How much should I reduce Synthroid to add more Cytomel?

[Bunny333]

I just got my most recent labwork back:

TSH = 0.06
Free T3 = 284  (Normal Range 240 - 420)
Free T4 = 1.3   (Normal Range .8 - 1.8)

I currently take 100mcg of Synthroid and 10mcg of Cytomel per day (that was upped from 50mcg of Synthroid & 10mcg of Cytomel 3 months ago).  Still have major hypo symptoms of depression/anxiety which have been consistently the same even on old dosage.  I understand that Free T3 needs to be in the upper 1/3 of range in order to get rid of depression/anxiety.  Clearly I need to be taking more Cytomel, but how much more?  and how much should I reduce the Synthroid to increase my Cytomel?  Please help!  Also, is my Free T4 okay?

I tried reducing my Synthroid to 50mcg and taking 20mcg of Cytomel this week..and it seems to be kicking up more anxiety!!  Would Armour be a better choice?  Any advice you can give would be greatly appreciated

[Barb135]

This is a very old thread, so it's unlikely that Bunny will respond; however, I would like to tell you that I, too, am on cytomel and it's done wonders for me.

It sounds like a good share of your problem is that you are making too many adjustments, without giving each one a chance to reach its full effectiveness.  

You need blood work (FT3, FT4 and TSH) prior to EVERY single med adjustment; then you need to wait several weeks to let the adjustment reach it's full effect, then retest to see where your levels are, readjusting again if necessary.

Many of us do best when our FT4 is approximately mid range and FT3 is in the upper 1/3 of its range.  I don't even look at TSH anymore, as mine stays very low (less than 0.001), so if I went by that, I'd be completely off med(s).  

Even though cytomel is a fast acting med, it still takes time for your levels to even out. I was on it for several months before my labs caught up.  In addition, when on more than 5 mcg cytomel/day, it's best to split it into multiple doses (some people even split 5 mcg, but I found that 2.5 mcg/dose did nothing for me).  Just make sure you space it throughout the day to stay steady and take the last dose early enough in the day/evening for it to be worn off by bedtime.    I'm only on 5 mcg/day cytomel, along with 88 mcg/day levo, so I take my cytomel in one dose about 7:00-8:00 am, that keeps me going all day, but it's pretty much worn off by bedtime.  

[bridgeovertroubledwater]

I have had a horrible experience with these two meds as well.  Recently been seeing and endo and his way of adjustments have now sent me for a real loop.  Eureka, he found that I'm good in the TSH level on 100 mcg of Synthroid, however I feel so low and flat, without any zest for life.  While on Cytomel and Synthroid had high blood levels yet felt better when we reduced the Cytomel from 25mcg.  Too many adjustments in the last 3 months and I have had a terrible time trying to find what would allow me to sleep.  I also have fibro and I've read that having fibro we are diminished in serotonin levels that is why I find the 3 100g of 5-htp, one before each meal along with 1000mg of tryptophan right after I eat my dinner, then 5-3mg sublingual melatonin @ 7:30 p.m. will allow me to sleep.  In the last month I had to discover this on my own.  Told this to the endo and his suggestion for the thyroid was to go back to 75 mcg of Synthroid along with twice a day 5mcg of Cytomel.  I did one day and back to not sleeping well again.  These drastic changes are playing havoc on my system and I am so depressed.  I am seeing my GP on Monday and have to figure out a better and slower approach as my system can't handle this much more.

Bridge over Troubled Waters

[Smilerdeb]

Hyper and Hypo sysmtoms can 'mimic' each other so be very careful in increasing the Ctyomel.
Also usually it is 1 to 4.
Cytomel is four times more potent than a T4 med BUT doesnt stay in the system as long as a T4 med.

I have had anxiety on BOTH ends of the scale..hyper and hypo.
That is usually the first sign that my levels arent right.
But I also get the anxiety for a few days when I have done a med increase too.

[JustmeMary]

      I take just Cytomel only, with adjustments soon to come.  People who are against Cytomel have no clue the hell I went through for years just to realize my body was not converting the T4 to T3.  Had fibro as well as a multitude of several horrible symptoms.
     Your TSH is within the Hyper range hence the symptoms.  Cytomel is a very powerful hormone that is more potent than synthroid and has a shorter life within your system.  Adjusting meds too fast or incorrectly is a bad idea.  Taking 20 mcg.s of Cytomel is equivelant to 40-50 mcg's of synthroid, not a good idea.  You need to monitor your levels with bloodwork with your doctor.  If you have a few weeks that you feel great, get your bloodwork done and see where your levels are when you feel good and always shoot for that level.   Numbers don't really mean anything when your hypo/hyper, the normal range is too broad.  I feel great on the lower end of the spectrum, but thats me, you could be different.  
     If you have hashi's, welcome to the world of your body slowly killing your thyroid.  Slight med adjustments are going to be a way of life.  Knowing the symptoms of both hypo and hyper are a great way to help with that regulation ( I have the list on my fridge).  See your doctor and discuss with him/her your proactive approach to your healthcare, because in the end, it will always come down to you taking charge of your health.

[goolarra]

I'm not convinced you need more Cytomel.  As you said, when you upped the Cytomel to 20 mcg this week, the anxiety kicked up, and that's exactly what I would expect doubling your dose of Cytomel to do.

How do you take your Cytomel?  Do you split the pill and take it in two separate doses?

Armour would probably not be a better choice...Armour has lots of T3 (4-5 T4 to 1 T3) compared to what the normally functioning human thyroid would have (20 T4 to 1 T3).

You should really discuss your meds adjustments with your doctor.  Self-medicating is not always the best way to go.  I did it for long enough because my doctor was an idiot, but I don't recommend it.