Adjusting to new Armour thyroid dose

[PocketPotato]

Hello all, hoping to hear from other longtime users of Armour whether or not my situation is unusual or any cause for concern. I am working with a doctor, unfortunately not able to get a ton of counsel or guidance from them beyond labs/prescriptions, so I’m grateful for any community support.

I have been on my dosage journey since December, working from 45mg (TSH 6), to 60(TSH 3.5), to 75(TSH 2.3), to 90(TSH 4.6!?)

After 4 weeks at 75mg, my symptoms were starting to really improve and my TSH was measured at 2.3. I still had lingering tiredness and chilliness, so I was eager for the jump to 90. However, over those four weeks, my symptoms returned rather severely, and my TSH tested at 4.6! I’m back to feeling quite poorly, and it’s SO frustrating after that glimpse of wellness.

Is this kind of nonlinear jumping around unusual, or a cause for concern? I have raised my dose to 120mg, and it’s been one week. I haven’t felt much relief yet, and I’m not sure how long it will take for symptoms to start to improve again. I’m just feeling nervous and discouraged.

I have a longer history than just this of trying to treat this thing, and it includes a really horrifically bad reaction to t4-only, so the NDT feels like my last hope. I just want to feel okay.

Thank you for any answers.

[pennyannie]

Hello PocketPotato and welcome to the forum :

It would help us better understand your health issue if you completed your Profile page detailing at the very least - your age, gender and if with a diagnosis of the thyroid health issue and any other medications you maybe taking :

[PocketPotato in reply to pennyannie]

Thank you! I updated my profile, and I put a much more detailed history in my reply to Jazzw below

[Jazzw]

We don’t know where in the world you are, so don’t know if you’re prescribed Armour or whether you’ve self sourced it. If you’ve self sourced it, there’s a chance your Armour tablets aren’t the real thing and that might explain what’s going on.

And we don’t know anything about your testing schedule, how often you’re testing or who you’re testing with. Or what your FT4 and FT3 levels are - we can’t tell very much about what’s going on with TSH levels alone.

Happy to try to help but we need a fair bit more info. 🙂

[PocketPotato in reply to Jazzw]

Hi, thank you so much and I appreciate the thoroughness of your approach. I have updated my profile, and I do have my full test information with free t4 and total t3, which I will include at the bottom of my comment here.

I am in the United States, and I am getting my testing done and getting my armour prescription through an endocrinologist with Kaiser Permanente, my standard healthcare provider. They also supply the medication.

My hypothyroidism is a side effect of an immunotherapy treatment for melanoma I underwent approximately two years ago, which ended in July 2023. I also got type 1 diabetes in 2020 from treatment, which is well-controlled with CGM and insulin pump. Cancer has been in full remission for 2.5 years now

The hypo showed up in my monthly screenings during treatment, when TSH suddenly jumped to 58. Not 5.8, 58. Levothyroxine was the first treatment given, and I’ve attempted it and stopped twice now. Unfortunately it didn’t relieve physical symptoms at all, and gave me incredibly dangerous psych side effects - severe anxiety, urgent suicidality, and just general disorientation. Really really frightening. We paused the meds to see if thyroid had recovered and I didn’t need it, but I got SEVERELY ill without it, so we assume I have little to no function left. I gave levo another full shot for six months and got to a TSH of 1.8 but it was pure torture that never improved. Armour does not have this effect. I switched to it this past December, going from 75mcg levo to 45mg Armour to start.

My endocrinologist is having me increase by 15mg and re-test free t4, total t3, and TSH every four weeks. Here are labs from December onwards, with each set of values taken after four weeks at the listed dose:

45mg - TSH 6 (0.5-4.2) Free T4 0.9 (0.8-1.7), Total T3 114 (50-170)

60mg - TSH 3.5, FT4 0.9, TT3 109

75mg - TSH 2.3, FT4 1, TT3 185

90mg - TSH 4.6, FT4 0.9, TT3 135

[PocketPotato in reply to Jazzw]

Oh, and for the final detail: per my endo’s instructions, those labs were taken fasting, in the morning, about 2 hours after taking my armour pill.

[Jazzw in reply to PocketPotato]

Thanks for this PocketPotato, that’s all really helpful. 🙂

Well, first of all, here we tend to recommend that you don’t take your thyroid medication shortly prior to a blood test as it results in artificially elevated FT4 and FT3 levels. We also don’t tend to find Total T3 results particularly helpful, as Total T3 measures both bound and unbound T3 in your blood stream and it can be difficult to tell if the dose is enough.

That result from when you were taking 75mg Armour seems to be something of a blip, doesn’t it? It’s almost like you were on a higher dose than you are now. I can’t explain that, I’m afraid, but with a TSH that’s still a over 1.0 when taking a medication that contains T3, it’s clear to me that you still have a way to go with dosage increases.

I take Armour and I’m currently on 150mg a day (or 2 and a half grains). I was on 180mg for many years but menopause seems to have resulted in me needing slightly less.

Hopefully you’ll start to feel the benefit of that dose increase soon but I have a feeling you’ll ultimately need more than 120mg.

Have you had vitamins and mineral levels tested, in particular, Vit B12, folate, ferritin and Vit D?

Levels of these tend to drop when undermedicated as gut absorption is lowered when the body is short of thyroid hormones. This can lead to symptoms that feel very much like hypothyroid symptoms and sometimes, a deficit in one or more of these vitamins and minerals can make it harder for your body to utilise the thyroid medication effectively (it may even be why you struggled on levothyroxine). So it would be well worth getting those tested.

It sounds like you’ve been on quite the rollercoaster over the last few years and I really hope this is the answer for you and that you feel much better soon.

[PocketPotato in reply to Jazzw]

Frankly, it’s been beyond nightmare. Definitely still scary to wonder if I’ll ever feel truly well again. The month on 75, I went back to work, was riding my bike with friends on the weekends, went to a concert, felt peace, optimism and joy again…..such a tantalizing gift after a full year of sick, bedridden fear. And to have it vanish and be back to feeling so disabled and sick this past month again….it’s been really demoralizing. Hope levels are at nearly 0% honestly. What do I do if nothing actually works? I know the hypo itself causes depression, so I’m sure it’s part of what’s weighing my brain down.

I’m glad to hear that I have plenty of room to go up in dosage from here. I’m glad I’m at least not at the end of this lifeline yet.

I’ll ask the doctor about the different type of test, the free t3. And I’ll switch to testing before taking the morning dose. Kaiser has a pretty hands-off doctoring style, I can pretty much just tell him what I want to do and he’ll facilitate. But it also means I’m on my own with decision-making. So thank you so much for the advice.

[Jazzw in reply to PocketPotato]

Hang in there. It takes time, unfortunately. You’ve had so much go on, it’s not surprising things are taking a while to settle. For what it’s worth, it sounds to me like you’re on the right track. x

[PocketPotato in reply to Jazzw]

Thank you, I know it’s only been four months on what is hopefully the correct treatment… I just feel so spooked that it “crapped out” and won’t do anything for me anymore. But, if hypothetically my correct dose is more like 180, then I suppose 120 is only 2/3 of what’s needed and would still feel pretty deficient.

[PocketPotato in reply to Jazzw]

ah, and I did get general vitamin levels taken, the ones you mentioned, and they were at good levels.