Cytomel or Synthroid?

[janemc]

I had a total thyroidectomy (papillary ca) six months ago.  Initially, I was placed on Cytomel pending the pathology report.  Once it was decided that RAI was not necessary, my endo switched me to Synthroid.  I felt wonderful on Cytomel and just okay on Synthroid and my endo does not believe in prescribing Cytomel due to cardiac side effects and the short half life.

I went for a second opinion and was told there was no contraindications to Cytomel so I could stop the Synthroid and take Cytomel.

With two completely opposing views, I am confused as to why I should do desides seek a third opinion.  Any thoughts?

Thx.

Jane

[strawberryseed]

I recently had to change endocrinologist, due to her being stuck in TSH lab mode only. My new endo just put me on armour. However, I will not be able to start until tomorrow, because my pharmacy does not stock it. They will have it from the warehouse by tomorrow. I had a TT on Sept. 2010. Since that time, my old endo had me on L-thyroxine 88 mcq most of the time, except for two weeks on synthroid. My body completely bombed out on the Synthroid 100mcq. I felt awful daily. So, I was put back on L-thyroxine with a lowered dose of 88mcq daily. I asked my old endo if she would supplement me with a T3. She refused. This is when I thought that we would not do well together. I am telling her my symptoms, and she is keeping me on something that is not working. I have not started my Armous, so I cannot say how I am going to do on it. I am trying to get as much info on it as possible. I know that there will be pros and cons, but nevertheless, give me a baseline for thought. My new endo says that Armour is not scarce now. Hopefully not.

[Terri627]

Armour is a T3/T4 combination, where synthroid is only T4, with the idea that the body converts T4 to T3. And Armour is a natural form, it's derived primarily from pig thyroid. I have been taking Armour for almost 3 years. There have been issues lately with availability, and if you contact Stella5349 on this forum, she can share more on that. Or, go on the "Save Natural Thyroid" page on Facebook, where you can find a ton of info on the shortages.

Personally, I have done so much better on the Armour. Until recently, that is. It's been reformulated, and the new formula doesn't seem to work as well. Anyway, Janemc, good luck with your search. I'd stick with the doctor who is willing to write for whatever you request, only because I found it very difficult with my HMO to get a doctor who would write for the Armour. Oh, and I had TT due to follicular thyroid cancer.

[mbell19]

Could you explain why Armour is better than Synthroid?  I had pappilary thyroid cancer almost 9 years ago.  Have been doing pretty well, usual tiredness but nothing horrible, until about 7-8 months ago.  That's when the utter exhaustion set in, short term memory loss (I'm a details person, so this was totally new for me), mood swings, increased allergy issues.  After a while I started researching and found these are typical hypo symptoms.  My Endo is also keeping me suppressed (on Synthroid 175) to keep CA from returning, but even after seeing him earlier this week and explaining my symptoms, they call today and say all bloodwork (CBC, Chem12, Vit B12, Iron) came back normal and to continue as I have been on the 175 (I asked for labs to be mailed to me and should have them by Monday).  What???? I should continue living this way?  

I am looking for some sort of solution here...even if it means switching from one of the most highly respected Endo's in the Atlanta area....

[Momma_Michelle]

Been there done that!  

Diagnosed with Thyroid papillar cancer in '03.  Had right Thryoid removed and that is when it was discovered so I consequently had a second surgery to remove the left thyroid.  I have been riding the Synthyroid/Levothyroxine roller coaster ride for several years now.

Kept telling the doctors I just don't feel good.  No energy, stamina, etc.  I had one Endo prescribe the Cytomel which is a T3 only to have heart palpitations and not be able to sleep at night.  

Stopped taking it.

Recently, I became educated about Armour Thyroid.  It has literally given me my life back after almost 6 years.  I am now on a compounded form of the Armour.  It is wonderful and I can't brag on it enough.  

There is a Nationwide shortage of the Armour Thyroid so you probably won't be able to get it unless you have a compounding pharmacy.  The good news is that most docs will prescribe Armour to be compounded.  The other good news is that most insuraces will pay for it.

Hope this helps some.  I sure wish I knew about the Armour a long long time ago!
Michelle

[janemc]

Barb,

I appreciate your post.  The range for T4 is .80-1.80 so it is at the mid point.  

Since one doc only believes in treating T4 and does test for T3 and the other prescribes anything you recommend, I am scheduling an appt with a third doc. Hopefully, three times is the charm in this instance.


Thx.

Jane

[Barb135]

Congratulations on winning the cancer battle.  I've never had thy ca but I've known some people who have and they all tell me that the TSH *should* be suppressed more to help prevent the cancer from returning.

What is the lab range for that FT4?  It seems that it might be close to  mid range, but since labs use a variety of different ranges, it's hard to say.  

I agree with goolarra -- cytomel is rarely used by itself for long term therapy.  I'm on a low dose of it, but I'm also on a T4 med with it.  If I were you, I'd also be sure to ask for FT3.  I find it hard to believe that a doctor would prescribe cytomel without testing FT3 to make sure that's what you need.  

Oh, by the way -- my TSH is suppressed to 0.02 and I'm doing fine with it that way, so long as my FT's are in line!!  

Good luck

[goolarra]

I should have said that Cytomel ALONE is seldom prescribed as a long-term therapy for hypothyroidism.  It is most often prescribed alone (temporarily) when RT3 is high to try to get RT3 to come down and sometimes prescribed when T4 meds are simply not tolerated.  However, even in the latter case, T4 meds will be attempted to be reintroduced eventually.

[janemc]

Thank you, Tamra!

Yes, I am excited about winning the fight against cancer and just need to iron out the minor issues surrounding hormone balance.  

My numbers are low but the endo indicated my thyroid has to be overactive in order to ward off any cancer.  

I will visit him one last time and see how he responds to a combination T3/T4 approach.  Also, I just looked at my lab slip and only TSH and T4 are ticked off so I may just add the T3 for argument sake. I am sure docs love patients like me!

I will read the recommended book and will revisit the top website.  I am new to this and can use all the knowledge I can get my hands on especially when "experts" aren't even in agreement.

Thanks again!

Jane

[TamraW]

Jane, congratulations on winning the fight against cancer!

If you live in the US, here's a list of recommended endos in your area:
http://www.thyroid-info.com/topdrs/

My NEW endo that I found on that list believes in treating both FT4/FT3 levels. If a patient doesn't feel well enough on Synthroid, he will also prescribe a low dose of Cytomel.

Your FT4 is on the lower end of normal. Your TSH is very low, but remember that it is a pituitary hormone, and not always indicative of thyroid - especially since you don't have one!!!

It would be nice to know your Ft3 results. Sometimes, Synthroid just doesn't do enough, so we need that little boost, usually half a pill taken in the morning and then half in the afternoon.

I must politely disagree with Goolara. My endo does not see Cytomel as a short term therapy. Some of us just don't do a good job converting Synthroid into T3, and we need that T3 supplement for life.

If you read The Thyroid Solution by Ridha Arem, he explains why Cytomel has worked so well for many of his patients.

:) Tamra

[janemc]

I appreciate your quick response.  My guess is that a combination is the best solution.  I just need to find an endo who agrees.

My labs are:

Free T4  = 1.29
TSH       = .04

[goolarra]

The problem with Cytomel is that it is very fast-acting and quickly neutralized by your body if not used promptly.  So, it is seldom prescribed long-term as a therapy for hyporthyroidism.  T4 (Synthroid, et al) is the "storage" form of the thyroid hormone and basically floats around in your bloodstream until it is needed, at which point it is converted to T3.  

What are the results of your FT3 and FT4 tests (and their reference ranges) and TSH?

Perhaps a combination of T4 and T3 meds is what might be best for you???