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Thyroid (Expert Forum)
poor reaction to T3
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).
poor reaction to T3
by tina999, Jan 21, 2006 12:00AM
Hi Dr. Mark,
I was diagnosed hashimoto's last summer with a TSH of 200. Upon treatment I started having symptoms of some sort of hypoaldosteronism like problem. My endo put me on florinef and synthroid and now I am down to a TSH of around 4 or so.
Now I was taking 75 ug, however three days at that dose and I feel kind of puffy, my vision gets worse, and I get lethargic and foggy brained-my hypo symptoms. Three days at the next dose 88ug and I feel distinct hyperthyroid symptoms-tremor, spastic thoughts, hot all the time.
I thought perhaps adding a dose of cytomel -T3/T4 instead of T4 might make a difference. My endo said I could try it. The first day I added 5 ug cytomel to 66 ug synthroid. I felt groggy. The next day I added 10 ug cytomel to 66 ug synthroid (am and pm doses of cytomel). I felt even groggier. Today I added 15 ug cytomel (am, lunch, and pm) to 75 ug of synthroid. I feel really tired, sluggish, puffy, my vision is off, I am cold, and my brain is really sleepy-all the hypo symptoms rather than the hyper symptoms you'd expect from too much cytomel. I also got really irritable as the cytomel dose was wearing off this afternoon(?). Also a lot of joint aches upon starting the cytomel.
Also does anyone else have problems storing the T4 or T3? If I mess up and take 50 ug rather than the 75 ug dose of synthroid (I did that once) I end up almost unable to move by midafternoon I am soo sluggish and lethargic. Taking the T4 fixed the problem within ten minutes of taking the dose.
Is there such a thing as a super metabolizer of T4/T3?
I was diagnosed hashimoto's last summer with a TSH of 200. Upon treatment I started having symptoms of some sort of hypoaldosteronism like problem. My endo put me on florinef and synthroid and now I am down to a TSH of around 4 or so.
Now I was taking 75 ug, however three days at that dose and I feel kind of puffy, my vision gets worse, and I get lethargic and foggy brained-my hypo symptoms. Three days at the next dose 88ug and I feel distinct hyperthyroid symptoms-tremor, spastic thoughts, hot all the time.
I thought perhaps adding a dose of cytomel -T3/T4 instead of T4 might make a difference. My endo said I could try it. The first day I added 5 ug cytomel to 66 ug synthroid. I felt groggy. The next day I added 10 ug cytomel to 66 ug synthroid (am and pm doses of cytomel). I felt even groggier. Today I added 15 ug cytomel (am, lunch, and pm) to 75 ug of synthroid. I feel really tired, sluggish, puffy, my vision is off, I am cold, and my brain is really sleepy-all the hypo symptoms rather than the hyper symptoms you'd expect from too much cytomel. I also got really irritable as the cytomel dose was wearing off this afternoon(?). Also a lot of joint aches upon starting the cytomel.
Also does anyone else have problems storing the T4 or T3? If I mess up and take 50 ug rather than the 75 ug dose of synthroid (I did that once) I end up almost unable to move by midafternoon I am soo sluggish and lethargic. Taking the T4 fixed the problem within ten minutes of taking the dose.
Is there such a thing as a super metabolizer of T4/T3?
Doctor's Answer
by Mark Lupo, M.D., Jan 21, 2006 12:00AM
, Jan 21, 2006 12:00AM
individual responses to t4/t3 vary a lot -- I don't know about a super-metabolizer -- that can be tested with thyroid function tests and if you are super-metabolizing the labs will look HYPO.
It takes some time for the body to adjust to dose changes - I would recommend sticking with a dose (ie 75mcg syn in am and cytomel 5mcg am & 2-3pm) for 3-4 weeks to see how you do. Another option as I am sure others on this forum will suggest is armour thyroid -- my experience is that it is also best dosed 2x/day.
It takes some time for the body to adjust to dose changes - I would recommend sticking with a dose (ie 75mcg syn in am and cytomel 5mcg am & 2-3pm) for 3-4 weeks to see how you do. Another option as I am sure others on this forum will suggest is armour thyroid -- my experience is that it is also best dosed 2x/day.
He is an M.D., FACAM and it is the best article I have read on thyroid treatment because he is so clear and concise about it, without lots of fillers etc...
He addresses the thyroid/adrenal problem that causes bad reaction to treatment that will be of most interest to you. He also addresses the T-4 to T-3 conversion problem.
I truely believe it is top-notch information. I also posted to you down below on your previous thread.
Best Wishes,
Jim
I did vary the dose a lot as i really was looking for an upperlimit of somesort-like the hyper symptoms I get from the too high synthroid. Perhaps the same dose for longer time frame might be helpful.
Cytomel T-3 dosing can be tricky -- actually, if people get too much their body lowers it's T-4 production -- so balance is key.(Your dose seems small enough to suggest your may still have a functioning thyroid -- see how much is left to guess? with just a post and a little bit of info.)
It takes at least a month to know how someone will do on a set dose of Cytomel.
One thought -- if you feel hyper with the addition of just 12 mcg's of T-4 med, then why add the equivalent of 20 to 40 mcg's with Cytomel?
T-3 is AT LEAST 4 times more potent than a T-4 med, and the mcg's do not have the same meaning.
If you do start taking the T-3 med, you may find that you would do better if you back down to 50 mcg's and then add in the 5 mcg's of Cytomel. Or, take the 75 and add in half the Cytomel, so that you'd be taking the equivalent of 85 mcg's T-4.
Without lab tests numbers, etc. it would be difficult for anyone to give you solid advice on doses -- including a doctor.
If you are interesting in the combo meds, you may be interested in reading the book "Thyroid Solution" by Dr. Arem who uses the combo dosing -- after a patient stabilizes.
Hope that you get your dose worked out. Think I'll check out Hashiman's findings. ~ M
Another thought occurred to me.
Many patients in the forums have found that supplementing their diet with magnesium, iron, & calcium, helped their bodies' "accept" thyroid doses with fewer hyper feelings. You might try such mineral supplementation.
Has your doctor run the usual hemoglobin and hematicrit? Anemia can affect your reaction to meds. Many patients favor having a ferritin test (another check of iron levels)-- they are looking for a number that is above 40 or 50 -- which differs somewhat from the lab norms. While my docs agree that the lab norm is suspicious, they do feel that los ferritin demonstrates a reaction to something else being off.
~ The best --
I may have already been misunderstood, so let me add this:
When trying to encourage patients ALREADY ON A SYNTHETIC, I don't like to tell them "it will never work" and that "Armour" (kind I'm on, believe it in highly), is the only possible treatment that will have success.
At least twice, I related my mother's success on Synthroid for over ten years and was replied to with the suggestion "if you'll look real close, you'll find she is still having hypo symptoms" (since it's Synthroid & not Armour), as if she doesn't have enough sense to know this herself!
This was the "fitting everyone in same mold" I was talking about. Others can do this, have freedom/right to do so, I'm just saying that I personally won't do this.
Sorry if I offended anyone but thought it might be okay to express this without feeling criminal about it. Honest-To-God not trying to start up a debate, just trying to comfort another poster that maybe felt intimidated.
I just wanted to say that I referred an article to Tina999 but I did so, more for reason of it containing info about her possible adrenal and conversion of T-4 to T-3 problem (article does actually advocate Armour). I don't however agree with everything in the article such as the "basal body temp" but as in many articles I seldom find I agree 100% but don't want to keep this from referring another patient who may benefit from that part they are needing.
I sometimes refer Mary Shomon articles. I have great respect for her and she is very well informed but I can't say I agree with her on 100% of everything. I can't however "throw the baby out with the bath water" and never refer persons to articles because there might be a thing or two incorrect in them. If I let that stop me, there would be almost nothing to refer and I believe people need information, whether the source is perfect or not.
I can't seem to store the T4 the way others do-I have tried the alternating the 75 ug and 88ug dose on different days. I feel pretty cruddy on the 75 ug days. It's a good thought though and thanks for the suggestion. You should be able to miss a couple of weeks of the T4 before you start to feel bad. I seem to notice the 10 ug change in a day. Not at all normal
I really expected the T3 woule be helpful but it I think maybe my body got so used to having so little T3/T4 that it makes every last bit of it available for use. So any free T3 gets used quickly and almost all the T4 gets converted to T3 within a day/hours rather than being stored long term. So I think maybe the T3 just gets eaten up within a few minutes or something. It doesn't give me any hyper symptoms at all though so who knows.
I think perhaps the thyroid isn't making anything anymore as as soon as I started taking T4 (after adding the florinef) I had to up the dose rapidly from 25 ug to 75 ug within one month as I started to feel really, really bad-wierd stuff like joint aches, scratchy throught, a tightness in my head. Taking a 25 ug dose of T4 made all the symptoms go away within ten minutes so I just kept adding doses as needed! I think the addition of the T4 caused the TSH (around 100 to 7) to drop pretty quickly which shut off whatever the thyroid was making. I think its dead in the water.
My poor endo is so cool though, as he always makes sure to say "normally this is this but you aren't normal" and then says that he has no idea about me though. The last time I went in he made jokes about my TSH being around 8000 or so. He throws his hands up in the air alot! If you need a good endo in the Texas area let me know!
I do keep a close watch on iron intake-sometimes I will sleep quite poorly-restless legs like sleep. If I take iron or eat more red meat it makes all the differance. I also have to watch and make sure I eat regularly or I feel like ****. Also the B vitamins made a huge differance especially at first. Also drinking a lot of water, however that's the florinef acting there.
I think perhaps I'll stick to the T4 for a bit longer to "stabilize" more-perhaps next summer I'll revisit the T4/T3 combo. I am hesiatant to use armour as it would be a drastic change relative to T4 alone and I am want to make changes that I can easily step back from if they go poorly. No more ER trips for me :)
Hey Jimlow,
Thanks for all the great advice. I got your email a bit back and just didn't have time to get in touch. I hope all is well for you and god bless!
Thank you