I (38 m) had my thyroid test yesterday. Here are the results:
TSH (mIU/L) 3.16 Range: 0.40-4.50
T4 (THYROXINE), TOTAL (mcg/dL) 3.8 L Range: 4.9-10.5
FREE T4 INDEX (T7) 1.1 L Range: 1.4-3.8
T4, FREEB(ng/dL) 0.9 Range: 0.8-1.8
T3, FREE (pg/mL) 2.9 Range: 2.3-4.2
T3, TOTAL (ng/dL) 93 Range: 76-181
T3 UPTAKE (%)30 Range: 22-35
I’m currently taking 120 mg(2grains) of Armour Thyroid. I’m suffering from fatigue and brain fog.
What should I do to feel better again?
Noted that I had my thyroid fully removed in 2014 due to hyperthyroidism no cancer. After surgery, I was on levo then levo and liothronine then armour thyroid and still suffering from very bad brain fog?
please help me!!!
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Moxyca
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Armour is the leading brand of Natural Desiccated Thyroid and was the only treatment option for hypothyroidism 100 years ago and derived from pig thyroid and the doctor would dispense varying sizes of pig thyroid for a hypothyroid patient to chew on until a size was found that suited the patient the best there were no blood test - just clinical symptoms.
Roll on some years and NDT is now made in a laboratory much like any other medication, and the pig thyroid now desiccated and made up into tablets referred to as grains.
The science of blood tests and ranges were all introduced around the middle of the last century when Big Pharma launched its T3 and T4 synthetic options on the back of NDT and went about gaining market share.
So you are now taking 2 grains Armour which is around 18 mcg T3 + 76 mcg T4 :
Was your thyroidectomy because of Graves Disease ? If so - elaine-moore.com
You say ' feel better again ' was there a time after the thyroidectomy that you felt 100% and if so what were you taking thn - T4 monotherapy - a T3/T4 combo or NDT ?
A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at arond 100 mcg.
No thyroid hormone replacement works well until your core strength vitamins and minerals, those of ferritin, folate, B12 and vitamin d are up and maintained at optimal levels.
Conversion can also be down regulated by inflammation, antibodies, any physiological stress ( emotional or physical ) depression, dieting and ageing - though harder to manage - needed saying.
Some people can get by on T4 monotherapy :
Some people find that T4 seems to stop working as well as it once did and need to restore thyroid hormonal balance with a litle T3 ( likely replacing that little bit lost when the thyroid was removed) + Levothyroxine.
Others can't tolerate T4 and need o take T3 only - Liothyronine:
Whilst others find their health restored better taking Natural Desiccated Thyroid.
Your TSH is much too high for a patient being treated with any thyroid hormone replacement and to be optimally medicated on NDT I would expct a low suppressed TSH - your T4 can be low in range BUT your T3 should be proportionately much higher.
How long did you leave between dose and blood draw - and do you split your dose ?
Do you measure your blood pressure, pulse and temperature - have any of these improved and how long have you been on 2 grains Armour ?
I want to express my gratitude for your detailed and informative response. It means a lot to me.
Regarding my thyroidectomy, it was indeed due to Graves Disease. I was diagnosed with hyperthyroidism in 2007, specifically "Graves disease." I was prescribed propylthiouracil (PTU) for quite some time, during which my TSH plummeted to very low levels (<0.002), while FT3 and FT4 remained within the normal range, leading to a diagnosis of subclinical hyperthyroidism. The only noticeable symptom I experienced was heart palpitations, for which I took Propranolol.
In short, every time I attempted to discontinue the medication, my thyroid levels skyrocketed, and no matter the dosage, my TSH remained "very, very low <0.001." As a result, my doctors recommended a thyroidectomy or Radioactive Iodine (RAI) treatment. It's important to note that at this point, I didn't experience any symptoms of depression or brain fog, and my cognitive functions were intact.
In late 2014, I underwent a thyroidectomy, and shortly thereafter, I encountered severe hair loss, substantial weight gain, and brain fog. Initially, I was prescribed 200 mg of levothyroxine, which was later increased to 250 mg. However, only my TSH normalized, while FT3 and FT4 remained at the lower end or below the minimum normal range.
Subsequently, I switched doctors and managed to persuade them to add liothyronine (5 mcg) to my regimen. The introduction of liothyronine had a remarkable effect on my mental clarity " felt like a light bulb was turned on in my brain". Unfortunately, its efficacy waned over time, leading to gradual increases in the dosage, reaching 25 mcg, in combination with 175 mg of levothyroxine.
Regrettably, this combination ceased to be effective, and my brain fog worsened. Consequently, I convinced my doctors to transition me to Armour thyroid. I commenced Armour thyroid a year ago. Initially, I started with 2 grains, resulting in a TSH level of 9.5, low FT3, and FT4. The doctor subsequently raised the dosage to 3.125 grains, within a week, my TSH was 0.43, FT4 was 0.9 (Range 0.93-1.70 ng/dl), FT3 was 2.6 (Range 2.0-4.4 pg/ml), and T3 total was 79 (Range 80 - 200 ng/dl). That was done in Jan 2023. so she drop it to 150 mg of armor thyroid a day.
I want to emphasize that my doctor primarily relies on TSH levels for prescription adjustments. From February 2024 until mid-August 2023, I consistently took 150 mg of Armour thyroid as a single morning dose.
Throughout this period, I continued to experience persistent symptoms of brain fog, fatigue, and some sort of depression. Intriguingly, when I felt depressed, I experimented with Ibuprofen (Advil) and experienced an improvement in my mood. This suggests a potential link to inflammation, though recent inflammation lab results indicate no significant elevation in inflammation markers.
As for my nutritional status, my folate level was 18.1, B12 measured 460 (within the range of 200-1100 pg/ml), and vitamin D was at 61 (within the range of 30-100 ng/ml), as of June 2023. Currently, I am not taking any supplements.
In response to your inquiry about dosing, I maintain a 24-hour gap between my dosage and blood draws. I don't split my dose; I take one 120 mg tablet in the morning, approximately 30 minutes before eating.
My blood pressure has been a cause for concern, as it occasionally elevates to worrisome levels, prompting the use of Losartan, although I dislike the side effects. This intervention results in a drop in blood pressure (to around 110/75) but is accompanied by increased brain fog, fatigue, and depression.
In light of these challenges, it appears that an adjustment to my medication is warranted. I am contemplating the addition of 25 mcg of liothyronine to my current regimen of 2 grains of Armour thyroid to see if it alleviates my symptoms. Alternatively, should I consider increasing my Armour dosage to 4 grains? I'm desperately seeking a solution to regain the well-being I enjoyed before my thyroidectomy and I wish I hadn't followed the advice to remove my thyroid.
Your insights and guidance would be greatly appreciated.
I'm with Graves diagnosed 2004 and had RAI thyroid ablation2005 though very well on the AT drug - told it was too dangerous to stay on long term and that RAI was perfectly safe and I would be better - I deeply regret this treatment option and do not understand why it is still a first line treatment in what I understood to be a health care system.
I only started myown research when extremely unwell in around 2014 - details on my profile page - just press the Profile icon alongside my name if interested.
It is essential that you are dosed and monitored on your Free T3 and Free T4 results and not a TSH - your Hypothalamus - Pituitary - Thyroid - the HPT Axis - on which the TSH relies on as working well - does not work as this circuit feedback loop is now broken as you have no thyroid to complete this loop.
The thyroid is a major gland responsible for full body synchronisation from your physical through to you mental, emotional, psychological and spiritual well being - your inner central heating system and your metabolism.
Graves is an auto immune disease for which there is no cure - and considered life threatening if not medicated - and if the AT drugs aren't tolerated the thinking seems to be that it is easier to manage hypothyroidism in primary care so definitve treatment is encouraged.
Graves tends to be triggered by stress and anxiety - there is likely a genetic predispoistion with someone maybe a generation away from you with a thyroid health issue and can be triggered by a sudden shock to the system, like an unexpected death of a loved one, a car accident etc - or come about simply ' out of the blue ' and hypothyroidism is considered easily treated in primary care, and ' just life limitiing ' rather than life threatening ?
I too remember that light bulb moment when I added some T3 to my T4 monotherapy.
I now self medicate NDT as I was refused both T3 and NDT through the NHS in 2018.
Do you prefer a partucular treatment option as it seems you have all the options on the table ?
Maybe after that light bulb moment your dose just needed adjusting with the T3 and T4 ratio as it's very personal where we actually feel our best and find ourselves again ?
You could try increasing NDT - go slow and steady with 1/4 grain increments -weekly/fortnight;y - monitor on blood pressure, pulse and body temperature AM and PM and see how you go - it does take time for NDT to settle and bed into the body and if you go too fast you risk missing your ' sweet spot ' and end up back at square one.
There comes a week where you don't feel as good as the week previously, so you drop back down to the lower dose and stay on that dose for 6-8 weeks and then run a blood test just to see where you are and to compae with your bench mark readings.
I don't see the point of mixing up 2 seperate treatment options and would first try increasing the NDT - it is the most fullest treatment option -
however if you find yourself needing 5/6 grains+ ( 45mcg/54mcg T3 ) it suggests that your are not converting the T4 content of the NDT and reliant soley on the T3 content so it would be sensible and a lot cheaper to try T3 only.
On T3 only I read we need around 50 mcg a day just to function.
Reading - Your Thyroid and How To Keep It Healthy by Dr Barry Durrant-Peatfield helped my understanding greatly :
Also Barbara S Lougheed - Tired Thyroid - From Hyper - to Hypo - to Healing - Breaking the TSH rule
Last but by no means least - Elaine Moore - Graves Diseae A Practical Guide - the first of several books to get published and Elaine also has a Sateside website - and a forum much like this life saver and Thyroid UK which I fell into researching low ferritin in around 2015.
No ferritin reading above and both B12 and vitamin D need supplementing.
As a woman I now aim to maintain ferritin at around 100 : folate around 20 : active B12 75 ++ ( serum B12 500 ++ ) and vitaimin D around 100.
Aplogies for any typos - hope it makes sense - I'm with a mild concussion and it seems my vision and writing aren't 100% yet.
Ok - so leaving 24 hours between 2 grains of Armour and the blood draw - is what we call a ' false low ' reading - as your thyroid hormones have tanked :
We generally suggest when taking any thyroid hormone replacement containing T3 to take a fasting blood test at around 10/12 hours from last dose so to see where your T3 sits at its peak -
eg - my T3 at 10 /11 hours - fasted and with only water to drink since last dose to blood draw is around 90/110 % through the range with my T4 at around 25/30% through it's range.
If I wait 24 hours my T3 and T4 would have ' tanked ' and much like a car with no fuel - but obviously I'd be ' in the range ' and likely considered ' good to go ' .
My TSH is 0.01 - low suppressed - if I'm to be well - whether on T4 monotherapy or NDT.
Your TSH wouldn't have changed much either way - and not a good indicator of anything when you havent a thyroid and taking any thyroid hormone replacement.
I guess here in the US, we have a different system in terms of the doctor. But generally speaking, I select a doctor who has an excellent reputation; usually, they are practicing in big hospitals.
While doing my own research to alleviate my symptoms, I found this forum, and it looks like many people have had awful experiences after thyroidectomy or RAI.
You brought my eyes to a good point, which is the relationship between the thyroid and BP. That’s why I wondered why my BP is out of control.
Here are the Ferritin results:
Feb 2022 was 61 ng/mL (Range 30 - 400 ng/mL)
Apr 2020 was 86 ng/mL (Range30 - 400 ng/mL)
Unfortunately, the doctors in the States always say you don’t need a Ferritin lab since your iron is good.
Well you ferritin is too low as well - aim for around 50% through the ranges.
yes it's in the range - but look at the width of the range - it is very wide -
When I researched my low ferritin ( 22 ) everywhere I researched - mostly American website sites - I often used Dr. Joseph Mercola and most suggested ferriin needed to be over at least 70 for any thyroid hormone replacement to convert and start to work.
The doctor subsequently raised the dosage to 3.125 grains, within a week, my TSH was 0.43, FT4 was 0.9 (Range 0.93-1.70 ng/dl), FT3 was 2.6 (Range 2.0-4.4 pg/ml), and T3 total was 79 (Range 80 - 200 ng/dl).
These results did not show over medicated
Bloods should only ever be tested 6-8 weeks minimum after any dose change and day before test always split the dose into 2 or 3 smaller doses spread across the day so with last dose 8-12 hours before test
Look at increasing iron rich foods in your diet to improve ferritin to at least over 70 and around 100 likely better
My doctor was concerned about me switching from hypo to hyper due to the significant increase in my levels in just one week. That's why she dropped the dosage to 150 mg NDT.
Here are the results for April 2023 after 2 months of taking a 150 mg dosage. Again, this was tested 24 hours after taking the dosage.
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