Where I am today

I talked with my doctor's office this morning and here's the scoop.  My heart palpitations and chest tightness/aches are from the Isocort (cortisol), not my Armour (natural dessicated thyroid).

I had read on page 96 (first edition, STTM) that you can have hypothyroid symptoms if you start cortisol after you're already on dessicated thyroid.  Duh, Mary, that's T3 thyroid, not dessicated.  The nurse informed me that Armour/dessicated is mostly T4.  I felt sheepish!  But this is how we learn, right?  So, moving on. (See update below.)

Another dumb thing I did was got confused about the schedule for Isocort.  On Saturday, I took the normal 4 in the morning, but I also took an additional 4 at noon.  It's actually very, very important to slowly increase.  (Actually, it's not; Janie's recommendation according to patient feedback is that it's increasing slowly can actually cause adrenaline surges - BAD - and shutting down of the HPA (hypothalamus-pituitary-adrenal) axis.  Yikes!  I did talk with doc about this later, and he's fine with a patient trying the new recommendation.  I hope he hurries and reads the second edition!)  Here's my doctor's schedule:

Days 1-3: 4 pellets Isocort cortisol upon waking
Days 4-6: 8 pellets in AM
Days 7-9: 8 pellets in AM + 4 pellets at noon
Days 10-12: 8 pellets in AM + 8 at noon
Days 13-15: 12 in AM + 8 noon
Days 16-18: 16 in AM + 8 noon

You can increase to 32 pellets total in one day and you can increase every 5 days rather then every 4, if needed.   

Doc's schedule allows for a rapid increase to get the job done, quick and easy.  It can't be denied that it's cheaper, too. (The new recommendation makes this statement a non-issue, now.)

However, there are some patients who won't be able to start at such a high dosage or increase so quickly.  Here is the schedule in STTM which Valerie Taylor, one of the top thyroid patient experts on adrenal support, suggests:

Days 1-3: 2.5 mg upon waking
Days 4-6: 2.5 mg upon waking + 2.5 mg four hours later
Days 7-9: 2.5 mg upon waking + 2.5 mg four hours later + 2.5 mg four hours later
Days 10-12: 5 mg upon waking + 2.5 mg four hours later + 2.5 mg four hours later
Days 13-16: 5 mg upon waking + 5 mg four hours later + 2.5 mg four hours later
Days 17-20: 10 mg upon waking + 5 mg four hours later + 2.5 mg four hours later + 2.5 mg at bedtime

STTM explains why this dosage pattern of four times daily, plus a bedtime dosage is important. 

My doctor did encourage me to follow the latter dosing schedule if I feel more comfortable or if that is what I need to keep from having symptoms.


So, the question remains: which dosage schedule should I follow?

Update:  A more recent doctor's appointment confirmed my belief that my symptoms were the result of active T3 having pooled in my blood due to low cortisol.  Since I had started Isocort, the raise in cortisol finally allowed the T3 to "dump" into my bloodstream. (See page 102 STTM, second edition).   

Also, the nurse at my doctor's office misinformed me about Armour, which does contain T1, T2, T3 and T4 and calcitonin.  I let her degree make me feel silly when I was right all along.