I was diagnosed with Hashimotos in July 2013 (10 years ago). Was put on 50 mcg Synthroid, then in 2014 I started taking a synthetic compound of T4/T3. Worked with my integrative NP for 5 more years to adjust this compound to get to a comfortable dose of 80 t4/12 t3 mcg.
Then in December of 2021 I had a partial thyroidectomy due to a precancerous thyroid nodule. After that I was treated by the endocrinologist who diagnosed the nodule. He is against synthetic compounding because he believes it leads to inconsistant delivery of medication.
So, I started on Tirosint (just T4) per his recommendation. At 88 mcg of Tirosint I felt pretty good, but my TSH was .029 (range .40 - 4.5) and my doctor (the endo) freaked out and insisted I drop my dose to 75 mcg. I started feeling irritable, depressed, foggy, weight gain.
When I asked him to go back up to 88 mcg he said no, and insisted I drop my dose even more. Against my better judgement I tried for a few weeks, but couldn't do it. My hypo symptoms got so bad, I was heading into depression. So, I posted on here, and took your advice and got a new doctor. This doctor prescribed me Armour Thyroid 60. Which I have been on for 8 weeks now. I just got my test results and they are below:
It's interesting to me that my TSH is almost the same as when I was on just 75 mcg and my FT3 is also still very low. My FT4 is actually out of range on the low side now. I think I might be undermedicated. I'm really tired, although not as moody as I was on the Tirosint. I have gained 5 pounds though and just don't feel very clear headed. I was hoping the extra T3 in the Armour would help with these symptomes. Can you help me make sense of this new data?
How do I interpret the new tests: the total T4 and total T3?
Do I ask my new doctor to up my Armour a bit more? Thank you so much for your help.
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KarmaMaya
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Total T4/3 aren't really much use. They measure all the hormone in your blood, both bound and unbound (Free), without telling you how much of each. What you need to know is how much free hormone you have in your blood, because that is what is readily available for your body.
You really are under-medicated. Both your FT4 and FT3 are too low. Your TSH is low, true, but that's because of the T3, it doesn't mean that you're adequately medicated - and certainly doesn't mean that you're over-medicated.
You probably want your FT4 up to around 1.3/1.4 at least. And the FT3 up around 3ish. Maybe even higher.
Armour contains about 68 mcg T4 and 9 mcg T3, so your dose has come down from when you were taking the compound. Could be you only need an increase of 1/4 grain to get you back to how you were feeling then. But you definitely do need and increase.
I agree you look under medicated, and 1 grain of Armour only contains 38mcg T4 + 9mcg T3.
If you previously felt better on a synthetic 80mcg T4 + 12mcg T3 dose, then raising by only a quarter grain Armour will satisfy T3 demand but only increase your T4 dose by a miserly 9.5mcg still leaving you dismally low.
If this were me I would add 50mcg Levo to the 1 grain Armour to raise FT4 levels. This will give you a total of 88mcg T4 + 9mcg T3 very similar to your previous dose where you felt ‘comfortable’.
NDT behaves slightly differently to synthetic and raising T4 in the presence of a little T3 (already within the Armour) often results in improved conversion so T3 levels should raise a little anyway.
Many of us have to add Levo to our Armour to create the right T4:T3 ratio to satisfy individual need. Don’t forget we also require optimal iron & nutrients to allow our thyroid meds best efficacy.
Thanks Radd - after reading your reply and the other helpful suggestions. I think this approach makes sense for me. I think I will start by asking my doctor if we can add 25 mcg Levo (T4) to my 60 Armour, and then if that isn't enough after 6 weeks, up it again to 50 mcg. I'll let you know what she says. I so appreciate your help. Warmly, Lisa
A missed decimal point, mixed up measurements, double/triple doses, incorrect med/hormone names, even myself calling NDT, HRT once (which had a load of members confused! 😬).
The forum's biggest attribute is members willingness and acceptance in correcting one another, enabling ongoing credible information to be replied upon. Now probably enough attention bought this matter Everywhere2!
Yes you look to need more thyroid hormone replacement - and we need to track on the T3 number not the T4 and especially not the TSH as this will likely be low suppressed when optimally medicated.
No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal levels - so you might like to get these blood tests run for ferritin, folate, B12 and vitamin D and we can advice where these need to be for optimal conversion and utilisation of the Armour thyroid hormone replacement.
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Please advise me on big change in Lab results after going from levo only to T3/T4 combo in June
Frustrated at endo's obsession with TSH when other results point in the opposite direction
RESULTS: LOW T4, NORMAL T3?
