One man's life with hypothyroidism

In 2015, I asked a GP in Ireland for a prescription for Armour Thyroid. What the doctor didn't know was that I was secretly recording him with my phone! Mhua ha ha ha! I am an evil genius. Here's a transcript of the conversation.

Doctor: How are you?

Me: Hi. I’m good thanks. How are you?

Doctor: My name is [name removed for anonymity]. It’s nice to meet you.

Me: It’s nice to meet you too.

Doctor: Why don’t you tell me what the trouble is?

Me: Ok. Well, basically it’s hypothyroidism.

Doctor: Hypothyroidism?

Me: Yes.

Doctor: Okay.

Me: I was diagnosed with it about a year ago. I’ve been taking levothyroxine. Then I found out about Armour Thyroid?

Doctor: Okay.

Me: And I kind of think that levothyroxine might not suit me, and I wondered if I could try Armour Thyroid, instead basically.

Doctor: That’s Eltroxin?

Me: Yes. That’s right.

Doctor: Eltroxin’s for underactive thyroid, not overactive thyroid.

Me: That’s right.

Doctor: So you have an underactive or an overactive?

Me: I have an underactive.

Doctor: So you have an underactive thyroid.

Me: Yes.

Doctor: And how much Eltroxin are you taking?

Me: At the moment it’s quite high actually. It’s 250 mcg.

Doctor: Yes, that’s a lot.

Me: Yes, it is.

Doctor: It is suiting you?

Me: I’ve seen an improvement on it. When I started, I was very tired all the time.

Doctor: That’s the only product available. Are there any other products that you’re contemplating taking?

Me: Well, no. All I know about is levothyroxine, which is T4, and Armour Thyroid, which is a mix of T1 to T5, I think.

Doctor: As far as I’m concerned, there’s only one. (Shit... maybe he won't give me Armour.)

Me: Oh, right.

Doctor: And that is Eltroxin. That’s the one you use. There is one which is taken from a pig. I can’t remember the name of it. (Strange... I've already mentioned Armour Thyroid twice so far.)

Me: Actually that’s the one. It’s taken from a pig thyroid.

Doctor: Yes, that’s the one. What’s the name of it?

Me: It’s called Armour Thyroid.

Doctor: Yes, Armour Thyroid.

Me: It's a natural desiccated thyroid.

Doctor: I mean the thing with Eltroxin is... it’s whatever your body makes. It’s exactly what you make.

Me: Yes, exactly. T4.

Doctor: Armour is the pig one. Bear in mind that Eltroxin is chemically made. Eltroxin mimics what your body makes, so it shouldn’t give you any side effects. The problem with Armour is it’s very difficult to determine the dose. And people mess the dose up.

Me: You mean they take too much or too little?

Doctor: They take too little. Because it’s not scientific. It’s more homoeopathic. Some people are on it and they’re controlled on it because they’re on the right dose. My suggestion is: if you’re on Eltroxin and your thyroid function tests are normal, then you stick to Eltroxin because if you change, it means you have to do blood tests every couple of weeks until we get you sorted. It’s a bit messy, you know? And also, the normal Eltroxin has been researched for a long, long time. So I don’t recommend switching from Eltroxin to Armour. But some people who have been on it, and have stayed on it, it’s okay. It’s not going to make any difference to you. How you feel is not going to change. It’s the same, you know? Basically, the normal Eltroxin is what your body makes. It’s like suited for your... chemically made, suited... like, it’s normal, you know?

Me: It’s true. Yes. My body does make T4, it’s true, thyroxine. But it might be a problem with conversion from the T4.

Doctor: It’s not to do with conversion, actually, the way it works is... just a minute. *Gets a sheet of paper to draw on*. A lot of people complicate it. I mean, at the end of the day, this is your pituitary gland, which is in the brain. It sends the hormone called thyroid-stimulating hormone to the thyroid gland which is in the neck. Okay? That’s the thyroid. And the thyroid gives you the T4 and T3. When this is increased... so this kicks this, okay? And this makes T4, right?

Me: Yes, yes, I understand that.

Doctor: It has a negative feedback effect. So when T4 is high, it sends the signal to this, to start kicking this. Basically when you have low, when this is not functioning, this will go up, because this will keep kicking this so it will increase thyroid-stimulating hormone, and this goes down. So what we do, this is malfunctioning. From the outside we give this, that’s all we do. So then, we help this. So I mean, if you want to switch, I’ll switch you. I don’t know the dose so we’ll have to titrate it. We start from scratch. And we’ll do blood tests on your regularly, like every two weeks for a while, because I don’t know what dose suits you. You’re stable now, so we’ll mess up everything, We’ll start as if you’re hypothyroid. You’ll start to get... it’ll be messy, really messy, you know?

Me: I wouldn’t say I’m stable though. I’m on 250 mcg which is quite high, but I still have some of the symptoms though, like...

Doctor: Well, I’ll do a blood test on you anyway, that’s what I have to do first. And if you’re stable on 250 mcg... If your TSH is normal, if your T4 is normal, then from my end you’re normal. This is your dose. Whatever symptoms you have, it’s not because of the thyroid. It’s something else. And then you know, we need to titrate. We start you on Armour Thyroid. Because Armour Thyroid, first of all, it comes from different makers, different doses. Secondly, it’s not licensed. Okay? But we give it because people in other countries give it. Thirdly, you know, what works... it’s not standardised. So what might work on your... The same dose might not work on the same people.

Me: I’ve heard some studies that show that some people are happier on Armour Thyroid than T4. But yes, I mean, I haven’t actually had a blood test for about six months. So a blood test would be good.

Doctor: We’ll start with that. And if you want to switch, we can work with it.

Me: Okay, thanks.

Doctor: My recommendation is: if your blood test is normal, you stay on what you’re taking. And if you want to switch, it’s your decision. It just means more blood tests, that’s all.

Me: Well, I don’t mind paying for blood tests. I figure, why not try, to see if it’s better, and if not, I can go back to the Eltroxin.

Doctor: Yes. I’ll do a blood test on you now then. You can come back when you’re fasting. I’ll do everything: kidney, thyroid, Iron, ferritin. Same price, whether you have one blood test, or all of them. Because we don’t charge for multiple blood test results.

Me: Oh really?

Doctor: We charge... I can do a non-fasting one, but the cholesterol result will not be accurate, and the blood sugar, if you’re a diabetic, will not be accurate. But the rest will be normal. They will be accurate. Everything else will be accurate.

Me: Well, if it’s the same price, then why not.

Doctor: It’s up to you. I can do it now. A blood test will cost €65. But the switching is going to cost you a bit more money. Because every time you come back for a blood test, I will charge you.

Me: Yes, I understand. By the way, I haven’t actually had anything to eat breakfast today. I just realised, I skipped breakfast to get here. I had a cup of tea, and that was it.

Doctor: Okay. Well, let’s do it.

Me: Okay. Well, that’s quite a coincidence actually. Today I was in a rush to get here, and my girlfriend cooked the breakfast and she left it on the side.

*The doctor prepares the blood test*

Doctor: I think I have two patients on Armour Thyroid.

Me: Oh really?

Doctor: Yes. And they came to me on it. To me, it’s all psychological. It’s a thyroid replacement. There’s no good thyroid and bad thyroid in the blood. *Over the phone to the nurse:* Paul, I have... Put Paul on the system. I need to do a blood test. *Turns back to me* Okay. Let’s do it then. So you’re taking 250 mcg every day?

Me: Exactly, Yes. For the past eight weeks now.

Doctor: Eight weeks. And who diagnosed you with it?

Me: It was in Canada. I lived in Canada. My TSH was 6.4 mIU/L.

Doctor: 6.4 mIU/L is not too bad. (He should try living with hypothyroidism, and then see what he thinks.) It’s not too bad, but 250 mcg is a bit too much, I think.

Me: I’ve kind of been getting increases for my symptoms rather than by blood tests.

Doctor: Somebody increased it or you increased it?

Me: No, I had a doctor in England who was just increasing it every time I went.

Doctor: But you were diagnosed eight weeks ago?

Me: I was diagnosed about fourteen months ago.

Doctor: Fourteen months, okay. And how long have you been on 250 mcg?

Me: For eight weeks.

Doctor: Eight weeks continuously?

Me: Yes. Continuously, Yes.

*The doctor draws my blood*

Doctor: The reason I’m doing all this is just to make sure there isn’t any other problem causing you to feel weak or tired. Because sometimes, with an underactive thyroid, people can have a vitamin B12 deficiency, they can get diabetes, and these can cause similar symptoms.

Me: Yes. Well, it’s always good to check.

Doctor: *gives me cotton wool for my arm* This is for the blood.

Me: Thank you.

Doctor: Put that there.

Me: Ah, right.

Doctor: And do you have enough Eltroxin?

Me: Yes, I have another three months’ worth at the moment. So I’m okay for that.

*The doctor fills in the blood test form*

Me: Thanks.

Doctor: I just have to check your blood pressure.

Me: Do you have many people with hypothyroidism?

Doctor: Yes

Me: Oh really?

Doctor: Yes.

Me: Especially in women, I heard.

Doctor: Yes, it’s more common in women. Yes. We see men with it though.

*The doctor measures my blood pressure*

Doctor: That looks good.

*The doctor takes the cuff off*

Doctor: Okay, so I’ll that to you. Give this to the girls outside, they’ll call a courier.

Me: Oh. Perfect.

Doctor: And I’ll talk you on Friday. This Friday. Or next week.

Me: Friday? Okay. Oh, that’s pretty quick. I guess it gets sent to a lab in England, or in Dublin?

Doctor: Yes, I’ll give them to you. If you want to send them, send them. It’s your patient information, I’m not going to send it.

Me: I have to send these? *holds up vials of blood*

Doctor: No, you have to give it to the girls. I’ll give you a printout.

Me: Oh, okay fair enough. Thank you very much.

Doctor: So I’ll see you Friday. So come here on Friday.

Me: Alright, I’ll talk to you Friday. Or maybe I’ll leave it to Monday.

Doctor: Okay, Yes.

Me: Okay, great. Well, thank you again then.

Doctor: Good luck to you.

Me: Cheers. Thanks.

Two days later...

Me: How's it going?

Doctor: Good good. Now, basically you're running overactive now. Your thyroid, the normal is 22 pmol/L, yours is 32 pmol/L.

Me: Is it T4 or...?

Doctor: T4.

Me: Total T4 or free T4?

Doctor: The, uh, fair enough. I know TSH is very low. Less than 1%. *finds the result on the computer* So the free T4 is 32 pmol/L.

Me: The free T4.

Doctor: And it should be between 12pmol/L and 22pmol/L. So you're doing about double.

Me: Yes. I don't know. I mean, I know the symptoms of hyperthyroidism, but...

Doctor: Not necessarily, some people need 40 pmol/L to get something, but the damage is done. It's been done if you leave it. Okay? So your T4 should be between 12 pmol/L and 22 pmol/L.

Me: That's the recommended...

Doctor: That's the recommendation, that's the normal...

Me: Range. Yes.

Doctor: Your TSH actually is very low. OK? And it's less than 0.1%. OK? So the normal is between 0.27 mIU/L and 4 mIU/L. So you're really... it's a bit too much. The Eltroxin on 250mcg is a bit too much, you know? So what I want you to do, I want you to skip... to reduce your dosage anyway. We need to get you back to around 100mcg to 150mcg. And I'll give you the equivalent of Armour Thyroid.

Me: Yes? Sounds goods, yes...

Doctor: Now the equivalent, roughly. I've researched the studies and I think that each milligram of Armour Thyroid is about 1.47 mcg of Eltroxin. Some studies said 1.67 mcg, okay? So 150 mcg is about 100 mg of Armour Thyroid.

Me: Yes, exactly. No, that's great, I would agree with that. I've read that 60 mg is...

Doctor: They come in 60 mg tablets and 30 mg tablets. That's what Armour Thyroid comes in. It doesn't come in 90 mg tablets, unfortunately... It has a 120 mg dose, but I wouldn't go for it, because you're high now. So what I’ll do, I'll put you on 90 mg: a 60 mg tablet and a 30 mg tablet.

Me: Yes, well, it sounds good as a starting dose, and then I guess...

Doctor: And then we will... Actually, there is a 90 mg tablet. I’ll give you 90 mg. Probably you'll end up on 120 mg eventually. You're overtaking them, so we need to go back, you know?

Me: I've heard that a lot of people on it take 120 mg, or even 180 mg, or more...

Doctor: It depends. I mean, I don't know, I mean, most of my people are... [Unintelligible] ...50mcg of Eltroxin. I have some people on it. Very rarely, I have people on more than 150mcg of Eltroxin.

Me: Really?

Doctor: Which is the equivalent of 120 mg of Armour Thyroid. (Wrong. 150mcg of Eltroxin is the equivalent of about 90 mg of Armour Thyroid.)

Me: Because on the website they say that it's unusual for someone to take more than 200mcg of Eltroxin, and very rarely people take more than 300mcg of Eltroxin. It’s been heard of.

Doctor: It’s more than... Yes, I don't go by what people say. I go by blood tests. And blood tests will tell me that this is it, scientifically speaking. So I don't go by hunches or what people tell me. I just go by blood tests, and blood tests sample you that, and that's what you take based on that.

Me: But is it not better to give people more if they still have the symptoms?

Doctor: No. None whatsoever.

Me: Really?

Doctor: Disastrous consequences.

Me: And why's that? But maybe for some people, a high dosage is better, even if the blood tests say not.

Doctor: I go by blood tests, I don't go by symptoms. If your thyroid is normal and you still have symptoms, it's not thyroid related. It's related to something else.

Me: Right.

Doctor: Basically that's how it works, you know? There's a lot of rubbish on the internet. Don't believe it. It's all rubbish. So I follow scientific evidence, you know, basically, and that's what I practise: evidence-based medicine. I don't practise hunches. I follow rules.

Me: Fair enough.

Doctor: And that's where we go, you know?

Me: But the body has to break down free T4 into free T3... And that’s entirely different...

Doctor: It doesn't matter. You know, the calculations would be going... We check TSH, it’s the most important. (Wrong. Free T3 is the most important since it's the active form of thyroid hormone. TSH can lie; free T3 can't.)

Me: Is it? I would say that the free T3 is more important because that's the thing that actually gives you the effect. Doesn’t it?

Doctor: That's rubbish. I told you, a lot of... to monitor the... thyroid function test, the most important one is the TSH. That's the most important one. And nobody checks your T3 unless you have low TSH and normal T4. So there's something else affecting the TSH, not the T4, so you've got to search for the T3.

Me: I don't know, my doctor in Canada, he started doing T3 tests, and there's an importance of...

Doctor: They do them in complicated cases. But in most of the cases, especially when you put people on treatment, that's what you follow. You know?

Me: Well, I guess if most people are happy with the treatment.

Doctor: Yes, that’s what I... if you want another opinion. I can send you to an endocrinologist, and you can just go and chat with him. But you have to pay €200 to see him. And then you follow up with him, and every visit is €200.

Me: I think they’re... endocrinologists are not very good. They’re...

Doctor: Endocrinologists are the best for thyroid disorders.

Me: It depends what you're looking for. Because If they follow the blood tests exactly. If you're a patient who doesn't fall...

Doctor: No, you follow symptoms and blood tests. But you cannot have thyroid symptoms if the blood tests are normal. Because when the blood tests are normal, it means you have enough thyroid going in your blood. So patients can imagine all sort of symptoms, and think, "Oh I feel terrible, I must increase my Eltroxin". Lots of rubbish. You do damage to your body. If you take too much Eltroxin, you damage your heart. Because if you make a mistake, if your blood tests show you’re taking too much thyroxine, it can cause problems with your heart, and before you know, you have a heart attack.

Me: Yes, that's true, but it has to be a very high dose.

Doctor: No... Like now, as you stand, you don't feel anything. You're in the state of hyperthyroidism. You may not be symptomatic. But your body is in a hyperthyroidism state. You may not have symptoms. Your pulse may not be high. I see a lot of people have hyperthyroidism with a normal pulse. Ideally, your pulse should be high with hyperthyroidism. But that’s in severe hyperthyroidism. Then you have thyrotoxicosis. Which many hyperthyroidism people have. And not necessarily with in thyrotoxicosis. Thyrotoxicosis is toxic.

Me: Yes, it is, the toxic level of the...

Doctor: You can have hyperthyroidism. High thyroid hormone is damaging. It damages the arteries, it damages organs. Your whole metabolic rate is messed up. You lose weight. Sometimes, most people are fine, you know. So that's what you do. But ideally, I want your TSH to be in the normal range. I want your thyroid, T4, to be in the normal. I want the TSH to be in the middle of the normal range. Ideally, you know? Not just for... for perfect control, I want it to be around 2mIU/L.

Me: Really?

Doctor: Like 0.3 mIU/L, that's normal. But you don't want it to be 0.3 mIU/L. *Laughs*

Me: I've heard though that some doctors prefer to go to the high range instead of in the middle. If you go too high, it means you have... it's okay, you can keep it in the high range, but it means you’re taking... you have to take less Eltroxin to push it up.

Me: No, I'm talking about TSH would be in the low range, with T4 it'd be in the high range.

Doctor: T4 would be in the high range. I mean, TSH, you have to middle-low. That’s what I want. Anyway. First of all, let's normalise you. So let's see, I'll see you in three weeks’ time for another blood test.

Me: Oh, okay. You don't want to start me off on 120 mg?

Doctor: You're high now. After I see you again I'll you 120 mg most likely. Now because you're high, I want... I was even thinking of asking you not to take any for the next two to three days.

Me: Oh right. Er... well...

Doctor: You know, that's what I was thinking of, you know? I don't want to suddenly withdraw it.

Me: No, well I'm happy then with the 90 mg.

Doctor: Yes?

Me: Try that, and...

Doctor: I have a feeling you'll end up on 120 mg. But we'll see. Because 120 mg is about 170mcg. But we'll see. I mean, we’ll follow blood tests as well. And I cannot give you anything unless I can justify it. Medically and legally speaking. We follow science. We don't follow symptoms, or hunches, or the Internet, or anything like that.

Me: Ah right. So if I had a heart attack, then you'd find yourself in court, I suppose.

Doctor: That's the problem, you know. Let's go to this. Many GPs don't give Armour Thyroid. I don't like giving it, you know, but...

Me: No, I know that.

Doctor: I think I have two more people apart from you on it.

Me: Can you tell me what doses they're on, by the way?

Doctor: It comes up 30 mg, 60 mg, 90 mg, and 120 mg.

Me: I mean your two other patients, with the hyper.

Doctor: I can't remember that.

Me: Fair enough. They came to you already taking it. Could I get a copy of the blood test as well?

Doctor: Oh yes, absolutely.

Me: It'll be interesting to see. I'll have a look at other stuff later. Vitamin B12, and the other stuff.

Doctor: Yes, absolutely.

*The doctor prints the blood test results.*

Doctor: It would have been easier and cheaper for you if you'd stayed on the Eltroxin.

Me: Yes, I understand, but I know there are a few studies that show that some people prefer the...

Doctor: Armour.

Me: Some studies break the dose of Armour Thyroid, and you know, before... But you know, I mean, that's not intelligent. Some people take a bit of each in some studies. You know? A bit of each. Like Eltroxin and Armour.

Me: And Armour.

Doctor: Yes. Mm-hmm.

Me: Yes. Do you know where I can get this...? *Indicates to prescription.*

Doctor: Er, I don't know, you can ask any pharmacy. They would normally...

Me: Yes, I'll ask the pharmacy.

Doctor: Yes.

Me: Because it's a bit of a...

Doctor: If they don't have it, they'll order it for you.

Me: Ah right. Okay.

Doctor: *Turns to printer* The problem with blood test results is that they don't give the normal ranges. Okay? But I'm going to...

Me: Oh yes, it's no problem.

Doctor: I'll write down the ranges. The normal ones I’ll leave. Your vitamin B12 is good. It’s actually 471. The normal is more than 206. And the main ones for me are free T4, which is 12 pmol/L to 22 pmol/L. And the TSH is 0.27 mIU/L to...

Me: You know the TSH? It used to be that anything under 10 mIU/L was normal, and then they changed it to 5 mIU/L , or... it’s 3.7 mIU/L now, and it keeps getting lower.

Doctor: Each lab is different. They have their own method. In this hospital here, it's 4.2 mIU/L. In some other hospitals, they calculate it differently. So it would be around 3 mIU/L.

Me: It was very fast, by the way, this blood test. It came the next day. That was quick.

Doctor: Yes, absolutely. It’s because we're electronically connected to them. Your iron is good, glucose is good, blood sugar is good, kidney is good, all of this is normal. Yes, everything else is fine. So these are the things. So I'll see you in three weeks’ time.

Me: Okay. Sounds good. I’ll...

Doctor: So let's start with 90 mg and see how it goes. And we do it again in three weeks, and maybe again in another three to four weeks, and we'll see how it goes.

Me: Yes, okay.

Doctor: Once we have it regulated, then every six months... you know... Keep an eye on it.

Me: Okay, sounds good. Well, I'm looking forward to seeing what result it has.

Doctor: Have you lost weight lately?

Me: Have I lost weight? No. I know that's one of the symptoms of hyperthyroidism but I haven't had any symptoms I know of. There’s excessive hunger, I haven’t had that. Like you said there’s diarrhoea, but I haven't had that.

Doctor: Palpitations? Sweating?

Me: No. Not at all. I've been looking out for the symptoms, but I haven't had them, to be honest.

Doctor: Well, we'll see, we'll see.

Me: Yes, we'll see.

Doctor: I mean you’d have to have a toxic, that's why you're running hyper, you know.

Me: Yes, I haven't reached such as a high level yet to be toxic.

Doctor: There was one guy who came in with severe hypothyroidism. Like, his TSH was like you. Less than point... Undetectable. And his T4 was quite low, very, very low. Like 1. Very very down.

Me: Oh, so he had hypo or hyper, sorry?

Doctor: He was hypo.

Me: Oh hypo, right. Yes, that's pretty extreme.

Doctor: I took months to get him up. You know?

Me: Really?

Doctor: Months. He had a lot of Eltroxin. He actually came in with depression.

Me: A lot of people with hypo have depression.

Doctor: Yes, he came in with depression.

Me: They get put on antidepressants when all they need is a higher dosage.

Doctor: Yes.

Me: But that's an extreme case. I don't think I was that extreme when I was diagnosed.

Doctor: Well, let’s see how it goes. I'll talk to you in three weeks’ time. Bye-bye. I'll show you out. Ok, bye. There's no charge.

Me: Oh right, okay.

So I got what I came for: an Armour Thyroid prescription. But the dosage was too low. So I started ordering thyroid medication online instead.

Here's the recording: