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Dr. Mariano, I’ve been diagnosed with secondary hypothyroidism, and have been seemingly well managed with Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM). My initial symptoms, which were cold intolerance plus cold hands and feet, are now gone.
My most recent labs showed the following:
Total T4
> 4.0 (6.0-12.0)
Free T4
> 0.8 (0.8-1.8)
Total T3
> 167 (97-219)
Free T3
> 435 (220-440)
TSH
> <0.01.I’ve read on this forum that you like to see a total T4 from 8.0-12.0, at least in part to assure that plenty of free T4 is available to cross the blood brain barrier. My doctor seems to think that as long at the free T4 is OK, the total T4 is not critical.
Without giving any specific medical advice, I’d appreciate hearing your thoughts on this issue.
Thank you.
@wolverine 1176 wrote:
Dr. Mariano, I’ve been diagnosed with secondary hypothyroidism, and have been seemingly well managed with Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM). My initial symptoms, which were cold intolerance plus cold hands and feet, are now gone.
My most recent labs showed the following:
Total T4
> 4.0 (6.0-12.0)
Free T4
> 0.8 (0.8-1.8)
Total T3
> 167 (97-219)
Free T3
> 435 (220-440)
TSH
> <0.01.I’ve read on this forum that you like to see a total T4 from 8.0-12.0, at least in part to assure that plenty of free T4 is available to cross the blood brain barrier. My doctor seems to think that as long at the free T4 is OK, the total T4 is not critical.
Without giving any specific medical advice, I’d appreciate hearing your thoughts on this issue.
Thank you.
Your T-4 being low looks strange. By taking armour more then 2 times a day is over kill and you are risking absorption from issues from food or any supplements. One would also look at the cortisol levels as this could have a major impact of thyroid signaling at the tissue. You could have hyper thyroid levels in the blood but at the tissue could have cellular deficiency. One may want to look at taking 90mg BID which will keep a more even keel. The logic that you are using is that t3 life is about 6-8 hours, but you forgot about the conversion to t4 to t3 which compensates for this idea. If you were taking t-3 on its own then yes every 8 hours may be recommended. According to Dr.Lowe and Gina Honeyman t-3 can be administered once a day and people be fine with it. The ideology behind this is that the best absorption occurs in the morning on an empty stomach. In theory then dosages in the mid afteroon should be actually larger then the morning because there may be competition from food or vitamins. If you are taking armour 3 times a day then you are really putting your self at risk of reduces absorption of thyroid meds. Instead of armour one may want to add in some t-4 to level bring the 2 levels back into more even level. May be reducing armour to 2 grains and then adding 100 mcgs of t-4 may be what may be needed by your Dr to level things out. Many thyroid boards would suggest increase your armour to 3.5 grains but this will drive t-3 even higher which in your case is not needed (unless you are getting pooling from low cortisol). When you mention adding in t-4 to the mix they get their panties in a bunch. Adding t-4 is taboo, but in some clinical cases may help to alleviate some of the symptoms that have not cleared up on current protocol.
@hardasnails1973 1177 wrote:
Your T-4 being low looks strange. By taking armour more then 2 times a day is over kill and you are risking absorption from issues from food or any supplements. One would also look at the cortisol levels as this could have a major impact of thyroid signaling at the tissue. You could have hyper thyroid levels in the blood but at the tissue could have cellular deficiency. One may want to look at taking 90mg BID which will keep a more even keel. The logic that you are using is that t3 life is about 6-8 hours, but you forgot about the conversion to t4 to t3 which compensates for this idea. If you were taking t-3 on its own then yes every 8 hours may be recommended. According to Dr.Lowe and Gina Honeyman t-3 can be administered once a day and people be fine with it. The ideology behind this is that the best absorption occurs in the morning on an empty stomach. In theory then dosages in the mid afteroon should be actually larger then the morning because there may be competition from food or vitamins. If you are taking armour 3 times a day then you are really putting your self at risk of reduces absorption of thyroid meds. Instead of armour one may want to add in some t-4 to level bring the 2 levels back into more even level. May be reducing armour to 2 grains and then adding 100 mcgs of t-4 may be what may be needed by your Dr to level things out. Many thyroid boards would suggest increase your armour to 3.5 grains but this will drive t-3 even higher which in your case is not needed (unless you are getting pooling from low cortisol). When you mention adding in t-4 to the mix they get their panties in a bunch. Adding t-4 is taboo, but in some clinical cases may help to alleviate some of the symptoms that have not cleared up on current protocol.
At this time I’m not having any untoward symptoms under my current protocol. My question is whether a total T4 of 4.0 and a free T4 of 0.8 indicate that I have a sufficiently large pool of serum T4 to insure adequate brain levels of free T4 and ultimately free T3.
@wolverine 1176 wrote:
Dr. Mariano, I’ve been diagnosed with secondary hypothyroidism, and have been seemingly well managed with Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM). My initial symptoms, which were cold intolerance plus cold hands and feet, are now gone.
My most recent labs showed the following:
Total T4
> 4.0 (6.0-12.0)
Free T4
> 0.8 (0.8-1.8)
Total T3
> 167 (97-219)
Free T3
> 435 (220-440)
TSH
> <0.01.I’ve read on this forum that you like to see a total T4 from 8.0-12.0, at least in part to assure that plenty of free T4 is available to cross the blood brain barrier. My doctor seems to think that as long at the free T4 is OK, the total T4 is not critical.
Without giving any specific medical advice, I’d appreciate hearing your thoughts on this issue.
Thank you.
When I believe a person has suboptimal thyroid signaling which requires thyroid hormone treatment (some can instead correct by improving iodine, addressing HPA Axis dysregulation, etc.), then I use either T4, Armour Thyroid, T3, or some combination of these.
—
Armour Thyroid is primarily a T3 treatment. The loss of native T4 production often is not made up by the T4 component of Armour Thyroid.
The question is: will this cause a problem in a patient?
It depends on the patient.
Many people can get along with Armour Thyroid quite well. The T3 component of Armour Thyroid generally gives it a noticeable kick when it comes to brain function in general than a pure T4 treatment (Levothyroxine), a sharper sense of well-being. But this does not occur with everyone.
For example, the rest of the system may not allow a heavily T3 treatment to work. If adrenal function is compromised, for example (which is common in mental illness), then the additional T3 may destabilize the system, causing anxiety, irritability, fatigue, stress, etc. In such a patient, a T4 only treatment may be a better choice.
—
My initial rule of thumbs regarding thyroid hormone levels are rules of thumb. There are always exceptions to a rule of thumb. But as a rule of thumb, it provides a starting point.
Thyroid signaling problems can be caused by problems not related to thyroid gland function. This is called Non-Thyroid Illness affecting thyroid function. This is a common problem in mental illness.
One use of my rule of thumb is as a screening tool to determine if a person needs thyroid hormone replacement or if the problems causing thyroid hormone signaling dysfunction are elsewhere in the system. For example, if T4 is already greater than 8.0, I may decided to forgo thyroid hormone treatment and instead improve functioning in the rest of the system to eventually improve thyroid signaling.
—-
T3 generally be taken once a day with up to a 24-hour half-life generally. But the half-life varies. Some people have shorter half-lives for T3 and thus they have to take their T3-containing thyroid treatment more frequently.
Again, treatment depends on the person and needs to be customized to the person.
@DrMariano 1181 wrote:
When I believe a person has suboptimal thyroid signaling which requires thyroid hormone treatment (some can instead correct by improving iodine, addressing HPA Axis dysregulation, etc.), then I use either T4, Armour Thyroid, T3, or some combination of these.
—
Armour Thyroid is primarily a T3 treatment. The loss of native T4 production often is not made up by the T4 component of Armour Thyroid.
The question is: will this cause a problem in a patient?
It depends on the patient.
Many people can get along with Armour Thyroid quite well. The T3 component of Armour Thyroid generally gives it a noticeable kick when it comes to brain function in general than a pure T4 treatment (Levothyroxine), a sharper sense of well-being. But this does not occur with everyone.
For example, the rest of the system may not allow a heavily T3 treatment to work. If adrenal function is compromised, for example (which is common in mental illness), then the additional T3 may destabilize the system, causing anxiety, irritability, fatigue, stress, etc. In such a patient, a T4 only treatment may be a better choice.
—
My initial rule of thumbs regarding thyroid hormone levels are rules of thumb. There are always exceptions to a rule of thumb. But as a rule of thumb, it provides a starting point.
Thyroid signaling problems can be caused by problems not related to thyroid gland function. This is called Non-Thyroid Illness affecting thyroid function. This is a common problem in mental illness.
One use of my rule of thumb is as a screening tool to determine if a person needs thyroid hormone replacement or if the problems causing thyroid hormone signaling dysfunction are elsewhere in the system. For example, if T4 is already greater than 8.0, I may decided to forgo thyroid hormone treatment and instead improve functioning in the rest of the system to eventually improve thyroid signaling.
—-
T3 generally be taken once a day with up to a 24-hour half-life generally. But the half-life varies. Some people have shorter half-lives for T3 and thus they have to take their T3-containing thyroid treatment more frequently.
Again, treatment depends on the person and needs to be customized to the person.
Thanks, Dr. Mariano. BTW, I’ve also been diagnosed with secondary hypogonadism and secondary hypoadrenalism (the latter on the basis of an insulin hypoglycemia test), and take supplemental testosterone, HCG, hydrocortisone, Florinef, DHEA, and pregnenolone.
I think I’m doing reasonably well with my Armour regimen. What symptoms might I experience if my CNS thyroid signaling were suboptimal?
@wolverine 1176 wrote:
Dr. Mariano, I’ve been diagnosed with secondary hypothyroidism, and have been seemingly well managed with Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM). My initial symptoms, which were cold intolerance plus cold hands and feet, are now gone.
My most recent labs showed the following:
Total T4
> 4.0 (6.0-12.0)
Free T4
> 0.8 (0.8-1.8)
Total T3
> 167 (97-219)
Free T3
> 435 (220-440)
TSH
> <0.01.I’ve read on this forum that you like to see a total T4 from 8.0-12.0, at least in part to assure that plenty of free T4 is available to cross the blood brain barrier. My doctor seems to think that as long at the free T4 is OK, the total T4 is not critical.
Without giving any specific medical advice, I’d appreciate hearing your thoughts on this issue.
Thank you.
My thoughts (I am not a doctor, not even close).
Per dr Mariano past recomendations, it is good to have Ferritin(100-150)
iodine + selenium
=(219-97)*2/3+97=178Your TotalT3=167 lacking
it is (slightly) less than 2/3 of range
In recent LEF magazine they recomend thyroid management to achieve TT3 higher than 2/3 of range
to be tested ReverseT3 and antibodiesmanage suplementation to achieve
RT3 in lower half of range
0.5
Off hand, there is a good possibility that 3Grains is too much as it totally suppresses TSH.
So possibly 2.5Grains would work better..
@JanSz 1189 wrote:
My thoughts (I am not a doctor, not even close).
Per dr Mariano past recomendations, it is good to have Ferritin(100-150)
iodine + selenium
=(219-97)*2/3+97=178Your TotalT3=167 lacking
it is (slightly) less than 2/3 of range
In recent LEF magazine they recomend thyroid management to achieve TT3 higher than 2/3 of range
to be tested ReverseT3 and antibodiesmanage suplementation to achieve
RT3 in lower half of range
0.5
Off hand, there is a good possibility that 3Grains is too much as it totally suppresses TSH.
So possibly 2.5Grains would work better..
Ferritin
> 142 (24-336)
Reverse T3
> 17 (11-32)
Thyroglobulin AB—> <20 (<20)
Anti-TPO AB
> <10 (<35)Since my pituitary can’t produce much TSH (I’m secondary), my doc isn’t worried about total TSH suppression.
The Journal of Clinical Endocrinology & Metabolism 2005; 90(12):6403–6409
Thyroid Hormone Concentrations, Disease, Physical Function and Mortality in Elderly Men
Annewieke W. van den Beld, Theo J. Visser, Richard A. Feelders, Diederick E. Grobbee, and Steven W. J. Lamberts Department of Internal Medicine , University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
This study of 403 men investigated the association between TSH, T4, free T4, T3, TBG and reverse T3 (rT3) and parameters of physical functioning. This study demonstrates that TSH and/or T4 levels are poor indicators of tissue thyroid levels and thus, in a large percentage of patients, cannot be used to determine whether a person is euthyroid (normal thyroid levels) at the tissue level. In fact, T4 levels had a negative correlation with tissue thyroid levels (higher T4 levels were associated
with decreased peripheral conversion of T4, low T3 levels and high rT3). This study demonstrates that rT3 inversely correlates with physical performance scores and that the T3/rT3 ratio is currently the best indicator of tissue levels of thyroid.
This study showed that increased T4 and RT3 levels and decreased T3 levels are associated with hypothyroidism at the tissue level with diminished physicial functioning
and the presence of a catabolic state (breakdown of the body). This study adds to the mounting evidence that giving T4 preparations such as Synthroid and Levoxyl are inadequate for restoring tissue euthyroidism and that a normal TSH cannot be relied upon as as an indication of euthyroidism, as it has a very low sensitivity and specificity for hypothyroidism. This poor sensitivity and specificity is further decreased with the presence of one or more systemic illnesses, including diabetes, heart disease, hypertension, systemic inflammation, asthma, CFS, fibromyalgia,
rheumatoid arthritis, lupus, insulin resistance, obesity, chronic stress and almost any other systemic illness.
Low T3 syndrome, with low T3 and high reverse T3, is almost always missed when using standard thyroid function tests, as the T3 level is often in the low normal range and reverse T3 is the high normal range, again making the T3/rT3 ratio the most useful marker for tissue hypothyroidism and as a marker of diminished cellular
functioning. The authors of this study conclude, “Subjects with low T3 and high reverse T3 had the lowest PPS [PPS is a scoring system that takes into account normal activities of daily living and is a measure of physical and mental functioning]…
Furthermore, subjects with high reverse T3 concentrations had worse physical performance scores and lower grip strength. These high rT3 levels were accompanied by high FT4 levels (within the normal range)…These changes in thyroid hormone concentrations may be explained by a decrease in peripheral thyroid hormone metabolism…
Increasing rT3 levels could then represent a catabolic state, eventually proceeding an overt low T3 syndrome.”
This study demonstrates that TSH and T4 levels are poor measures of tissue thyroid levels, TSH and T4 levels should not be relied upon to determine the tissue thyroid levels and that the best estimate of the tissue thyroid effect is the rT3 level and the T3/rT3 ratio.@wolverine 1190 wrote:
Ferritin
> 142 (24-336)
Reverse T3
> 17 (11-32)
Thyroglobulin AB—> <20 (<20)
Anti-TPO AB
> <10 (<35)Since my pituitary can’t produce much TSH (I’m secondary), my doc isn’t worried about total TSH suppression.
I suspect that you are as perfect as one can get (numerically), while on medicine.
What is your oral temperature (if you do not have any oral infections).
Goal, Oral temperature (36.25 – 36.80)C = (97.25 – 98.24)F (no sinus or oral infections)There is talk about new ArmourThyroid formulation.
Hopefully it will not affect you.Just in case
3GrainsArmour=114mcg(T4) + 27mcg(T3)========================================================
Armour 180 mg a day (60 mg at 4:00 AM, 60 mg at 11:00 AM, and 60 mg at 5:00 PM).
TSH
> <0.01.
Total T4
> 4.0 (6.0-12.0)
Free T4
> 0.8 (0.8-1.8)
Total T3
> 167 (97-219)
Free T3
> 435 (220-440)
Reverse T3
> 17 (11-32)
Thyroglobulin AB—> <20 (<20)
Anti-TPO AB
> <10 (<35)
Ferritin
> 142 (24-336)Since my pituitary can’t produce much TSH (I’m secondary), my doc isn’t worried about total TSH suppression
.
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