Is the fatigue caused by MC or under-treated thyroid?

DebE13 · Post by **DebE13** » Wed Mar 15, 2017 3:27 pm

I have been taking Armour for eight weeks now and have my follow up visit with my doctor on Friday. It was a slow transition to the 2 grains I currently take (60 mg at 7 am and 60 mg at 1 pm). The nurse told me that it is not likely he will allow anything higher but I'm wondering if I should ask to add a quarter grain just to see if it helps. It seems I'm never satisfied. I got my lab results and I am back to pretty much the same numbers I was at when taking the Tirosint/Liothyronine combination. I can say taking one brand has been absolutely heaven. It seemed like I was running to the pharmacy every other week.

free T3 was 2.7 (2.4 - 4.1 pg/mL normal range) previously was 2.5
free T4 was 1 (0.9 - 1.5 ng/dL normal range) previously was 1.3
TSH was 0.18 (.60 - 5.40 uIU/mL normal range previously was .88

I was hoping to get my free T3 into the upper end of the range to see if it would make a difference in how I feel. I'm not there yet so would adding a quarter grain possibly raise it? I tried to increase the dose previously with the synthetics but then had palpitation issues and that little experiment failed. Does my train of thought make sense? I went into a bit of a flare about the same time I was having hyper symptoms so the increase D I attributed to being over medicated. I can say my brain fog has cleared but my tiredness remains. There are just so many factors involved that it's hard to know if continuing to claim I am not at my optimal dose is a legitimate gripe. Due to my cancer history my plan was to keep my TSH close to zero. I haven't had the night and day difference feeling with the switch to Armour but I do notice some improvements and want to continue with this as my medication.

So I am now at a cross roads with deciding if my uncontrolled MC is the cause of my fatigue. My doctor already expressed his concern that he wasn't sure the switch to Armour would resolve my complaints since I also deal with the chronic pain issues/fibro. Then I also wonder how perky I expect to be when I wake up at four every morning. Of course, by 8 PM I am going to be tired. Add in a very long, dark winter and I seriously don't know what my next step should be. I am so very tired of pooping 4-8 times a day. I was contemplating giving an elimination diet a try (hamburger an rice?) to see if there are food triggers left in my diet. Doing that would take an extreme amount of willpower and would be devastating if nothing improved. What do the people with MC do when nothing works? I know my diet is key because I absolutely know when I eat something I shouldn't. So in that regards, I'm feeling pretty good (food-wise) but still have WD as my norm.

Post by **tex** » Wed Mar 15, 2017 5:01 pm

Frankly I'm surprised that your TSH and other numbers look so good with such a low treatment. I used to take 1 grain of Armour for years and my thyroid is intact and functional. I took 2 grains for a few months and that worked well, also. It's hard to say if another quarter grain would help, but it might. I didn't even realize quarter-grain doses were available.

Do you chew the tablets or swallow them? A lot of Armour users insist that since the formulation was changed (back in 2009 I believe) the coating is much harder and slower to dissolve so they chew their tablets in order to get a better response. I still swallow mine.

Yes, MC can cause world-class fatigue when it's active.

Tex

DebE13 · Post by **DebE13** » Wed Mar 15, 2017 5:37 pm

I think I have it right.... 1/4 grain (15mg). Thought it'd be worth a try if my doc is agreeable to it. I have no doubt I can recognize what it feels like to take too much. Been down that road three times now. I'm not sure what my labs would be at but if it doesn't work then we are back to what we know is an acceptable dose. I was thinking it would be just my luck to start Armour and have my labs get thrown way off and then I'd be back to the doctor insisting I revert back to the synthetic.

I seem to be extremely sensitive to any medications. I was relieved to see my numbers basically the same as before I switched. I started out at one grain only and slowly increased to 1 1/2 grains which is where he wanted to leave it at. I asked to give the two grains a try and I could feel the difference. One day I accidentally took two 90 mg pills instead of the two 60 mgs and within a few hours after the afternoon dose, I was well aware that it was too much. It wasn't as bad as previous increases with Tirosint (had horrible chest pressure and palps) but I knew it wasn't right.

I just let them dissolve under my tongue. They don't seem to be uniform though. Most of them are quick to dissolve and a bit grainy but sometimes I get one that takes a bit longer and almost feels like the "skin" comes off and then sticks to my teeth. Either way, it doesn't take that long and I'm still tickled pink everyday that I am taking what I WANTED to try. How do you argue NDT is a bad thing when the numbers shake out the same. Plus, I'm I much more pleasant patient.

I don't think I can say I've ever had remission since my MC started in 2007. I feel better because I eliminated many offending foods from my diet but there's still major issues if I continue to have D. I am still happy that I've made the progress I have but am hoping that this isn't as good as it's going to get. It may be the case but I can't say I will ever stop trying to figure it out.

Gabes-Apg · Post by **Gabes-Apg** » Wed Mar 15, 2017 5:47 pm

MC is a big contributor to fatigue - for me and my combo of health issues, my digestion/poop quality can be perfect but I still have fatigue issues.
I am having a sleep study done next week to see if there are oxygen issues contributing to that.

for me and my combo of health issues - to function on a normal day I need a minimum of 9 hours sleep rest.
in hot weather, or days where there is additional stress ( be it physical, emotional, mental) then I can need 10-12 hours sleep to wake up feeling ok.

This summer we had excessive heat, that was interrupting my sleep badly during the week. On the weekends I was needing 2-3 hour naps in the day, plus the minimum 10 hours of a night to 'recover' from big week to have enough energy and focus to do complex work tasks.

it has been like this for over 4 years for me. Despite ongoing functional treatments and supplements like active B12, CoQ10, etc to help with energy, focus. my sleep quality is pretty good once asleep, many nights I can sleep through storms, fireworks, gunfire.
and when overtired have slept through alarms going off

The sleep requirement coupled with the high maintenance eating plan does invade weekend time/relaxation time a fair bit, Albeit for me, it is what it is.

Deb · Post by **Deb** » Thu Mar 16, 2017 6:44 am

DebE, I have continually tweaked my NDT amounts based on how I felt. At one point I was taking 5 grains, which I think I needed at that time. I built up to that amount over the course of at least a year. If I got hyper symptoms I would reduce by 1/4 to 1/2 grain until they went away. I was on 3 grains for at least a couple of years recently. When I started on the ReMag I started getting some symptoms so I reduced by 1/2 grain. I am feeling good on this dosage. I take two in the morning and 1/2 of one around noon. Deb

Post by **Rosie** » Thu Mar 16, 2017 9:50 am

DebE, I just want to mention here that I had to adjust my dose of levothyroxine when I started supplementing with the active forms of the B vitamins. I had Graves Disease about 8 years ago and had the radio-iodine ablation treatment that wiped out my thyroid gland. I had been stable on 100 micrograms of levothyroxine for at least 5 years when I started supplementing with the active forms of the B vitamins about 2 years ago. Within a week I was having hyperthyroid symptoms, with rapid heartbeat, etc. When I told my doctor about this and that I wanted to reduce my dose, he didn't really believe me. So I challenged him to order a blood test, and was a bit smug when it showed that indeed I was hyperthyroid. So I reduced my dose to the next level, 88 micrograms, but then after a few weeks was feeling a bit sluggish and like that wasn't enough. So back to my doctor, where another test showed that indeed I was a bit hypothyroid. By this time my doctor was finally willing to believe that my self-monitoring was accurate, and agreed to prescribe both the 100 microgram and 88 microgram pills and let me find an intermediate dose that worked for me. So now I alternate the two doses, feel just fine and my lab tests are good. Occasionally I will feel a bit hyper or hypo, and then adjust by taking more of a particular dose for a few days. I wonder if other supplements might also affect the utilization of the various thyroid hormones? I think that it's a moving target to find the right dose of thyroid hormone, as it is so central to our metabolism, and there are so many interacting pathways. I wish that doctors would pay more attention to how we feel.......

Good luck with fine-tuning your NDT.

Rosie

Post by **tex** » Thu Mar 16, 2017 11:33 am

Most MDs seem to feel that once they have settled on a dose, that's it — case closed. But it's not that simple, because many other things affect the demand for thyroid hormones. It's a far more complex situation than they are trained to comprehend.

Tex

brandy · Post by **brandy** » Thu Mar 16, 2017 2:36 pm

Hi Deb13,

I couldn't remember if you had tried the LDN for WD? Or the cholestyramine? I've never tried LDN but just mentioning it.

My MC fatigue was the worst symptom of MC, much worse then dealing with WD.

Brandy

Deb · Post by **Deb** » Thu Mar 16, 2017 3:08 pm

I agree. No one knows or understands exactly how I am feeling. I need to make decisions that understand and honor that. It is sometimes scary to step out on our own but it gets easier. Deb

DebE13 · Post by **DebE13** » Sat Mar 25, 2017 5:11 am

Thank you all for sharing your experiences. I currently take LDN for pain management issues and at the moment it seems to be less effective but I don't want to discontinue in fear I am misjudging its effectiveness. I had a rough start when I began taking it so don't ever want to go through that again. I have no clear dx of fibro since I don't react to the points of tenderness that I should yet it still regularly comes up. Whatever it is I have, at one point, I was worried I wouldn't be able to do my job anymore because I was in so much pain. That simply is not an option. Looking through my medical dx I found: Arthralgia of multiple joints, Iron deficiency anemia, unspecified iron deficiency anemia type, Morton's neuroma of left foot, Primary osteoarthritis of both hands, Bilateral carpal tunnel syndrome, Polyarthralgia, Positive ANA (antinuclear antibody), Central pain syndrome.... there's more but the more I read, the more irritated I get because nothing has been done to help any of my issues except for what I have pushed to do.

I have tried cholestyramine and it seemed to make things worse. I've stopped Entocort again, this time for about two weeks. I'm at loss with what to do with my ferritin. It's at 28 and that's been after almost two years of iron pills. I've stopped now because they made me sick within an hour of taking them. I've been dealing with MC for ten years now and it has gotten easier but not by much. I'm trying to commit to an elimination diet to see if anything improves before I see my GI next month. Nothing seems to help and I need some relief. I am diligent with avoiding gluten and soy. I avoid dairy but have had small amounts of cheese infrequently with no noticeable changes. The only eggs I eat would be what is in Udi's bread. Areas I could improve on are avoiding legumes, sugar (fruits, lara bars, etc) and now I'm focusing on nightshades since I have so many pain issues. I cringe to think about eliminating potatoes- it is one of my staples. Although, I like sweet potatoes so maybe it would be an easy transition. It seems only logical to suck it up and try an elimination diet before seeking other medications. I read the side effects of those meds and I don't know which is worse- the possible damage from those or continued inflammation and a very tight leash with what I do outside of my own home.

Tex, you are right..... My doc has reached that settling point. I wanted to try a quarter grain more and he would not oblige. My FT3 went up slightly but I still wanted to try to get it in the upper range to see if it would help. He made a comment that still confuses the heck out of me. He said at this point chasing numbers would not be productive since the numbers don't mean anything because I am taking Armour. That was the jist of it anyway. We are dosing based on how I feel and not my numbers and since I feel better (I do but not "better" enough) the dose will stay at 2 grains. I go back in July.

I asked why the lab numbers would not be accurate when we basically hit the same mark I was at when I was on the synthetics. I didn't get a clear answer and knew I was beginning to push it. He is quite aware that it is virtually impossible to find a doctor that will consider NDT in this area. He also isn't convinced that my fatigue is caused by my thyroid. I'm can see his point too considering my other health issues. He could be right but that leaves me with a big question mark as to what my next step should be. My son takes Lialda and aziathioprine. I'm beginning to think that if taking a pill would help- it would actually be a nice change. Then I think more.... and don't know if I can go down that road.

Lots of bad attitude today..... I am happy to be taking NDT and have more good days than I have had in a long time. Progress is in baby step which is still a good thing.

Post by **tex** » Sat Mar 25, 2017 1:31 pm

Deb,

It appears that your doc doesn't actually understand Armour — he just tolerates the concept of using it.

Deb wrote:He said at this point chasing numbers would not be productive since the numbers don't mean anything because I am taking Armour. That was the jist of it anyway. We are dosing based on how I feel and not my numbers and since I feel better (I do but not "better" enough) the dose will stay at 2 grains.

No wonder you're confused. He's talking out of both sides of his mouth. Yes, if you're going to use Armour then you should treat by symptom resolution rather than by test results. But he obviously doesn't actually believe that because he ordered blood tests anyway. And if he's going to order blood tests anyway, then either the numbers mean something or they don't. If they don't, why did he order the tests?

But that's sort of irrelevant anyway. The point he is missing is that the reason for using NDT is not to match the patient's lab results with synthetic treatments, nor is the point to make the patient feel as well on NDT as she or he felt on synthetic treatments. The point of using NDT is to do a better job of resolving symptoms than is possible with synthetic treatments. Apparently he isn't willing to do that which makes him somewhat of a hypocrite. Still, he's definitely a step above his holier-than-thou colleagues who aren't even willing to consider the use of NDT.

But that's just my opinion. Are you aware that it's possible to buy all the NDT you want without a prescription? I'm not recommending that, I'm just pointing out the option.

Tex

DebE13 · Post by **DebE13** » Sun Mar 26, 2017 5:17 am

No I did not. I actually thought about trying to split my 90 mg tablets that I don't take anymore to try the quarter grain addition that I was hoping might help but dismissed it because it would be too difficult to get an accurate dose and I would eventually run out. I have no doubt in my mind what too much feels like and am not that foolish to make a bad situation worse but it sure would be worth a try IMO. If I get hypo symptoms I stop and know I've tried. I am hung up on the comments I read over and over again that many don't feel good until their FT3 is in the upper range- mine still is not. The down side would be if my labs are thrown off then I would have some explaining to do and I would loose his trust. Got my wheels turning though.....

Deb · Post by **Deb** » Sun Mar 26, 2017 5:41 am

Deb, for my half grain increase I just bite my pill in "half". It all equals out over two days (or in your case 4 days). I didn't find that a quarter dose made a huge difference either way but I haven't had to deal with what you have. Mine are 60 mg though.

Post by **tex** » Sun Mar 26, 2017 9:29 am

I'm only taking 30 mg these days so I use a pill splitter to split 60 mg tablets. It works OK.

Tex

Jonas · Post by **Jonas** » Mon Mar 27, 2017 4:50 am

I’m just wondering have you checked your adrenals? Fatigue can be adrenal fatigue, and if you have adrenal fatigue you should be very careful with increasing thyroid medication. It will stress them even more.
I have that problem with T3 medication since my adrenal function is far from optimal.

https://stopthethyroidmadness.com/adrenal-info/

https://www.drlam.com/blog/adrenal-fati ... rt-1/3643/
http://drrind.com/therapies/metabolic-symptoms-matrix