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Cytomel
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Cytomel

First day of taking generic Cytomel 5mg. Feeling tired after the second dose. Is this normal???
27 Comments Post a Comment
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649848_tn?1424570775
What are your thyroid hormone levels?  

You're taking 5 mcg generic T3 - are you splitting a 5 mcg tablet so you're taking 2.5 mcg at a time or are you taking a whole 5 mcg tablet 2 times/day for a total of 10 mcg/day?   Please be more specific about your dose.

How long after you took the dose did you get tired?  

Are you taking a T4 thyroid medication with the T3?
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Avatar_f_tn
Sorry, I am taking Liothyronine 5mcg twice a day. At 8 am and at 3pm. I also take levothyroxine 25mcg daily. I have been on the Levothyroxine 25mcg since August 29th. In August when I was diagnosed my TSH was 8.08 Ref range 0.4-4.50 Vitamin B12 was 374 Ref Range 200-1100 pg/ml.  Vitamin D was 17 Ref range  30-100 ng/ml

In October TSH REFELX TO FREE T4 TSX RFLX 1.46  REF RANGE 0.40-4.50
T3 FREE 2.7
THYROID PEROXIDASE ANTIBODIES  <1    REF RANGE <9 IU/ML

JAN 30TH
B12 494   REF RANGE 200-1100 PG/ML

THEN I WENT TO SEE ENDOCRINOLOGIST ON JAN 27TH.  THE FIRST THING SHE DID WAS PUT ME ON VITAMIND D 50,000 IU INSTEAD OF 2000IU I WAS TAKING.
DID MY BLOOD WORK AND GOT MY RESULTS JUST A 3 DAYS AGO
TSO AND FREE T4 FREE THYROXINE, FREE DIRECT  1.2  REF RANGE 0.8-1.8NG/DL
TSH 1.70 REF RANGE 0.40-4.50 MIU/L
T3 TOTAL(TRIIODOTHYRONINE) 103   REF RANGE 76-181 NG/DL
MY COMPLAINTS TO HER WAS WEIGHT GAIN, MUSCLE AND JOINT PAIN, ALWAYS TIRED EVEN THOUGH I DID FEEL MORE ENERGETIC WHEN I FIRST STARTED TAKING LEVOTHYROXINE IN AUGUST. BUT THAT DID NOT LAST VERY LONG. HAIR FALL, BRAIN FOG.
SHE NOW HAS ME ON THE CYTOMEL. TODAY IS THE SECOND DAY OF ME TAKING THIS. DO HAVE MORE ENERGY IN THE MORNING BUT AFTER MY AFTERNOON DOSE I WAS VERY TIRED YESTERDAY. COULD HAVE BEEN BECAUSE I DID NOT SLEEP WELL THE NIGHT BEFORE (ONLY 3 HRS). I AM SO TIRED AND BODY HURTS SO MUCH THAT I SOMETIMES DO NOT EVEN WANT TO GET OUT OF BED. I AM WATCHING WHAT I AM EATING. DO WALK FOR AN HOUR A DAY AND ELLIPTICAL FOR 1/2 HR 5  TIMES FOR WEEK. STILL NOT LOSING ANY WEIGHT AT ALL. JUST GAINING EVERY WEEK.
I WANT TO FEEL NORMAL.
I DO TAKE A DAILY MULTI VITAMIN, 1200MG OF CALCIUM, FISH OIL 1200MG , SELENIUM 200MCG,
I HOPE YOU CAN HELP ME.
THANKS




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Avatar_f_tn
I WAS TIRED ABOUT 2 HRS AFTER I TOOK MY SECOND DOSE YESTERDAY.
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649848_tn?1424570775
The first thing I have to do is ask you to please not type in all capital letters.  You probably don't know it, and I know you don't mean to, but typing in caps indicates that you're yelling at people.  Secondly, for some of us, it's very difficult to read capital letters with no breaks for sentences/paragraphs.  Thank you.

I think your endo did the right thing to increase your vitamin D, since yours was very low.  Vitamin D is necessary for the metabolism of thyroid hormones, plus vitamin D deficiency can cause hypo-like symptoms.

In addition, your vitamin B-12 is way too low in the range... did your endo suggest that you supplement that?  Vitamin B-12 below 500 can cause symptoms, even though the range goes all the way down to 200.  My lab puts a note on the report that anything under 500 can cause symptoms.

Your FT4 is just slightly low at 40% of its range - rule of thumb is that it be around  mid range (50%), which for the range used by your lab would be 1.3.  Your TT3 is way too low, but unfortunately, TT3 is not very useful.  Your doctor should be testing Free T3 instead, since Free T3 is the hormone that's actually used by individual cells.

That said, your TT3 is only at 25% of the range and it's recommended that Free T3 be in the upper half to upper third of its range.  Approximately 90-95% of the Total T3 will be bound by protein and is unavailable.  You should ask your doctor to test Free T3 from now on, instead of Total T3.

Your symptoms certainly indicate that you are still hypo.  25 mcg of T4 is quite a small dosage and you do still have some room to increase that a bit, however, since you're on the cytomel, you should do well.  

I'm sure you've read, and your doctor probably told you, that cytomel is very fast acting and it should make you feel better very quickly... well, it doesn't work quite as fast as they say it does.  

It won't make a whole lot  of difference the very first day you're on it and probably not even for the first or so.  I was on T3 med for quite some time, before I could even tell I was on it.  

I'd say your tiredness after taking the cytomel yesterday had as much to do with lack of sleep the night before and your low vitamin B-12 levels as with your thyroid hormone level.  You also took the second cytomel pretty late in the day, so maybe if you had taken it a bit earlier, before the first one wore completely off, you might not have gotten as tired.  By contrast, I take my T3 at about 6-7 in the morning and again about 11:00-12:00, only leaving about 5 hrs between them, where you're leaving 7 hrs between yours.  You can play with that timing a little bit and see if you can get it better.

Even though cytomel is faster acting and doesn't stay in your system very long, it's going to take a while for it to build in your blood, so you actually feel better.  And the fact still remains that you might not be on a high enough dose of T4 med, either.

I notice that you had Thyroid Peroxidase Antibodies (TPOab), but I don't see Thyroglobulin Antibodies (TgAb)... you need both of these tests to rule out autoimmune thyroid disease, since some of us have TPOab, some have TgAb and some have both.  Ask your doctor to order the TgAb to confirm/rule out Hashimoto's.

If you have Hashimoto's, you will need periodic adjustments to your medication dosage in order to keep up with destruction of your thyroid.
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Avatar_f_tn
Sorry, I didn't even realize that I was typing in caps. I forgot to mention that I am taking Vitamin B12 3000mg. It did go up from 374 to 494 in Jan. On my prescription doctor said to take at 8 and and second dose between 2 to 3 pm.
I think I will do what you are doing.

Thanks
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649848_tn?1424570775
I see where your B-12 went up from 374 to 494, but it's still too low.  I have to keep my B-12 level at the very top of the range in order to keep symptoms at bay.  Many people (even doctors) don't realize how tired, too little B-12 can make one.

Typically, T4 thyroid hormones are taken when one gets up in the morning, on an empty stomach with a cup of water, then nothing should be eaten or drank for 30 minutes to an hour afterward.  I take my first T3 pill with my T4.  Unlike T4, Cytomel/T3 can be taken with or without food, so it's okay to take it with lunch or slightly before.  

It's okay to experiment with the timing and see what works better for your schedule.  Do make sure you don't take any calcium or other mineral supplements within 4 hours of taking either thyroid hormones.
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Avatar_f_tn
How long does it take for Cytomel to kick in?
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649848_tn?1424570775
You should start seeing positive effects within a few days, but with your low B-12 levels, you aren't going to feel the full effect until you bring that level up, since low B-12 makes you feel similar to low Free T3 - tired and fatigued...

Hopefully, within a few days, you'll start sleeping better with the T3, also, which could/should help you feel more rested and have more energy.  

You should ask to retest FT3 and FT4 in a few weeks.  You might also need a higher dose of T4 med.
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Avatar_f_tn
What is the maximum Vitamin B12 one can take?
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649848_tn?1424570775
B-12 is not toxic, so you can pretty much take what you want... excess will go out in urine...
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Avatar_f_tn
Thanks
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Avatar_f_tn
Thanks
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Avatar_f_tn
U do know you are not supposed to take any calcium within 4 hours of taking Cytomel right?
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Avatar_f_tn
Says right on the bottle do not take any antacids, iron or calcium supplements within 4 hours of taking Cytomel. One reason why I'm glad I'm. It taking it anymore. Just thought I would throw this out there because that is what messed me up.
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Avatar_f_tn
Stupid phone auto correct. I mean that is why I am glad I am not taking it anymore.
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649848_tn?1424570775
The calcium, antacids and iron "rule" holds true with ALL thyroid meds and you should be on something by now, so make sure you aren't taking them with your your thyroid med, as well.
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Avatar_f_tn
Ok I just got my results back.

Ferritin  43  Ref Range 10-232 ng/ml
T3 Free  3.8  Ref Range  2.3-4.2pg/ml
TSH 1.67   Ref Range  0.40-4.50
Vitamin D 42  Ref Range 30-100ng/ml
If my Ferritin is on the low side. What do I need to take?
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649848_tn?1424570775
Your Ferritin "is" on the low side... you need to supplement iron, but you should do this under your doctor's supervision to make sure you are getting a proper dosage.  If your doctor won't help you, get a good quality iron supplement at your local health food store.  Be sure to get a non-constipating brand and make sure you don't take it within 4 hours of thyroid medication.

Your vitamin D is also, still, too low - are you supplementing that?  

Your FT3 level is at 79% of the range - that's getting quite high... did you take your dose prior to the blood draw?  

Was there no Free T4 test done?  
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Avatar_f_tn
I am taking 50,000iu of vitamin D weekly.

I took my med about 7:30 A.M and had bloodwork done around noon.

Free T4 was not done in this last test.
I take my T4 and T3 meds around 7 or so then my second dose of T3 around 1pm.

I take my vitamins around 6 pm. I always
make sure they are not taken within 4 hrs
Of taking my thyroid meds.

What does it mean when my FT3 is at 79% range. Good or bad?
Thanks
Tha
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649848_tn?1424570775
Your FT3 is pretty high in the range at 79%. Mid range would be 50%, which would be half way between the bottom of the range and the top of the range.  Recommendation for FT3 is upper half of the range, but not too high...  If you feel okay with it that high, it's okay, but you can tip to hyper very quickly.  Since you took your med just a few hours prior to the blood draw that's probably a false high...

When you take a T3 med, it gets into your system and peaks within a few hours, then it's gone - that's why we take it in 2 doses/day... you should always have your blood draw prior to taking the T3 med.  Since you took your med at 7:30 and had the blood draw at noon, the med would have been just past its peak... Next time, try to have the blood draw earlier and wait until after to take your T3 or skip that dose and just take the afternoon dose, you'll get a much more accurate result.

You're taking your T4 and T3 meds just fine, if that works in your schedule... also good that you're leaving a 4 hour gap between thyroid med and vitamins/minerals.
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Avatar_f_tn
Thank you so much.
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Avatar_f_tn
How about the timing on iron supplements?
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649848_tn?1424570775
Keep iron separated from thyroid hormones, by 4 hours, as well.
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Avatar_f_tn
Is it ok to take at the same time as my calcium and all my other vitamins? I was concerned about the absorption of iron.
Thanks.












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649848_tn?1424570775
Yes, you can take iron at the same time you take calcium and other vitamins.  I don't think you'll have an issue with the absorption of the iron, but if your levels don't start coming up, you can try separating by a couple hours and see if that helps.
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649848_tn?1424570775
If you worry too much about all this, you'll end up becoming a slave to meds and vitamin/minerals - it's important, but you have life to live, as well.
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Avatar_f_tn
Thanks for all your help. You have helped me more than my doctor has. God bless you. You are so knowledgeable.
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