Armour Thyroid Dosage Guide: Are you Taking Enough?

Are you currently taking Armour thyroid but not sure that your dose is where it should be?

Are you still struggling with fatigue, weight gain, or hair loss even after transitioning from levothyroxine to Armour?

Are you thinking about switching medications but not sure if Armour is right for you? 

If so, this article is for you. 

Article highlights:

  • Armour thyroid dosing is highly individualized and each person will need a different dose. 
  • Several factors influence the dose that you will need. 
  • The average dose is somewhere between 60 mg (1 grain) and 120mg (2 grains) per day. 
  • Sensitive individuals will need doses smaller than 60mg while resistant individuals may need a dose higher than 120mg. 
  • The best way to find your optimal dose is through lab testing and closely following your symptoms. 
  • Many patients are underdosed when converting to Armour thyroid from other thyroid medications.

More...

Armour Thyroid Dosing - How to Find your Dose (The Good, the Bad, and the Ugly) 

This article is going to be all about Armour thyroid and finding the right dose for your body. 

This is probably the most important aspect to consider when taking thyroid medication and it's not given enough attention by both patients and doctors. 

And, believe it or not, it's not always as straightforward as you think. 

There are many factors which can alter how much Armour thyroid your body needs and other factors which can influence how effective the medication is once you take it. 

If you are already familiar with Armour thyroid then you can skip to the sections below, but if you are new to it then you'll want to read this section as well. 

First off, what is Armour thyroid?

Armour thyroid is a thyroid medication which is used to treat conditions which result in LOW thyroid hormone production (known as hypothyroidism). 

Armour thyroid is one of many thyroid medications available but it is special because it contains a combination of both biologically active thyroid hormones. 

Most doctors prescribe thyroid medications such as Synthroid or levothyroxine which contain only 1 form of thyroid hormone. 

Armour thyroid is often considered superior and more powerful than those medications because it contains both T4 and T3 (it also contains other ingredients such as calcitonin, T2, and iodine but we won't focus on those for today). 

But, because it has T3, it's often inaccurately dosed by doctors who aren't used to prescribing these types of medications (1). 

This can lead to persistent symptoms of hypothyroidism and other issues such as the inability to lose weight, hair loss, and persistent fatigue

Most of these issues can be improved (or completely resolved in some cases) with accurate dosing. 

Each Person is Different (So is your dose!)

Before we jump into the specifics, it's important to realize that the dosing of thyroid medication is highly unique and individualized. 

Each person will require a slightly different dose compared to the next person, even individuals who have the same body weight/metabolism/etc. 

Having said that, I want to give you some idea as to what dose range you should be expecting when taking Armour thyroid. This way you know if you are likely being underdosed or overdosed. 

The average dose that most people need is somewhere between 1 grain (60mg) and 2 grains (120mg) per day. 

About 60-70% of individuals will fall into this range. 

About 5-10% of people will need a dose less than 60mg per day (anywhere between 15mg and 60mg). 

About 10-20% of people will need a dose higher than 120mg per day (anywhere between 120mg and 240mg). 

These percentages are not perfect, but they are based on my own personal history in treating patients and discussing various doses with other doctors and practitioners. 

Finding out where you fit into this spectrum can be difficult, but you can use the resources found here to help you find your optimal dose. 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

Dealing with Sensitivities

Even though Armour thyroid may be the right medication for you, you may not tolerate traditional doses. 

What do I mean?

Armour thyroid is unique among thyroid medications in that it contains the active thyroid hormone T3.

And T3 is the most potent thyroid hormone available. 

While it's incredibly powerful and useful, there's also a small chance that you might be someone who is sensitive to this particular ingredient. 

You'll know if you are sensitive because you may experience side effects such as heart palpitations, a jittery or anxious feeling, or a headache after taking your dose. 

This doesn't automatically mean that you shouldn't take Armour thyroid (though it could), but instead may be a reflection of your sensitivity to the T3 found within the medication

The good news is that most of the time these side effects can be mitigated by simply altering how much medication you take (and also how frequently you take it which is discussed below). 

Those people who find that they are sensitive to Armour thyroid may also need a reduced dose compared to the average (2). 

Most people need somewhere between 1 to 2 grains (or 60 to 120mg) per day, and those who are sensitive may only need 1/4 to 1/2 of a grain per day. 

If you find that you are sensitive to the medication (3) then you'll want to start out on a low dose and slowly increase your dose over a prolonged period of time. 

Starting out with a dose around 1/4 of a grain may be ideal. 

From there you can increase your dose every 1-2 weeks as needed. 

While some individuals may react to the T3 in Armour thyroid there are others who may react to the inactive ingredients inside the medication as well. 

Each medication contains fillers/binders which can potentially cause issues for certain people. 

If you are reacting to the binders/fillers then you may need to switch medications entirely. 

Do you Need to Dose Multiple Times per Day?

Another strategy to mitigate the potential side effects of Armour thyroid is to split your dose and take it multiple times throughout the day. 

This is a strategy employed successfully by many people taking all types of thyroid medications (including pure T3 medications and even T4 medications). 

The logic for using this strategy is simple:

A normal thyroid gland, when functioning correctly, secretes a small amount of thyroid hormone constantly throughout the day. 

When you take thyroid medication by mouth you are taking one massive dose which is supposed to last all day. 

This means that you are temporarily taking more than you need first thing in the morning and this large dose of thyroid hormone can cause problems for certain sensitive individuals. 

You can combat this by splitting your dose in half (or even thirds) and taking your dose in regular intervals throughout the day. 

This reduces the massive flush which occurs from once a day dosing and may be ideal for some people, especially those who are sensitive to the T3 found within Armour. 

Splitting your dose is actually very easy and shouldn't cause any issues (as long as you follow all regular precautions when taking your medicine). 

Let's use an example:

Suppose that you are taking 2 grains of Armour thyroid per day.

Let's also suppose that you are someone who is experiencing palpitations and flushing about 30-60 minutes after you take your medication. 

You decide to alter how you take your medicine and split your dose into 2 divided doses. 

You would proceed by taking 1 grain (60mg) first thing in the morning around 7:00 am (on an empty stomach). 

Following that dose, you would take another 1 grain (60mg) around noon (on an empty stomach). 

Following this regimen, you would still take your total dose of 2 grains each day but they would be split by at least 5 hours. 

This may allow you to stay on your same dose while mitigating completely the side effects of heart palpitations and flushing. 

You can also split this further and take your dose in 3 divided doses if necessary. 

That would look something like this:

  • Take 1 grain (60mg) at 7 am in the morning. 
  • Take 1/2 grain (30mg) at noon. 
  • Take another 1/2 grain at 4:00 pm.

With this regimen, you are still taking a total of 2 grains per day (60 mg + 30mg + 30mg) but it's split between 3 doses. 

If you elect to follow any of these schedules just make sure you take your medication on an empty stomach and away from other supplements (especially calcium or iron!). 

Lab Testing on Armour Thyroid

Like other thyroid medications, it's important that you check your lab tests regularly when you take Armour thyroid. 

In the beginning, this may mean getting your labs tested every 6-8 weeks. 

Once you find a stable and steady dose you may only need to check your dose every 3-4 months (or less frequently). 

But because Armour thyroid is different from other thyroid medications such as levothyroxine and Synthroid, you need to be ordering more than just the standard TSH and free T4

Remember:

Armour thyroid contains both T4 and T3 thyroid hormones. 

When you are taking Armour thyroid you should, therefore, make sure to test BOTH your free T3 and Free T4 in addition to your TSH at a minimum. 


I also recommend that you look at other thyroid lab tests, but these should be what you get at a minimum. 

You should also be aware how Armour thyroid changes your thyroid lab tests. 

When you take T4 only medications (such as levothyroxine or Synthroid), your TSH should drop and your free T4 should increase (free T3 doesn't always increase when taking T4 only medications). 

When you take Armour thyroid (or other brands of NDT), you should see your TSH drop, your free T4 increase and your Free T3 increase as well. 

This pattern doesn't always hold true, however. 

Some individuals will find that their TSH will drop, their T4 will drop and their free T3 will increase. 

This pattern is not always bad, but it does typically indicate that you are someone who is sensitive to the T3 found within the medication. 

But, unless you check all these lab tests you won't have any idea how you are reacting to the medication. 

When taking Armour thyroid you should try to find a dose (typically between 1 and 2 grains per day) which keeps your TSH in the low/healthy range, your free T4 in the middle range, and your free T3 in the higher end of the reference range. 

You can find more information about these ranges in this post

If you are taking Armour thyroid and you find that your TSH is NOT decreasing then that is an indication that your dose is insufficient. 

This typically occurs when your doctor attempts to transition you from a thyroid medication such as levothyroxine to Armour. 

Remember:

The average dose of 1-2 grains per day is simply an average. 

You could easily be on the high side or the low side of that average. 

Some people may need doses as high as 4 grains per day while some people may need doses as low as 1/4 grain per day. 

You can use your lab tests to help you figure out where you fit on this spectrum. 

How to Tell if your Dose is Too High

Another issue to watch out for is accidental overdosing of your medication. 

Believe it or not, this can happen either accidentally or intentionally and is probably more common than people realize. 

But it is something that you want to avoid because overdosing on your thyroid medication can lead to long-term consequences if you aren't careful. 

Some patients have been chronically underdosed with standard T4 medications for many years and, when they finally feel better on Armour thyroid, may think that they need more medication than they really do. 

Persistent hypothyroidism can cause a range of issues including hormone imbalances that may not be corrected even when taking the appropriate dose of medication. 

This can lead patients to take ever-increasing amounts of Armour thyroid in hopes of fixing these problems. 

But the reality is that taking these high doses is not helpful and may be harmful. 

You can read more about the dangers of taking too much medication in this post here

So, how do you tell if your dose is too high?

You can use the combination of your lab tests and your symptoms. 

If your dose is too high you will experience symptoms which include heart palpitations which do not decrease over time, flushing, headaches, sweating, weight loss, fatigue, and hair loss. 

In addition, you will most likely find that your TSH is suppressed (or very low) and your free T3 is high (flagged as elevated and outside of the reference range). 

The combinations of these two things are an indication that you are taking too much thyroid medication and that you should reduce your dose. 

Experiencing a high dose for a few days to weeks is probably not a huge deal to your body, but you should not continue to take medication causing these symptoms for longer than necessary

Typically, reducing your dose will be enough to reduce these symptoms and bring your thyroid back to an acceptable level. 

When & How to Take Your Medicine

For best results, you will want to make sure that you are taking your medication correctly. 

Failing to take your medication correctly can cause all sorts of issues and may reduce the total effectiveness of your dose of medication and, in some cases, can render it completely ineffective. 

When you go pick up your medication you are usually given instructions by the pharmacist to 'take your medication on an empty stomach first thing in the morning'. 

This holds true for ALL thyroid medications including Armour thyroid. 

And the reason is simple:

Taking your thyroid medication with food has been shown in studies to reduce its absorption (4). 

This means that instead of entering into your blood it is exiting your body in your stool! 

In addition, you also want to avoid taking your medication with coffee which can also reduce its absorption. 

Other items that interfere with thyroid medication include all supplements but especially supplements which contain calcium and/or iron (5). 

These two are notorious for binding to and inactivating thyroid hormone before it enters into your body. 

I typically recommend that you wait at least 30 to 60 minutes after taking your thyroid medication before you use thyroid supplements, but you'll want to extend that out to 3-4 hours if you are taking iron or calcium. 

You don't always have to take your medication first thing in the morning as studies have shown that even taking your medication at night is effective (6). 

That advice is typically given because it's easiest to take your medication on an empty stomach first thing in the morning, but you can take it at any point in the day so long as you don't take it with food/coffee/supplements (7). 

Converting from T4 Medications to Armour Thyroid

Another important topic to cover as it relates to your dose is converting from other forms of thyroid medications to Armour thyroid. 

This is an important point because typically this is done incorrectly. 

The standard advice when transitioning from levothyroxine/Synthroid to Armour thyroid is to replace every 100mcg of Synthroid with 60mg of Armour thyroid. 

The problem with this advice is that it typically results in underdosing of Armour thyroid. 

Why?

Because each grain of Armour (which is 60mg) contains only 38 mcg of T4 and 9 mcg of T3. 

When you transition from 100mcg of T4 down to 38 mcg of T4 + 9 mcg of T3, the patient typically feels worse because they are taking a smaller dose of thyroid hormone than they were previously. 

So, instead of following this standard advice, just be sure that you are aware that the conversion isn't perfect and it may require a higher dose than you or your doctor anticipate. 

As long as you are aware of this, you shouldn't be surprised if your labs look 'worse' upon your transition. 

They will improve with time and as you adjust your dose appropriately. 

In my experience, 100mcg of T4 is probably closer to 1.5 grains (or 90mg) or Armour thyroid than the 60mg that most places recommend. 

Armour Thyroid vs Other Brands of NDT

Armour thyroid falls into a class of drugs known as NDT. 

NDT stands for natural desiccated thyroid and drugs in this class are all similar but differ in their inactive ingredients. 

Armour thyroid is the original formulation of NDT but there are many other medications including WP thyroid, Nature-throid, NP thyroid, and more. 

Each comes with its own advantages and disadvantages. 

Because of this, it's important that you are at least aware of these other brands of medications. 

Why?

Because it's possible that while you may not necessarily tolerate one formulation of NDT it doesn't mean you won't tolerate them all.

I've seen many patients who don't tolerate Armour thyroid but do tolerate Nature-throid and vice versa. 

Don't give up on NDT medications if you experience a small reaction during your transition to Armour or when you first start it. 

Instead, take note of your symptoms, try to determine what is causing them, and make changes as appropriate. 

You may find that your problems are dose-related, medication-specific, or related to your sensitivities. 

All of these issues can be overcome with careful consideration. 

Conclusion

Armour thyroid is a great medication and one that can potentially help a great many people. 

The key to using it correctly is to get your dose right!

This includes adjusting your dose based off of your laboratory tests and based off of your clinical symptoms. 

Don't be afraid to adjust your dose, take your dose at multiple times during the day, or potentially switch to another brand of NDT if you are having trouble. 

As you make these changes you will find that your symptoms improve and you should finally start to feel better. 

Now I want to hear from you:

Are you currently taking Armour thyroid?

Do you feel that your dose is optimal?

Are you experiencing any side effects? 

Are you sensitive to T3?

Leave your questions or comments below! 

References (Click to Expand)

This post was most recently updated on August 23rd, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

37 thoughts on “Armour Thyroid Dosage Guide: Are you Taking Enough?”

  1. Benn on Armour thyroid 5 months now. My hair is coming back, my fibromyalgia is gone and I am now sleeping 4-5 hrs instead of 0-2 hrs max. $38.00 out of pocket worth every penny.

    • Hi E. Neel,

      I definitely agree! I’m always confused by people who aren’t willing to spend $30-40 per month for medications not covered by insurance but which help them tremendously. Health is the most important thing we have in the world and so we should spend some energy on it, at least in my opinion.

  2. My thyroid lab results keep coming back low. I’m taking 1 grain of Armour, I’m exhausted all day long, my nails are brittle, losing lots of hair. Dr. Uped my dose and I got worse. I feel like stopping my thyroid medication altogether.

  3. I have been on NDT for a couple months, half of a 65mg capsule 2x/day, then increased to a full 65mg 2x/day. I take 10mg of progesterone on days 14-28 monthly. I added the T3 Booster and Adrenal Supplements in 2 weeks ago, and all was OK and feeling great until Day 14 when the progesterone was added in… I now can’t sleep with high cortisol all through the night, dizziness, heart palpitations, shortness of breath, racy but tired and cannot concentrate. Will I need to decrease the amount of NDT now that I’m supplementing with a T3 Booster and the progesterone is possibly making me dump thyroid hormone? What could be causing these symptoms out of nowhere?

  4. Dear Dr. Child’s,
    I have been on Synthroid 200mcg for 9 yrs. I had thyroid cancer in 09 removal and ablation. I have had all kinds of issues with the generic ( levothyroxine) since I am highly sensitive to almost all meds I take for other ailments. I was put on Armour back in 2014 and it worked great. I was diagnosed with free T3 syndrome, went on 30mg at that time and stayed on that dose for 2yrs. I started feeling fatigued, gained a huge amount of weight, hair loss and the labs showed my TSH was almost 31. My cancer developed into the soft tissue of my neck and anything over 10 for my TSH is dangerous and my cancer could come back. As a result of these labs my PCP put me on Armour 60 mg. I never recovered. I am still extremely fatigued, never lost that weight and actually gained 30lb more. I am now off Armour, because I felt that it was not helping. My current PCP doesn’t know I stopped. I gradually cut down my usage and then stopped. I am not feeling any better, very fatigued, insomnia has gotten worse, aches and pains everywhere and persistent swelling in my feet and ankles, which makes it hard to walk. I am still on Synthroid 200mcg, but I feel like I am off daily. I have many health issues and trying to pinpoint any of my symptoms being related to thyroid is hard. My recent labs showed my TSH was 0.80 and I wasn’t given my free T3 at that time. I always get TSH, free T3 drawn every 6 months or so. I too fall into the category of insurance not covering Armour. ($100 for 90 day) Since I cannot tolerate the generic form of Synthroid I sometimes have to fight with that too. Any suggestions would be greatly appreciated. Thank you very much!
    Dawn Campbell
    Texas

    • Hi Dawn,

      Most people who have their thyroid removed need some form of T3 medication along with T4. If you are taking Synthroid then you are only getting T4 without any T3. Armour does have T3, but not a lot, so your dose of T3 within Armour was very small.

  5. I feel that my armour thyroid dose is way off. I also just learned I can split my dose that has helped with one of my problems. I am very tired because I’m only getting 3-4 hours of sleep, fully awake now. I take 120 mg of my armour thyroid and within an hour, I feel like I haven’t slept in weeks. I lay down anywhere from twenty minutes to an hour and a half. The longer I sleep the second time the better I feel. I noticed months back approximately 12 hours after my morning dose I would get so hot, I only sweat from the neck up, but my body inside felt real, so instead take 150 mg in the am I take 120 mg, then about 10-12 hrs later I take the 30 mg, and the hotness and sweating throughout the night stopped. I also take 15 mg Mon, Wed, and Friday. I now take 15mg every day. Splitting the dose has helped but if I take the 30 and 15 together at night I can’t sleep until 3-4 am because I feel like I’m on an upper. My TSH was very low and T4 very high but he didn’t do the T3. So as of right now, I’m on 135mg in the am then when I start getting hot and sweaty I take the 30mg. I know my thyroid is off he thinks I need more I think less. My hair breaks and all these little pieces are sticking out, my skin is dry, I’m tired no matter how much or how little sleep I get, and my thinking is so slow. Can you tell me what is going on? Thank you and especially thanks for the article. Rose.

  6. Hi! I have been on 60mg of Armour for 5 weeks. I could tell the foggy head had disappeared but I was still so tired. So I had my labs done 4 days ago and am now on 120mg and I already feel better. My TSH was 13.1 when I started and it was 4.5 when I went back 4 days ago. My doctor said since I am at the high end and still so tired is why we are trying me on the 120mg but I am taking it in 2 doses a day.
    I really enjoyed reading this article. Thank you.

  7. I been on armour 60mg for one month and brought my TSH level from 3.8 to 1.58 I feel so much better and less hair loss. Before I started having hypothyroidism my level was always in 1.4 range and I always felt good. Now that I brought my level down to 1.58, I want to be a dosage of Armour that maintains my level. I asked my doctor if I should try 30mg of Armour now to maintain my TSH level. My doctor recommends that I continue with the 60mg since it was affective for me. I was wondering if this recommendation is ideal since I am worried that with continuing the same dosage my level will decrease and I end up with hypothyroidism.

  8. Hi
    I have been on 2 grains of Armour Thyroid since August of last year my TSH is low and my Ft4 and FT3 are low in range. I sleep 8 hours a night and I still feel tired every inch of my body just feels exhausted even breathing makes me tired, is this normal?

    I’m not allowed to increase my Armour because my tsh is too low. Any suggestions on getting over this crazy exhaustion would be helpful.

    I did have a vitamin panel done and everything is good. I do supplement hours after my last AT.

  9. Great articles, informative and helpful. I am taking Levothyroxine 25 mcg. My thyroid tests were all normal except for my Thyroperoxidase antibody is 129. How can I get this back to normal.
    [email protected]

  10. I was on 75mg of Levothyroxine for three years thinking my Dr knew what was best. Having Myxoedema symptoms (all symptoms minus a coma) for 8 years and continuing within the three years and still today. I asked to be put on Armour. I was given just 30mg. All my test results show up as normal but my symptoms scream severe hypothyroid. Weight increased to the most I’ve ever weighed. It took me 5 months to lose 35 lbs. I used to be about to lose 10 to 15 pounds in a month. Stuck with just 35 lost now for past 3 months. Not budging a pound except to gain when my pitting edema is thicker around my calves. I can carry 10lbs of water weight from one day to the next as the scale keeps within a ten pounds range. I eat very healthy fats, no dairy, and no gluten. I’ve incorporated healthy carbs such as Quinoa and Chia seeds, sweet potatoes to my once Keto regime. Keto and intermittent fasting likely increased my RT3. Body thinks it’s starving and now won’t let go of any weight. I’m trying hard. My lifestyle should produced far better results than I’m getting. I’ve been working hard on sleep hygiene even though insomnia and huge bursts of energy run through me at night. Tired of feeling tired and joint and back pain. Electrolytes are good, no inflammation, no autoimmune antibodies show up, though could be a false negative. I had to request my RT3. Only thing that shows up for an out of range result. In response my Dr upped my 75mg of Levo to 100. Kept my Armour at 30mg. I’m tired of being under dosed, must be as nothing feels good yet. Even the pharmacist said my diuretic (electrolyte friendly) dose was less than half the normal dose. Pitting edema is getting quite old and rather uncomfortable. Especially with the weather getting warmer as I only swell up more where it feels like my skin is going to pop!
    With RT3. Is Armour helpful? I’m more than certain I have Adrenal fatigue, have many characteristics that follow under Cushings Syndrome, buffalo hump and all. I want to feel normal, have energy and live more fully instead of compromising my life all the time!

    • Hi Taresa,

      If your question is whether or not Armour thyroid can be used if you have high rT3 the answer is that it can potentially be helpful in that situation (but not always). If that wasn’t the crux of your question then please elaborate and I would be happy to try and answer it.

  11. Is it safe to take a thyroid support supplement with Amour thyroid? I know I do not need extra iodine, or at least I do not think I do. I do know though when I eat shrimp I feel good afterward. I wonder if it really affects me.? I do not get that often tho.
    I know that armour took my brain fog away. I have been on thyroid medicine for 43 years. First Synthroid, for about 35 years. Then it was not helping at all. I finally found a Dr. To try me on Armour. It made a huge difference. We have to change my dose every now and then. But I am really overweight. I hold fluid a lot. I am not a sedentary person. I am moving a lot. So I have a battle. All the time. I did have low adrenal function at one time and with supplements and eating correctly it healed. I try to read and learn all I can. I just do not apply everything I read. I get in a slump and then try to talk myself into starting a diet. A vicious cycle all the time. Thank you for your expertise.

  12. [email protected]
    I have been on Armour for about 8 years, and I probably should have been on it 8 years before that. I think that giving birth to four children in six years is what threw me into hypothyroidism. I used to fall asleep, like a mini nap, while driving or talking to colleagues at work. I thought I was just overextended. I could not control the fatigue. My TSH was “within normal limits”‘. Later, I sought help from a Body Logic doctor for other perimenopause symptoms. This doctor did a full thyroid panel and found I was “subclinical” hypothyroid and started me on Armour. I gradually titrated dose up to 3.5 grains, taking 2 first thing in morning and 1.5 mid morning, about 4-5 hours after first dose. I no longer fall asleep in the middle of a conversation. I feel like me again. And I’m sad that this was not diagnosed earlier. I am working with my family doctor now, and he gets a little upset when my TSH is less than 1, but I explain that the T3, T4 and Reverse T3 are in appropriate range.

  13. I just started taking 15 mg (1/4 grain) of Armour Thyroid 5 days ago. Obviously I am not expecting to see any changes yet but how long do you recommend before upping the dose? My doctor said 4 weeks but I feel like that would be too long. I was diagnosed with Hashimoto’s and my free T3 wasn’t optimal it should be about 3/8 and it’s only at 3.0. I haven’t noticed any changes but this morning I noticed I feel a little bit more anxious and I’m not sure if that means I’m just too low of a dose and should move up or it just doesn’t work for me since I’m on the lowest dose. I definitely don’t want to give up I just don’t know how long I should give it! Thank you!!

    • Hi Elizabeth,

      I base dosing off of a number of factors including the history of the patient, their current dose of thyroid medication, and so on. If you are just starting out on the medication and you are sensitive then a slow titration may be the safest option but I don’t have enough information to say one way or the other.

  14. Are you currently taking Armour thyroid?
    Do you feel that your dose is optimal?
    Are you experiencing any side effects?
    Are you sensitive to T3?

    Hi Dr. Childs,
    I’ve been taking 2 grains for 5 years, but lately have been having hypo symptoms (depression, fatigue & hair loss always being the worst ones).

    Week old Lab:
    TSH: 0.186 (0.450 – 4.5)
    FT4 : 0.84 (0.82 – 1.77)
    FT3 : 1.9 (2.0 – 4.4)

    Lab from a few years ago:
    (Still taking 2 grains)
    TSH 0.008 (0.450 – 4.5)
    FT4. 1.25 (0.82 – 1.77)
    FT3 2.50 (2.0 – 4.4)

    T4 6.0 (4.5 – 12)

    Lab from 2014:
    (50mcg Synthroid)
    TSH: 3.27 (0.4 – 4.5)
    FT4: 1.5 (0.8 – 1.8)
    FT3: 2.2 (2.3 – 4.2)
    Thyroglobulin Antibodies 167 (<20)

    Looking at these numbers, what do you think the problem is: Conversion? Low T3?

    Is the solution to add more Armour, more T3 or adjust the ratios?

    Do I need more tests to find the answers, of so, which ones?

    I read at least 5 of your articles, but I don’t think I can answer them myself. Thank you for this wonderful website!

  15. I have been on Armour for 18 years, I went un DX’d for years, my TSH tests came back normal, turns out I had a Pituitary tumor which seems to somehow “fake out” the TSH test, by the time I got to a doctor that did more labs I had 7 nodules, enlarged thyroid, and a goiter. The problem is most docs freak out when they see my labs, my TSH is completely suppressed between the meds and tumor, my T3 and T4 usually come back high. Fast forward I now live in France, they do not sell Armour or ND meds here, though they will write it for me, a huge hassle getting it. I was taking 2.5 60 mg a day but got lowered to 2 – 60 mg a day, finally I am now taking 1 – 60 mg every morning and 1 – 60 mg at night 3 times a week. So I have gone from 17.5 pills to 10 during the last year. I am SO sick, I can’t get out of bed, I am like a zombie most of the day, not just hair falling out, my fingernails are just crumbling and splitting away, along with all the other hypo symptoms. I have had trouble sleeping all my life and now sleep is impossible, I just lay there all night but can’t get up. I need to somehow show to the doctors here how normal Armour labs look, so they don’t think I am over medicated. Is there a chart somewhere that shows how different labs are when taking Armour? I am also most likely going to have to switch to Lev. and hopefully a little T3, and am dreading it. The last time I got put on T4 only I crashed and was also very sick. I hope you can somehow help me, point me in the right direction of what labs should be when taking Armour, I think the values are more in line with taking just T4 meds, not the ND ones. Thank you for any help you can provide.

  16. Are you currently taking Armour thyroid? yes. 1 gain.
    Do you feel that your dose is optimal? better than the past but still have days where fatigue. My TSH test suggested I should lower my dose but I feel better on a higher dose.
    Are you experiencing any side effects? I don’t think so.
    Are you sensitive to T3? not that I know of.

    My questions. Does calcitonin have anything to do with calcium as measured for bone density test? Would it impact arthritis? What does T2 do? Your article talks about iron impacting absorption of Armour (and I assume other thyroid meds), would having unusual iron results cause absorption issues? Like high iron levels, though after a series of test it was determined my iron was not high, the unusual part keeps me wondering. What could one do for better absorption?
    Also, could you explain the difference in NDT like Armour and a supplement like “NatureSources Raw Thyroid” which according to label is Whole Raw tissue concentrated from bovine? Is it just the quality or is it different from Armour?

    • Hi Sher,

      Over the counter thyroid supplements, if manufactured in the United States, do not contain any active hormone whereas Armour thyroid contains a standardized concentration of T4 and T3 per grain. Over the counter supplements are not a substitute for thyroid medications because they work differently and contain different ingredients.

  17. Dr. Westin,

    I have been taking 30 mg of Armour thyroid in the morning and at night and getting bioidentical hormone pellets. I also take a drop of nascent iodine in the morning with my thryoid.

    I am still exhausted most of the time and unable to lose weight, even with a healthy diet and exercise.

    I did know to wait at least 30 minutes in the morning before eating, but didn’t know about not having coffee -which I drink as soon as I get up. How long should I wait before drinking coffee and having supplements?

    My doctor said it was okay for me to go up to 60 mg twice a day so I am about to try that.

    • Hi Jodi,

      While those medications can potentially help with weight loss, it doesn’t guarantee that they will work. For instance, they will only work if the problem leading to your weight gain is related to your thyroid or other hormones, but this isn’t always the case. In addition, weight loss, particularly when it comes to thyroid medication, is dose-dependent.

  18. Hello,
    I transitioned from Synthroid to Armour after 24 years use of Synthroid. I changed to a second doctor after that, then a third, who both want me back on Synthroid. I feel better on Armour, but admittedly was overdosed by the first doctor and had heart palps.

    My issue is that I am a thryoid cancer survivor. Current doctor wants my TSH under 0.1 and my T4 higher and T3 lower. He also has lowered me to 150mg Armour a day and says he wants T3 lower and T4 higher, and is concerned that my TSH is too low. Incidentally, my blood glucose A1C rose to 6.8 after the dose reduction. My question is would I necessarily feel better on a divided dose of Armour, and have more reasonable lab numbers? Last two doctors complain that their lab ranges dictate my T4 should be increased and my T3 should be decreased. I really believe some of these doctors are shills for pharmaceutical companies or just plain lazy. Really fed up after two surgeries and 26 years of thyroid medication side effects.

    Appreciate your thoughts.

    • Hi Lee,

      The major problem is the paradigm treatment which puts major emphasis on the TSH and T4. This is why all doctors seem to be obsessed with these values even if altering them causes obvious symptoms of hypothyroidism in patients. I don’t think they are necessarily lazy or shilling out for pharmaceutical companies but instead following guidelines which themselves are flawed.

      The divided dose probably won’t have a major effect on your symptoms because dividing the dose is probably not the main issue. Instead, it’s probably just that you need a total higher dose.

  19. Dr. Childs,

    A little backstory. I was diagnosed Hashimoto’s at 22. I was put on Armour thyroid from the start and did well on 90-120mg for about 12 years. I saw a new Endo about 3.5 years ago who would not prescribe it, and I was put on Tirosint 112 mcg and 5 mcg of Cytomel. My labs were perfect.

    My body, however, was not. I gained 25 lbs. over that period of time, my cholesterol, which had always been normal, shot up to high levels, and I began developing a rash on my arms and torso when I’d work out. At first, I chalked it up to getting older and other supplements, but one day I decided to try not taking my thyroid meds and almost instantly noticed a difference in how I felt. In hindsight, I wish I had not stopped taking the meds for a month as I waited for my next appointment with my PCP since I through myself into a major hypo State (TSH went up to 40), but I was put back on Armour in May of this year.

    Since May 1, I have been back on 90 mg of Armour, which I’m splitting and taking twice a day. With a small tweak to my diet, I have already lost 15 of the 25 lbs. I’d gained and feel better overall. I do have increased anxiety, but everything else feels good (the rash when working out has been reduced by about 80-90% in both frequency and intensity).

    That takes me to today. I just got my 8 week check on my labs, and my FT4 was at .82 (normal but tad low), FT3 was 4.6 (a tad high) and my TSH is down to 17.7 (still too high but moving in the right direction from my last test in May. I did take my half dose of Armour the morning of my last appointment not realizing I’d be getting my labs done in office, so I am almost certain the T3 spike is from that. I think I should move up to 120 mg of Armour, but I’m a little concerned that T3 may be too high (or the doctor will be hesitant because of the higher T3 on these labs). Supplement wise, I am also taking a standard men’s multi vitamin, extra Vitamin D, and have added Cholest-Off and Red Yeast Rice (half the recommended dose of each), as well as Psyllium husk and fish oil to help speed up the reduction of cholesterol that I assume Armour will help with also. Any suggestions on next steps?

    Thanks in advance,
    Stephen

  20. Hi,

    This site has been invaluable to me on my journey, thank you.

    May I ask a question please:

    I’m UK based and so will not be prescribed anything with T3, or have T3 tested. I was on 75mcg Levothyroxine which had no effect on my health but levels of T4 and TSH were in range (not optimal).

    I went private for a full range of blood tests and am now on supplementation and have managed to secure some 60mg NDT (I Have both Thiroyd and Thyroid-S to trial).

    As I have no access to personal advice on NDT dosage I am wondering where to start, and whether to also continue with a lowered dose of Levothyroxine?

    For the past 4 days I’ve taken 1/2 grain Thiroyd 30mg once a day, no Levothyroxine and can feel the heart rate and anxiety raised above normal (but manageable) so assuming this is the T3 element.

    Do I stick at this to see how I get on?
    Add in some Levothyroxine as the NDT will not be providing enough?
    Add in some Levothyroxine and lower the NDT slightly?

    I know it’s going to be a bit of trial and error but a prod in the right direction would be appreciated.

    Bloods 06/06/2019 75mcg Levothyroxine, before I started on supplements:

    Free T3: 3.67 pg/ml
    Free T4: 1.69ng/dl
    TSH: 2.76 miu/l
    25 OH Vit D: 23.2ng/ml
    TPO: 453 iu/ml
    TGA: 110 iu/ml
    CRP HS: 0.47mg/l
    Ferritin: 360ug/l
    Folate: 4 ug/l

    Any help you can provide is very much appreciated.

    Many thanks,
    Tom

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