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Thyroid  (Expert Forum)
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Cytomel in addition to Synthroid
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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MedHelp Member's Question

Cytomel in addition to Synthroid

by JDrake, Oct 16, 2005 12:00AM
Dr. Mark,



My doctor just added Cytomel in addition to my Synthroid.  I am taking 137 mg of Synthroid and 25 mg of Cytomel, I am 5'6" and weigh 122 lbs.  Does this dose seem to high?  I thought when adding Cytomel, the Levothyroxine dosage was suppose to be lowered by 50%?



Thanks,

Jenni
Doctor's Answer

by Mark Lupo, M.D., Oct 16, 2005 12:00AM
Cytomel is about 4x as strong as synthroid.  So, 25mcg of cytomel is roughly 100mcg of synthroid - making your new daily dose 237mcg -- a bit high on average for your weight.  If you were on 225-250mcg of synthroid alone before the change and the TSH was at goal (about 1) then this may be appropriate.



I usually add cytomel by decreasing the synthroid dose by 40mcg and starting cytomel 5mcg in am and 5mcg about 2-3pm.  I have found that dividing the T3 into two doses is helpful.  The 50% drop in l-t4 may work out okay for some patients, but I like to be more precise.  The 25mcg of cytomel all at once may give you palpitations/anxiety -- then take 1/2 in am and 1/2 mid-afternoon -- often I work patients up to this dose but like to start with the 5mcg as mentioned above...
Member Comments (22)

by JDrake, Oct 16, 2005 12:00AM
To: Dr. Mark
When I was on 150mcg of Synthroid my TSH was 0.77 (0.3-5.0 lab range), my FT4 was 1.6 (0.9-1.8 lab range) and my T3 was 119 (80-180 lab range).  But I continued to lose my hair.  I posted previously about the dosage changes of my Synthroid from 150mcg to 137mcg because of my hair loss, my endocrinologist said that reducing my dose would help and it did slow the hair loss, but not enough, and now I have all the symptoms of hypothyroid (dry course hair that falls out more than ever, cold feet and hands, my body temperature mid-day is 97.6, fatigue, depression, etc.  Am I now taking to much thyroid hormone replacement with the 137mcg of Synthroid and the 25mg of Cytomel according to what my labs were on 150mcg of Synthroid alone?  How long, on average, does it take to notice a difference in relieveing the hypo symptoms with the addition of Cytomel?



Jenni

by Nitter, Oct 17, 2005 12:00AM
I currently take 300mcg of synthroid daily. My tsh levels have been as high 451 when I have been off my meds. I cannot afford insurance and ocassionaly skip a week or so. I get so emotional and tired and easily forget basic tasks not to mention I'm depressed. I am 48 years old and have been on thyroid replacements for over 30 years. My problem is my boy friend thinks I am just being a flake and does not care or understand how I am feeling. He is judgemental and verbally abusive. I am visiting him in Ireland and don't have enough money to go home (to America)for a couple of weeks. I have been back on my replacement now for about 5 days. Last week My tsh levels were in the 30's How long before I should start feeling better. Nitter

by Mark Lupo, M.D., Oct 17, 2005 12:00AM
Cytomel takes about 3-7 days to notice a difference.  The dose sounds a little high based on previous TSH - but if you are not feeling over-stimulated then it may be wortwhile waiting 4-5 weeks and rechecking TSH and re-evaluating.

by JDrake, Oct 17, 2005 12:00AM
To: Nitter
How long have you been off of your Synthroid?  I am not a doctor but I have been told it takes about 6 weeks to really notice a difference when starting or changing a dose of Synthroid.  I am sorry to hear about how your boyfriend is treating you, he just doesn't seem to understand what you are going through.  Being hypo is extremely hard on a person both physically and mentally.  Hang in there and I hope you can get home!



Jenni

by j.drake, Oct 20, 2005 12:00AM
I had to stop taking the Cytomel as I had several anxiety attacks that lasted for more than three hours.  The doctor said that my body is resisting the thyroid hormone replacement (that is why I've had so many problems since starting the meds in April), he said that he has only seen this in a few patients.  So he is reducing my Synthroid from 137mg to 125mg (only for 4 weeks) and taking me off of the Cytomel.  He said I will be fatigued but after the 4 weeks he will begin to slowly increase my meds. Has anyone else experienced this?



Thanks!

by ArmourGal, Oct 20, 2005 12:00AM
To: jdrake
just my two cents...



i've only seen problems like this when someone had low adrenal reserve....and then one time with a person who had a bipolar background (which the literature indicates can be a problem starting thyroid hormone replacement).

by j.drake, Oct 20, 2005 12:00AM
To: ArmourGal
I am positive I am not bi-polar and that leaves me with the low adrenals, which is what I have read on several sites and also heard from others on the Yahoo Natural Thyroid Hormone Users Group.  I am going to ask my doctor about having the adrenal saliva test and go from there.



Thanks, ArmourGal!

by femmecuzz, Oct 24, 2005 12:00AM
To: forum dr.
I had a couple questions regarding Cytomel - but first my brief background: 35yr. old male, 6'4" 190 pnds.,been on 100mcg. levo for 2 months, tsh went from 22.6 to now a 4.2 - still felt hypo. (constip.,depression, low energy, no libido) so I had my shrink add Cytomel for "depression" he told me to stop levo. completely and prescribed me 50mcg cytomel to "activate" the 300mg.Wellbutrin he's got me on. Does this sound like good practice to you? I thought people do better with t4/t3 together rather than either one on their own? For now I've just started taking 25mcg t3 and 50mcg t4. Is this what you would do? I will go back to my doctor I just need a good opinion on the subject before I go to him without a plan. Also, I don't feel any effects of the t3. Should I? If I don't feel any immediate effects does this mean I need more or something? I've been on it for 4 days now. I really thank you for your expertise and your time in advance! It's awesome to have a place like this to go to rather than looking up 100 different conflicting articles on the internet.

by doodlebug1, Oct 24, 2005 12:00AM
To: femmecuzz
I know you directed your question to the good doc--but would you entertain some comments from another thyroid patient? What you are describing is called the Wilson's Syndrome treatment, where patients are treated with T3 alone. I belong to a group of nearly 1500 thyroid patients, and there are severals folks in that group that tried T3-only treatment, and were not impressed. Several also did the synthetic T3 and synthetic T4 treatment, and reported some success. But.....those that switched to natural dessicated thyroid, also known as Armour, reported the best success--they report that the results on Armour are even better. I can only infer from that the complete package of Armour does the trick--it contains T4, T3, T2, T1 and calcitonin, exactly what your own thyroid gives you. And....bar none...everyone reports relief from depression, IF they are allowed to dose high enough with Armour---i.e. NOT by the TSH, but by getting their free T3 at the top of the range.

by ArmourGal, Oct 24, 2005 12:00AM
To: femmecuz
whew -50 mcg of cytomel..wow, that would be heavy duty for me, but I'm 50+ lbs lighter than you..but I've read the usual recommendation for adding Cytomel to an antidepressant is 25 mcg.  But here's a question...if you have depression and are hypo, why not just take a T4/T3 combo like Armour Thyroid or a synethic combo?  

Also, I've never seen anyone get rid of their depression from hypo when they were on an anti-depressant.  Yea, that sounds weird...but look at it this way.  If the problem is hypo and the brain needs healing...and you're putting another chemical action in there while trying to heal the brain from the hypo...well, sometimes it doesn't work too well.  Low thyroid hormone in the brain causes low serotonin...and i believe those SSRIs are messing with that action...and well, it's true that the folks on my thyroid forum seem to have more trouble with the hypo depression when they have added other psychotrophic meds.  

Cindi

by v.kinga, Oct 27, 2005 12:00AM
Hello everybody! My sister has a problem related. She seems to be allergic to Thyroid Armour an dalso to the T4. We don't know what to do, because she usually faints every time she takes something in. Doctors say that it could be psychosomatic but I know it's not. We live in Europe and we have difficulties getting the medication. Can you help me with some ideas/experience?

Thank you very much!

by ancientmariner, Oct 27, 2005 12:00AM