Cytomel in addition to Synthroid

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

[Mark Lupo, M.D.]

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...

[JDrake]

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

[Nitter]

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

[Mark Lupo, M.D.]

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.

[JDrake]

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

[j.drake]

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!

[ArmourGal]

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).

[j.drake]

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!

[femmecuzz]

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.

[doodlebug1]

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.

[ArmourGal]

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

[v.kinga]

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!

[ancientmariner]

There are other natural thyroid hormones available, at least in the US. They are pretty much the same as Armour, except they are made with different fillers. Try Westthroid or Unithroid.

[v.kinga]

Thank you so much!

[balance]

I have been taking synthroid for 9 years now and I am wondering if anyone can tell me what is the Cytomel for?

[balance]

Wonderful website to share with you. http://www.drnorthrup.com/womens-health-thyroid.php
I refer to this sight quite often in my journey of trying to stay in balance:)Hope this helps you all!

[ancientmariner]

I misspoke in my last post to you - Unithroid is not the natural, I meant to say Naturethroid. but Westhroid is natural, too.

[ancientmariner]

Cytomel is synthetic T3. Synthroid is synthetic T4. A healthy thyroid produces T4 AND T3, as well as other hormones. Your body uses T3, some of which is direct from the thyroid, and some is converted from the T4 from the thyroid. But when you take a T4 only medication like Synthroid, you're not getting that direct T3. Also, many people who are hypothyroid have trouble converting the T4 to T3, so there's even less T3 available for use. So some doctors prescribe T3 (Cytomel) to be taken with the Synthroid. I personally use Armour thyroid, a desiccated porcine thyroid product, which contains ALL the hormones my own thyroid used to produce, in slightly different proportions.

[balance]

Thank you for your response. The website that I referred to on an earlier posting (Dr Christiane Northrup) says to add T3 to the mix when test results are within range and still experiencing mood changes. Prior to reading this message I phoned a pharmacist and he said they don't add T3 to synthroid. This makes more sense to me now. I phoned the pharmacist back and he said he hasn't prescribed Cytomel in the last 10 years. I have been experiencing anxiety and tearfulness prior to my menstrual cycle. With anxiety/depression high in my family history and part of the thyroid overlapping with the above and perimenopause, I am questioning what I should do next? Estrogen/progesterone seems to come to mind. We have a shortage of doctors here so I have to educate myself and take an assertive approach when working with the health care team to tell them what I want. I do not have a family physician.I would like to know what tests I should have done? I do yoga once or twice/week, aeorobic/weights 2 times/week and maintain a healthy weight and diet. I do not want to add to the problem with the wrong treatment. Presently I am looking over my life to reduce any stress that may be escalating above the norm:) Thanks again for your feedback. I do hope to get an MD to respond and of course I am open to any other comments out there.

[balance]

Please refer to C18. I would appreciate a response. Thank you:)

[Mark Lupo, M.D.]

(please not that usually I am not always able to read/respond to comments)

The T4/T3 combo treatment has been studied in about 10 trials in the last 10 years -- while there has not been a definitive objective benefit over straight T4 -- patients seem to prefer it (at least in 4 of the trials) -- this was more pronounced at 3 months and not different at 12 months in the largest trial.  To sum up -- I do sometimes add cytomel to see if a patient feels better in certain cases but more important may be to ensure the TSH is around 0.5 on T4 alone before making such a change.  There are no published randomized trials comparing armour type products to synthetics, while some patients do seem to prefer that as well (the T3:T4 ratio is higher than normal human physiologic production of these hormones) - this high ratio is a potential concern for over-stimulation of the heart which over the long haul may decrease cardiac function.  This being said -- in young patients without heart disease T4/T3 trial may be appropriate for 3-6 months to see if you not an improvement - if there is no clear benefit (or if there are side effects), switch back to T4 alone.

Regarding E/P balance - talk to your GYN regarding pro's and con's in this greatly debated arena.

[gsheps]

I just started on 25mcg of Cytomel in addition to 112 mcg of Levoxyl. It has been three days and I have noticed that I can not get to sleep at night without doubling up on my Ambein (sleep med)now. Also, I recall dreaming alot, but wake up feeling totally unrested as if I did not sleep at all. I am also Bipolar. All day I feel like a depressed zombie with no intiative to do anything. Then at night I wake up and talk my husband's head off so that he also is not getting much sleep. I don't have heart palpations, nor do I feel anxiety or shakiness. Does anyone know if the insomnia is just my body adjusting to the Cytomel??? Should I continue using it, or go off it and see if the insomnia abates? I know I should just call my doc about it, but I am so unmotivated I don't want to use, or even answer, the phone. I also take 250 mg of lamictal and 10 mg of Prozac for the bipolar. Any comments would be gratly appreciated! Thank-you.

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