I would be really grateful for some advice. I've not been feeling great on Armour despite some improvement initially. I just got my test results back. I had not taken any Armour on the morning of the blood tests.
TSH 1.7 (0.270-4.2)
Free T4 11.12 (12-22)
Free T3 3.2 (3.1-6.8)
I take 1 grain of Armour crushed up, in the morning with a glass of water.
My previous results with the same lab were taken a week before starting Armour, when I was on 75mcg thyroxine. They were
TSH 2.0
Free T4 17.9
Free T3 3.6
I am feeling very tired with joint pain and tightness around my throat. I'm very confused by the results and cant understand why my T4 has dropped so much. When I first started taking Armour I had headaches particularly behind my eyes and forehead. The pain only lasted about a week but returned again (for a few days) once I increased from 1/2 a grain to 1 grain and dropped the last 25mcg of thyroxine (that was three weeks ago). Could this have something to do with my pituitary?
I'd really welcome any thoughts as I wont be seeing my doctor (private for another 2 weeks). Thank you x
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girlfoley
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I really think you are just not on a high enough dose. The t3 will artificially suppress your TSH, which is one of many reasons we shouldn't rely on the TSH test. That being said, TSH can be a useful indicator along with other things for some people. Your TSH is well above 1. Normally someone on Thyroid meds will need a much lower TSH to be well (although not always). Your T4 and t3 are also low in range showing that you are not getting enough thyroid hormone.
It's best to look at t4 and t3 results and, primarily, symptoms rather than TSH.
For comparison, average required doses of Armour are 3-5 grains a day. You are taking a much smaller dose. Maybe it's time to start increasing slowly.
You may want to see if you can phone your doctor about a small increase. It would be a good idea to discuss your symptoms.
Armour Thyroid tablets provide 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per grain of thyroid. So You're taking 38 mcg of T4 instead of 75 mcg (but the equivalent of 65 mcg if you include the T3 in the Armour). TSH tends to respond to the peak T3 levels rather than the average, so TSH comes our lower. T3 has a half-life of one to two days, if you didn't take any Armour within the previous 24 hours your T3 figure will be a little above half what it was just after taking Armour. As a very, very rough guide maybe add 50% to the T3 figure if you're on Armour, giving a figure of 4.8 instead of 3.2.
Thank you both for your replies. I had started to panic that I had somehow caused more damage to my thyroid by changing medication. What you've said makes perfect sense and I feel much more reassured. The knowledge and experience of the people on this site really is invaluable. I will call my doctor tomorrow. Thanks again x
I am confused that one grain of Armour is equivalent to 100 Levo. How can that be, if it is only 38 T4 and 9 T3? That makes it around 74 or 83, depending on what value you give T3 to T4 ( 4 or 5 times) Could you please tell me where that info came from as I need to review my doses, if that is the case. Many thanks.
1 grain Armour=100 mcg levothyroxine=40 mcg Thyreogland. Clear gelatin capsules with loose powder inside. May have magnesium searate as a filler. The 25 mcg tablet specifies “25 mcg T4 and circa 6 mcg T3″ on the label. Thanks to thyroid patient Amy for the above information.
This is a guess. The "effect" of 1 gr is equal to 100 T4 due to the fact that T3 is more powerful (i.e the effect of 9mg of T3 would be about 50mcg levo). When T3 is added to T4, you drop 50mcg of T4 for 10mcg of T3 so NDT @ 38 + 50 + T2 + T1 approx 100mcg levo.
If someone is more numerate they will comment. As I said it is a guess and I was surprised as you were. I probably took a little too much NDT.
I have never felt that T3 is anywhere near the ratio commonly stated and I thought that T1 and T2 were simply made by T3 gradually becoming T2 and then T1 in our cells. I was not aware they had any potency in their own right, which would make the total figure of 100 T4. Do you think this is another myth to stop us having enough medication to make is well? Seriously, I was on 60 mcg T3 only for a few months and I cannot believe I was on the equivalent of 300 Levo. I still felt under medicated. In any case, surely it is about what gets into our cells, not what is floating around in our blood stream? I hope someone will come in on this and help out. Thanks Shaws.
You are right about the graduation of T3, to T2 and T1.
Here's another came across:-
If you’re new to the use of thyroid hormone, and you’re up to a dose that should be working for you, but you’re not benefiting from it, be sure to let your doctor and your pharmacist know. The dosage range that’s safe and effective for most patients is between 2-to-4 grains (120-to-240 mg) of desiccated thyroid. The equivalent dosage range for T4 is 200-to-400 mcg (0.2-to-0.4 mg). If you’re not improving within this dosage range, you may have thyroid hormone resistance, or the potency of the tablets or capsules you’re using may be lower than what’s stated on the label.
For someone taking 100 mcg of T3, we expect your pattern of lab results—a low TSH and high T3. However, your TSH and T3 levels are irrelevant to whether you're overstimulated or not. Two studies we just completed confirm other researchers findings: these tests are not reliable gauges of a patient's metabolic status. Many patients taking T3 have TSH and T3 levels like yours but still have severely low metabolic rates. Their metabolic rates become normal only when they increase their dosages further. Their metabolic rates become normal and they have no detectable overstimulation.
Thanks, Shaws. So 2 grains is not such a high dose? I took it for the first time this morning and panicked when I read your first post. I still cannot believe it is equivalent to 200 Levo. Maybe we should not be trying to convert it? Is it perhaps like comparing apples and oranges?
Thanks, Shaws, that was a marathon but still does not tell me that one grain of Armour is magically transformed to a neat Big Pharma 100 mcg of Levo. I have a feeling this was concocted in the big changeover which occurred when Levo was first introduced and pharmaceutical companies needed to give GPs a neat figure from which to prescribe the new wonder drug to all their happy, healthy Armour patients. If you come across any other info, please post, as I am determined to get to the bottom of this.
I think you are quite right about T2 and T1 - though they might have some function within our cells.
Yesterday I posted a link which suggests why so many people claim desiccated thyroid contains T2 and T1 - basically it is probably confusion between T2 and T1 and the very different substances MIT and DIT:
I believe the idea that one grain of desiccated thyroid is around equal to 100 micrograms of levothyroxine is intended to provide an initial estimate - but is very much on the safe side. That is, if you convert to desiccated thyroid on that basis, you are very unlikely to overdose. However this seems to mean that many (possibly all) people doing so will end up underdosed.
The classic T4 to T3 potency ratios are also potentially very misleading. You can easily find suggestions that the ratio is anywhere from 5:1 to 3:1 and if you look harder, quite possibly even lower. All that matters is what happens in your body. These ratios simply provide a starting point.
It does seem bazaar that whilst on 50 mcg 4 years ago and then 75 for the last couple that my t4 and T3 have always remained pretty much the same (above mid range free T4 and low range Free T3. Yet if 1 grain of Armour is equivalent to 100mcg thyroxine why would my T4 plummet to below range and hypo symptoms return within 5 weeks? Just as an update, I spoke with my doctor today and he has increased my dose by 1/2 grain to 11/2 as he said I'm under medicated. So basically I'll be taking 'the equivalent' of double the dose I was on 5 weeks ago when my T4 was above mid range. Sorry to add to the confusion but the convertion tables haven't worked for me so far. Is it that it's ok for your T4 to be low in range if taking NDT?
However on most pig thyroid your T3 levels will be near the top with T4 near the bottom. Because pig thyroid ratio has more T3 per T4 than human thyroid.
If high T3 freaks out your Dr, then get labs in the AM before your morning dose.
When ever changing brands it takes time for the body to recognize and fully use the new brand (like a couple months sometimes).
The interesting point to me is not that your T4 dropped but that your hypo symptoms returned. This accords with my view that 1 grain Armour is definitely not equivalent to 100 Levo and explains why, two years ago. when a new Endo gave me one grain of Armour to replace 75/100 (alternate days) of Levo, it simply made me feel worse and I stopped it and blamed the Armour. Only now am I beginning to realise the true facts.
Yes, I agree, it doesn't seem to equate at all. It would be interesting to know if the conversion of 100mcg to 1 grain was actually accurate for anyone swapping from thyroxine to NDT or if everyone ends up doubling or tripping their dose.
I found NDT a lot milder than levo to be honest. Not sure I fully believe the equivalents they give you as felt hardly anything from the t3 in ndt and had to add uni pharma t3 separately.
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