# Want to switch to Armour



## Enigma (Jun 13, 2011)

I am going to my doc's today since I am still having anxiety symptoms, dry mouth, increased hair loss, dizziness, pain, fatigue... I know that it's not a quick fix, but I would really like to switch to Armour.

Just a recap:

May blood test (Dx'ed with Hypothyroidism):
TSH 15.4, fT4 .8 (1/10th above the lowest normal) in May, put on .05 mcg generic levothyroxine

July 5th blood test (Dx'ed Hashimotos):
TSH 6.8, fT4 1.0, upped levo to .075 mcg and put on name brand Levoxyl. 
TPO (first time tested) 867 (RR 0-9)

I have not been feeling much better at all. I am losing more hair, getting dry skin again, and now feel nauseous at night and having reflux. Still having muscle aches.

How can I talk to my doc about switching to Armour? I don't want to push him too much and make him mad, but I do want to try it. Plus, I am a teacher, so I am off this summer, so it would be best to play around with meds while I am not working rather than waiting until the fall and watching the levothyroxine fail miserably.

Any ideas are very appreciated!! I go to the doc's at 2:30 EST...


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## lainey (Aug 26, 2010)

No offense, but you are not done titrating the T4 meds up yet so that your levels are in a reasonable range to be able to say that they don't work or will "fail miserably".

Your last labs were still hypo, you had the dose increase. Unfortunately, you have to wait the 6 to 8 weeks to see where you are, and perhaps increase your meds again. That is just the process, there really isn't any way to hurry it up.

Armour or none, the process will be the same. There's no guarantee that it will make you feel better.


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## Andros (Aug 26, 2009)

Enigma said:


> I am going to my doc's today since I am still having anxiety symptoms, dry mouth, increased hair loss, dizziness, pain, fatigue... I know that it's not a quick fix, but I would really like to switch to Armour.
> 
> Just a recap:
> 
> ...


Lainey is correct; that said..........................

For the life of me, I can't imagine any doctor being mad at his/her patient under ordinary circumstances and discussing Armour comes under that classification.

You need to speak knowledgeably. Armour is dessicated porcine thyroid. One grain (60 mgs.) has 38 mcg. of T4 (note mcgs.) and 9 mcgs. of T3.

Best to start on 30 mgs which would be 1/2 grain, get labs in about 6 to 8 weeks to titrate upward by 1/2 grain each time provided this is indicated by labs and clinical evaluation.

You really should peruse this before you go.
http://www.frx.com/pi/armourthyroid_pi.pdf

Good luck and if the doctor won't entertain the idea; find one that will. Bottom line here.

Let us know.


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## hochelaga (Jul 10, 2011)

Hi,

I'm a newbie here but I've been dealing with my hypothyroid for 7 or 8 years and only discovered that I have Hashi's a couple of months ago. I was on Erfa dessicated thyroid (Canadian version of Armour) for the entire time but was unable to get my thyroid normalized - always swinging between hypo and hyper.

Just over a month ago I found a new doctor who has experience with Hashi's and he suggested that dessicated thyroid was not a good choice for Hashi's because it would trigger my anitbodies. So for the past month I've been on Synthroid with a small amount of T3. I'm not feeling better yet but one amazing thing so far is that the diarrhea which has been plaguing me ever since starting thyroid meds has almost completely subsided. My suspicion is that (antibodies or no antibodies) the dessicated thyroid contained too much T3 for my body.

Although you didn't post the reference ranges for your labs it looks as though your TSH is still high(?) which suggests that your doctor will still need to increase your meds before you will be feeling better.

Elle


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## Enigma (Jun 13, 2011)

Thank you guys for your honest thoughts... I am just so tired of feeling so tired... it's been like this for about 10 years, but finally have a reason (although my TSH has always been above 3, but no one has done anything about it until now). I am getting so stressed with always feeling like this. The levothyroxine has just made me feel worse. I just don't know what to do anymore. My husband is stressed from me being so stressed, and I am just feeling lost. I also don't feel like I can trust any doctor 100% since they have screwed me over for the last 10 years... I just don't know what to think anymore. My doc won't even test my fT3... I have to prove to him why it is important for him to even consider it.

btw, the reference ranges for my TSH are .4-4.0, and mine was 15.4 (undiagnosed) then 6.8 while taking .05 mcg levothyroxine, now I am on .075 mcg to bring it down...


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## Andros (Aug 26, 2009)

Enigma said:


> Thank you guys for your honest thoughts... I am just so tired of feeling so tired... it's been like this for about 10 years, but finally have a reason (although my TSH has always been above 3, but no one has done anything about it until now). I am getting so stressed with always feeling like this. The levothyroxine has just made me feel worse. I just don't know what to do anymore. My husband is stressed from me being so stressed, and I am just feeling lost. I also don't feel like I can trust any doctor 100% since they have screwed me over for the last 10 years... I just don't know what to think anymore. My doc won't even test my fT3... I have to prove to him why it is important for him to even consider it.
> 
> btw, the reference ranges for my TSH are .4-4.0, and mine was 15.4 (undiagnosed) then 6.8 while taking .05 mcg levothyroxine, now I am on .075 mcg to bring it down...


That's another thing; why would you continue to see a doctor that won't run the tests you want?

Also, see if you have this in your area.........
HealthCheckUSA

http://www.healthcheckusa.com/

What is your doctor's specialty besides being oppositional? Endo, GP, Internist etc.??

Believe me; we "all" understand your angst and disappointment. I went for over 20 years undiagnosed. The better part of my adulthood went down the drain. I have deep resentments. We share your feelings in a very big way!


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## Enigma (Jun 13, 2011)

Andros- My doc is a GP, and has been the best doc I have had so far, which is why I have stuck with him. He really listens and doesn't get offended when I offer suggestions and back it up with evidence, or bring in copious notes. It probably helps that I went to school with his son and we were good acquaintances, and that he worked with my dad at the same hospital (my dad is a pediatrician). He also works closely with my cognitive behavioral psychologist- they call each other to update each other on mutual patients, so that was one main reason I switched, to get better integrated coverage. But I've been with him less than a year, so I am still learning about how he treats things. I don't want to be labeled as a doctor jumper, you know? I am going to call around and see how the local endos treat their patients, since my doc has mentioned possibly sending me to an endo. At the very least i can be ready with a name of someone who is more "open" to treatment.


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## Enigma (Jun 13, 2011)

Just checked the healthusa site you linked, and there are about 4 states that don't have locations, and my state is one of them! Argh!


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## hochelaga (Jul 10, 2011)

Enigma said:


> My doc won't even test my fT3... I have to prove to him why it is important for him to even consider it.
> 
> btw, the reference ranges for my TSH are .4-4.0, and mine was 15.4 (undiagnosed) then 6.8 while taking .05 mcg levothyroxine, now I am on .075 mcg to bring it down...


Here's a question for your doc... How does he know if you're converting T4 to T3 unless he runs a check? TPO antibodies work against the T4 to T3 conversion process. And if he does switch you to Armour (which contains T3) how will he monitor your T3 levels?

Don't forget... it's often the case that when starting on thyroid meds people may feel worse before they feel better - that's because it takes time to find the right dose.

Hang in there!


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## Andros (Aug 26, 2009)

Enigma said:


> Andros- My doc is a GP, and has been the best doc I have had so far, which is why I have stuck with him. He really listens and doesn't get offended when I offer suggestions and back it up with evidence, or bring in copious notes. It probably helps that I went to school with his son and we were good acquaintances, and that he worked with my dad at the same hospital (my dad is a pediatrician). He also works closely with my cognitive behavioral psychologist- they call each other to update each other on mutual patients, so that was one main reason I switched, to get better integrated coverage. But I've been with him less than a year, so I am still learning about how he treats things. I don't want to be labeled as a doctor jumper, you know? I am going to call around and see how the local endos treat their patients, since my doc has mentioned possibly sending me to an endo. At the very least i can be ready with a name of someone who is more "open" to treatment.


That sounds like a most tactful approach!


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## Andros (Aug 26, 2009)

Enigma said:


> Just checked the healthusa site you linked, and there are about 4 states that don't have locations, and my state is one of them! Argh!


Wouldn't you know it! However, don't give up. There must be a lab in your area where you can just order your own labs.


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## lainey (Aug 26, 2010)

Certain states, New York is one of them, not only do they not allow you to order your own labs, but the lab will not send you a report-- you have to get it from the doctor.

It's really too early to measure the free T3--you can't really tell if a patient isn't converting until their TSH is low enough with a free T4 in the range--this is because T3 is made from T4--if you don't have enough T4 yet, the T3 is going to be low anyway. However, most people on replacement do better with the free T4 in the upper third of the range, so hopefully that is what you can aim for.

Stick with it, Enigma, you're not "done" yet. Unfortunately, "not a quick fix" really means several months or more--a lot of doctors don't tell their patients that, and a lot of people don't really have a good concept of it.

Remember, you did not likely become hypo over night, and if your body was somewhat used to it, it is to your advantage to come up slowly--changing your levels very quickly can make you feel even worse.

The "worse before better" idea also works with dose adjustments--each time you change your dose, you may have an increase in symptoms.

It is a chronic disease. You can and will feel better when your medication level is correct. It takes patience, it can be maddening, but it can happen.


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## bigfoot (May 13, 2011)

lainey said:


> Stick with it, Enigma, you're not "done" yet. Unfortunately, "not a quick fix" really means several months or more--a lot of doctors don't tell their patients that, and a lot of people don't really have a good concept of it.


Boy, isn't that the truth!


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## Enigma (Jun 13, 2011)

Thanks again guys for your support. Today was quite frustrating with the doctor. I did not end up mentioning Amour or fT3 because there were too many other things that he said to me that frustrated me. Over the past 3 weeks, he's upped my levo dose from 50 to 75 mcg, started weaning off Effexor (my choice, with his support) and started Prozac to help with the Effexor withdrawal side effects. I've been off of Effexor for almost two weeks, and taking Prozac and the increased levo. Also have been taking Vyvanse for my ADD and Ambien (generic) at night, as well as BC pill. Vyvanse has been the only thing to help me through the past 8 months, before I was Dx'ed with hypothyroidism and through the ups and downs of starting levothyroxine. Between that and my cognitive behavioral psych, I don't know what I would have done.

I typed up my list of symptoms during the past two weeks, which included worsening of my symptoms pre-diagnosis of hypo. Added to this was a very jittery feeling/butterflies in the center of my chest, especially after taking the Prozac dose.

He told me these things today: 
1. Stop the Prozac (which was temporary anyway). One less variable to have to account for.

2. I'm probably under-medicated for hypo right now, but we have to go up slowly and see what the blood tests show during the next 6 week testing (in another 3 weeks).

3. All of my symptoms are caused by Vyvanse and he wants me to stop it soon. This is what made me mad. I'll give him that *maybe* the jittery feeling is cause by vyvanse, but everything else was happening before I started vyvanse and is a symptom of hypothyroidism. I feel better after taking my daily dose of vyvanse, and worse when it wears off or I don't take it. Why is he targeting the vyvanse and not the symptoms? Why not also target the prozac, since that is when the jittery feelings started? or the B pill, since that doesn't help with hypothyroidism? why vyvanse, the one thing that has helped me? I talked to my mom and dad after the appointment, and they suggested being careful with how I talk to my doctor about symptoms and how specific I am, since he seems to always attribute it to vyvanse and not hypo. Why should I have to dance around a doc? And not be true to my symptoms? Then how will I be treated for anything?? When will I get better??

4. He did mention doing an ultra sound and barium swallow (??). I convinced him to do it within the next two weeks, while I am not teaching, so I don't have to take a day off of work. I have an appt. for both on August 9th.

5. I asked him gently about switching to an OB/GYN that is familiar with hypothyroidism... and he thought that was a great idea. I already see one for my annual pap, but they don't focus on thyroid issues. I found a women's clinic about 1/2 hour away from me that focuses on thyroid issues (and other hormonal issues). He thought it would be a great idea to go see them. I get the impression that he really doesn't want to deal with hypothyroid issues... he even said he is not sure how to treat women with hypothyroidism if they get pregnant (not that I am, but plan to be in the next 5 years or so).

Anyway, look at what the clinic's website has on it!! Does this look promising or what?!?!?! I just hope they don't target vyvanse like my current GP does. But, we'll see I guess. I have an appointment on August 22nd, or earlier if there is a cancellation.

From WomentoWomen.com

_"Our approach to the thyroid test

In publishing new clinical guidelines in 2002, the American Association of Clinical Endocrinologists fairly dramatically formalized a reversal of its previous doctrine, establishing a narrower "normal" TSH margin of 0.3-3.04. At Women to Women, we have used the TSH thyroid test for many years as a screener. And in our view, a woman's TSH level should ideally be less than 2.0, but she should also be thriving and free from hypothyroidism symptoms. If she reports symptoms, or shows a TSH level greater than 2.0, she may have subclinical or clinical hypothyroidism.

For women with more pronounced hypothyroidism symptoms, we feel that the TSH test is inadequate because it doesn't tell us enough about the underlying problem. To do that, we need more detailed tests to show what the thyroid is producing and what is available for the body to use.

The predominant product of the thyroid is T4 (thyroxine), which is then converted by the liver into the usable form T3 (triiodothyronine). There are many causes of inadequate T4 production, including adrenal stress, poor nutrition, and autoimmune thyroid disease. Similarly, many factors cause inadequate conversion of T4 into T3, including lack of adequate nutrients and minerals and poor liver function."_

http://www.womentowomen.com/hypothyroidism/testing.aspx


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## bigfoot (May 13, 2011)

That sure does look promising! Hopefully you can get in and see somebody there soon. Ultimately, you need to be happy with your care. (A little OT, but I sure wish places like that existed for men's health.)

Personally, I think your doc is limited on how much he knows about thyroid issues and the interactions with your other medical issues. The fact that he thought it was a great idea that you change to another doc who focuses on thyroid/hormone issues is a big, fat, flashing red neon sign. He is probably a smart, well-educated doc, but it never hurts to get a second (or third) opinion. He just may be in over his head at the moment.

I have to agree that you will want to wait on boosting your levothyroxine dose. Too much, too fast will not be a fun experience. Better a little at a time (12.5MCG) instead of all at once (25 or 50MCG). I learned this firsthand the hard way a couple of months ago while trusting the doc a little too much.

Good to hear you can get an ultrasound and it works into your schedule! One more piece of the puzzle to put into place...

Keep toughing it out, you're doing great! :anim_32:


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## lainey (Aug 26, 2010)

The key part is #2, where he acknowledges that you may still need a med increase. You know this, and the observation was a good one.

With so many things changing at once (effexor, prozac) I would also say that there is some truth in the fact that these changes, including the dosage increase (even when it is not yet at "capacity") are contributing to your symptoms. As time goes on, some of them should wash out, I would think. It is difficult to wean off of these types of medications, so you need to give yourself a chance.

The theory would also be, that as you treat the hypo, the psych symptoms could well improve (because they could be caused by that), and that you could expect to try to be free of the meds, and the symptoms because of this.

Your doctor would not be the first nor the last to attempt to attribute your symptoms to psych issues or their medications, or life or anything else except properly treating the thyroid. It's common to "blame" that for everything, but as long as you also take a medication with side effects that are similar to hypo, it is a risk that the doc, any doc, will attribute your symptoms to that. Right now you have to stick with point #2, that the doc knows that your hypo is still under treated, and will follow through with dose increases.

I agree about the ob/gyn also--women with thyroid issues require a little more extra monitoring in pregnancy with bloodwork at least monthly when pregnant, and dosages changed accordingly, so it is useful to develop a relationship with a clinic that openly says that they will handle it. The doc wouldn't handle the pregnancy anyway, so it makes sense that during that period of your life that someone experienced would also take over the care of your hypothyroidism. As for targeting your other meds, you yourself would want to research what impact they would have on pregnancy, and whether they are compatible with fetal development, so that you can include their use/discontinuation in your pregnancy planning.


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