Dosing Thyroid Medication

[Di-gfree]

I really need help with this. Many of you are taking Armour (I'm taking the equivalent called Thyroid (in Canada)). I started in early July and worked my way up to 60 mgs by the time I had my first bloodwork done (so that was a 6-week period of time). A week prior to that I spoke to my doctor to get him to add some tests to my blood requisition and he was shocked that I was up to 60 mgs (he prescribed 30 mgs). He gave me 'the look'; and told me not to increase.

He doesn't think I need more than 60 mgs! He says at my weight, 95 - 100 lbs, that's all I need! He said it is equivalent to 100 mcgs of synthroid. So... I'm up to 90 mgs on my own because I couldn't function at 60. I couldn't sleep, could barely walk because my legs were so heavy, couldn't think (well, you get the picture). He doesn't know I've increased, though. And 90 mgs isn't cutting it for me - I have to increase. Dare I say I'm afraid to tell my doctor. And, I'm testing out 120 mgs today. He obviously thinks I'm going to make myself hyperthyroid.

I go to see my doctor on Monday, and I'm actually scared to tell him! But, I need my prescription changed to reflect my increase. I'm bringing 'the letter' with me from the stopthethyroidmadness site; and I'm telling him I want to feel better, not go by numbers. I told him that *everyone* (on the internet - ha!) takes at least 120 mgs and more; and I've just learned of a 77 year-old woman that takes 240 mgs a day. This sucks - how can I explain this to him?

[ShayFL]

My first doctor was not letting me increase either.....so I did on my own. Like you I am thin. I was told for 10 years that I could not possisibly be hypothyroid because I was thin and not constipated. Well.....when they finally got wind of the new lab ranges......ho ho ho.....seems I am hypo afterall.

10 years of my life in misery due to doctors that think they "know it all". So when my doctor wouldnt up my dose, I didnt care. I found a source online and bought extra to augment my prescription. My doctor started me on 30 mg Armour, then reluctantly took me to 60. I augmented he rest. I am now at 180 mg. And I am roughly 115 pounds. I have had to increase periodically over the past year.

I know when I need an increase because my muscles start twitching and spasming non-stop day and night and my face/lips get numb. I up my dose and within a few days those symptoms disappear. There are also other more subtle signs I need an increase like: Hair starts falling out, eyebrows get thinner, tired, heart palps, anxiety and depression.

On the right dose or Armour I dont have these symptoms. So I simply do not care what ANY doctor thinks. However, my current doctor knows I up when I need to and doesnt chastise me for it. She asks how I feel. Now that is a novel idea!!!

How does the patient feel?????

[MaryJones2]

Odd question here but is it possible that you are taking too much? I get some of these symptoms when my dosage is too high. But you know your body and what works so if your doctor won't listen it might be time to shop around for a new one.

Edited: I also should mention that I don't think the synthetics can compare apples to apples with the naturals because one is T4 and the other T3. Armour just might not be the right med for you.

[georgie]

I go to see my doctor on Monday, and I'm actually scared to tell him! But, I need my prescription changed to reflect my increase. I'm bringing 'the letter' with me from the stopthethyroidmadness site; and I'm telling him I want to feel better, not go by numbers. I told him that *everyone* (on the internet - ha!) takes at least 120 mgs and more; and I've just learned of a 77 year-old woman that takes 240 mgs a day. This sucks - how can I explain this to him?

May I suggest you take the Armour Thyroid pdf printout of the dosing instructions? Go to www.armourthyroid.com

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120mg is still considered a normal dose and not everyone is 'normal' - especially if they have cellular resistance from long term untreated HypoThyroidism, or if they suffer malabsorption and leaky gut damage from Celiac ( for eg).

If your Dr is still unsure on how to treat Thyroid - suggest he/she read Dr Hertoghe "The Hormone Handbook " which is written for medical professionals and has over 300 pages of references why his Endocrine methods are correct. Dr Hertoghe recommends Armour Thyroid - 30 mg - 240mg with 20 pages explaining the symptoms re the correct dosage. Or find a Dr that already knows all this ....

Apparently having too much Thyroid feels terrible. It makes you go hyper and feels like a panic attack with racing pulse, sweating, trembling etc. Has your Dr been checking your pulse and Blood Pressure ? Have you kept records yourself - so that you can counter claim his idea that you are now 'hyper' ?

Good luck !!

[georgie]

He doesn't think I need more than 60 mgs! He says at my weight, 95 - 100 lbs, that's all I need! He said it is equivalent to 100 mcgs of synthroid

And another thing. 60mg of Armour ( 1 grain) has 36mcg T4 and 9mcg T3. How your Dr thinks that 100mcg of Synthroid (T4) is equal to that - I do not know !!

Hertoghe states that the human thyroid produces around 80-100mcg T4 and 20mcg T3 every day, with further T3 coming from the body's conversion of T4 to T3. These figures are variable and decline with age by approx 10 - 20%. So you can see that pig thyroid - although in a slightly different ratio to our own - is still much more bio identical that a T4 med alone!

[ShayFL]

Hertoghe states that the human thyroid produces around 80-100mcg T4 and 20mcg T3 every day, with further T3 coming from the body's conversion of T4 to T3. These figures are variable and decline with age by approx 10 - 20%. So you can see that pig thyroid - although in a slightly different ratio to our own - is still much more bio identical that a T4 med alone!

This would explain why most people do best around 3 grains of Armour as it is what we would produce naturally.

[Di-gfree]

Thanks for the helpful information. I

[georgie]

Thanks for the helpful information. I

[Di-gfree]

The adult dosages are there. Just above that chart you read and under the chapter titled 'Dosage'. The normal adult dosage of Armour is as I said 60 - 120mcg as stated by the Armour Thyroid data sheet.

Thanks. I saw that. I was kind of looking for something that gives more exact amounts per kilogram.

So if you are taking 100mcg Synthroid now - the equivalent dose would be just under 3 grains or 180mcg Armour Thyroid in my opinion ( 36mcg T4 x 3 ).

I'm actually taking dessicated thyroid; but my doctor compared it to the amount of synthroid I would need at my weight. I guess that's the scale he goes by for himself. I tried synthroid for a very short period of time, but I had problems with it. I definitely prefer being on the dessicated.

You have a mixture of symptoms there that may be 2 separate issues. You do know that if you have adrenal fatigue - that it needs treatment before starting Armour ? If you have untreated adrenal fatigue then Armour won't work for you properly. That used to be on the Armour data sheet too. Haven't checked for it recently. Your slightly low BP could be an indicator for that as well as the jittery , irritable feeling. Have you been tested ?

Yes, I do know about adrenal issues. Plus, I have anemia. So both could work against the medication. I checked into getting an adrenal saliva test. I read in the stopthethyroidmadness website that the samples should be shipped overnight; but I found out through the lab (in Canada), that it wouldn't be possible, since they are on the other side of the country from me. It would take 2 to 3 days to get there. They assured me that they have performed in-house testing on saliva samples from one day to one week old, and that there are no significant differences. I'm still a little worried that I wouldn't get a true reading. Still thinking on doing the testing.

I do have a question about taking cortisol. It is a steroid, isn't it? And, does this shut down your adrenals permanently? That's what I'm afraid of, to be honest.

So you know how to read your results ? TSH ...useless test. Free T4 needs to be mid range, and Free T3 midrange or higher. Thyroid Antibodies as close to 0 as possible. If all these tests were not done then you need to find a new Dr .... or order them yourself.

I went over that with my doctor - he doesn't believe I need anymore than the one anti-body test since (he says) the test is only to see if I have the antibodies (which I do). I couldn't convince him to do that one again. I know the TSH should be suppressed, and that the Free T3 should be in the high range. Back to the antibodies - are you saying that with thyroid replacement, the antibodies should completely disappear?

[georgie]

Thanks. I saw that. I was kind of looking for something that gives more exact amounts per kilogram.

Armour doesn't really work that way. There is no precise dose that be calculated like that. The Dr has to use his /her judgement. Back before the TSH test was available - this was all they could do anyway , and was how Armour was medicated.

I checked into getting an adrenal saliva test. I read in the stopthethyroidmadness website that the samples should be shipped overnight; but I found out through the lab (in Canada), that it wouldn't be possible, since they are on the other side of the country from me. It would take 2 to 3 days to get there. They assured me that they have performed in-house testing on saliva samples from one day to one week old, and that there are no significant differences. I'm still a little worried that I wouldn't get a true reading. Still thinking on doing the testing.

The lab I used told me up to a week is good. They do this regularly.

I do have a question about taking cortisol. It is a steroid, isn't it? And, does this shut down your adrenals permanently? That's what I'm afraid of, to be honest.

Correct and very wise to be wary. There are two ways of looking at this and one is if you already have a partial deficiency then you need cortisone supplemented in 'tiny' amounts - maybe for life. Using tiny amounts you won't get the side effects as you simply are supplementing what is missing - not doubling up.... But ....it can be so easy to get this wrong, that you need a Dr that understands all this. I believe short term use of cortisone is less risky , and also have heard of some Drs using alternate day dosing or mixing the dose around a bit - to keep your own adrenal function 'thinking' for itself. There are OTC herbal and glandular adrenal preparations too but I would be wary of those as many are not FDA or standardised. Just my opinion of course. Many people say they do well on them.

I went over that with my doctor - he doesn't believe I need anymore than the one anti-body test since (he says) the test is only to see if I have the antibodies (which I do). I couldn't convince him to do that one again. I know the TSH should be suppressed, and that the Free T3 should be in the high range. Back to the antibodies - are you saying that with thyroid replacement, the antibodies should completely disappear?

How does your Dr know your current Thyroid meds are working if you aren't watching the fall and fall of the Antibodies ? Yes - 0 is the goal #. This then suppresses the Antibody attack on the thyroid and the nodules and cancer risks etc.

[ShayFL]

Before you go the steroid route, you might just try healing your adrenals.

Reduce stress as much as possible

Mediation

Extra sleep and rest

Vitamin C

Panteothenic Acid

B Vitamins

Astragalus

Things like this can be a big help.

[Di-gfree]

Armour doesn't really work that way. There is no precise dose that be calculated like that. The Dr has to use his /her judgement. Back before the TSH test was available - this was all they could do anyway , and was how Armour was medicated.

Interesting. It seems dosing would have been easier that way - just going by how the patients feels, and not the TSH. That's what I told my doctor I want to do anyway. He agreed. Which is a good start.

The lab I used told me up to a week is good. They do this regularly.

Good - glad to hear that. I feel more confident about getting it done.

Correct and very wise to be wary. There are two ways of looking at this and one is if you already have a partial deficiency then you need cortisone supplemented in 'tiny' amounts - maybe for life. Using tiny amounts you won't get the side effects as you simply are supplementing what is missing - not doubling up.... But ....it can be so easy to get this wrong, that you need a Dr that understands all this. I believe short term use of cortisone is less risky , and also have heard of some Drs using alternate day dosing or mixing the dose around a bit - to keep your own adrenal function 'thinking' for itself. There are OTC herbal and glandular adrenal preparations too but I would be wary of those as many are not FDA or standardised. Just my opinion of course. Many people say they do well on them.

Whew - thank you for the excellent information. I really want to know what I'm doing, so I can avoid making mistakes that can't be changed.

How does your Dr know your current Thyroid meds are working if you aren't watching the fall and fall of the Antibodies ? Yes - 0 is the goal #. This then suppresses the Antibody attack on the thyroid and the nodules and cancer risks etc.

Ah, now I understand. Now I'll have to get my doctor to understand. I've also got high prolactin that he'll be checking each time (which will hopefully lower as I'm on the medication longer).

And Shay, thanks for the suggestions. I would prefer healing my adrenals naturally, if it's possible. I'm afraid sleep is a big problem for me. (And stress - I get stressed about everything/nothing.) I sleep ok for a few nights each time I up my dose of thyroid; but as I start to need another raise (I assume), I only sleep for a few hours a DAY. Do you have adrenal problems? I also read your signature about where you take neem oil - very interesting. I'll have to research that.

[ShayFL]

My adrenals used to be tired. I went the natural route. I know they healed because you cannot raise Armour if your adrenals are shot. You will get horrible symptoms. Some people with adrenal exhaustion cannot even take 15 mg of Armour without reacting (when they are clearly hypothyroid).

I took 2000 mg Vit C a day plus the other supplements I mentioned for a good 6 weeks before I started Armour.

I also do a type of meditation everyday for 1/2 an hour. This was not easy for me as I am type A personality. Anal. High energy. But it paid off. I use a Rebuilder which makes the brain release endorphins. I find it relaxing. I hook it up and it goes off automatically in 30 minutes. I spend that time repeating healing affirmations to myself. I generally doze off though for 15 minutes. I wake up refreshed.

I have done many things along my healing journey and no one thing was the answer.

BUT that Neem did something to me. Something good. It was nearly a miracle. The bloat was awful. It is gone. Even tonight I had soup, plantain chips and coconut ice cream for dessert. A splurge night and NO BLOAT!!

I cannot say that Neem will do anything for anyone else. But I share my experience.

[georgie]

Ah, now I understand. Now I'll have to get my doctor to understand. I've also got high prolactin that he'll be checking each time (which will hopefully lower as I'm on the medication longer).

Glad it helps. Its important to know the facts but also to keep the communications there with your Dr. Most Drs train years which costs them a lot of money and they are understandably a bit negative about people that barge in to a short appt with stacks of paper they have read off the internet. Mary Shomon had a good article about this recently and how we have to be fair at all times and consider their feelings too. If we present some papers - make sure they are referenced and credible.

BTW - do you know what is causing your high prolactin ? Have you had your other Pituitary hormones checked and any MRI imaging done ?

[Fiddle-Faddle]

Di, how long have you been gluten-free?

I had to keep increasing my synthroid--from .1 all the way to .175, and still felt hypo--and then discovered the gluten problem.

Every couple of months, my synthroid dose then had to be lowered. I am now on .112 (for 8 months!) and feeling normal.

Apparently, because of the leaky gut, I wasn't absorbing the Synthroid until the gut healed.

Georgie--once the celiac and the thyroid supplementation are well-controlled, do we still keep producing anti-thyroid antibodies?

[Di-gfree]

Shay, it sounds like all of your hard work is paying off for you! I googled the Rebuilder (hadn

[ShayFL]

Im not the "relaxing" type myself......but the Rebuilder does do it for me. I have had it for about 4 years. I pray it doenst break because they are not cheap.

[Di-gfree]

Im not the "relaxing" type myself......but the Rebuilder does do it for me. I have had it for about 4 years. I pray it doenst break because they are not cheap.

Ya... I noticed that. Maybe I can find one at a yard sale?

[georgie]

Georgie, I only found out about the high prolactin when I had my thyroid panel done

[Fiddle-Faddle]

You

[Di-gfree]

Fiddle, I guess I shouldn't have assumed you found out about both at the same time. : )

I checked out the pituitary link, Georgie. It's scary stuff; unfortunately, my brain isn't working so hot, and I can never remember what I just read. I wish I was kidding.

I got my lab results today. First I'll give the first results of my thyroid panel (this was before starting dessicated thyroid) (I'm not sure if I should give the results here, or separately, but here goes):

April 08

TSH 4.86 (ref. range 0.34 - 4.82 mIU/L)

Free T4 10.99 (ref. range 9 - 24 pmol/L)

Free T3 4.4 (ref. range 3.5 - 6.5 pmol/L)

Antibodies TPO 155 (ref. range <40 IU/mL)

Ferritin 21.30 (ref. range 11.10 - 264.00 ug/L) Low

Folate 31.90 (ref. range >6.25 nmol/l)

Vit B12 674 (ref. range 176-687/L) (sublingual B12 did its job)

Prolactin 30.7 (ref. range 6.0 - 24.0 ug/L) High

For some reason, I don't see T4 or T3 on either of the tests (I could have sworn my doctor wrote down T4, and T3).

August 08 (Was taking only 60 mgs dessicated at time of test)

TSH 0.01 (ref. ranges same as above)

Free T4 13.57

Free T3 5.5

Ferritin 30.10 (have been taking Floravit for a month now)

Folate 32.50

Vit B12 676

Prolactin 62.5

I'm totally shocked that my TSH became suppressed so quickly, and on only 60 mgs. The bizarre part of the story is I felt terrible on 60 mgs. Swore up and down I needed more. And, surprisingly slept better once I increased. I've actually managed to work my way up to 105 mgs - which is obviously way more than I need since 60 seemed to be closer to my maintenance dose. My doctor wants me to get the TSH up a bit... I sort of thought we're supposed to get the Free T3 in the upper range no matter how low the TSH gets? He said that low of a TSH is inviting problems like osteoporosis. Hmm.

So, now instead of working my way up with my dose, I'm heading back down. Would you experienced people think that I might need slightly more than 60 to get my Free T3 a little higher? I also picked up a saliva hormone kit from my naturopath. I have to find out from the lab whether I should wait to take the samples until I get my dosage down a bit... And, oh, the prolactin - I'm unhappy about that. My doctor said if the next blood test results shows it hasn't lowered, he'll order a cat scan of my brain. I am happy my iron is going up for the first time ever, though.

[ShayFL]

Dessicated thyroid will ALWAYS suppress your TSH. Always. Doctors who really understand thyroid DO NOT go by TSH when Rxing Armour/natural. TSH is useless once you start taking it.

My last TSH was .008 and I am fine. I feel best when my Free T3 is at the very top. Last one was 4.1 and the range goes to 4.3 (my labs ranges).

I have no symptoms of hyper. I hit the pillow at 10 and am asleep within seconds. I sleep through the night and feel refreshed when I wake. My temperature runs around 98.4 - 98.8 at any given time of the day. BP is consistently 110/70. Heart rate is 80. No sweating. No anxiety. No weight loss. No D.

MOST doctors would look at my labs and say that I am severely hyperthyroid. I am not.

[georgie]

You cannot look at TSH once you are taking Armour. It doesn't matter . Mine is 0.001 and has been so for 2 years. The levels of Free T4 and Free T3 are what matter. Based on those levels it looks like your 60mg was not that far away from your best dose. A bit less than you are taking now and a bit more than your Dr said

He said that low of a TSH is inviting problems like osteoporosis

Unproven. And infact there are studies to confirm the opposite to that.

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Of much more concern for you right now is your high ( and increasing) Prolactin and your Dr umming about that and talking of a CT Scan.....

You need a MRI with and without contrast for the Pituitary. Sorry to highlight but this is important. A CT Scan will not be correct. Or a Brain MRI. And you also need other Pituitary hormones tested - Cortisol , DHEA, GH, Aldosterone etc. Some of those tests are in hospital although there are blood tests that can start to indicate a problem. If there is a Pituitary problem then that can be causing many of your symptoms as well - so you probably need an experienced Pituitary Endo . Saliva tests may show a problem but the results will not be accurate enough for an Endo...

This is another site that may help you. Try to get some blood tests for what is mentioned in it. And that MRI....

Open Original Shared Link

I was just dx as HypoPit myself yesterday and am about to start Florinef for my giddiness. The xray lab got it wrong and did a Brain MRI instead of Pituitary so I may have a small tumour but at this stage I am not rushing back for another MRI. The Brain MRI showed no problem so if a tumour is there it won't be very big ( MRI's take 'slices' of your brain in about 5mm and if its not the right type of MRI and has no contrast then a small tumour can still be missed ). So - don't be like I was and get the wrong Scan or MRI done

[Di-gfree]

Dessicated thyroid will ALWAYS suppress your TSH. Always. Doctors who really understand thyroid DO NOT go by TSH when Rxing Armour/natural. TSH is useless once you start taking it.

I read your post; and afterwards a lightbulb went on in my head. Of course, I thought - my doctor is going by his experience with synthetic thyroid. He only has one other patient, other than me, who is taking the dessicated. So, he doesn't realize that dessicated thyroid has the same component's (including calcitonin - sp?) as human thyroid (except in a different ratio); so when we suppress our TSH, we're still supplying the same hormones with the dessicated, which makes our own suppressed TSH, not important. Whereas, with synthetic T4, that's all it supplies - T4. At least that's what I think he was thinking. So, I'll have to go in to see him again, and explain why it's ok if my TSH is .01 (or lower).

My last TSH was .008 and I am fine. I feel best when my Free T3 is at the very top. Last one was 4.1 and the range goes to 4.3 (my labs ranges).

Whew. Thanks. I think I should focus on getting my Free T3 a little higher. So, I probably won't lower myself all the way to 60 mgs. Of course, I have to sort out whether my adrenals are a problem, work on getting my ferritin higher, and the pituitary issue.

I have no symptoms of hyper. I hit the pillow at 10 and am asleep within seconds. I sleep through the night and feel refreshed when I wake. My temperature runs around 98.4 - 98.8 at any given time of the day. BP is consistently 110/70. Heart rate is 80. No sweating. No anxiety. No weight loss. No D.

You are so fortunate. I do have symptoms of both hyper and hypo. I don't sleep well, if at all. My body temps are low. Lots of anxiety (I have some to spare, if you'd like some ; ) ). Some weight loss. And C; although I have had a few days of normal bm's since starting thyroid hormone. Which is a huge deal.

[Di-gfree]

You cannot look at TSH once you are taking Armour. It doesn't matter . Mine is 0.001 and has been so for 2 years. The levels of Free T4 and Free T3 are what matter. Based on those levels it looks like your 60mg was not that far away from your best dose. A bit less than you are taking now and a bit more than your Dr said

Specifically, I know you can't say exactly how much - it'll be experimentation for me - but I guess you're saying more than 60mg but less than 105 mgs? Maybe that dosing chart for children wasn't too far off when they said a child of 12 who is 45 kgs would take 81 mgs.

Unproven. And infact there are studies to confirm the opposite to that.

I think I have it straight now. I also remember reading in the sttm website that dessicated thyroid prevents osteoporosis; and not the other way around. It was just such a shock to see my results - I was expecting a bit of a struggle with trying to convince my doctor to approve of my going higher with my dosage. And not expecting total suppression of my thyroid so soon. I've been having problems thinking clearly for awhile now; and I'm an intelligent person, so it's sad that I can't articulate well - speak well to people. I'm definitely inward... (and getting away from the subject at hand).

Of much more concern for you right now is your high ( and increasing) Prolactin and your Dr umming about that and talking of a CT Scan.....

You need a MRI with and without contrast for the Pituitary. Sorry to highlight but this is important. A CT Scan will not be correct. Or a Brain MRI. And you also need other Pituitary hormones tested - Cortisol , DHEA, GH, Aldosterone etc. Some of those tests are in hospital although there are blood tests that can start to indicate a problem. If there is a Pituitary problem then that can be causing many of your symptoms as well - so you probably need an experienced Pituitary Endo . Saliva tests may show a problem but the results will not be accurate enough for an Endo...

Oh, man. Thanks - I'll talk to him about it. Actually, I may ask to see a pituitary expert. He actually thought it was a good idea to test my adrenals (via the naturopath); and at the same time, he's checking my morning cortisol level, and DHEA on my next blood test. I'll mention GH and aldosterone (which I'll look up). But I do realize the saliva test won't be exact; but it's mainly for my peace of mind, and to see if it's interfering with my thyroid hormone.

This is another site that may help you. Try to get some blood tests for what is mentioned in it. And that MRI....

I just started reading that link you gave me. I've read some of the sttm site, and didn't notice the pituitary information. Once again, thank you.

I was just dx as HypoPit myself yesterday and am about to start Florinef for my giddiness. The xray lab got it wrong and did a Brain MRI instead of Pituitary so I may have a small tumour but at this stage I am not rushing back for another MRI. The Brain MRI showed no problem so if a tumour is there it won't be very big ( MRI's take 'slices' of your brain in about 5mm and if its not the right type of MRI and has no contrast then a small tumour can still be missed ). So - don't be like I was and get the wrong Scan or MRI done

Sorry to hear that. Good luck with the Florinef. I don't blame you for not rushing to get another MRI anytime soon. That's terrible when they make mistakes like that.