Think I am not tolerating Cytomel

[yorkieville]

My D.O. has had me on 62.5 mcg. Levoxyl & 20 mcg. Cytomel. I am experiencing neuropathy, inability to fall asleep, nervousness, weight loss, esp. all the fat along my spine, back pain. He says my labs are in range:
TSH <0.1L   0.3-5.8
FT4  0.9    0.56-1.50
FT3  3.17   1.68-3.54

Please, doctor, can you give me your opinion?

I am 54, female, 5'2, 86#s. I hurt so bad that I can barely get out of bed.

If my labs are in range, do you think my system just cannot tolerate Cytomel?

Has anyone else experienced these types of problems with Cytomel?

Thank you for any insight.

[Mark Lupo, M.D.]

These are exactly 'in range'  -- The TSH is low, reflecting the brain interpreting the current dose as too high.   The cytomel dose is a little high in relation to the levoxyl.  Remember, cytomel is 4x as potent as T4 (ie, levoxyl or synthroid) -- so your total current levoxyl equivalent dose is 142.5mcg which is high for an 86 pound woman.

That is based on labs alone.....the symptoms also suggest too much medication, so would consider cutting out/back the cytomel.

[yorkieville]

Thank you for replying, Doctor. I actually spoke with someone at King/Pharm this morning, and reported my symptoms taking Levoxyl & Cytomel, and was advised that the FDA has not approved them for combination therapy. After reviewing in detail, when my symptoms began, it appears that I may be one person that cannot tolerate one, or the other, or the combination therapy.

Again, thank you for your response.

[yorkieville]

Dr. Lupo, you said the Cytomel was a little high in ratio to the Levoxyl, may I ask what ratio the Cytomel to Levoxyl should be? Is it customary for a doctor to prescribe two new meds at the same time? I was originally prescribed 75 mcg. Levoxyl and 10 mcg. Cytomel, and told to increase the Cytomel to 15 mcg. in two weeks, and again itcrease it to 20 mcg. in another two weeks.
My legs and thighs hurt so badly with each increase, and my doctor insisted that my body would 'adjust'. I eventually stopped aching, but developed all the other problems. Thank you for helping me.

[RenWilk]

I find it interesting that very few doctors recognize that it can be the T4 containing medications that some people cannot tolerate.  I have Hashimoto's and Hypothyroidism and I"ve been on Synthroid, Levoxyl, Westhroid, and Armour.  Within the first week of being on Synthroid, I started experiencing vertigo.  I blamed it on everything else in my life.  As time went on and the dose got larger, all my hypo  and vertigo symptoms got worse.  Another doctor later, I was put on Levoxyl and had the same experience. Also, I had discovered by my own research that my low cortisol (by saliva and blood testing) was causing much of the trouble.  Interestingly, the first two doctors poo-poo'd this correlation, even though there's a warning on the prescription insert to not start thyroid therapy until adrenal insufficiency is addressed.  A very high percentage of people who have Hashi's have low cortisol.  Another doctor later, I was put on Armour.  As the dose got higher, I started getting hyper symptoms and that was blamed on "Armour" (the old "see, I told you so!" attitude by that doctor because I insisted on trying natural).  So - the final doctor (yes, I went through 4!) took one minute to recognize the adrenal connection and added Cortef (20 mg/day).  However - and my point of writing this - as we started the ladder to higher doses of Westhroid, I began to experience the vertigo and palipitations again.  Dr. B took me off Westhroid and put me on Cytomel only (T3) - and hello! - my life is starting anew!  I'm working my way up to 50 mcg. and feel just fine on it.  Bottom line - some people are thyroid hormone resistent and T4 meds only build up in the body without being utilized.  Dr. B goes on symptoms and how a patient feels.  He could care less what my TSH is because TSH fluctuates throughout the day anyway.  So to all you patients out there that KNOW something isn't right - listen to your BODY - don't take NO for an answer - do your research - and keep looking for the doctor that HEARS you!  Synthroid is NOT the answer for many, many people!  Good luck :)