My private doctor has given me the choice of Armour or T3 by private prescription. Both will cost an arm and leg so I don't know which way to go. I am only on 50 mcg levo have been for over a year and getting nowhere. I have low morning and lunchtime cortisol so that seems to be my stumbling block. I am concerned about my adrenals if he wants to give me anything with T3 in it. NHS have put me on propranolol for my night time palpitations. I want off these too coz it's not doing my T3 any good. Latest results
TSH 2.83 (0.3-4.5)
Ft4 17.7 (10-22)
T3 4.25 (3.1-6.8)
I asked him for low dose hydrocortisone but he said no as it wasn't his area of expertise. I would have thought a thyroid specialist would have known about such things?
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magsyh
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your results aren't bad enough for hydrocortisone, it's usually prescribed for Addison's disease/primary adrenal insufficiency.
Just your first two results are on the low side and could do with lifting into the green band, I would have thought an adrenal glandular would be the first thing to try.
If you do decide to start T3, it can be ordered from Germany at a much lower cost (the admins have a list of pharmacies). That will only be the case until the end of the year, though, and then that might/will most likely change in case of a hard Brexit. Under the current rules (expiring on 31/12/2020) you can use your UK prescription in Germany (or any other EU country) based on the principle of EU wide recognition of medical prescriptions.
Some brands, such as Greek Unipharma, Turkish Tiromel, and Cytomel/Cynomel are available online without a prescription, but not all sellers are legit so never order T3 without contacting one of the administrators first since they have a list of many online suppliers and know which ones are legit and which aren´t! Since you have a prescription, I think it would be wise to use it, but try to order T3 from other countries where it´s much cheaper than in the UK.
If you do decide to try NDT, I´d actually recommend trying Thai NDT (Thyroid-S or Tru Thyroid) instead. They are much cheaper than prescription brands of NDT (Armour is by far the most expensive brand) and work well for many.
Besides, there have been reports on the STTM website about all prescription brands of NDT working less well nowadays. Given how expensive prescription NDT in general, and Armour in particular, is, I´d recommend you check out Thai NDT. There are many posts here about it (please note that Thiroyd and TR TMan have been discontinued).
It would seem that Armour is now considered "the least bad" of prescription brands of NDT, after being dismissed as more or less useless following the 2009 reformulation; however, given that it´s by far the most expensive brand, I´d not recommend it unless you are one of the patients who do great on it:
I have been quoted £120 for 100 1/2 grain armour + private prescription fee £30+ £15 delivery. Or £99 for 90 T3 @2.5mcg all seems very expensive to me from a UK pharmacy.
It´s expensive everywhere. I have a friend in Belgium who takes 240 mg of Armour daily, and she pays the equivalent of £1800 a year for it. Of course, the more you need, the more expensive it gets. But, as far as I know, prescription NDT is expensive everywhere, and often not covered by health insurance.
Obviously propranolol is not helping as slows uptake and conversion of Ft4. Palpitations likely due to being under medicated
you have room for dose increase in levothyroxine. Why won’t endo increase levothyroxine first?
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
Hi no I don't have hashimotos. I test my vitamins etc yearly so due again October. Last time they were all doing well. I have been gluten free for about 4 years now. I'm not sure why he thinks I should try T3? I'm putting on an awful lot of weight over a stone this year. Been worse since the propranolol.
Well propranolol is used to treat hyperthyroidism and slows how you use levothyroxine
Think of your 50mcg levothyroxine as half gallon on petrol to last whole day .. (when you really need a gallon a day) propranolol puts the breaks on so you don't run out of gas before morning
I was stuck on propranolol almost 20 years ...more on my profile
As you are gluten intolerant you almost certainly have hashimoto's ....20% never have raised antibodies
Ever had thyroid ultrasound scan?
As Gluten intolerant likely to benefit from addition of T3
Starting slow ....I started on 2 X 2.5mcg am and pm ....
Has your doctor suggested increasing your Levo, you have room to add more.
Your conversion may benefit from optimal levels of -
Vit D
Vit B12
Folate
Ferritin.
Your results indicate hypothyroidism and I suspect your doctor has scant knowledge of thyroid disease......not unusual!
50mcg is just a starter dose....I would be inclined to optimise the nutrients, increase levo to 75mcg and retest in 6 - 8 weeks and increase further if appropriate.
Only then would I consider T3.
Your FT4 is 64.17% through the ref range....should be around 75%
FT3 is only 31.08% - extra levo will begin to raise this
Apologies if I'm wrong but it seems the possibility of additional problems is being created where they may not exist!
Save yourself some money and trial more levo!
You were advised to trial a levo increase 2 years ago.
I take a huge dose of T3 only ( I have RTH). I self medicate so have been down that road.
I have twice got as far as 88mcg. Both times I've ended up feeling 10 times worse even with hypo symptoms I never had before I started levo. So I get scared and go back to 50mcg but doing that I have piled on weight. I'm heavier now than I have ever been. My cortisol and DHEA have got much lower since I started levo, that scares me too coz when I get the palpitations my GP tells me it's my fault I shouldn't be taking thyroxine so I should stop taking it. So I don't know what to do when it comes to raising it is it normal to feel worse?
In that case you've done the "trial and error" and levo isn't working
How slowly did you increase the levo?
iI t seems that you do not tolerate levo and your medic may be on the right track to suggest you trial T3 or Armour. I have no knowledge of Armour so can't comment, T3 has helped me.
You need to start low and very slowly build up the dose....SlowDragon has explained the way to go.
Crazy how medics blame women when their treatment doesn't work!
Maybe it's time to give T3 a trial...might your endo prescribe a trial dose?
Palpitations are a symptom of under-medication. What does he mean, you shouldn't be taking levo? Either you're hypo or you're not. And, I would say you are.
My GP says I don't have a thyroid problem and my private doc is a quack! I had to go private as I was on my knees with a ft3 of 3! Ft4 of 13 but TSH of 2.8 but according to my GP I was normal. My GP thinks I have a mental problem and refuses me any help unless I agree to take antidepressants!
Your low T3 dosage choices are meh, but perhaps it can be viewed as a hopeful sign that your physician is trying to work with you by giving you a tiny bit of T3 from an external source to start, to see if you respond in a positive fashion
- 2.5 mcg of T3 is a tiny dosage but you can take T3 sublingually and get it directly into your blood stream which is an advantage for some under treated hypothyroid patients, so there's that plus factor
- 1/2 grain [ i.e. 30 mg] of Armour, which has 19 mcg T4 + 4.5 mcg T3, is also a tiny dosage - previously patients could take Armour sublingually but since it's been re-formulated many patients do not find that Armour can be taken sublingually too easily
- since you are already taking 50 mcg of T4, a 1/2 grain of Armour would increase your T4 by 19 mcg to a total of 69 mcg while adding 4.5 mcg T3 to your regimen, which you are not getting currently being on a T4 med only and being entirely dependent on "natural" T4 to T3 conversion
- fyi, propranolol is an older beta blocker medication and weight gain is a side effect associated with it.
beta blockers like Propranolol are used to treat serious, potentially life threatening medical conditions typically involving cardio vascular problems e.g. angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. Beta blockers have also been used to treat anxiety related hand tremors. I'm curious why have you been prescribed a beta blocker. Saying you experienced "palpations" as an isolated symptom typically does not get you a beta blocker script from a cardiologist or GP, unless you have been tested and diagnosed with afore-mentioned serious medical conditions. Have you been diagnosed as having heart and/or circulation issues?
No I don't have a heart condition. I was tested got heart monitor and a few ECG's they say my heart is beating normally but much too fast. It is being used as an adrenaline blocker. I wasn't getting much sleep having bad palpations 4-5 times a night. 10 mg of propranolol seems to have done the trick. Doc wanted me to take 40mg but I said no as I don't want to have to continue taking them.
My resting heart rate is normal but I would get woken from my sleep with heart pounding between 150-170 per min. Would last sometimes 20 minutes and then it would take me about an hour to calm down with the adrenaline. It got to the point I hated going to bed I was so scared. I refused antidepressants so propranolol was the alternative. Before I asked for propranolol I took antihistamines they knocked me out and I slept like a log but next day when they wore off my resting heart rate would go up so I didn't like that. I have been so scared in the past by palpitations I'm now paranoid about my heart rate.
Have you tried a different brand of Levo. Different brands can have different fillers which can upset you otherwise always stick with the brand you are happy with and ask GP to name it on your prescription.
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