fibromyalgia and thyroid

Dear Friends,
I was diagnosed with fibromyalgia a while back and suffered for several years with unremitting, extreme, body wide pain. Finally, God answered my prayers for HELP, and it was determined that I had a Thyroid problem that had gone undiagnosed for several years. I was put on a natural Thyroid replacement hormone (ARMOUR THYROID), and I am now pain free!!! In doing some research I found out it is common to be diagnosed as fibromyalgia, when the underlying (hidden) issue is the Thyroid. Maybe you can benefit from my experience

First, here is some information on Docs in your area that are Armour friendly I got from the following website: http://www.armourthyroid.com/locate.html

Second, I have attached an article on the connection between Hypothyroidism and fibromyalgia, along with three articles from my then doctor, Dr. Mercola, on the proper treatment of Hypothyroidism. Dr. Mercola's approach is a radical improvement over the current traditional method, which typically uses only the TSH tests (Thyroid Stimulating Hormone) to diagnosis and monitor hypothyroidism, and synthetic hormones, like Synthorid, to treat the condition.

Below I outline the problems in getting effective help for hypothyroidism, and the ways to overcome these hurdles through the use of Dr. Mercola's non-traditional, yet medically based, approach(on a side note, I would not recommend following Dr. Mercola on a number of other issues, as he gets way into some areas of Alternative Medicine that are too far out but on Hypothyroidism he is on target)

The first and most basic problem in finding help for hypothyroidism is that the traditional test to diagnose the disease (the TSH test) is far too insensitive. Today, the most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood, which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed. Thus, many patients with TSH results of greater than 2.0 but lower than 4.5 have classic symptoms and signs of hypothyroidism (see articles below) yet remain untreated. These poor persons, who constantly feel ill and ill tempered, are often labeled as hypochondriacs and/or as having emotional problems. Depression, menopause, fibromyalgia, chronic fatigue syndrome, and other elusive, degrading diagnosis may also be given. It is a pitiful and maddening plight, and the louder one cries out for help the more one is derogatorily labeled. THIS IS EXACTLY WHAT HAPPENED TO ME.

The second basic problem with traditional approaches is that most traditional approaches use the synthetic hormone (Synthorid) to treat the condition rather than natural thyroid hormone (as in Armour Thyroid), which is now considered old fashion. When one has low T3 levels, which are typical with synthetic hormone use, the brain does not work properly. Unfortunately, unlike natural hormone, most synthetic substitutes contain only T4 (thyroid hormone #4), while T3 (included in natural preparations) is the key component necessary to relieve the very common mental and emotional disturbances that are classically caused by hypothyroidism. Only natural thyroid hormone preparations, such as Armour, contain both T4 and T3, and even a minute deficiency of T3 in the brain can cause havoc on ones emotional life and mental state.

The third problem with the traditional approach is that traditional fails to use Free T3 and T4 tests, and uses only the TSH test to monitor the effectiveness of hormone replacement therapy. Thyroid hormone replacement dosages (both synthetic and natural) are increased typically in very small increments (15 mg) until elevated TSH levels fall into the normal reference range of .40 5.5. Unfortunately TSH is NOT an indicator of how much thyroid hormone is circulating in the body, but only how much thyroid hormone the pituitary sensors perceive is in the body. Based on this perception the pituitary gland secretes thyroid-stimulating hormone (TSH), which controls thyroid gland hormone secretions. Unfortunately, the use of TSH test alone causes many physicians to under-prescribe thyroid hormone replacement therapy. Thus many hypothyroid patients never receive enough of the replacement hormone to completely relieve their often many and varied symptoms of hypothyroidism. Patients might continue to complain, but under the traditional approach to hypothyroidism treatment such patients are told nothing is wrong, the test results prove their thyroid condition is under control.
After TSH levels fall below .40, Dr. Mercolas method uses Free T3 and Free T4 (which is the amount of thyroid hormone which is actually circulating in ones body) to monitor the effectiveness of natural thyroid replacement therapy. These levels should be above the median (middle) but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiac and/or elderly patients, the numbers should be in the middle of its range.

The fourth problem is that most physicians, even those who use Free T3 and T4 to monitor thyroid levels, fail to use the bodys own wisdom in establishing the optimal dosage (balance point) required for any particular patient. While a great boon to thyroid treatment, even Free T3 and T4 tests do not show the REAL picture. T3 and T4 test show only much T3 and T4 is circulating in your body. NO CURRENT TEST can tell you how much of the circulating hormone, T3 and T4, is actually being utilized by the body in its metabolism. The only way to really find the optimal dosage of thyroid replacment hormone is to push the dosage up in tiny (15 mg) increments until a personal balance point is reached. This means increasing the dosage until hyperthyroid (overactive) condition is induced, and immediately backing off this dosage by the said 15 mg amount. Each person has a specific balance point where a minute amount of replacement hormone (15 mg) would cause that person to be in a hyper or hypo thyroid condition. The trick is to find that balance point. A 15 mg overdose is easily identified by the bodys reaction including excessive sweating, constant activity, and inability to sleep. The dosage should be increased until either ALL SYMPTOMS (however many, varied, or seemingly insignificant) are eliminated; or the balance point is reached, as indicated by a temporarily induced hyperthyroid (overactive) condition.

The fifth problem with effective treatment for hypothyroidism is having the personal wherewithal and patience to continue with this strategy alone, resisting the temptation to intermingle other therapies until the optimal dosage is found. At first it seems impossible that a few tiny pills could resolve so many varied and odd symptoms as hypothyroid patients may have, but it is possible, with perseverance, by applying above therapeutic strategy. Intermingling of therapies will only confound the situation, making it impossible to tell the true effectiveness of thyroid replacement therapy. In some cases this will be impossible, but when it is possible such a strategy is ideal.

The sixth problem, is finding a physician to work with you until all your symptoms are eliminated or your balance point dosage is reached. Personally, knowing what I know now, I would recommend that one search for a physician who is willing to treat with this method, and keep searching until one is found.

The seventh and perhaps largest problem with getting help for hypothyroidism is that the many and varied symptoms of hyperthyroidism seem unconnected, and while bothersome, unimportant why then try to get help in the first place. The reason they seem so disconnected is because thyroid hormone is essential to metabolism, and thus a deficiency of hormone can affect literally every system in the body, from head to toe. In addition, such symptoms often creep up on one so very slowly that they seem to be normal. For example one thinks it is just normal to be cold all the time (even in the summer), it is just normal to have irregular bowel habits, it is normal to have hair fall out with every washing, it is normal to have emotional ups and downs all the time, it is just normal to be tired all the time, etc., etc. -- and so no medical advice is sought. Yet left unattended a hypothyroid condition can wreak on the body to the point of incapacitation.
Here are the titles and links to the articles I have enclosed:
How To Know If Your Thyroid Is Working Properly With Blood Tests: http://www.mercola.com/article/hypothyroid/diagnosis.htm
Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels: http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
How To Monitor Your Treatment With Natural Hormone Therapy: http://www.mercola.com/article/hypothyroid/treatment.htm
Also, I would recommend the following books if you are interested:
Living Well With Hypothyroidism What Your Doctor Doesnt Tell You That You Need To Know by Mary J. Shomon.
Hypothyroidism: The Unsuspected Illness, by Broda O. Barnes, M.D. and Lawrence Galton.
The Thyroid Solution: A Mind-Body Program for Beating Depression and Regaining Your Emotional and Physical Health.
I hope this information help you. Also, feel free to pass this information out to whoever might benefit, as it would make me happy that others could possibly benefit from my experience.
Sincerely In Christ, Phyllis

How To Know If Your Thyroid Is Working
Properly With Blood Tests
http://www.mercola.com/article/hypothyroid/diagnosis.htm
A recent study showed that nearly 13 million Americans may be unaware of and undiagnosed for their thyroid conditions. Are you one of them? Another study showed that if you are a pregnant woman and you have a low thyroid your child's IQ will be affected. Yet another recent study showed that if you an elderly woman with thyroid problems you will have an increased risk of heart disease
The big myth that persists regarding thyroid diagnosis is that an elevated TSH (thyroid stimulating hormone) level is always required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would typically suggest an underactive thyroid.
Your Doctor Does Not Likely Understand How To Interpret Your Tests Properly
Thyroid function tests have always presented doctors with difficulties in their interpretation. Laboratory testing is often misleading due to the complexity and inherent shortcomings of the tests themselves. Many doctors not having an adequate understanding of what the test results mean, will often make incorrect assumptions based on them or interpret them too strictly. A narrow interpretation of thyroid function testing leads to many people not being treated for subclinical hypothyroidism.
Old Laboratory Tests Unreliable
Most all older thyroid function panels include the following:
Total T4
T3 Uptake and
Free Thyroxine Index (FTI).
These tests should be abandoned because they are unreliable as gauges of thyroid function.
Current Laboratory Tests Readings (TRH) Inadequate
Today, the most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood, which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed.
Basal Body Temperature
Basal body temperature popularized by the late Broda Barnes, M.D. He found the clinical symptoms and the body temperature to be more reliable than the standard laboratory tests was provided. This is clearly better than using the standard tests. However there are problems with using body temperature.
Sleeping under electric blankets or water beds falsely raise temperature
Sensitive and accurate thermometer required
Inconvenient and many people will not do (poor compliance)
New and More Accurate Way To Check for Hypothyroidism
This revised method of diagnosing and treating hypothyroidism seems superior to the temperature regulation method promoted by Broda Barnes and many natural medicine physicians. Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly-accurate measure of TSH but not of the height of thyroid hormone levels.
New Range for TSH to Diagnose Hypothyroidism
The basic problem that traditional medicine has with diagnosing hypothyroidism is the so-called "normal range" of TSH is far too high: Many patients with TSH's of greater than 2.0 (not 4.5) have classic symptoms and signs of hypothyroidism (see below).
So, if your TSH is above 2.0 there is a strong chance your thyroid gland is not working properly.
Free Thyroid Hormone Levels
One can also use the Free T3 and Free T4 and TSH levels to help one identify how well the thyroid gland is working. Free T3 and Free T4 levels are the only accurate measure of the actual active thyroid hormone levels in the blood.
When one uses free hormone levels one will find that it is relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in its normal range, even in the low end of its normal range. When patients with these lab values are treated, one typically finds tremendous improvement in the patient, and a reduction of the classic hypothyroid symptoms.
Secondary or Tertiary Hypothyroidism
There are a significant number of individuals who have a TSH even below the new 1.5 reference range mentioned above, but their Free T3 (and possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary hypothyroidism, so, TSH alone is not an accurate test of all forms of hypothyroidism, only primary hypothyroidism.
Symptoms of Low Thyroid
The most common is fatigue.
Skin can become dry, cold, rough and scaly.
Hair becomes coarse, brittle and grows slowly or may fall out excessively.
Sensitivity to cold with feelings of being chilly in rooms of normal temperature.
Difficult for a person to sweat and their perspiration may be decreased or even absent even during heavy exercise and hot weather.
Constipation that is resistant to magnesium supplementation and other mild laxatives is also another common symptom.
Difficulty in losing weight despite rigid adherence to a low grain diet seems to be a common finding especially in women.
Depression and muscle weakness are other common symptoms.

Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels

http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
Diagnosis of Hypothyroidism
The big myth that persists regarding thyroid diagnosis is that an elevated TSH level is always required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would typically suggest an underactive thyroid.
The traditional tests of thyroid function, the T4 (or total T4), T3-uptake, FTI, 'T7', total T3, and T3-by-RIA tests should be abandoned because they are unreliable as gauges of thyroid function. The most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed.
The clinical symptoms of hypothyroidism are many. Perhaps the most common is fatigue. The skin can become dry, cold, rough and scaly. The hair becomes coarse, brittle and grows slowly or may fall out excessively. There is a sensitivity to cold with feelings of being chilly in rooms of normal temperature. It is difficult for a person to sweat and their perspiration may be decreased or even absent even during heavy exercise and hot weather. Constipation that is resistant to magnesium supplementation and other mild laxatives is also another common symptom. Difficulty in losing weight despite rigid adherence to a low grain diet seems to be a common finding especially in women. Depression and muscle weakness are other common symptoms.
Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly accurate measure of TSH but not of the height of thyroid hormone levels.
The basic problem that traditional medicine has with diagnosing hypothyroidism is the so called "normal range" of TSH is far too high: Many patients with TSH's of greater than 1.5 (not 4.5) have classic symptoms and signs of hypothyroidism.
The alternative to monitor thyroid disease is to use the Free T3 and Free T4 and TSH levels and interpret them with new reference ranges. If one measures the Free T3 and Free T4 levels the only accurate measure of the actual active thyroid hormone levels in the blood, as well as the TSH, one will find out how often a low normal TSH does NOT exclude hypothyroidism. It is relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in its normal range, even in the low end of its normal range. When patients with these lab values are treated, one typically finds tremendous improvement in the patient, and a reduction of the classic hypothyroid symptoms.
There are a significant number of individuals who have a TSH below 1.5 but their Free T3 (and possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary hypothyroidism; so, TSH alone is not an accurate test of all forms of hypothyroidism, only primary hypothyroidism.
This revised method of diagnosing and treating hypothyroidism seems superior to the temperature regulation method promoted by Broda Barnes and many natural medicine physicians.
Treatment of hypothyroidism
After proper diagnosis of hypothyroidism, the next issue is with what substance to treat.. The traditional approach is to use Synthroid/ Levoxyl/Levothroid (levothyroxine) which is only T4. Natural medicine doctors tend to use Armour thyroid which is a mixture of mono and di-iodothryonine and T3 and T4, the entire range of thyroid hormones.
If the Free T3 level is significantly lower than the Free T4 level, it is next to useless to treat with Synthroid/ Levoxyl/Levothroid (T4) only replacements. If the patient could not muster sufficient T3 from their gland (which produces some T3 directly), then they are certainly not going to convert enough T3 from T4 only. Traditional medicine assumes that preparations like Synthroid which are T4 only converts peripherally in the body to T3 in fairly standard amounts and at fairly standard rates. Unfortunately, clinical experience shows this is not true for the majority of patients. Consistent measuring of both free T3 and free T4 blood levels in hypothyroid patients who are on T4 only therapy will very rapidly dispel this myth. A certain percentage of hypothyroid patients do convert enough T4 to T3 at a sufficient rate for T4 treatment to be adequate as a source of T3; but a substantial proportion of patients require some combination of both exogenous T3 and T4.
Once on hormone replacement, the TSH remains useful until it goes BELOW 0.4. Then one has optimized thyroid function by the TSH yardstick; it then remains to optimize thyroid function by the yardstick of the accurate measures of the 2 thyroid hormones, the Free T4 and Free T3 levels.
So one should use a combination of T4 and T3 which compensates for the inability to convert T4 to T3. This is most frequently done with Armour thyroid. However, Cytomel, which is T3 only, can be used in combination with one of the T4 only preparations. It is important to recognize that T3 should always be prescribed twice daily due to its shorter half life. This is typically after breakfast AND supper for compliance reasons.
Taking the dose at these times overcomes traditional medicine's major objection and resistance to using natural thyroid preparations - its variability in its blood levels. Armour thyroid is desiccated thyroid and has both T3 and T4. Most doctors using Armour thyroid are not aware that Armour thyroid should be used twice daily and NOT once a day. The major reason is that the T3 component has such a short half life and needs to be taken twice daily to achieve consistent blood levels.
Once or twice daily dosing one can then optimize both the T4 and T3 levels, with whatever thyroid preparation is required. This is not possible in most hypothyroid patients with T4 only preparations. It is important to use a preparation with T3 because T3 does 90% of the work of the thyroid in the body. The only exception to pursue optimization of the T3 level without using Armour thyroid is in severe acute cardio-pulmonary conditions, when the metabolic slowing effect of a low FT3 level can actually be life-saving. However, the vast majority of hypothyroid patients do not have acute cardio-pulmonary conditions, such as congestive heart failure.
The most common starting dose for patients with hypothyroidism is Armour thyroid, 90 mg which is cut in half with a razor blade and half is taken after breakfast and the other half after dinner. Taking it after meals also helps to reduce volatility of the blood-level of T3. If the patient has any problem breaking or cutting the pill, they should purchase a pill-cutter at the pharmacy. The TSH, Free T3 and Free T4 are then repeated in one month and the dose is adjusted.
In order to optimize the hormone replacement, the Free T3 and Free T4 should be above the median but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiace and/or elderly patients, the numbers should be in the middle of its range. The Free T3 and Free T4 levels should be checked every month and the hormone therapy readjusted until the FT3 and FT4 levels are in the therapeutic range described. A small number of large, overweight, thyroid-resistant women may need 6-8 grains of Armour Thyroid or the equivalent of thyroxine per day (counting 0.1mg of T4 as 1 grain of Armour Thyroid).
If the patient is currently taking Synthroid (thyroxine), their Free T4 level is usually at or above the high end of its normal range and the Free T3 level is below. In this situation, or if a patient is allergic to Armour thyroid or is resistant to taking Armour thyroid, one may then add 5-12.5 mcg Cytomel (pure-T3) after breakfast and supper daily, rather than Armour Thyroid or Thyrolar (synthetic T4/T3 combo). It is important to remember that if the FT4 is being raised by a still-high TSH, the FT4 level will drop some when the TSH drops when adequate T3 is added to the hormone replacement.
Patients need to be warned about the overdosage symptoms which are frequently only temporary during the adaptation stage. The symptoms may include: palpitations, nervousness, feeling hot and sweaty, rapid weight-loss, fine tremor, and clammy skin. There is one exception to the 1.5 level of TSH as the cutoff for treatment. Overweight patients who have classic symptoms of hypothyroidism and have made heroic unsuccessful attempts to lose weight may benefit from thyroid hormone replacement even if their TSH slightly below 1.5 and FT4 and FT3 are not below their normal ranges
Patients who are already on once daily Armour thyroid should split their doses immediately and take half after breakfast and half after dinner. Since the only change will be in the FT3 level, which has a short half-life, the serum FT4 and FT3 levels (and TSH, if indicated) can be measured 48-72 hrs after the splitting of the doses if the patient had been on the hormone for 4-6 weeks before the splitting of the doses. This is because the T4 fraction is the one that takes a number of weeks to build up to its steady-state serum level.

How To Monitor Your Treatment With Natural Hormone Therapy.
http://www.mercola.com/article/hypothyroid/treatment.htm
After proper diagnosis of hypothyroidism (click here for article), the next issue is with what substance to treat.
Should You Use Synthetic Hormones?
The traditional approach is to use synthetic hormones like Synthroid/ Levoxyl/Levothroid (levothyroxine). These products only contain T4 hormone, they have no T3.
When a patient attempts to ask their physician for the natural hormone they are usually ridiculed and made to feel stupid that they would request an inferior hormone product.
The common argument the physicians give is that the synthetic provides steady hormone levels. What the doctors tend to overlook is that the vast majority of people can not convert the T4 to the active form of thyroid which is T3. This is easy to cofirm by measuring the free hormone levels, but virtually none of the doctors use these tests.
Armour Thyroid -- The Natural Alternative
When one has low T3 levels, which are typical with synthetic hormone use, the brain does not work properly. It is important to use a preparation with T3 because T3 does 90% of the work of the thyroid in the body. So one should use a combination of T4 and T3 which compensates for the inability to convert T4 to T3. Armour thyroid is desiccated thyroid and has both T3 and T4
A 1999 study published in one of the most prestigious medical journals in the world, the New England Journal of Medicine, showed that the natural hormone product, such as Armour, was far better at controlling the brain problems commonly found in hypothyroidism. Nearly all natural medicine doctors tend to use Armour thyroid which is a mixture of mono and di-iodothryonine and T3 and T4, the entire range of thyroid hormones.
Armour Thyroid Dosing -- TWICE a day.
The most common starting dose for patients with hypothyroidism is Armour thyroid, 90 mg which is cut in half with a razor blade and half is taken after breakfast and the other half after dinner. Taking it after meals also helps to reduce volatility of the blood-level of T3. If the patient has any problem breaking or cutting the pill, they should purchase a pill-cutter at the pharmacy. The TSH, Free T3 and Free T4 are then repeated in one month and the dose is adjusted.
Taking the Armour thyroid twice a day overcomes traditional medicine's major objection and resistance to using natural thyroid preparations - its variability in its blood-levels. Most doctors using Armour thyroid are not aware that Armour thyroid should be used twice daily and NOT once a day. The major reason is that the T3 component has such a short half life and needs to be taken twice daily to achieve consistent blood levels.
Dose Adjustments With Lab Monitoring
Once on hormone replacement, the dose should be increased until the TSH falls below 0.4. Then one needs to optimize the 2 thyroid hormones by using the Free T4 and Free T3 levels.
The Free T3 and Free T4 are used to monitor the treatment. They should be above the median (middle) but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiac and/or elderly patients, the numbers should be in the middle of its range.
The Free T3 and Free T4 levels should be checked every month and the hormone therapy readjusted until the FT3 and FT4 levels are in the therapeutic range described. Once a theraputic range is acheived the levels should be checked at least once a year. A small number of large, overweight, thyroid-resistant women may need 6-8 grains of Armour Thyroid or the equivalent of thyroxine per day (counting 0.1mg of T4 as 1 grain of Armour Thyroid).
For those people who are already on once daily Armour thyroid should split their doses immediately and take half after breakfast and half after dinner. Since the only change will be in the FT3 level, which has a short half-life, the serum FT4 and FT3 levels (and TSH, if indicated) can be measured 48-72 hrs after the splitting of the doses if the patient had been on the hormone for 4-6 weeks before the splitting of the doses. This is because the Free T4 hormone is the one that takes a number of weeks to build up to its steady-state serum-level.
Symptoms of Excessive Thyroid Hormone
There are frequently only temporary during the adaptation stage. The symptoms may include: palpitations
nervousness
feeling hot and sweaty
rapid weight-loss
fine tremor
clammy skin
What To Do If You Can Not Tolerate Armour Thyroid or Want To Continue Synthetic Hormones
My experience is that well over 90% of people do much better on Armour thyroid. However, there are a small number of people who do not tolerate it. This is most frequently done with Armour thyroid. However, Cytomel, which is T3 only, can be used in combination with one of the T4 only synthetic preparations mentioned above. It is important to recognize that T3 should always be prescribed twice daily due to its shorter half life. This is typically after breakfast AND supper for compliance reasons.
If you are currently taking Synthroid (thyroxine), your Free T4 level is usually at or above the high end of its normal range and your Free T3 level is usually below. In this situation, one may then add 5-12.5 mcg Cytomel (pure-T3) after breakfast and supper daily, rather than Armour Thyroid or Thyrolar (synthetic T4/T3 combo).
Once or twice daily dosing one can then optimize both the T4 and T3 levels, with whatever thyroid preparation is required. This is not possible in most hypothyroid patients with T4 only preparations.
People Who Should Not Take Cytomel
The only exception to pursue optimization of the T3 level without using Armour thyroid is in severe acute cardio-pulmonary conditions, such as congestive heart failure, when the metabolic slowing effect of a low FT3 level can actually be life-saving. However, the vast majority of hypothyroid patients do not have this problem.