Feeling tired as always, but this week I’ve felt like I’m coming down with something. I have Hashimoto’s. NatureThroid 65mg. I tried Armour Thyroid 2-3 years back and didn’t feel any better than on Synthroid, so changed back.
It was interesting that when the PA’s office drew the TSH it was lower than ever, then last week when I had the draw before taking my dose the TSH was about the same as it was in paperwork my PMD gave me (not sure when that result was from, 1 year?) My diet is probably average, some junk food. The PA wanted me to go gluten-free and dairy-free. I’m certain I can’t do both; everything gluten free in the freezer section has cheese in it! I don’t have time to cook from scratch for every meal.
OK. That explains why you still have symptoms and why your FT4 went down, FT3 stayed the same, resulting in drop in TSH. 65 mg NatureThroid is “1 grain” and is the beginning dosage. This is following the 32.5 starter dosage. 1 grain does not contain much T4. 1 grain contains only 38 mcg T4 (levothyroxine) and 9 mcg T3 (liothyronine). 38 mcg T4 is a low amount of T4. 9 mcg T3 is close to the common dosage of liothyronine. The problem with these “natural” medications that are combo T3 and T4 is that if a person requires more T4 than is in 1 grain, to get more, you are also increasing T3 by 9 mcg. Could always just add more plain T4. By comparison, the starter dose of levothyroxine is usually 50 mcg (test at 6 weeks, increase to 75 mcg if necessary). Starter dosage of liothyronine is 5 mcg few days, then to 10 mcg or eventually to 15 mcg if FT3 remains too low.
1 grain of Armour thyroid medication contains the exact same T3 and T4 levels at NatureThroid, 9 mcg and 38 mcg. Synthyroid is name brand T4. Generic, Levothyroxine. Cytomel is name brand T3. Generic, Liothyronine. Some people need both T3 and T4, so they take Levothyroxine and Liothyronine together. I take both. In the beginning, I briefly tried NatureThroid. It was awful. Felt sick and fatigued. Like some Hashi’s patients, I had an autoimmune response to the ingredients.
A year is a long time to go between lab work if you still have symptoms. Testing is every 6 weeks until the correct med dosage is found that eliminates symptoms. TSH isn’t what’s so important, it’s FT3 and FT4. Rising TSH can go with reduced FT3 and FT4, or sometimes just one or the other. Medication should be prescribed based on the symptoms and current FT3 and FT4 levels, not TSH. Fluctuating levels is normal until stabilized by medication and diet. Blood drawn prior to medication is expected to have increased TSH and decreased FT3 and FT4 to some degree compared to blood drawn after medicating.
LOL. The Diet! I said the same when I was told I needed to do an elimination diet. I said I couldn’t do it. I didn’t believe it would help. I rebelled for 8 more months, felt like complete crap, and then gave in. It took awhile but I discovered that it really is possible to feel better if you eliminate inflammatory junk. Eliminated gluten, dairy, soy. They are inflammatory. Inflammation increases autoimmune reaction and increases the attack on your thyroid. Benefits can out weigh the bad effects of eating gluten, dairy and soy, then it makes sense to stick with it. Processed gluten free food is not healthy anyway. Long long list of chemicals. Veggies, protein, gluten free starches and fibers and be prepared as simply or as elaborately as you choose. I eventually added in some dairy, but now I can tell that it causes inflammation if I have too much. Not worth it.
My PA as well as online comparison charts say 1 grain Nature-Throid is equivalent to 100 mcg levothyroxine, which is twice the levothyroxine I was on before seeing the PA.
Comparison charts are made by the manufacturer of WP Throid and NatureThroid and try to compare apples to oranges. Medication containing a combo of T3 and T4 cannot be directly compared to a straight T4 medication. Each medication serves a different purpose. T4 converts to T3 but some people don’t convert due to autoimmune or other problems. Some patients only need T4, while others don’t do well on straight T4 because they also need T3. These patients either take a separate T3 with their T4, or they try a medication that combines T3 with T4, like an NDT. Some people do horribly on medication containing T3 because their FT3 is already at a good level and they don’t need more.
The chart saying that 1 grain NatureThroid (38 mcg T4) is equivalent to 100 mcg synthetic T4 is rather misleading. 38 mcg of T4 is 38 mcg of T4, and 100 mcg of T4 is 100 mcg of T4. 100 mcg T4 how ever you take it is a generous serving of T4. If 1 grain containing 38 mcg T4 actually was equivalent to 100 mcg T4, then your FT4 would probably not have dropped and your FT3 would probably not have only remained the same. If it really is the equivalent, then why did I have similar symptoms to you when I tried it as my first medication? I then switched to 50 mcg T4 and 10 mcg T3 and immediately felt so much better. Felt even better when I increased to 75 mcg T4 plus the T3. Night and day feeling over the 1 grain NatureThroid, which made me fatigued, felt ill. No comparison.
If you were previously only on straight T4 at the starter dosage of 50 mcg and you still had symptoms, sounds like you possibly either needed a higher dosage or you also needed T3. You tried Armour for 2-3 years but didn’t feel any better than you did on Synthroid, so you switched back. Now trying NatureThroid (identical levels T3 and T4 as Armour), still having symptoms and T4 drops. Once you are finally on the right type of medication for you and at the right dosage that you need, you will feel great and you will have few or no symptoms. This can take a few cycles of follow up labs every 6 weeks following each med adjustment and should be achieved within 6 to 9 months. Repeat the process if symptoms increase again.
I wasn’t on the Armour for 2-3 years, it was 2-3 years ago. Not sure for how long. Back when I was still seeing an endocrinologist; dumped him when he seemed to have little interest in me and my health.
I tried to take Armour but couldn’t metabolize it properly, I now take compounded sustained release T3. My GP feels it’s safer that Cytomel (T3), and I’m doing quite well on it.
My primary doc changed my levoxothyroxine dose from 50 mg to 25 mg about three years ago without letting me even consult with endocrinologist who had me on the higher original dose since I was 4 1/2 years old. It has been terrible experience with my periods just about disappearing, less energy, thin hair that tends to fall out, slower all the way around, less focusing ability, and general down spin in life. This primary doc refuses to refer me to endocrinologist as my labs are “normal” since he changed my med dose. I felt so much better when I was on my original dose from endocrinologist for over fifteen years, but insurance now doesn’t allow me to get opinion from endocrinologist if my primary doesn’t refer me. To be a pain, my primary doc did send me to OBGYN who did lots of tests and confirmed I do not have problems in that area. I do not have early menopause. It is all very frustrating.
I forgot to update after my PA appointment. Since it took so long to get an appointment and I had leftover levothyroxine, I started taking 25 mcg in addition to the Nature-Throid. After a week or two I bumped up to 50 mcg. When I saw the PA she was talking about going to 81.25 mg of Nature-Throid (I didn’t think that was going to help!) but decided to keep the 65 mg of NT and increase to 75 mcg of levothyroxine. Some days I feel like I have a little more energy, but I still feel dead on other days–especially my days off when I need to get things done.
I feel your pain! Yes, it is so frustrating! I too was dished bad medical guidance when I was first diagnosed (and many, many times after). Within a month of diagnosis and not being given any medication, I crashed really hard and could barely function or move. I went thru 8 doctors trying to find one who agreed that the problem was my thyroid and that I needed meds. It “only” took me five months to do this and then I was finally started on the two right medications. I knew I needed T3 in addition to T4 from the beginning. Of course my primary and an endocrinologist ignored my T3, so I went elsewhere for that within days of starting my T4. Jackpot!! Is there any reason you are putting up with all of this suffering? There are always other doctors. You don’t need an endocrinologist. You just need a doctor who is knowledgeable about thyroid disease…that’s all. Three years passing and suffering from increased symptoms is an awfully long time. If a doctor pulls something like changing the meds you’ve been on all your life, you don’t have to tolerate it if it makes no logical sense, and especially if you feel much worse. If your symptoms increase after med changes, that usually means it’s the wrong meds and/or dosage.
Can you get a new doctor? It’s ok to stand up for yourself and to be your own advocate. No one else will. You don’t need to suffer. The right medication will take all if not almost all of your symptoms away. If you also have autoimmune thyroid disease, the right diet and supplements will lower your antibodies, which lowers the attack on your thyroid, and you will feel so much better with this, too. Have you checked your antibodies?
Sometimes it not just a thyroid problem that causes extreme fatigue. Sleep apnea is one that comes to mind and is frequently associated with hypothyroidism. Others are adrenal insufficiency, depression and chronic fatigue syndrome. Of course, when your thyroid levels are all in the normal range, the automatic go-to for most doctors is depression… they don’t bother to find out if there are other conditions that may be contributing to the fatigue.
She has Hashimoto’s, which is an autoimmune immune disease and much different than just hypothyroidism. With Hashimoto’s, the body’s immune system is attacking the thyroid. Some people with Hashimoto’s end up hypothyroid, but not all. The leading cause of hypothyroidism is Hashimoto’s, but many people don’t even know they have it because their doctors never thought to test their antibodies. Undiagnosed and untreated autoimmune activity and/or insufficient thyroid medication plus a diet containing antigens or inflammation causing foods only compounds the body’s attack on the thyroid, and increases autoimmune reactions and hypothyroid symptoms.
I’m sorry to hear you still don’t feel well after all this time. That is so frustrating! At this point, if your meds and diet to reduce autoimmune activity were right for you, you have your normal energy levels and you’d be feeling great. You should feel better within days or a few weeks with the right medication. If the problem is your thyroid antibodies, that will take much much longer to see and feel improvement. You also might not be feeling well from all those med changes. That’s good you didn’t didn’t send yourself into a thyroid storm or cardiac arrest from fast and large increases in meds. Increases are usually very small and only after labs indicate a need, plus consideration of current symptoms. After a med increase, labs are done 6 weeks later. Additional increases are only done if labs and symptoms indicate a need. Hopefully had current labs before and then after all those increases to see where you’re at.
What do you do for your Hashimoto’s to reduce autoimmune activity and lowering of your antibodies? If your thyroid hormones are currently in the optimal range, it could be your antibodies and autoimmune activity are causing your symptoms. I hope you find out what’s going on and you feel better soon!
Not following how you think it was a “fast and large increase.” Since “they” say 1 grain (65 mg) NT = 100 mcg levothyroxine, I was originally on 1/2 grain equivalent of NT=50mcg l-thyroxine. Before getting labs, the PA added another 1/4 grain of NT–a 50% increase. After labs I changed to 1 grain NT = 33% increase.
When I added my l-thyroxine on, I was on 1 grain NT and added on 25 mcg l-thyroxine= 1/4 grain–a 25% increase. Then when I upped l-thyroxine to 50 mcg that was a 20% increase.
The PA did recommend a gluten and dairy free diet to lower antibodies; she did not mention that it might make me feel better. I’ve reduced gluten quite a bit, but going completely GF for more than a few days is next to impossible since I can’t cook for every meal. If I buy GF frozen meals, most of what appeals to me has dairy. I’ve been thinking “screw it” WRT diet because I unexplainedly lost 30 pounds over about a year, gained a little back, now have lost again. I want to gain 20 pounds and trying to eat GF restricts me so much that I eat hardly anything.
Thanks, but I am well aquatinted with Hashimotos, what it is, the symptoms/effects on the body, and the various diagnostic tests and treatment approaches. From OTTB’s posts it sounds like she is experiencing symptoms of hypothyroidism and is being treated as such.
What I was trying to point out previously was that sometimes continued fatigue could be also related to an undiagnosed sleep disorder, especially if your Hashimotos has been treated and is stabilized.
Hashimotos, hypothyroidism and sleep apnea have been linked for quite some time. It could be a “chicken or the egg” type relationship. Apnea results in increased levels of stress hormones/cortisol which can cause inflammation, autoimmune problems, weight gain, etc. Hashimotos can cause weight gain, macroglossia, swelling of the larynx and mucus membranes, enlarged neck, etc.
If you don’t know about the suspected relationship of Hashimotos and sleep apnea, here is one paper on it.
Thank you, but I am acquainted with what Hashimotos is, the symptoms, tests, diagnosis and different treatments.
What I was trying to point out is that sometimes the continued fatigue could also be related to other problems, such as sleep apnea, in addition to the Hashimotos. Just something to be aware of if you are still exhausted even if your Hashimotos is under control.
The incidence of sleep apnea in people with Hashimotos has been known for quite some time and is a continuing topic of research. It could be a “chicken or the egg” type occurrence for some. Sleep apnea causes an increase in stress hormones/cortisol that can trigger autoimmune problems, cause weight gain, etc. Hashimotos can cause weight gain, swelling of the tongue, throat, neck, etc. If you have both apnea and Hashimotos, treating one condition may help with the other or you may need to treat both.
if your unfamiliar with the relationship between sleep apnea and Hashimotos, here is a link to one of the research papers on it
Thank you COL. I do know about Hashimotos, it’s symptoms/effects, diagnostic tests and different treatment strategies.
i was trying to point out that sometimes the fatigue can be also related to a co-existing condition such as sleep apnea. The relationship of apnea to Hashimotos was found quite a while ago and is a topic of continued research. For some, it may be a “chicken or the egg” situation. Apnea can cause a release of stress hormones/cortisol that can trigger or exacerbate autoimmune problems. Hashimotos can cause weight gain and swelling of the lips, tongue, throats and neck.
If you are unfamiliar with the connection between sleep apnea and Hashimotos or hypothyroidism, here is one research paper on the topic
