From the Guidelines
I would recommend increasing the Armour Thyroid dose from 60mg to 90mg daily. This adjustment is based on the patient's lab values showing hypothyroidism with low T3 (1.95), low T4 (0.70), and elevated TSH (6.414), indicating inadequate thyroid hormone replacement at the current dose 1. The dose should be increased gradually, so the patient should take the medication once daily in the morning on an empty stomach, 30-60 minutes before eating.
Key Considerations
- After 6-8 weeks on the new dose, thyroid function tests should be repeated to assess the response.
- If symptoms persist or lab values remain abnormal, further dose adjustments may be needed.
- Armour Thyroid contains both T3 and T4 hormones, which should help address both low hormone levels.
- The elevated TSH indicates the pituitary is signaling for more thyroid hormone production, confirming the need for a higher dose.
Monitoring and Precautions
- Patients should be monitored for signs of overtreatment such as palpitations, anxiety, or insomnia, which would suggest the dose may need to be reduced.
- Thyroid function should be monitored after metabolic control has been established for several weeks, with a TSH measurement, and if TSH is abnormal, free T4 and, if indicated, total T3 can be measured 1.
From the Research
Adjusting Armour Thyroid 60mg
To adjust Armour Thyroid 60mg in a patient with a T3 level of 1.95, T4 level of 0.70, and TSH level of 6.414, consider the following:
- The patient's T3 and T4 levels are low, while the TSH level is high, indicating hypothyroidism 2, 3.
- The conversion of T4 to T3 may be influenced by various conditions, and circulating T3 is a less reliable reflection of thyroid hormone production than T4 2.
- Free T4 (FT4) and free T3 (FT3) measurements are considered more reliable than total hormone measurements for assessing thyroid function 2, 3.
- The patient's thyroidal status is unstable, and TSH determination may be diagnostically misleading; therefore, free hormone measurements are more reliable for thyroid function assessment 2.
Considerations for Adjustment
When adjusting the Armour Thyroid 60mg dose, consider the following:
- The patient may benefit from a combination of thyroxine (T4) and triiodothyronine (T3) hormone replacement therapy, as some patients do not feel well on monotherapy 4.
- The use of combination therapy should be undertaken by clinicians experienced in the field, with appropriate monitoring for adverse outcomes in both short and long term 4.
- The selection of the correct patient for a trial of combination therapy is crucial to avoid delaying diagnosis or potentially worsening an undiagnosed condition 4.
- Monitoring of thyroid function, benefits, and adverse effects is vital in the trial setting, given the lack of evidence on safe long-term use of combination therapy 4.