HI Deb,
I started on one-half grain, and after a few months doubled it to one grain. I stayed on that dose for ten years, until I started having hyperthyroidism symptoms (this was a couple of months after the kidney stones episode) as my magnesium deficiency finally became severe. At that point my doctor suggested cutting the dose in half, by slicing the tablets in half (because there's not much difference in the cost of different dosage pills), so I've been taking a half-grain since then. Magnesium deficiency can indeed cause hyperthyroidism symptoms. Cutting the Armour dose in half did bring my thyroid labs back into the normal range, but unfortunately it only helped to suppress the clinical symptoms for about two weeks, then they came back.
At the time we cut the dose in half, I suggested that we just eliminate it altogether, but he insisted that once your body becomes accustomed to taking a thyroid supplement, you can't completely stop. I have a pretty strong hunch that my initial hypothyroidism symptoms were due to my chronic magnesium deficiency. The symptoms started a couple of months after my first abdominal surgery. I'm guessing that all of the antibiotics (it was an emergency surgery, so I couldn't clean out first), plus all of the stress, knocked what was left of my meager magnesium reserves for a loop. And the anesthetic probably added to the problem. At any rate, that was when I first became unable to take a deep breath.
According to my calculations (above), one grain is about half of what you will actually need, but it will depend on how you respond to the T4/T3 ratio in Armour. You should be reasonably close to equilibrium with the starting dose in about two weeks. IOW, if you feel rough after a couple of weeks, you're probably not going to feel any better after a month. Endos seem to be overly-cautious by nature, so as a group they tend to prefer to wait a month (rather than a couple of weeks) before assessing the results of dosage changes.
But remember, my thyroid is still intact, so treatment isn't as important as it is in your case.
You're on your way (hopefully on your way to feeling much better in general).
Tex
What to do, What to do.... Cytomel is not my friend (today)
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
I had to ditch the endo population and the doctor I am working with is in internal medicine. If things go well, I will part ways with my team of doctors and will have to come up with a new plan for the annual cancer follow ups. We've already discussed this scenario so it seems doable. He is familiar with LDN and has no problem with continuing that line of treatment for pain management. I am tempted to discontinue just to see how I feel but it was a rough ride adjusting to it so I don't want a repeat if the pain comes back and I have to start taking it again. Plus, I don't want to try anything new (including foods) right now in addition to the Armour because it will be too difficult to determine the cause of not feeling right.
My new doc has gained popularity by word of mouth and has knowledge of fibromyalgia and understands the complications of multiple health issues. He already knows that I won't get any help from the endo community because my labs are in the therapeutic range and commented that it is quite rare, in this area at least, that I was allowed the Tirosint/Cytomel combination. I am well aware of that so am appreciative that he is willing to let me have a go at it. I found that he messaged me this morning asking if I had any post visit questions. I was quite surprised and will ask about adding a half grain in 1-2 weeks depending on how I feel. From there we will just have to keep increasing every 4-6 weeks until we find what works.
I am chuckling at how simple that sounds..... Maybe it's finally my turn for something to go smoothly and I'm not jinxing myself by saying so.
I don't expect a flawless transition but am determined this is going to work. Or it might not..... however it turns out, I am just very thankful that I have the opportunity to try what has worked for so many others.
Thanks for all your thoughts and calculations Tex. It puts me on the right path to knowing the best way to move forward. As always, You are so very appreciated.
My new doc has gained popularity by word of mouth and has knowledge of fibromyalgia and understands the complications of multiple health issues. He already knows that I won't get any help from the endo community because my labs are in the therapeutic range and commented that it is quite rare, in this area at least, that I was allowed the Tirosint/Cytomel combination. I am well aware of that so am appreciative that he is willing to let me have a go at it. I found that he messaged me this morning asking if I had any post visit questions. I was quite surprised and will ask about adding a half grain in 1-2 weeks depending on how I feel. From there we will just have to keep increasing every 4-6 weeks until we find what works.
I am chuckling at how simple that sounds..... Maybe it's finally my turn for something to go smoothly and I'm not jinxing myself by saying so.
I don't expect a flawless transition but am determined this is going to work. Or it might not..... however it turns out, I am just very thankful that I have the opportunity to try what has worked for so many others.Thanks for all your thoughts and calculations Tex. It puts me on the right path to knowing the best way to move forward. As always, You are so very appreciated.
Deb
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease
Sorry, I forgot that you mentioned that.Deb wrote:I had to ditch the endo population and the doctor I am working with is in internal medicine.
I'm half asleep this morning anyway. I got to bed late, woke up early with a stiff, sore neck (that's been getting worse every day), and couldn't get back to sleep. It finally dawned on me that I'm sensitive to beef. A sister gave me some beef sausage for Christmas, and I've been eating it most days for the last 4 or 5 days. 
I think I'll write a separate post about it.I agree that you seem to have found a keeper. It's not easy to find a physician who is so open-minded, keeps up with alternative treatments (or treatments not endorsed by most of mainstream medicine), and is so willing to work with his or her patients. I definitely believe that he will turn out to be the light at the end of the tunnel that you have been searching for.
And of course, as always, you're most welcome.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I sent my doc a message just putting the thought out there that even though one grain is the typical started dose, maybe I should start slightly higher since I don't have a thyroid and it seemed a bit low. No luck on that one. The nurse replied and said the conversion chart states that the 100 mcg of Tiorsint equals one grain of Armour and to give an update in two weeks. I also suggested bumping up my dose in two weeks so I am at least happy it wasn't a check back in a month or 6-8 weeks. I refrained from shooting back a response asking what happened to the consideration that I wasn't only taking Tirosint. The conversion did not factor in that I was also taking 10 mcg of cytomel too. I was not pleased at all but considering it took me three years to find someone to even let me try NDT, I didn't want to shoot myself in the foot and start things off the wrong way. I've felt pretty crappy for quite a long time so I figure I can tough it out, whatever that may be.
It's been seven days now and I am very aware that this dose is severely inadequate. Day three I started noticing that I felt worse than usual but was not totally convinced that it wasn't just me obsessing about it. Last night, I hit the couch at six to watch movies with my husband and was dead to the world until I woke up at five this morning. So much for Friday date night, huh?
It's been interesting to notice previous issues creeping back. I've developed a mild headache that won't go away. That ache and burning in my eyes has returned. Remember years ago, I complained of the same thing and had no clue what caused it. This is the same pain that lasted for over a year and caused me to be unable to wear contact lenses. It's scary to have it pop up again but it also gives me confirmation that it was linked to my thyroid. Of course, I am TIRED- more than usual and afternoons hit me hard. I look forward to taking a split dose. My neck and shoulder tension and pains have returned and the sensation in my neck (another type of pressure) is back. My carpel tunnel has flared in both wrists and is most bothersome. That one I know is linked in part to the ice storms we had this week. I did a lot of ice chopping which sparked the flare but it is reluctant to subside. I keep hearing my first endo saying "You can't blame everything on your thyroid....." Well, actually everything I was complaining about actually seems to be very related. Rant need not continue.
I've had a couple of mornings where my trips to the bathroom have been surprisingly improved. I am reluctant though to give an credit yet to the change in medications. I've found my body likes to tease me. I quickly go through the list in my head of what did I eat or not eat that caused an improvement. If I get too big of a smile my body quickly reminds me how unpredictable MC can be. It's still a glimmer of hope.
So I have one more long week to wait it out. I plan to message my doc Thursday night so he has all day Friday to send that increase of Armour to the pharmacy so I don't have to wait through the weekend. So my next question is, I suspect he will only want to increase it by a half grain. How long do I hold that dose before the next increase? Two weeks, four weeks?
Would it be better to increase to two grains and hold it there for 6-8 weeks and then run labs?
I have such high hopes in this changing things around. I can see why people throw up their hands and say NDT doesn't work for them if this is what they have to go though. There are no quick fixes and I want to keep moving forward because right now I am taking huge steps backwards and I don't know how long it will take to un-do what is being created.
It's been seven days now and I am very aware that this dose is severely inadequate. Day three I started noticing that I felt worse than usual but was not totally convinced that it wasn't just me obsessing about it. Last night, I hit the couch at six to watch movies with my husband and was dead to the world until I woke up at five this morning. So much for Friday date night, huh?
It's been interesting to notice previous issues creeping back. I've developed a mild headache that won't go away. That ache and burning in my eyes has returned. Remember years ago, I complained of the same thing and had no clue what caused it. This is the same pain that lasted for over a year and caused me to be unable to wear contact lenses. It's scary to have it pop up again but it also gives me confirmation that it was linked to my thyroid. Of course, I am TIRED- more than usual and afternoons hit me hard. I look forward to taking a split dose. My neck and shoulder tension and pains have returned and the sensation in my neck (another type of pressure) is back. My carpel tunnel has flared in both wrists and is most bothersome. That one I know is linked in part to the ice storms we had this week. I did a lot of ice chopping which sparked the flare but it is reluctant to subside. I keep hearing my first endo saying "You can't blame everything on your thyroid....." Well, actually everything I was complaining about actually seems to be very related. Rant need not continue.
I've had a couple of mornings where my trips to the bathroom have been surprisingly improved. I am reluctant though to give an credit yet to the change in medications. I've found my body likes to tease me. I quickly go through the list in my head of what did I eat or not eat that caused an improvement. If I get too big of a smile my body quickly reminds me how unpredictable MC can be. It's still a glimmer of hope.
So I have one more long week to wait it out. I plan to message my doc Thursday night so he has all day Friday to send that increase of Armour to the pharmacy so I don't have to wait through the weekend. So my next question is, I suspect he will only want to increase it by a half grain. How long do I hold that dose before the next increase? Two weeks, four weeks?
Would it be better to increase to two grains and hold it there for 6-8 weeks and then run labs?
I have such high hopes in this changing things around. I can see why people throw up their hands and say NDT doesn't work for them if this is what they have to go though. There are no quick fixes and I want to keep moving forward because right now I am taking huge steps backwards and I don't know how long it will take to un-do what is being created.
Deb
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease
Yes, they're much more conservative with their conversion. Here's a link to a PDF of the conversion chart that they use. They just ignore the T3 (doctors like to keep their math as simple as possible).
http://centraldrugsrx.com/pdf/Thyroid_C ... 08-13a.pdf
The reason why your BMs are somewhat improved may be due to the tendency of hypothyroidism to slow down motility, which can cause constipation. Of course there's always a chance that it may be due to the more balanced T1–T4 ratios. Time will tell, as the dose is increased.
And yes, doctors probably love to prove (if they can) that Armour is no better than the synthetic substitutes. Some may do it subconsciously, while a few probably do it intentionally.
You're fortunate that he's willing to update in 2 weeks rather than 4 or 6 weeks. IMO 2 weeks is a reasonable turnaround time for thyroid treatment changes because only tiny changes are likely to occur after that. Long intervals between tests can be counterproductive if results are out of range.
I will agree that for a patient who doesn't even have a thyroid, 1 grain appears to be a ridiculously low treatment dose. But please give the guy a chance to do it his way. Remember that you're playing in his ballpark and if he doesn't like the way the game is going, he can call it off at any time, and that would be disastrous. Hopefully your lab results will indicate a need for a much larger dose.
If you get to a point where he thinks your labs look good, but you're still having clinical symptoms, he'll probably give you an opportunity to try an increased dose to see what it does to your symptoms, and hopefully the labs will still remain in range. He's already indicated a willingness to treat symptoms by agreeing to prescribe Armour. You just have to be patient until you get to that point. If you get to a point where your labs look good and you still have symptoms and he's unwilling to try a dose adjustment, then it's time to consider whining a bit.
You're on your way, and better days are in your future, but remember that doctors like to feel that they're in charge. And we tend to get along with them much better if we allow them to feel that way.
If they feel threatened, they can be very uncooperative.
Tex
http://centraldrugsrx.com/pdf/Thyroid_C ... 08-13a.pdf
The reason why your BMs are somewhat improved may be due to the tendency of hypothyroidism to slow down motility, which can cause constipation. Of course there's always a chance that it may be due to the more balanced T1–T4 ratios. Time will tell, as the dose is increased.
And yes, doctors probably love to prove (if they can) that Armour is no better than the synthetic substitutes. Some may do it subconsciously, while a few probably do it intentionally.
You're fortunate that he's willing to update in 2 weeks rather than 4 or 6 weeks. IMO 2 weeks is a reasonable turnaround time for thyroid treatment changes because only tiny changes are likely to occur after that. Long intervals between tests can be counterproductive if results are out of range.
I will agree that for a patient who doesn't even have a thyroid, 1 grain appears to be a ridiculously low treatment dose. But please give the guy a chance to do it his way. Remember that you're playing in his ballpark and if he doesn't like the way the game is going, he can call it off at any time, and that would be disastrous. Hopefully your lab results will indicate a need for a much larger dose.
If you get to a point where he thinks your labs look good, but you're still having clinical symptoms, he'll probably give you an opportunity to try an increased dose to see what it does to your symptoms, and hopefully the labs will still remain in range. He's already indicated a willingness to treat symptoms by agreeing to prescribe Armour. You just have to be patient until you get to that point. If you get to a point where your labs look good and you still have symptoms and he's unwilling to try a dose adjustment, then it's time to consider whining a bit.
You're on your way, and better days are in your future, but remember that doctors like to feel that they're in charge. And we tend to get along with them much better if we allow them to feel that way.
If they feel threatened, they can be very uncooperative.Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I agree with Brandy, I worked back office for some Docs. And they don't get to their phone messages promptly. Also add after you give him the symptoms etc. Add what do you think Doctor? So you make it sound as if it is his idea to increase or add a med. Ego!! Also make his nurse your friend. Be extra nice etc. "Get more bees with honey" In fact I would call around 11 am, in case he is in the office and finishing his morning patients.
Janie
Great advice to someone who has a difficult time being patient. 
I do plan on fostering this relationship because he is not the typical doctor. He takes his time during the visits and actually listens to what I have to say. He is very up front in his hesitations and easily admits that cases with multiple issues are very hard to treat. I wish other doctors would realize how meaningful that can be. Not always encouraging but it something we all know- no one has all the answers to everything. His willingness to "practice" medicine instead of writing it off my complaints as unrelated provides the hope to keep on going.
It may be a fluke but I've noticed those painful ridges on the side of my tongue that have never gone away are almost nonexistent right now.
Thanks Brandy and Janie for the suggestions. I've actually started using the on-line messaging system through my patient account. I've found it preferable to leaving phone messages because I don't have to worry about my verbal message being condensed/edited/or misunderstood. The nurse most likely relays the information that way too but at least I know my whole thought is in print and on record. I totally agree with getting on the nurse's good side. I've had issues before with crabby nurses and I wasn't even able to make contact with the doctor because they didn't feel it was necessary. Luckily, his nurse has a pleasant demeanor and has been very friendly so far. There is a different feel in the office. I'm not sure if it's because it's a small town and there seems to be less patient traffic.
My doctor seems more focused on finding a method that works than stroking his own ego. I am always sure to ask his view on my understanding of "how things work" because I don't want to come across as a pushy know-it-all. I know I am far from being an expert but I am also in tune with my own body and know I have always been the square peg that doesn't fit in the round hole.
I think I will send the message Thursday afternoon. My luck, he will be off on Friday and I will be stuck waiting until Monday.
I do plan on fostering this relationship because he is not the typical doctor. He takes his time during the visits and actually listens to what I have to say. He is very up front in his hesitations and easily admits that cases with multiple issues are very hard to treat. I wish other doctors would realize how meaningful that can be. Not always encouraging but it something we all know- no one has all the answers to everything. His willingness to "practice" medicine instead of writing it off my complaints as unrelated provides the hope to keep on going. It may be a fluke but I've noticed those painful ridges on the side of my tongue that have never gone away are almost nonexistent right now.
Thanks Brandy and Janie for the suggestions. I've actually started using the on-line messaging system through my patient account. I've found it preferable to leaving phone messages because I don't have to worry about my verbal message being condensed/edited/or misunderstood. The nurse most likely relays the information that way too but at least I know my whole thought is in print and on record. I totally agree with getting on the nurse's good side. I've had issues before with crabby nurses and I wasn't even able to make contact with the doctor because they didn't feel it was necessary. Luckily, his nurse has a pleasant demeanor and has been very friendly so far. There is a different feel in the office. I'm not sure if it's because it's a small town and there seems to be less patient traffic.
My doctor seems more focused on finding a method that works than stroking his own ego. I am always sure to ask his view on my understanding of "how things work" because I don't want to come across as a pushy know-it-all. I know I am far from being an expert but I am also in tune with my own body and know I have always been the square peg that doesn't fit in the round hole.
I think I will send the message Thursday afternoon. My luck, he will be off on Friday and I will be stuck waiting until Monday.
Deb
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease
"Do not follow where the path may lead. Go instead, where there is no path, and leave a trail.
-Ralph Waldo Emerson
2007 CC
2013 thyroid cancer- total thyroidectomy
2013 Hashimoto's - numbers always "normal"
2017 Lyme's Disease