I would like some input from those of you on Armour Thyroid:
Three and a half years ago, I was put on Armour Thyroid. I was on 200 mcg of thyroxine daily back then, and started on 45 mg of Armour, while decreasing thyroxine by 25 mcg, and then I continued to add 30 mg of Armour every other week while continuing to decrease thyroxine by 25 mcg at a time, until I had weaned off thyroxine completely and ended up on 300 mg (5 grains) of Armour daily. I felt GREAT. Already when I reached 60 mg of Armour daily (along with 150 mcg of thyroxine), I started peeing like crazy, and lost a lot of water weight....for the next six months, I felt truly great (from December 2011-July 2012). I had 15, 30, 60, 90, and 120 mg pills, and combined them (90x3+30, 120x2+60, etc). These were my labs in July 2012:
FT4 1.1 (ref 0.7-1.5)
FT3 4.2 (ref 1.8-3.8)
TSH <0.001 (my doctor does not care about the TSH at all)
In July 2012, my doctor prescribed 240 and 300 mg pills along with the smaller pills (15 and 30 mg) to keep the cost down. I immediately started going downhill. These were my labs six months later, on 240 and 300 mg pills combined with 15 or 30 mg pills:
FT4 1.1 (the same)
FT3 2.9 (big change)
TSH <0.001 (no change)
The only thing that changed were my FT3 levels, by many declared to be the most important ones when on NDT.
I always go to the lab 24 h after taking NDT, and I don't know what optimal levels of FTs look like when optimally treated. I know you should go by symptoms more than labs, but I cannot help but wonder why my labs looked so different within a six months' period...on the same drug, but different strengths.
Has anyone else noticed a difference in efficacy (and/or lab results) between the smaller and larger Armour pills; I read somewhere that the larger pills contain more cellulose, which is logical as they are bigger and therefore need more fillers to hold them together, but I read an intervention by a compounding pharmacist who pointed out that cellulose is an extremely common filler in all sorts of drugs, and nobody ever questioned the efficacy of those drugs...so why would thyroid hormones be any different?! I know the STTM claims Armour can no longer be taken sublingually, but I have never taken thyroid meds like that (nor are they supposed to be taken like that), so that would not be a problem to me...as long as they worked once swallowed (and possibly chewed up before that).
I understand many have problems with Erfa as well, and find it rather inconsistent? There have been rumours about a recent reformulation, but Erfa denies it...
It has been suggested to me that I was given the original (pre-reformulation) Armour the first time around (September 2011), but that would have been more than two years after the reformulation. The first pills I got expired in late 2012, so I wonder if they could really have been manufactured as early as late 2008/early 2009? I chewed the pills up, following the advice of many patients on NDT, and I did not find them sweet at all (unlike Erfa...), so I wonder if I could really have been given the original Armour the first time around?!
I think it is unlikely that you were given the original pills in 2011 because they had well and truly run out of them everywhere - I had to switch to Nature Thyroid during that time and the shortage lasted for a few months.
I have had all the different combinations of pill sizes at different times depending on price and what was actually available and can't notice a difference from pill size to pill size.
However, when I first started taking Armour - and felt great - my T3 was in the top 25% of range and has dropped constantly over the next five years so that it is now in the bottom 25% of range. FT4 has bounced up and down all over the place but now settled well below range and TSH has stayed much the same at 0.02ish.
It feels somehow as if your body gets used to it and it then stops working as well. Would love to know the answer to this.
The reformulated one. I didn't have much of the old one before I then couldn't get hold of it for a while. I felt at my best in 2011 after going back to it after the shortage and then FT3 levels dropped in every single blood test since then even though the dose was the same.
I then stupidly decreased my dose at my doctor's request when it was already low in range (because he thought TSH was too low) and it went down even further and I became very unwell indeed. Am now back to my original dose of 3 grains and there has been an improvement but haven't had a blood test recently - due in the next month - to see what the FT3 levels are now.
It does feel as though the Armour is not working as well as it used to and I am wondering whether to add some T3 or T4 back in but don't know which.
I am certainly no expert, but if both your FT levels are below range, chances are you are under medicated. The TSH is unimportant when on meds containing T3, as I have noticed that as little as 1/4 grain of NDT will suppress my TSH, even though my FT levels are still suboptimal.
The Belgian doctor I'm seeing (trained by Hertoghe) has many patients on 7-8 grains of Armour, and even some on as much as 10 or 11 grains, so 3 grains may not be enough for you. Granted, 7 grains or more is a lot, and may point to impaired absorption, but it is important not to settle for a dosage that clearly indicates that you are not on enough thyroid hormone.
From what I understand, the cellulose that was added to Armour (and replaced sucrose) back in 2009 makes it absorb less well. For some, it seems enough to simply raise the dosage, for others, that does not seem to make any difference. After the reformulation, some say they never noticed any difference whatsoever, some say they needed to raise Armour, but still do well on it, while others say it does not work anymore, regardless of dosage, so it's all pretty confusing.
My doctor is on Armour herself, and says she personally never noticed any difference. Dr. Hertoghe, on the other hand, switched his patients to Erfa after Armour was reformulated. It's pretty confusing when not even the doctors can agree on this...!
The STTM claims that Erfa too has been reformulated, and does not seem to work as well anymore...not sure what to believe.
I personally feel that it has something to do with your body somehow adapting to it and getting used to it and it then working less well in the same way that other medications do such as antibiotics. Totally unscientific of course but just my gut feeling.
7-11 grains of Armour sounds crazy, not least because of the cost! Wow!
I am exploring other avenues at the moment as to why the FT3 keeps going down and have recently had everything I can think of tested and am waiting for the results to see if anything comes up.
I am not convinced that the TSH is unimportant in the longer term.
I have read a lot of medical papers on the subject and the link between suppressed TSH and osteoporosis seems to be there. Having seen my parents suffer horribly with crumbled vertebrae, I think I would rather be undermedicated a little bit than have osteoporosis.
Whilst I totally get that T3 meds cause the TSH to be suppressed, until proven otherwise, I would be happier if the TSH would rise a little if I could somehow achieve that with a simultaneous rise in FT3.
For me, it is simply impossible to raise my TSH (not to mention get it in normal range) when I take meds containing T3...even as little as 15 mg or 1/4 grain of NDT will suppress my TSH below 0. My GP, who believes that nobody should need more than 75 mcg of levothyroxine a day, is very nervous about my suppressed TSH, and has mentioned the risk of osteoporosis...however, I feel so much better on meds containing T3, so I have decided to take the risk.
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