commencing Armour NDT : Hi I am starting Armour... - Thyroid UK

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commencing Armour NDT

Dukemaster profile image
23 Replies

Hi I am starting Armour as advised by a private Dr recommended via Thyroid UK

Apparently from my bloods it appears I’m a poor converter and have been under treated. ( exactly what has previously been suggested on this site)

My GP has only ever prescribed levothyroxine 50mcg since my diagnosis in 2015 as my TSH has always been within range.

I have been feeling pretty unwell lately with joint pain getting worse and an increase in tinnitus.

The doctor has advised to start Armour half a tablet AM and half a tablet late afternoon.

Also advised Vit D and folate.

I'm a bit concerned as some people have said the Armour medication should be commenced more slowly than twice daily even though it’s half a tablet.

Any thoughts or advice on this appreciated.,

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Dukemaster
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23 Replies
rosael56 profile image
rosael56

Hello, I did the exact same as you - went from 50mcg Levo to 1 grain (1 tablet) of Armour split twice a day.

I increased to 1.5 grains after a week, and now 5 weeks in taking 2 grains a day.

I have had a few side effects, but my doctor told me to expect them and they've been manageable. I'm feeling better than I was on Levo!

Dukemaster profile image
Dukemaster in reply torosael56

Hi thank you for your response. I will go with what had been prescribed and see how I feel. It’s just that I read a post saying the T4 takes time to leave your body and that 1 grain is equivalent to 80-100 mcg which I thought was maybe too much too soon as I’ve only been taking 50mcg. Although not been converting very well 🤔

pennyannie profile image
pennyannie in reply toDukemaster

Hello Dukemaster :

I switched from 125 mcg T4 to another brand of NDT and self medicating.

The T4 will take around 6-8 weeks to fully leave your body and for a smooth transition from from one treatment option to another - one reason why it's recommended to go up on small, slow, dose increments when taking NDT.

I increased by 1/4 grain weekly - and I dosed just once a day at around 3.00 am in the morning at a natural toilet break so very sure I had an empty stomach and wouldn't be eating anything for over an hour ( as recommended for good absorption of the NDT )

I had no trouble going back to sleep until around 6.00 am-

My ran my blood pressure, pulse and body temperature Am and Pm daily and whilst the first 2 symptoms remained stable tracked my temperature slowly rise from 35.4 to 36.6 where it is today some 6 years later.

There came a week when I felt a bit edgey and just not comfortable in my skin - so I dropped back down to the previous weeks dose - stayed on that dose 8 weeks and then ran a blood test to see what was happening and I was feeling so much better.

My T3 and T4 had literally switched places as now my T4 was at 25% but my T3 at 110% through the ranges.

If you get to 2 grains - best to stay on that dose for 8 weeks and then run a blood test.

If your T3 hasn't moved much - and if still with symptoms - maybe NDT isn't the best treatment option for you - if you results look much better but you still have some symptoms slowly start upping the dose by a 1/4 grain weekly :

No thyroid hormone replacement works well until your ferritin, folate, B12 and vitaminD are up and maintained at optimal levels.

I find it strange that you have only ever been on 50 mcg T4 - as this a just a starter dose and needs titrating up as T4 doesn't ' top up ' thyroid support but replaces it - and this dose too low to have worked well for anybody.

pennyannie profile image
pennyannie in reply topennyannie

Ok - so just looked back and see you have Hashimoto's Auto Immune thyroid disease and likely your low ferritin could have been part of your issue with poor conversion previously.

Many forum members find the research and suggestions of Dr Izabella Wentz useful as it does seem with this AI disease - stomach and gut health may need some attention - before you will see the full benefits of any treatment option.

and checking for certain food intolerances, especially those of gluten, wheat and dairy being common triggers for one's immune system -

All things Hashimoto's AI disease - thyroidpharmacist.com

Some Hashimoto's patients find that taking NDT ( pig thyroid ) actually increases their immune system response and need to stay on synthetic thyroid hormone replacement treatment options.

Dukemaster profile image
Dukemaster in reply topennyannie

Thank you for all this information really appreciate it. I want to get as well as I can by trying other medication now as suggested by the Dr on Thyroid UK I feel it’s worth a try.

pennyannie profile image
pennyannie in reply toDukemaster

Yes - I understand but first off ensure that your core strength vitamins and minerals are all optimal - and get tested for celiac while still eating your chosen foods, if you haven't already had this checked out.

I know now I need to m my ferritin up at around 100 - folate around 20 - active B12 around 125 ( serum B12 500++ ) and vitamin D around 125 :

I am not aware there is any one doctor on Thyroid UK - there is a list of patient to patient recommended endos and thyroid specialists - NHS and private - which can be acquired by contacting admin @ thyroiduk.org - is that what you are referring to ?

SlowDragon profile image
SlowDragonAdministrator

Well 50mcg is only the standard STARTER Dose Levo

You can’t know if you are a poor converter until on full replacement dose Levo

Dose Levo should have been increased slowly upwards in 25mcg steps until on full replacement dose. This is typically around 1.6mcg of levothyroxine per kilo of your weight per day

Unless extremely petite that’s likely to be at least 100mcg per day

What are your most recent thyroid and vitamin results

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

What vitamin supplements are you taking

Is your hypothyroidism autoimmune

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Dukemaster profile image
Dukemaster in reply toSlowDragon

Thank you for all your help and information, it was on here that from my blood results suggested poor conversion although the Dr also said 50mcg is the starter dose. The GP has never altered it as TSH always within range. They don’t seem to understand it much

SlowDragon profile image
SlowDragonAdministrator in reply toDukemaster

The GP has never altered it as TSH always within range. They don’t seem to understand it much

previous post shows your TSH far too high for someone on levothyroxine

healthunlocked.com/thyroidu...

FT4: 18.1 pmol/l (Range 12 - 22)

Ft4 is 61.00% through range

but

FT3: 4 pmol/l (Range 3.1 - 6.8)

Ft3 only 24.32% through range

Your high thyroid antibodies which confirms autoimmune thyroid disease

Request GP increase dose levothyroxine to 75mcg

(But initially only increase yourself to 62.5mcg daily)

Meanwhile working on low ferritin by increasing iron rich foods in your diet

Are you on gluten free or dairy free diet

If not yet gluten free GP should do coeliac blood test BEFORE you trial gluten free diet

as per NICE Guidelines

nice.org.uk/guidance/ng20/c...

Dukemaster profile image
Dukemaster in reply toSlowDragon

Thank you

SlowDragon profile image
SlowDragonAdministrator

Armour is extremely expensive

You will never get prescribed this on NHS

It’s a significant long term financial commitment

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

Dukemaster profile image
Dukemaster in reply toSlowDragon

Thank you

Im overweight for my height 5ft 3 weigh around 11st have trued hard to lose weight but find it impossible, yes it is expensive but getting desperate to try anything that may help

Heard about Armour and felt to give it a try as my ratio for conversion wasn’t good.

FancyPants54 profile image
FancyPants54 in reply toDukemaster

I'm an Armour user. It's not the magic bullet you might think it is. It works very well for some but others it's a battle to get the dose right. Given the cost and the difficulty using it, in your shoes I would be buying some Levo and increasing that to a sensible amount before I switched to Armour. You have never been given the opportunity to know if Levo works for you because your clueless GP has never given you enough of it.

Seriously, if you can get Levo to work it's so much easier and cheap as chips. First stage is to increase from 50mcg a day to 75mcg a day. You don't know how well you might convert if you have good levels of vitamins and minerals and a therapeutic dose of T4.

If I were you I would ask this private doctor for a prescription to increase your Levo first. And try optimising your dose. You can always switch to Armour at a later stage but I'd be afraid you were likely to throw away the baby with the bathwater switching straight from a long-term starter dose of Levo to Armour 1 grain.

Dukemaster profile image
Dukemaster in reply toFancyPants54

Yes understand what you mean thank you for your help

SlowDragon profile image
SlowDragonAdministrator

previous post this morning by someone else left inappropriately on only 50mcg dose

healthunlocked.com/thyroidu...

Dukemaster profile image
Dukemaster in reply toSlowDragon

Thank you

SlowDragon profile image
SlowDragonAdministrator in reply toDukemaster

Which brand of levothyroxine do you take

Have you ever tried increasing levothyroxine

Would have to increase very slowly having been left grossly under medicated for years

Initially to 62.5mcg daily

Waiting at least 6-8 weeks before retesting

Then up to 75mcg daily…..repeating test

And onwards

Guidelines on dose by weight

11 stone = 69.8 kilo

69.8 kilo x 1.6mcg Levo = 112mcg as likely daily dose levothyroxine required for your weight

The cheaper option is to consider adding T3 alongside Levo …..but first getting Levo dose increased as high as you can possibly tolerate

You might find this video interesting from talk at Thyroid Trust by Dr Paul Jenkins

youtu.be/g_WNKop-S_Q

Dukemaster profile image
Dukemaster in reply toSlowDragon

Thank you all this is extremely helpful

I’ve not tried to increase the levothyroxine mercury this was mainly due to thinking I’m a poor converter and really had no idea how to go about improving that other than trying the Armour. I can see now there are alternatives such as adding T3 ?

The tinnitus does seem to amplify a while after I take the levothyroxine not sure why also the Vit D I started gave me leg pain that I didn’t have before I started taking it.

There is so much knowledge on here I need to read more and maybe even change GP

SlowDragon profile image
SlowDragonAdministrator in reply toDukemaster

You can’t know if you’re a poor converter until on a decent dose Levo

At moment you are only on tiny dose

I can see now there are alternatives such as adding T3 ?

Well trying increasing Levo FIRST

Adding almost any dose of T3 (or NDT) will significantly reduce TSH, shutting down your own thyroid output

Vitamins

Increasing metabolism does initially exacerbate vitamin deficiency

Very common to initially notice vitamin deficiency symptoms get worse

What vitamin supplements are you taking

Many people find they need daily vitamin D, magnesium, daily B complex.

Some need daily B12 too

Dukemaster profile image
Dukemaster in reply toSlowDragon

Sorry meant I understand more about the T3 now if my increase of levothyroxine still wasn’t helping me as in if it was a conversion issue

I do have B12 injections every 3 months

Started Vit D but experienced leg pain even waking me in the night so I stopped will research an alternative

SlowDragon profile image
SlowDragonAdministrator in reply toDukemaster

vitamin D

Start magnesium first if not already taking it for 2-3 weeks before adding vitamin D.

Personally I had excruciating bone pain for 3-4 months after starting vitamin D.

Decades of vitamin D deficiency. Can be painful as bones remineralise.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Too much Vitamin D is toxic

Test twice a year

healthunlocked.com/thyroidu...

Dukemaster profile image
Dukemaster in reply toSlowDragon

Great thank you for this information

SlowDragon profile image
SlowDragonAdministrator in reply toDukemaster

As you have B12 injections recommended that also take daily Vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

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