poor reaction to T3

[tina999]

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?

[Mark Lupo, M.D.]

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.

[HashiMan]

There is an article you can find by going to google and using "The Diagnosis and Treatment of Hypothyroidism Micheal Schachter". When the page listing articles comes up, click on the on by "healthy.net". I would recommend this article to every hypothyroid patient!
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

[tina999]

Thanks you guys,

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.

[tabtools]

Have you and your doctor tried alternating the 75 mcg & 88 mcg each day?  My doc tried that with me once, and it did the trick. (However, she says she prefers doing the same each day.)

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

[tabtools]

Tina, I never know when to be quiet.

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 --

[HashiMan]

Can I clarify a little on my above comments?
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.

[HashiMan]

Thanks, Chocobabe, your kindness and politness in posting your view is appreciated! I respect that far more than the attack-kind and I might add, I agree with much of what you say!

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.

[tina999]

My thoughts on this are that perhaps I was so hypo for so long that my ability to store and use T4 is altered at a very basic level.

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!

[tina999]

Hi choco,

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!

[PNWBabe]

I am very confused...where is the posting by chocobabe that several of you are referring to?

Thank you

[ancientmariner]

I just noticed, you and I are the only ones that have posted comments all day! I wonder what's up with that! Very strange, don't you think?

[PNWBabe]

Do you think there are posts being deleted due to censorship?

[ancientmariner]

I can't imagine why - the posts I remember that were missing didn't seem to me to be anything outrageous or inflammatory....but maybe someone thought they were.....The psots were about some new website - maybe we're not supposed to post info about other websites? Anyway it was Stop the Thyroid Madness, or something like that, and someone said it scared her and it was inaccurate, but I looked at it and thought it might have some interesting information. I wanted to get the website name again, but the posts were gone....Hmmmm

[four corners]

Hello, new person here.  In 1997 i had partial thyroidectomy, on 1mg. synthroid up until 2003,, i think i felt ok on it all those years, peremenopuase happened, then menopause, so did feel off. Any way, oct.2004,, my labs started to go haywire, and primary care docs, overdosed me , then under dosed, every 4 to 6 weeks, my mind was turning to mush, mentally. then about 5 weeks ago ,I took some advice from another thyroid site,and tried armour, for four weeks, started at 15mg, 3x dailey. first week or so , felt no differance, then wow, i started to feel the worse than i have ever felt, since this whole thyroid thing started(had a inflammed thyroid, doc chose to partial remove)My throat tightened up, crawling sensation, slurred words, blurry vision,not hyper or hypo,, felt like an allergic thing.. endo. said stop immediately, and switched me to 75 mg. synthroid, and 5mg. cytomel,, has anyone had that reaction to armour(possibly the t3 in it?) and sometimes when i take full dose of cytomel 5mg, i feel a little jittery, head tight. Is that normal , when introducing t3 into a thyroidless person(partial not removed, I am sure does not function any more)And where should levels be? tsh, and t3, ? for a thyroidless person.. So many on other sites, say snythroid, and cytomel will slowly kill me, and that armour is THE ONLY WAY..ABSURD, I KNOW..So if any of you have good results with snythyroid, and cytomel,, and had bad reaction to the armour..  thankyou, i hope this is understood.

[ancientmariner]

Have you had any adrenal testing done? Prescribing information for ALL the thyroid meds (natural AND synthetic) says to check adrenal function, but I have yet to find a doc who prescribes synthetics who tests them first. Many of the symptoms you described could be due to adrenal dysfunction which tends to show up more when you take a form of T3, which is the active form of thyroid. (T3 is in Armour and Cytomel is T3).....You might be interested in www.drrind.com - Dr. Rind has a temperature chart for you to monitor temps. Do this for about a week, and he explains how to analyze the patterns. Also, he has an extensive list of symptoms for hypothyroid, hypoadrenal and both.

[silver101]

I was diagnosed with hyperthyroidisam in 1999 after which I was treated with radioactive iodine.
Immediately after, I became hypo.  In 2002, my eyes protruded  and now I have Graves disease.  I'm on Synthroid 0.15mg for three years already.

However, doctors have told me that my T3, T4 and TSH are all in order even though I definitely don't feel balanced. Very often I feel confused, disoriented, at times almost manic and depressed.
I used to take antidepressants which didn't help anyway, so I'm determined this time to try to improve without antidepressants.  

I have heard that a deficiancy of T3 can cause depression, mood swings and many symtoms that I have.  
I like to know if anybody here has experience with justing adding Cytomel on top of existing Synthroid dosage.

[Hate you thyroid]

Hi,
I am new to the thyroid world. My reverse T3 is high while my TSH is normal .75. My doctor wants me to try GTA, does anyone have a thought or suggestion about this drug? I am nervous getting off T4(Lovyxal). I have been Hypo to Hyper in the last 11 months with NO stabilazation of my TSH?? I don't think my current drug is good since I have not been well since the day I began  it so it might be good to try natural??? I hate this thyroid and could use some help!!!!!


Thanks
Hate you thyroid