Need help with next steps given recent lab results (hypothyroid)

[windysea]

Hi! I'm new here and also new to making my own decisions on my thyroid care. Thanks in advance for help from the community!

I'm on 1gr daily of Armour and some of my symptoms are getting worse. Here are my recent (02/2021) labs:

TSH 5.94 uIU/mL, FT3 2.4 pg/mL, FT4 1.02 ng/dL, TPEX <^15 IU/mL, TGAB <^45 IU/mL

I've been on NDT for 20 years and it's generally worked well for me, switch in Jan 2021 from Naturethroid to Armour because of recalls. My doc only ever tested TSH and ignored the results and I hadn't noticed my hair was thinning, skin was very dry since 2018, when I also developed benign heart arrhythmia. My new functional medicine doc wants to treat me with thyroid support supplements and adaptogens only (plus vitamins) but lately I'm developing worse periorbital edema (very puffy eyelids and bags under eyes) and I don't feel any better after 3 wks on supplements. So far keeping my energy and no brain fog although I'm concerned it won't be long.

I added 1/2 gr of Armour a few weeks ago but my BP got spiky. I think it was the combo of supplements and Armour. My thought was to add 1/2 gr to take advantage of T4/T3 combo in the NDT to see if symptoms improved (get T4 edged up into the higher range and raise T3), at least to get to the point where the extreme puffiness is relieved and I feel better, and dropping the supplements in the meantime (some are non-active glandulars).

I'm new to managing my thyroid care so I'd really like some help from the community on what a good next step would be. I'm grateful for any help, I hope I've included all the relevant info..

[pennyannie]

Hello Windysea and welcome to the forum :

Off the top of my head I'd say you need a dose increase as generally when optimally medicated on NDT the TSH can go low suppressed, T4 can be low in range but T3 which is the most important number will be high in the range.

However NDT was used successfully for over 100 years prior to the medical science of blood test, ranges and guidelines and you simply dosed to the relief of symptoms in 1/4 grain increases every 7-10 days until symptoms were reduced.

When on previous brands of NDT - were you well, what dose of NDT were you taking and where do you prefer your T3 and T4 levels to sit ?

There are no ranges with these results : generally we feel at our best when our TSH is low

at around 1 : T3 and T4 " look " low, and do not understand the Tpex and Tgab readings :

Are you diagnosed with a thyroid auto immune disease, as that may explain this " blip " in your years of successful treatment with NDT ??

Could it be these other medications your doctor has introduced alongside your NDT ?

I'd recommend arranging a full thyroid blood panel to include TSH .T,3, T4, inflammation, antibodies plus ferritin, folate B12 and vitamin D as no thyroid hormone replacement works well if your core strength vitamins and minerals are not maintained at optimal levels and then we can then see more fully any negatives coming from too low a level of these essential nutrients.

[windysea in reply to pennyannie]

pennyannie, thanks so much for the reply! I used letsgetchecked.com for my labs, anti-thyroid peroxidase antibodies (TPEX) is normal (according to the lab) at <^15 IU/mL and anti-thyroglogulin antibodies is normal at <^45 IU/mL. So not zero but labeled as normal from the lab.

My doc didn't think I needed the labs for irons and vitamins but I'm going to get them done anyway. I supplement highly already but you never know.

Also a good suggestion to go up 1/4 instead of 1/2 gr. I'm not sure I can get hold of the 1/4 dose, I know it's unreliable to split the pills but I might have to try it temporarily.

For the years I was taking NDT, it was usually Armour but switched to Naturethroid after Armour was reformulated. The NT was recalled and switched back to Armour. I felt the best at 1.5gr for long periods and over-medicated at 2gr or higher.

Thanks again and will report back with news.

[pennyannie in reply to windysea]

OK then -

I split my 1 grain NDT into halves and then quarters with a pill cutter, some people use a craft knife, others their thumb nails !!!

Anyway, yes, you know you are undermedicated then :

I've only ever read of going up by 1/4 grains and some people split their dose into 2 :

Morning and afternoon as the T3 content is said to have a short half life - however I take all my 1 + 1/2 grains at around 3 am in the morning so not to interfere with anything else.

Maybe you should be aiming back up to 1 + 3/4 - back in the middle ground of where you used to be : before all the recalls, reformulations and changes.

Conversion of any thyroid hormone replacement can be compromised by several factors, first and foremost low levels of vitamin and minerals, and then we could be looking at inflammation, depression, dieting, any physiological stress ( emotional or physical ) and ageing.

So, over a period of 20 years I'd also think there's some ageing going on here, and you might just need a little more NDT rather than less.

Go low and slow measuring temperature and blood pressure daily :

I'm with Graves Disease post RAI thyroid ablation in 2005 and became very unwell on T4 only medication - i was refused both T3 and NDT trough the NHS so now going it alone :

I do also support my adrenals and daily supplement vitamins and minerals and now just have a yearly blood test mainly to check my core strength nutrients.

[greygoose]

My new functional medicine doc wants to treat me with thyroid support supplements and adaptogens only (plus vitamins)

Oh, is that the sound of alarm bells I hear ringing? I don't like the sound of that at all. And, if any of the 'support' supplements contain iodine, it could be dangerous.

I've never seen one myself - nor would I - but from reading on here I find that functional medicine docs tend to know even less about thyroid that normal ones. Be very, very careful what you take. Adaptogens are not likely to help your thyroid, but may mess with your adrenals. You can only replace a hormone with a hormone, not a vitamin.

[Batty1 in reply to greygoose]

My functional med doc won’t touch my thyroid stuff ... flat out refused!

[greygoose in reply to Batty1]

Then you're probably better off without him touching it. Full marks to him for knowing his limitations.