# Why is it not a good idea to mix T4 meds with a T4/T3 combo?



## nvsmom (Sep 30, 2012)

Why is it not a good idea to mix T4 meds (like synthroid) with a T4/T3 combo like Armour or Nature throid? I saw someone post that comment and I was wondering why...

I would have thought that a T4 and Armour blend would be ideal for many since you can more closely replicate the T4 and T3 ratios found in the human body. I've read that natural dessicated thyroid usually has a higher ratio of T3 than normally found in people but it will have T2, T1 and some other substances that could be used in a mammal body that scientists haven't figured out yet...

I think of it as being a similar situation to a baby with a mother with an inadequate milk supply. The mother will feed baby with formula, which has many nutrients a baby needs but is lacking in many ways (antioxidants, antibodies, etc) that scientist did not realize 40+ years ago when they invented it; so the mother will also use her breastmilk since some is proven to be better than none. (And I do support mothers who choose to use formula exclusively for whatever reason.) I hope that analogy made sense...

I'm curious because I am fairly recently diagnosed with Hashi's and am still quite undertreated by my doctor, lab wise and symptom wise. He doesn't seem very knowledgeable so I've done a bunch of reading which led me to guess that I will eventually want to try a synthroid / Armour combination some time in the future.

My TSH is 7.something or other (range 0.20-6.00) and I know my Free T4 was just under the bottom 30% of the range and my Total T3 was in the bottom 6%. This is after starting off on 50 mcg Synthroid for 6-7 weeks; my TSH prior to taking synthroid was about a 14. I just switched to 75 mcg yesterday. If my t3 stays as low as it is, it will need some help and I like the idea or adding Armour...


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## Andros (Aug 26, 2009)

nvsmom said:


> Why is it not a good idea to mix T4 meds (like synthroid) with a T4/T3 combo like Armour or Nature throid? I saw someone post that comment and I was wondering why...
> 
> I would have thought that a T4 and Armour blend would be ideal for many since you can more closely replicate the T4 and T3 ratios found in the human body. I've read that natural dessicated thyroid usually has a higher ratio of T3 than normally found in people but it will have T2, T1 and some other substances that could be used in a mammal body that scientists haven't figured out yet...
> 
> ...


Armour already does that. It's a 4.22 to 1 ratio. T4 is 38 mcgs. per grain and T3 is 9 mcgs. per grain.

It is not necessary to tamper with this. You only need a small amount of T4 to achieve peripheral deoiodination. Additionally, everyone I have ever known to add synthetic T4 to natural dessicated is never never ever well. There are maybe a few exceptions but that happens to be true with anything.

Free T3 is the active hormone the body needs and that should be the only concern "generally" speaking. Once again, there are always a few exceptions.

You may find this link of interest.
http://content.karger.com/ProdukteDB/produkte.asp?Doi=123900

All that said, "All you can do is try it and see if it works for you!"


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## lainey (Aug 26, 2010)

> I'm curious because I am fairly recently diagnosed with Hashi's and am still quite undertreated by my doctor, lab wise and symptom wise. He doesn't seem very knowledgeable so I've done a bunch of reading which led me to guess that I will eventually want to try a synthroid / Armour combination some time in the future.


Treating thyroid disease is not rocket science, however it does require some attention and patience on the part of the patient and clinician. Doctors do go to school for many years however, and it is dangerous when patients begin to think that because they have done some reading on the internet, that they should diagnose and treat themselves.

Keep in mind that in forums on the internet, you are not hearing from the millions of adequately treated thyroid patients who are seeing regular doctors and leading normal lives. Some people are newly diagnosed and seeking information, but internet is full of that minority who are having difficulty with their replacement that can often be attributed to a multitude of factors--endless medication "tinkering", an assertion that they must be in the <1% category of people who only do well with a very suppressed TSH--are only a few of the issues.

As for taking T4 with a T3/T4 combo medication, there really should be no reason to add what is already there, i.e., more T4, to a medication that is already designed to be a proper ratio for replacement. If you read the posts of the few here who have done it, you will see that it hasn't ended well--overmedicated and left to start their dosing all over again. A very few I have seen have had their doses compounded for them (usually do to allergies in fillers), but even then these ratios can easily be recreated with synthetic T4 and T3 dosed individually. As for "natural" replacement--that is just an adjective. Who knows if pig thyroid has the right components for humans, any more, than to use your analogy, than cow protein in formula is good for babies?

That said vast majority of patients world wide do very well on synthetic T4--it is the standard of care in most of the rest of the world. In much of Europe, for example, adding exogenous T3 is very rare, and "natural" products are not readily available. Properly dosed, you many do quite well on T4--even people without a thyroid do remarkably well.


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## Lovlkn (Dec 20, 2009)

Since you are already on Synthroid, why not supplement with Cytomel instead?

Or should I say in addition to your Synthroid.


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## iroczinoz (Aug 15, 2011)

Started off on t4 only at 50mcg then upped to 100mcg. Later I got my hands on t4/t3 combo. Felt heaps better. Then they stopped making t4/t3 combo went back onto t4 only at 150mcg. Results were ordinary and did not feel that great.

Just managed to get t4/t3 combo last of the supplies only 10months worth.

Elevated rt3 does not help and t4 contributes to it.

I think patients should be able to direct the direction of treatment. If need be sign the paper work to take responsibility on yourself and not the doctor. Every other decision you are allowed to make in life but not in this case, doctors have a lot of power.


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## nvsmom (Sep 30, 2012)

Andros said:


> Armour already does that. It's a 4.22 to 1 ratio. T4 is 38 mcgs. per grain and T3 is 9 mcgs. per grain.
> 
> It is not necessary to tamper with this. You only need a small amount of T4 to achieve peripheral deoiodination. Additionally, everyone I have ever known to add synthetic T4 to natural dessicated is never never ever well. There are maybe a few exceptions but that happens to be true with anything.
> 
> ...


The armor T4:T3 ratio (4.22:1) is quite different than a human's ratio (as far as I have found) which is more like 20:1. That is why I thought using T4 might work well with the combo. If a patient got about 80% of his T4 from synthroid and the rest from Armour, those ratios would more closely mimic the human ratio....

I'm still learning about this and could be way off. I think I've read many books on thyroid problems recently and the advice on treatment is all over the place. It doesn't seem very consistent. I find this a bit frustrating because in the past my autoimmune problems can be treated only one or two ways: cut out gluten (celiac) and live on steroids or remove spleen (ITP). Treating hypothyroidism is proving to be more difficult. 



lainey said:


> Treating thyroid disease is not rocket science, however it does require some attention and patience on the part of the patient and clinician. Doctors do go to school for many years however, and it is dangerous when patients begin to think that because they have done some reading on the internet, that they should diagnose and treat themselves.
> 
> Keep in mind that in forums on the internet, you are not hearing from the millions of adequately treated thyroid patients who are seeing regular doctors and leading normal lives. Some people are newly diagnosed and seeking information, but internet is full of that minority who are having difficulty with their replacement that can often be attributed to a multitude of factors--endless medication "tinkering", an assertion that they must be in the <1% category of people who only do well with a very suppressed TSH--are only a few of the issues.
> 
> ...


It was on these forums that I first heard that T4 is not good to mix with Armour. I've actually read a book that said otherwise, and the other half dozen books I've read did not mention that problem at all.

I do like to hear personal stories on the internet about people's experiences because if I had not heard about personal stories about thyroid testing for celiacs (because of the very close relationship between the two) I would not have been tested or discovered my Hashimotos. I had thyroid problems for about 15 years (in hindsight) and I've been tested many times but my thyroid levels were always "normal" to the doctor (or so they told me) and then I was dismissed; my "normal" thyroid levels were in the 6's, 4's, and 2's yet I had symptoms. I just don't trust doctors to do right by me anymore; they've done me more harm than good (excluding giving me antibiotics when I can't kick an illness).

I would never add Armour on top of a good T4 level. For example, if my TSH was at 1 with 100mcg of synthroid but I still had symptoms, I think a reasonable route would be to cut the synthroid to 75 mcg and add half a grain of armour (approx 19mcg T4 and 4.5mcg T3). KWIM?

I mention Armour because I think including T2 and T1 makes sense. I've read, I can't remember what book now, that they don't think T2 and T1 are as benign as previously thought; I believe they were thought to help with transport... shoot, I wish I'd written it down!

I do hope I do well on T4. I may not even need T3... I just doubt it. I've never actually noticed people say they felt worse with a properly dosed T4/T3 combo than with a properly dosed T4 (alone). I'll have to look into that. 

Thanks for the advice.  I appreciate your input.


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## nvsmom (Sep 30, 2012)

Lovlkn said:


> Since you are already on Synthroid, why not supplement with Cytomel instead?
> 
> Or should I say in addition to your Synthroid.


I'm not against Cytomel but it is so pure. I don't know if that's better. In my experience it isn't. It's sort of like having vitamins rather than eating a vegetable... My analogies are stretching things a bit, aren't they? LOL

Thanks. 



iroczinoz said:


> Started off on t4 only at 50mcg then upped to 100mcg. Later I got my hands on t4/t3 combo. Felt heaps better. Then they stopped making t4/t3 combo went back onto t4 only at 150mcg. Results were ordinary and did not feel that great.
> 
> Just managed to get t4/t3 combo last of the supplies only 10months worth.
> 
> ...


Yeah... they do have a lot of power and I'm one of the many who have not been helped in times when I didn't fight them. I wish I had their knowledge... maybe I should go to the university book store and buy their endocrinolgy text book. Hmmm.

I have no problem taking more than one pill a day so if they want to add or spread out my dosing (if I get T3) I will do fine with that.

I don't yet know if rT4 is a problem for me. I would imagine I should wait until I'm closer to a good dose (for me) and if I'm still symptomatic it should be checked?

Thanks for sharing your story. Do you mind telling me what your T4/T3 combo is that's working so well for you; just so I can see how it related to your T4 doses?


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## CA-Lynn (Apr 29, 2010)

RE "patients should direct the treatment....":

Sure.....when they pay the medical malpractice insurance. Signing a ton of documents holding the doctor harmless for the outcome will not negate liability on the doctor's part. Really, that's equivalent to just turning over a pad of blank prescription forms to the patient.

Patients should strive to find a physician who believes in "collaborative" relationships. Such a relationship involves agreement between doctor and patient regarding choice of treatment options. In the end, patients, unless they are MD's themselves, are clueless about the myriad of effects of drugs.


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## nvsmom (Sep 30, 2012)

CA-Lynn said:


> RE "patients should direct the treatment....":
> 
> Sure.....when they pay the medical malpractice insurance. Signing a ton of documents holding the doctor harmless for the outcome will not negate liability on the doctor's part. Really, that's equivalent to just turning over a pad of blank prescription forms to the patient.
> 
> Patients should strive to find a physician who believes in "collaborative" relationships. Such a relationship involves agreement between doctor and patient regarding choice of treatment options. In the end, patients, unless they are MD's themselves, are clueless about the myriad of effects of drugs.


I agree with you, a collaborative relationship really is the ideal, it's just really difficult to find. In my city of a million people, there is a doctor shortage. When you go to the initial interview, it's the doctor who decides if they want to take you on and not the patient. My mother, who is overweight and has high blood pressure, was turned down by two doctors who were still accepting patients because she had too many health issues. Grrrr.

The ideal is just that, the ideal. Not many people get to experience it. For those of us who don't have it, I would LOVE to get a hold of my doctor's lab requisition sheet so I could check some things that he's refusing to do. The precription pad would be handy too...


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## iroczinoz (Aug 15, 2011)

CA-Lynn said:


> RE "patients should direct the treatment....":
> 
> Sure.....when they pay the medical malpractice insurance. Signing a ton of documents holding the doctor harmless for the outcome will not negate liability on the doctor's part. Really, that's equivalent to just turning over a pad of blank prescription forms to the patient.
> 
> Patients should strive to find a physician who believes in "collaborative" relationships. Such a relationship involves agreement between doctor and patient regarding choice of treatment options. In the end, patients, unless they are MD's themselves, are clueless about the myriad of effects of drugs.


I just look at all the other things we are allowed to do and nobody gets in your way.

Buying alcohol
tobacco
Jumping off a bridge

Where is the doctor to hold you back and not allow you to do that? I would be willing to bet that tobacco would kill more people than having the option to use any medication you want.

This choices are yours to make and really who is going to stop you.

If you are educated and I would think when it comes to health everyone should be looking out for themselves as it is the most important thing you own. Last thing I want is some know it all doctor telling me I am fine and in range when I feel terrible. He has no idea what you are feeling yet he thinks he does and just blocks you from getting the treatment that could possibly change your life.

The reason it is almost impossible to find a doctor who will work with you is that their ego's are just to big for their own good. They think they know it all yet they are clueless on improving quality of life.

A doctor who smokes or who is an alcoholic is the last person you want to be taking advice from or have him look after you. How are they supposed to have your best interest in mind when they don't even have their own best interest in mind.

I just think the system sucks and there is a lot of room for massive improvememt.

Sorry for the rant just in the last 6 years have not found a doctor who is switched on. 6 years of suffering and wasting time and they are doing me a service, how nice of them.


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## CA-Lynn (Apr 29, 2010)

You'll find that the younger docs are more apt to work with you.


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## CA-Lynn (Apr 29, 2010)

I'll tell you this story, ever so briefly.

I was in Kuwait, became ill....and knew that I needed to get home so I got on the next plane. Long story short, it was holiday time and doctors were away. So I saw what I believed was a good pulmonologist who diagnosed a pulmonary embolism. [Was accurate.] What made my blood boil was when I tried to delay a test by one day and HE blew up and said, "You will do as I say."

I am rarely caught with my mouth open and speechless.

Once I gathered my wits I replied, "The hell I will. Give me all my records. Now. I am terminating this relationship."

I did just that, called another pulmonologist [a much younger one whose expertise is critical care and pulmonology] and he got me out of the woods. Turns out, if I had done what the first pulmonologist had told me to do, I would have bled out.

Moral to the story is.....get the right doctor. It's like finding a prince. You've got to kiss a lot of frogs....

Keep searching. Ask around. Word of mouth is good. Have a doctor you really like for another medical specialty? Call his office and leave a message and ask which doctor he would send his wife to.


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## iroczinoz (Aug 15, 2011)

nvsmom said:


> Thanks for sharing your story. Do you mind telling me what your T4/T3 combo is that's working so well for you; just so I can see how it related to your T4 doses?


Was on 150mcg T4.

The combo is dosed 40mcg t4 / 10mcg t3 and I take 2 a day. Morning and then at 2pm.

So it is 80/20 which is roughly equivalent to 160mcg t4 but the effects are vastly superior to 150mcg t4 only.

Next time you get blood work ask for

ft3
ft4
tsh
anti tpo
anti ta
rt3

Once you get ft3 and rt3 you want to work out your ratio! It has been said that for a good ratio it needs to be 20 or higher.

As an example here is mine

rt3 613 pmol/l (140-1200) 
Ft3 was 5.8 pmol/l

calculated ratio 
5.8 x 1000 = 5800 / 613 
ft3/rt3 ratio = 9.46

Well below 20 and no wonder raising t4 meds did nothing.

As you can see both ft3 and rt3 in range doctor sees it as all good. You bring up the ratio discussion and he looks at you like some idiot and tells you no everything in range all good. Even though you tell me you feel bad you must be feeling good as you are in range. You continue to try and get him/her to listen to you, but they tell you everyone feels tired me included this is life.


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## nvsmom (Sep 30, 2012)

CA-Lynn said:


> I'll tell you this story, ever so briefly.
> 
> I was in Kuwait, became ill....and knew that I needed to get home so I got on the next plane. Long story short, it was holiday time and doctors were away. So I saw what I believed was a good pulmonologist who diagnosed a pulmonary embolism. [Was accurate.] What made my blood boil was when I tried to delay a test by one day and HE blew up and said, "You will do as I say."
> 
> ...


Wow. Scary situation... I'm glad it worked out well for you. Yikes.

I will start looking around. With our doctor shortage I'm not sure if I'll have luck but I'll look. Thanks.


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## nvsmom (Sep 30, 2012)

iroczinoz said:


> Was on 150mcg T4.
> 
> The combo is dosed 40mcg t4 / 10mcg t3 and I take 2 a day. Morning and then at 2pm.
> 
> ...


 Thanks for sharing your info; it helps me to see what others are doing.

I had the TPO Ab test done about 2 months ago. It was at the high end of the range (a 33.8 in a range of 0-34). My doctor called it normal and did not want to diagnose me as Hashi's but I have a few other AI problems so what else would it be? He has actually refered to it as Hashi's since then so I think he agrees with me now. I don't think I need it tested again. Anti ta ... is that antibodies for thyroglobulin? I will ask for those other tests.

I didn't know about checking Ft3 and rT3 ratios. It makes sense that you would want low rT3 compared with fT3... Do you remember where you got that information from? I would really like to look into that more so I have a better understanding... and so if it applies to me, I can come armed with information if I need to talk to my doctor about it.

Thanks!


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