Armour vs Synthroid & Cytomel

[CheriYM]

[COLOR="Purple"]I'm venturing in here to see if anyone has some input on my thyroid issues. I have had a whole host of medical issues (click on the link in my siggy line below and scroll down in the thread) and then in '06 had total thyroidectomy. Finally got my TSH down to .1 about 3 months ago, (my doc checks FT3&4 but I don't have the #'s handy) so doc overcompensated and it was 4 about a month ago. I'll have bloodwork done in 2 weeks.
I did some reading on Armour last year and thought about trying it, but back then my TSH was bouncing around between 6 and 60 for no apparent reason except that I was dealing with lupus issues and going in the hospital coughing up blood every couple of months and getting blasted with high dose steroids for a week or 2 and then going off of them because they didn't think it was lupus - but it was . . . So, now that we have that established:

Does being on prednisone interfere with synthroid absorbtion?

Would Armour be a better choice - or should I leave it alone since it has taken so long to get my levels anywhere near suppressed? I currently take 212 synthroid and 10 cytomel.[/COLOR]

[nonstickpam107]

I'm all for the Armour...too bad you don't have the FT's handy. Can't comment on the rest.

Armour suppresses quickly. At the right dosage. Yes, pred can interfere...I am on a daily dosage of Medrol (I can't handle prednisone...I like Medrol, doesn't have the creepy side effects for me) for another autoimmune disease, and I take my thyroid hormone 4 hours away from calcium, six hours from iron, and things like birth control, or hormones, and prednisone can bind the thyroid hormones in the bloodstream. That is WHY you have FT's done, cuz they show how MUCH is unbound/usable.

ETA: Having another autoimmune issue is rough too...Lupus combined with thyroid (I have Sjogren's, polyarteritisnodosa (Pan) and Hashi's plus a hyper IgE). They tend not to play together nicely.

Pam

[CheriYM]

[COLOR="Purple"]Hey Pam-
Thanks for the info. I kinda figured the nasty prednisone wouldn't be able to leave my thyroid meds alone! I'm curious what side effects the medrol lets you avoid? Moon face? Fluid retention? Weight gain? Insomnia? Would love to avoid any of those - although ambien is my new friend and lets me sleep 5-6hours, but would be nice to not have to take it.
Boy, girl - sounds like you've been through it with the health stuff, too. The lupus, prior to the thyroid stuff had really not been that hard to deal with - but the thyroid thing really kicked me in the butt - and then kicked the lupus into a whole new stratosphere with the lung thing. Has been a scary year! I'm hoping for a turn in the tide . . .
I will go dig for my lab slip and try to find my FT3&4 and post it later tonight or tomorrow. I've been in a 100mg steroid brain fog and have trouble holding onto a thought - and my sanity from time to time!
Thanks again - by the way - where in NE Indiana are you? I lived in Warsaw for 8 years back in the '80s - worked at the Bowen Center.[/COLOR]

[nonstickpam107]

I'm in the Northeastern corner (I could walk to MI line, but the OH line is about 20 miles away).

I'm one of those who get psych symptoms on the Pred. I also break out pretty bad, but Medrol allows me to not have as much fluid retention (although I find if I drink a LOT of water, no other liquid, I do better anyway). I don't get moon face as badly, I'm a 'natural born insomniac' so I'm like that on or off steroid, but I don't go all Jekyll and Hyde with Medrol like I do with pred.

Actually, benadryl at bedtime does the most for me. I'm on enough meds for my lungs.

Pam

[CheriYM]

[COLOR="Purple"]I hear you on the Jekyll and Hyde thing - my husband gets the brunt of it, unfortunately. I'm lucky that he's a pretty patient, understanding guy . . . I definitely have a much shorter fuse and am meaner on the 'roids. In the past I was always on 60mg max (except inpatient on IV)- so was not happy about the 100mg dose this time - although if the alternative is ending up back in the ER - I'll take it. I'll talk to the doc and see if we can try a switcheroo to medrol since it looks like the protocol is that I will have be on them about 6 months while I'm starting the Cellcept. He did lead me to believe that we could start reducing the dose when I see him in 2 weeks, so hopefully I heard that correctly . . .
Well, no luck finding my lab results so far But - I do have my new lab slip from this rheumatologist to get blood drawn in a week or so - and just noticed that he did not order my thyroid tests as I asked so I will alter the slip accordingly
I see the TSH, FT4, T4C, and T3C. Should I check all those? Do I need to write in the FT3? Any other tests you'd like to order for me?
Also - any input on timing of thyroid meds and immunosuppressants? I usually take my thyroid meds first thing when I wake up to pee, anywhere from 5-7, then go back to bed - or go play spades on the computer. I've started taking my AM cellcept (have to take on an empty stomach 2x/day an hour before or 2 hours after meals) an hour or so after the thyroid meds and then wait another hour to eat breakfast. Then take all my BP drugs just before breakfast and the prednisone after lunch. Second cellcept 1 hr before or 2 hrs after dinner depending on the timing and then ambien and atenelol before bed. Any thoughts on if it would make any difference to take thyroid meds further apart from cellcept? Maybe late afternoon?

Thanks for your help . . .[/COLOR]

[nonstickpam107]

Whoa! You're taking a beta blocker? Is that for heart rhythm, or is it for BP? (And BP could be better controlled maybe by something that's not a beta blocker?) Beta blockers (atenelol) really slow thyroid down, they use them when people are hyPER.

I can't tell ya what to do with lab test request, lol. Up to you.

Pam

[CheriYM]

[COLOR="Purple"]Yeah - beta blocker for my heart (had 3 MI's in early 90's - either lupus or steroid related) and also triple vessel disease - but good collateralization, so no bypass so far. So have been on it for years. Then had 3 or 4 more (mild ones) last year along with the hemoptysis. Sooooo - they are supposedly using the beta blocker to help protect my heart from being too taxed when I am properly suppressed with the thyroid meds - at least that's what they told me . . .
I see my Primary Care doc tomorrow - so will have him alter my lab slip[/COLOR]

[nonstickpam107]

I'd want Armour then..I think that would at least be 'splittable'. What thyroid hormone and how much are you on right now?

Pam

[CheriYM]

[COLOR="Purple"]Here's my current drug schedule:

6-8a - synthroid 212mcg (half a 300 and half a 125) and cytomel 10mcg
7-9a - cellcept-1000mg 1-2 hours later
8-10a - atenolol-50mg, Imdur-60mg, Lasix-40mg, aspirin-325g
9-11a - breakfast
2pm-ish - potassium chloride-10meq, calcium citrate/mag/Vit D
2-4p - lunch
3ish - prednisone 100mg (after lunch)
6p - lisinopril 5mg
8ish - dinner (lasix-40mg if ankles puffy/dinner isn't low sodium)
10ish - cellcept-1000mg
12-2a - atenolol-50mg, ambien-5 mg, novolog

Nitro for occasional angina
Flonase for allergies and occasional spiriva.
And I take insulin for the steroid induced diabetes [/COLOR]

[nonstickpam107]

You do know that 10mg. of Cytomel is 'gone' in four hours? Most women make about 27mg. of T3 in any given day. It's only 'active' for about four hours.

If you were switched to Armour, you'd be looking at starting at about 3 grains..and if your doc is 'hinky' about seeing VERY low TSH (under lab range sometimes) with Armour, he/she'll NEVER Rx. you enough to make a difference.

I'd be getting my FT4, FT3 labs...and get it four HOURS exactly after you take about 5mg. Cytomel, and your T4.

OR if the doc wouldn't go with Armour (enough of it) than I'd want to probably back down to (this is AFTER we see your Free T4 and Free T3 and TSH) about 150mcg. T4 and take 10mg. Cytomel in am, then 5mg (they make it in 5mg. tabs) four hours later, then 5 mg. about four hours after that, for a START. You'd do that for about three months, then retest FT's.

Pam

[CheriYM]

[COLOR="Purple"]Hey, Pam-

Got the labs back:

TSH - .14 range: .32 - 4.05

Triiodothyronine, Free - 2.4 Range: 2.4 - 4.2

Free T4 - 2.51 range: .7 - 1.24

I did know that the cytomel is short acting - but hadn't thought about spacing it throughout the day - makes sense - pretty sure my endo won't do Armour - haven't seen her in a long tiime - right now my PCP has been pretty agreeable, but he was hinky about a tsh of .06 - although he does look at the FT3 & 4
Right now I'm just excited that at least my tsh is suppressed AND that I get to reduce the prednisone from 100mg to 60 [/COLOR]

[nonstickpam107]

Your FT4 is OVER range, and you have virtually NO T3. Not a good thing. Would make you ache more, etc. It should be the other way around.

MOST patients on a combo are taking about 125mcg. T4, then 10mg. Cytomel in the morning, another 10 early afternoon, and 5mg. about 6pm. Just a suggestion. But FT4 being over range has a clear cut problem and association with osteoporosis problems.

Pam

[CheriYM]

[COLOR="Purple"]Hmmm . . . ok - not good as the steroids are also leaching calcium out of me already - although now we will reduce fairly quickly down to 10 or 20mg if I continue to tolerate the chemo/cellcept
My concern is that 125mcg is a big drop from the 212mcg I'm taking now and would not be enough for me - I weigh 210 right now and have seemed to always need more than the average person to suppress my tsh - and since I had soft tissue and vascular infiltrates with the papillary cancer would be important to stay suppressed . . . How much cytomel would be necessary to cover the synthroid? Is there a rough "equivalent" of t3/cytomel to t4/synthroid?

As for Armour - do people seem to absorb it better? And the fact that it has both t3 and t4 means you don't need cytomel? To complicate things further - my cardiac issues necessitate being careful of palpitations/heart rate/generally not overtaxing it . . . Do you know of any with cardiac issues that are on Armour?
Any thoughts on if it would be beneficial to try and get things into a better balance by reducing the synthroid and increasing the cytomel and taking it every 4 hours before attempting to switch to Armour?
Sorry to bombard you with all these thoughts/questions - and again, thanks for your input.[/COLOR]

[AllieCat0817]

Cheri, there is a TON of info about Armour online. Thyroid Disease Information - Hypothyroidism - Hyperthyroidism - Thyroid Cancer - Autoimmune Disease - Hashimoto's - Graves' - Goiter - Nodules is a great resource, but so is Google. You can read other people's experiences switching from Synthroid to Armour, or from Synthroid/Cytomel combo to Armour. Based on what I have read, people absorb Armour (or natural thyroid) better than synthetics because the porcine thyroid closely mimicks the human thyroid, MUCH better than synthetics ever could. Furthermore porcine thyroid has all of the thyroid hormones in it (T1, T2, T3 and T4).... and that also apparently helps for better absorption.

Since the Armour also has T3 in it in the actual RATIOS that mimick the human's, Cytomel plus Armour is probably overkill (but I have read that some people DO take both..).

[nonstickpam107]

Originally Posted by CheriYM

[COLOR="Purple"]Hmmm . . . ok - not good as the steroids are also leaching calcium out of me already - although now we will reduce fairly quickly down to 10 or 20mg if I continue to tolerate the chemo/cellcept
My concern is that 125mcg is a big drop from the 212mcg I'm taking now and would not be enough for me - I weigh 210 right now and have seemed to always need more than the average person to suppress my tsh - and since I had soft tissue and vascular infiltrates with the papillary cancer would be important to stay suppressed . . . How much cytomel would be necessary to cover the synthroid? Is there a rough "equivalent" of t3/cytomel to t4/synthroid?

As for Armour - do people seem to absorb it better? And the fact that it has both t3 and t4 means you don't need cytomel? To complicate things further - my cardiac issues necessitate being careful of palpitations/heart rate/generally not overtaxing it . . . Do you know of any with cardiac issues that are on Armour?
Any thoughts on if it would be beneficial to try and get things into a better balance by reducing the synthroid and increasing the cytomel and taking it every 4 hours before attempting to switch to Armour?
Sorry to bombard you with all these thoughts/questions - and again, thanks for your input.[/COLOR]

Um, I don't think you're grasping the 'concept'. here. First of all, the Cytomel you are taking is way too little T3, and the synthetic T4 is way too much T4. Ok? MOST women like labs around FT4 being 'midway of range', and FT3 being anywhere from midway to all the way up in range. Your labs are backwards of that.

It doesn't go by weight, throw that theory out the door.

And T3 is about four times more 'biologically available' as T4.

MOST (about 99%) humans would rather take natural thyroid hormone, not synthetic. Because you get T1, T2, T3, and T4 plus calcitonin for bone health (already has bone protection in it). Cardiac issues stem from too much T4 too, as well as too much T3. If you don't ALREADY HAVE CARDIAC ISSUES, than a natural thyroid would be fine. Also, menopause and low progesterone and estradiol gave me heart palps that practically raised me off the bed!

Yes, the doctor COULD reduce the T4 and increase the Cytomel. But at this point it's quite obvious the doctor doesn't 'get it' that your FT4 is too high and your FT3 is quite low. And this is usually the product of a doctor who's only ever seen most people on T4 ONLY who can convert.

So, that's the research. And my doctor is doing a massive study on bone thinning, osteoporosis and thyroid (he's a pioneer in the BHRT world) and I'm in it. My FT3 is at top of range, and my FT4 is about midway, and my TSH is a blip on the radar. I feel great. I've post meno, on no BHRT (now) and my bones are tip top. Go figure, even with massive steroids use. The steroids are a threat to the bone, and the Armour's calcitonin is a Godsend to combat it.

Pam

[CheriYM]

[COLOR="Purple"]Thanks, Allie, and Pam - for the info,
OK - I think I'm starting to 'get' it. I have an appt with a doc who prescribes Armour this Wednesday and in the meantime I dropped to 150mcg of synthroid today and took 5 of cytomel at 6, 10, 2 and 6. Was a little afraid of palpitations taking 10 and 10, so spread it out a little more and felt fine.
I had no idea that weight was not a factor in determining thyroid replacement needs - I figured bigger body would mean a need for bigger dose.
I am just now going through peri/meno had my last period at christmas so what - is it 6mo w/o a period and you are officially in meno? Up to this point my bones have been great. Hope to jeep it that way! Are you still on steroids? Can I ask how much? And my cardiac issues, unfortunately, were either lupus or steroid induced starting back in the early 90's. so will have to see what the doc says about all that.[/COLOR]

[nonstickpam107]

I'll be on steroids the rest of my life. I have PAN. It's a year with no period (unless you have thyroid disease, then you have to be tested for prog. estradiol, testosterone cuz having thyroid disease can stop your period anyway) for 'menopause' going by old fashioned docs. In my doctor's office, it's where your testing is at.

Pam

[CheriYM]

[COLOR="Purple"]So. when I go see the Armour doc - what dose would I reasonably expect her to start me out on and then I assume we would work up to a more therapeutic level?
Related to PAN - are you sensitive to fluorescent lights? Have you heard that they're phasing out incandescent bulbs? If you want more info let me know . . .[/COLOR]

[nonstickpam107]

Lighting doesn't have much affect on me. PAN is polyarteritisnodosa. After having Sjogrens, Hashimoto's, RA, OVCA, HIE and PAN, I could care less what type of bulbs are over my head, lol (sorry...it's just good to be alive at this point).

Up to the doctor on dosage. My doctor started me on 30mg (1/2 grain) for five weeks, then one grain, split into two doses for two months, than 1/2 grain, wait 3 months, another 1/2 grain, etc. Depended on my FT's labs.

Pam

[CheriYM]

[COLOR="Purple"]lol - I am so with you on it just being good to be alive!! I'd read somewhere that Sjogrens caused light sensitivity and could cause problems . . . supposedly can be enough UV to cause problems for some with fluorescents.[/COLOR]

[nonstickpam107]

I already have eye problems...from Sjogrens and from treatments for cancer, but not bothered by it so much that I would change lighting. Gosh, I'm never home anymore since starting this new job anyway, lol. They removed my salivary glands (I kept getting stones in them cuz I had hyperparathyroidism too before everything else). But sunlight bothers me the most...from skin reaction to the light sensitivity. I just buy really good sunglasses, lol.

Pam

[CheriYM]

[COLOR="Purple"]OMG, girl - you had cancer, too!?!? Geeesh!! Your attitude is amazing considering all you've been through!! Thanks for taking the time to pass on all the knowledge you've gained . . .

Ok - so now I am obsessing over not wanting to go hypo when I switch to Armour - I know you don't know what the new Armour doc will say/do - but am I right in assuming that since I'm already on synthroid and cytomel, she might start me on a higher dose - like maybe 3 grains split into 2 doses?[/COLOR]

[nonstickpam107]

3 grains would be overkill to the max. Don't even go there. No one would 'start' or switch to that, you'd go hyPER and be back to square one (several of us have been there, done that). So, if she DOES go there, don't do that.

What patients sometimes don't understand is the difference in the 'bioavailability' of Armour/natural thyroid. You cannot compare it to synthetics. And you'll find out why after awhile. When you are replacing ALL your hormones (T1, T2, T3 and T4 plus calcitonin in Armour/Westhroid) it feels more normal to the human than just taking synthetics.

Pam

[CheriYM]

[COLOR="Purple"]Alright - I'll just try to relax my hyper steroid foggy brain and be patient and wait and see what she says on Wednesday. And tell me if I'm starting to 'get' this . . .

Even though my TSH is .14, the fact that my body's not converting T4 to T3 means that technically I am probably hypo now?[/COLOR]

[nonstickpam107]

I don't put too much store by 'TSH' measurements. If your FT4 is way too high and FT3 way too low, it's an imbalance. High T4 will shove TSH down too, but no benefit cuz it's not converting to T3. It's talking you need BOTH at good levels, balanced to each other, with FT3 a bit higher than FT4.

They had me all the way up to 175mcg. and it did NOTHING for me except keep me from getting goiter. Without T3 I just feel like a lump of crap.

Pam

[tinatina]

Originally Posted by nonstickpam107

They had me all the way up to 175mcg. and it did NOTHING for me except keep me from getting goiter. Without T3 I just feel like a lump of crap.
Pam

This is exactly how I've been feeling lately. I've got a dr appt in a few hours!

[CheriYM]

[COLOR="Purple"]Well the doc yesterday was a wash with regard to thyroid stuff, but I'm getting my hormone levels checked - estrogen, progest. etc.
She wants me to see an endo and she was a little freaked about my tsh being 0.14. She did acknowledge that the FT4 was too high and FT3 too low - so I guess I'll either go back to my old endo or try to find another one.[/COLOR]

[CheriYM]

[COLOR="Purple"]Hey, Pam - in the meantime, while I am waiting to see/find an endo who will prescribe Armour, I have dropped my synthroid to 150 and upped cytomel to 20 (taken at 6,10,2 and 4). Should that be enough to keep my tsh suppressed? I understand the importance of getting the t3 and t4 balanced - but if I don't find a doc to prescribe Armour, can I do this with synthroid and cytomel successfully?
Today, I noticed some fullness under my chin and neck - not sure if that has anything to do with changing my doses - but have reduced my prednisone from 100mg to 60mg, so don't think I can blame it on the steroids.
Thanks again for your help . . .

PS - my mom - also a thca survivor - asked her doc (who is ALSO a thyca survivor) about testing FT3 & 4 and she wouldn't do it! Said she thought they got all the info they needed from the TSH!![/COLOR]

[nonstickpam107]

TSH is considered 'suppressed' when it is under .30. I see where you live (I'm from NY state) and it's HARD to get a good doc in NYC. I do believe there are a few who Rx. Armour (you might start another thread: 'Who's near NYC and has a doctor rx.'ing Armour?'). I know there are a few on this board who are near/in NYC who are on Armour OR have doctors doing FT's and not just going by TSH.

Fatal mistake is to change your Rx. if you aren't a doctor. You need a doctor to change your Rx. or amount of meds.

Pam

[CheriYM]

[COLOR="Purple"]OK - finally getting back and dealing with stuff again. Kinda needed a break from all the health crap. Saw my PCP doc - he agreed with my dosing of synthroid and cytomel, but when I asked him what he thought of Armour - he said they were a good hot dog company
So, no dice there on getting a script. Will post a thread asking if anyone knows of any docs in nyc who prescribe it as Pam suggested.[/COLOR]