Cytomel and synthroid

[Coquito53]

after only taking 112 synthroid And severe hypo symptoms my dr. at my request added 5 mcg of cytomel. Although i still continue to suffer from hypo symptoms such as severe hair loss, joint pain, constipation and brain fog, my energy has increased since adding the cytomel. I have not been able to find an endo knowledgeable or willing enough to help. however, i did find a general practitioner who is willing to try various meds.  However, she is not very knowleadgeable with hypothyroidism. My last test are as follows:
T4 of 10.8 ug/dl and the lab range is 4.5 -12.0 -    
T3 uptake of  3.6 lab range of 1.2 - 4.9.  
T3 108 ng/dl  lab range of 71-180
Tsh of 0.394 lab range of 0.450-4.50.
Any suggestions? I cant afford to loose any more hair as i have lost over 70 percent of it already.  
T4, free direct 1.55 ng/dl  lab range of 0.82-1.77

[gimel]

Yes, first I want to point out that palpitations can occur with hypothyroidism as well as hyperthyroidism.  Second, your test results do not reflect being hyperthyroid, either.   TSH is frequently suppressed when taking significant doses of thyroid med, so your low TSH does not mean you are hyper.  Also, your Free T4 is still below the middle of the range, which is a good target.  Your Total T3 (should test for Free T3 instead) is below its range.  I expect that your Free T3 would also be too low.  Knowing Free T3 is very important because it largely regulates metabolism and many other body functions.  Scientific studies have also shown it to correlate best with hypo symptoms.  Free T3 levels that are in the lower half of the range are frequently indicative of being hypo also.

Other areas to work on are B12.  It could be increased further into the upper third of the range, for best effect.  Also, you need to know your Vitamin D level, so I suggest testing for that.  Your iron test is way too low.  I am assuming that the test was for serum iron, consistent with what you posted.  Next time I suggest that it should be for ferritin.  Taken as a single test it is a better predictor of iron status, and it also needs to be well up in its range.  I say this because low ferritin/iron can result in hyper symptoms like palpitations, when taking T4/T3 thyroid med.   Also, low ferritin/iron can cause tissue thyroid levels to be lower than indicated by serum thyroid test results, thus contributing to being hypo.  

So those are my suggestions.  Also, I think your doctor is going in the wrong direction with your medication and you need to discuss all this with the doctor and persuade her to do the suggested tests and consider the actions recommended to address the issues I mentioned above.

[Coquito53]

I went back to the dr this week to get my meds adjusted as i thought i may be overmedicating because since being placed on 7.5 cytomel and 112 synthroid I lost ten lbs. without trying. In fact I have been very hungry, hence overeating and still loosing weight. While taking the above mentioned for the past three months I was feeling great, my hair started to grow and I was no longer tired.  Well now three months later and ten lbs lighter I  having heart palpitations.  I am assuming I am overmedicating for my new current weight of 118 lbs in a 5'3 frame.  The dr. Gave me blood test and the results are as follows:
t4 free  1.1 ng/dl    range of 0.8-1.8
tsh        0.27 miu/l  range of  0.40-4.50
t4 total   8.2 mcg/dl  rage of 4.5-12.0
t3 total 66 ng/dl    range 76-181
b12 serum 516 pg/ml  range 200-1100
Iron  25 mcg/dl range 40-175
during a doctors visit five days ago she asked me to take my cytomel 7.5 every other day as opposed to daily as I am showing symptoms of hypertyroidism.  After a few days of following her new orders I was still experiencing the heart palpitations and a bit tight on my chest.  Yesterday she told me to lower my dosage to 5mcg every day. I am still experiencing the same symptoms but I don't want to stop taking the cytomel in combination with the synthroid because i used to take synthroid 112 alone and I did not see any improvements on my symptoms.  Any suggestions?

[gimel]

It has been our extensive experience that just because test results are somewhere within the so-called "normal" range doesn't mean they are always adequate.  The ranges are too broad to be functional ranges for many patients.  

If you will please post test results and reference ranges it will help us respond better.  Also, have you been tested for ferritin.  If not, it is an important test for hypo patients.

Since there are credible sources that say that the best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3, I think you should also get Reverse T3 tested along with the Free T3 that is so important.

[Coquito53]

Gimel, Thank you for your comments.  I had test for vitamin d, and b12 and they were within normal range.  I will have my dr. increase my t3 meds. All suggestions are welcome as my hair is falling in big clumps.

[Coquito53]

Gimel, Thank you for your comments.  I had test for vitamin d, and b12 and they were within normal range.  I will have my dr. increase my t3 meds. All suggestions are welcome as my hair is falling in big clumps.

[gimel]

You should request that tests for T3 up[take and Total T4 be discontinued, since they are somewhat outdated and not very useful, compared to the tests for the biologically active thyroid hormones, Free T3 and Free T4.  So be sure to get tested for Free T3 along with the Free T4.  I say this because scientific studies have shown that Free T3 correlated best with hypo symptoms.  

Many of our members, myself included, say that symptom relief required Free T3 adjustment to the upper third of its range and Free T4 adjustment to around the middle of its range.  Your Free T4 is fine.  Your Total T3 result indicates that your Free T3 may be too low in the range.  This frequently occurs with hypo patients taking T4 thyroid meds, as you are.  If the T4 med is not adequately converted to T3, then you will end up with Free T3 that is too low in the range to relieve hypo symptoms.  To counter this problem you need to add more T3 into your meds.

When you go in for the Free T3 test, I also suggest that you should test for Vitamin D, B12 and ferritin.  Hypo patients often are too low in the range for these as well as Free T3.  

When test results are available, please get a copy of the lab report and post results and their reference ranges and members will be glad to help interpret and advise further.   One other suggestion is to read through the info I posted to CDKay.  I think you will find it to be of value for you.