until I can get some desperately needed jobs behind me. It's been virtually impossible for me to stay on any task more than a few minutes and I'm proud to say I've worked hard today!

Paul has an appointment tomorrow morning with the internist who insulted me so badly about taking Armour. I've been planning to let him have it with both barrels for being so insulting about my Armour but I'm reconsidering, I might end-up thanking him!! :anim_63:

My daughter called to ask how I was feeling this morning? She laughingly said, "Are you dancing around like Julie Andrews in "The Sound of Music"? I said no, but I'm not chasing your father around like Carrie at the prom!! :tongue0013:


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## bigfoot (May 13, 2011)

Excellent news!! While you're at it, can you come over here and do a little cleaning, too? Haha, just kidding. hugs3


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## nvsmom (Sep 30, 2012)

LOL... Carrie at the prom... LOL


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## I DClaire (Jul 31, 2011)

If the perfect day I have enjoyed today with the Synthroid turns out to be a flash in the pan, the disappointment will be unbearable. I have felt more like myself today than I ever imagined I'd feel again!

I never took a nap - for months on end I've been sleeping all night and off and on all day. I had enough energy to work in my house then walk my dog and go to choir practice tonight.

BUT...the most unbelievable miracle of all has been that I have not had so much as a hint of an anxiety attack today. Not from the moment I woke up this morning. I've been taking Librax before every meal because I was having excruciating abdominal pain from eating while so anxious.

I can't believe the way today has played out. I'm not jittery, I'm not anxious, I'm tired tonight but I've been alert and focused all day. In all sincerity, I really didn't realize how crazy I've been feeling until today. I told my husband tonight that for months on end, even when I felt my best, I never felt like myself. Today I've been me again.

I feel like my prayers have been answered. I am looking forward to getting up tomorrow morning to another good day.


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