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Cytomel/Synthroid

As listed before, I am struggling with increased exhaustion.  I no longer make it through the day without sleeping, and can barely function.

Since my last post, medication has been adjust several times, and additional tests taken.  
I was at 112 mcg Synthroid/20 Cytomel.  Then, we reduced to 88 mcg Synthroid/10 mcg Cytomel.

These reductions affected only the t3 readings, (by 50%-understandabley), while the t4 and tsh remained steady at 0.01 throughout all the adjustments.

The most recent decision was to up the Cytomel to 24 mcg and reduce the Synthroid to 50 mcg. shooting for a higher t3 and a lower t4, to see how that felt in symptoms.

Meanwhile, here are the labs.  

1/2014        88 Syn/10 Cyt                            12/2013  88 Syn/20 Cyt
                t4, free:  1.2       [Range:  1.2]                        1.5  
               tsh:  0.01 (L)      [Range: 0.8-1.8]                   0.01  (L)
      t.3, Free:  2.9              [Range: 2.3-4.2]                   5.9   (H)
t.3, Reverse: 8                  [Range: 8-25]                       10
t3, Total:  67 (L)                [Range: 76-181]

And below, the results of one of the 24 hr. Cortisol tests, (the saliva test) which make no sense to me.

ACTH: 16 (6-50)
Cortisol:         0.30mcg/dl  Range 0.04-0.56
Cortisol:         0.10 mcg/dl  Range: <OR= 0.15
Cortisol:         0.14 mcg/dl  Range: <OR=0.09
Cortisol:         0.04 mcg/dl  Range: <OR=0.15

Any thoughts on what is happening, and what way we are approaching this, would be most welcome.  Thanks.

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Avatar universal
Hi Bulbo,
I am also from India, my recent lab test shows my TSH is elevated(5.3). Do you know what is generic version for Cytomel. Thank u so much for your help
Helpful - 0
Avatar universal
Hello RenKat
     Have you tried taking cytomel only without adding synthroid. I am from india and I am not hypothyroid but I have fatigue, brain fog. So I tried the generic version ( which is only available in my country) of levothyroxine
( eltroxin). On the fist day brain fog and fatigue were lifted but later on brain fog and fatigue became more severe. Anyway I have ordered cytomel and I am waiting for its arrival. I dont know whether synthroid can make you more fatigue . But you can try taking cytomel alone for a while for a change. Its only a suggestion.
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Avatar universal
Thank you for the response.  My symptoms have been severely increased fatigue.  I am generally unconscious by 2:30 or 3:30 every day.  I have noted that after eating a soy vegetable burger, I sleep.  I crave iodine(mushrooms & spinach) and fish constantly.  I am told not to have these, as they contribute to the development of nodules.  The reason I had the partial thyroidectomy.  In an attempt to help with the weight issues, I have cut out gluten and wheat to the best of my ability.

Exhaustion, moodiness, depression and memory problems have also increased.  I am usually energetic, but  am hardly functional anymore.

I did list the cortisol test  as throughout the day, from morning to evening.  What would be the solution, to the cortisol being in range?  Is this a medication issue, as well?

The t4 numbers are listed as t4, free.  The only other, is tsh which has been 0.01 consistently.  There is no other t4 readings on any of my labs.

This new endo thought to make the Cytomel the predominant med, as a trial to see if that would work for me.  I called him a few days ago, to say I am worse.  He said to give it another week.  
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Please check the ranges for TSH and FT4?  It looks like you have the FT4 range, listed as that for TSH.

We don't worry about TSH, since it's common for it to be suppressed when taking a thyroid replacement hormone, particularly one with a T3 component.

Your FT4 is only at 40% of the range; rule of thumb is for it to be about mid range.

Doubling the cytomel was not a very smart move on your doctor's part.  T3 meds should always be increased slowly, to prevent over medication.  Would have made much more sense to increase it by 2.5 mcg at a time, until your level got to where you need it.  

I assume that each one of the cortisol results are from a different time of day?  If the first one is morning and you've listed them in order throughout the day, the only one off would be the third one, which I'd assume to be afternoon and which could be causing a pm "crash".   Cortisol is supposed to be highest in the morning, and taper off over the course, of the day, in order to prepare you for sleep, again.

Do you have symptoms of over medication?  If so, which ones?  Fatigue can be caused from either over or under medication, as well as inadequate sleep, inconsistent cortisol levels, etc.

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