Cytomel/synthroid dosage for 19 yr. old with Hashi's

[allie12]

My daughter has been sick since March (got mono which covered up the Hashi symptoms and they didn't figure out the Hashi dx until late June. My daughter has been on the synthroid since July 1st., was bumped up to 75 after 2 weeks and then dropped down to 50 again when the cytomel was added first week of August.

Based on my daughter's latest labs a few weeks ago the doctor adjusted her Synthroid from .75 down to .50. and added 12.5 cytomel.The doctor's reasoning for lowering the synthroid from 75 to 50 was that he was adding 12.5 cytomel so he said he was actually increasing her dosage from a total of 75 (synthroid only) to 100 (50 synthroid and 12.5 cytomel).

Here are the labs that he based the decision on:
Free T4 - 1.0 Range 0.8-1.8 previous month's result - .78
Free T3 - 229 Range 210-440 previous month's result - 220
TSH .08 Range .50-4.30 previous month's result - 1.9

She did better on this dose for about 10 days- less depression,decrease in facial swelling and more energy. Now her face is starting to swell, stomach is bloating again and she is a lot more tired.

How long should we give it until we push for a dosage increase. I just don't know what to push for...Should I ask for her synthroid to be increased to 75 and leave cytomel at 12.5 or ask for an increase in both? She is desperate to get to college. The school is allowing her to work from home for a few weeks but they won't allow it forever.

Sorry to be so long winded but my daughter is at the end of her rope,  Any and all opinions welcome!!

[TamraW]

Allie, before you can ask your doctor to do anything, you will need more labs. Usually, docs say you must get new labs each time you intend to change a dose. I don't know why the Synthroid was decreased in the first place when the FT4 was only around a 1. IMHO, he should have kept her on that dosage and added Cytomel, because, yes, her FT3 labs were very low. However, with Hashi, sometimes we have to play with the numbers until we get them right.

I have been reading and I also conducted a poll in this forum (To Soy or Not to Soy?) on soy/gluten free diet. If your daughter is not soy/gluten free, it will also impact her T4 absorption. I do feel better without soy or gluten.

Also, make sure she's taking her vitamins. We Hashi's tend to lose our vitamins fast, especially the D and B12. For the bloating, give her Cirtrucel drink mix to help her go to the bathroom more. We hypos have constipation issues. Citrucel has no gluten/soy, unlike some of those liquid gel stool softners.

Vitamin chart:
http://www.drlowe.com/nutrition/supplementlist/supplementtable.htm

Take care...
:) Tamra

[allie12]

Tamra,
Thanks for commenting. She actually had new labs run yesterday and we should have them back by Monday which is why I was looking for input so I know what to push for when we get the results. I agree about upping the Synthroid back up to 75 where it was before the doctor added the cytomel.

As far as supplements, the doctor put her on b-12 injections and she retested her Vit. D levels as part of the labs yesterday.

She tested negative for celiacs last month and eliminated all artificial sweeteners, caffeine, soy, iodine, processed food, wheat and flour from her diet which now consists of only fruit, veggies, eggs, chicken, and oatmeal/oatbran. The doc also started her on magnesium which has really helped with the constipation...just no relief in site yet on the stomach bloating/weight loss.

Thanks!

[Barb135]

When using both synthroid and cytomel, it's common to adjust them both at the same time or lower synthroid when adding cytomel.  Cytomel is a T3 only med and is about 4 times more potent than the T4 med (synthroid) and too high doses of either could very easily cause a swing to hypER.  Cytomel is a fast acting med, but doesn't last in the body very long - so in effect, the doctor WAS raising her total dosage.  Many people find that splitting the dose throughout the day helps.

I was on 50 levothyroxine (generic synthroid) plus 10 cytomel for some time.  I took 5 mcg cytomel first thing in the morning, along with my levo, then the second dose (5 mcg cytomel) about 10:00 - I get up at 3:30 am, so the dosages would have to be timed to match her schedule.  The last time I saw my endo, he raised my levo to 75 and lowered my cytomel to 5 because I was having rapid heart rate and palps caused by the cytomel.  Now those are gone and I'm ready to move on up with my levo dosage, but will leave the cytomel the way it is.  

Your daughter might benefit from an increase in the T4 med, but I don't think I'd want to increase the cytomel at this point. Just remember that it takes at least 5-6 weeks or more, before a dosage change takes effect, so changing meds too fast could be dangerous also.  You need to give the meds time to "do their thing" and hopefully her levels will come up/stabilize.  

I know that no one ever wants to hear this, but this takes time and patience.  You can't expect the meds to work over night - it could take weeks/months for her levels to balance out so she feels good.  I know that's a hard concept to grasp - I don't have a lot of patience either, but with this, I'm learning.............I was dx'd in Jun '08 and am still not where I need to be, although I'm getting pretty close.  

I don't know what is causing the bloating - if it's constipation, which is very common with hypo, make sure eats plenty of fiber and drinks plenty of water.  She might also benefit from a gentle laxative occasionally.  I find that taking Pearls daily does a world of good, also.  

I'm not sure about the facial swelling, the puffiness was one of the first things to leave me when I started on med.....Don't forget too, that fatigue/tiredness can be a symptom of BOTH hypo and hyper.....so watch that she doesn't go hyper.  If this doesn't start clearing up, you might need to check with her doctor.  When will she go back for testing again?  Labs are usually done 5-6 weeks following a dosage change to see how it affected the levels.  

It would be helpful if she had the antibody testing done - TPOab and TGab to check for Hashimoto's.......Good luck..

[Barb135]

You posted your response to Tamra while I was typing mine.  If your daughter's doctor put her on B12 injections, it will also take time to get her b12 levels up to par, so that could be why she's so tired.  

I'm on b12 injections as well and when I first started them, I was on once/week for 3 weeks, then once/month, but that wasn't enough, so now I'm on every 2 weeks.  Once her b12 levels come up, she should start feeling a lot less tired......

[goolarra]

In my opinion (not a doctor, just a fellow patient), I do not understand why your daughter's doctor dropped her Synthroid when her FT4 was only 1.0.  That's still very low and needs to be raised, not lowered.

The 12.5 mcg of Cytomel is also a pretty hefty dose of T3 relative to the 50 mcg of Synthroid she's taking.  Is she splitting the Cytomel into two doses, one first thing in the morning and one whenever she feels the need for a boost (early to late afternoon seems to work for many - you have to experiment).  T3 is very fast-acting and is quickly neutralized by your body if not used promptly, so one dose a day usually doesn't do it.

T3 is the most biologically active of the thyroid hormones (four times more potent than T4).  However, it is also very transient.  We also need to have adequate levels of T4 (the "storage" form of the thyroid hormones, so that it is available for conversion to T3 when our bodies need it.  Otherwise, there are apt to be peaks and valleys in hormone levels throughout the day.

BTW, your doctor's math is right on the drop to 50 Synthroid and the addition of 12.5 Cytomel actually amounting to an increase overall.

I believe the FT4 needs to increase (perhaps significantly).  I'd push to go back to at least 75 (perhaps 88? and then 100 after labs five weeks after the start of the first increase) and drop the Cytomel.  It's too early to add T3 meds when FT4 isn't even stabilized in a higher part of the range.  I know your daughter is in a hurry to get stabilized, but there is simply no way to rush meds adjustments when it comes to thyroid without incurring worse problems.

[allie12]

Thanks for your information. I agree on upping the synthroid back to 75 and leaving the T3 at 12.5. SHe is taking the T3 all at once since it is a compound capsule that can't be split. I will ask the doctor to write a new RX for 6 mcg twice a day (instead of 12.5 once a day) and see if that helps. I know it takes a long time to get regulated but she has been sick since March and has pretty much spent the entire summer in bed (partly due to the mono I know) and I just feel she should be further along than this.

Thanks so much for your help...I really appreciate it!

[Barb135]

She's been sick since March, but only got the Hashi dx in June, so she's only been on the thyroid med for a couple of months and that's not necessarily long enough to see a significant improvement.  Like I said, no one likes to hear it, but this takes patience.  If you try to push too fast or make the med changes too soon, you could end up doing more harm than good.  

When I first started, I saw very small improvements, sometimes so subtle that I didn't even realize it until all of a sudden, one day, I'd think - golly I haven't had those bags under my eyes in a couple of weeks now; or some other small change.  As far as weight loss - well, I'm just now, a year and 1/2 into it, beginning to see some slight loss, but I really have to work at it......some people take longer than that.

[goolarra]

Also remember that both mono and hypo take longer to "get over" than one might think.  The symptoms of both fade very slowly.

I think you'll have to ask the doctor for a prescription for 5mcg Cytomel.  Cytomel comes in 5, then 10 only.

[Barb135]

Ask for the cytomel in 5 mcg tabs - then you can split the dosage much easier.......Mine are 5 mcg, which worked out perfectly when I was on 10 mcg/day - I could take one first thing in the morning, then another later in the morning, without having to split pills.  Now that I'm down to 5 mcg/day, I still don't have to split the pills - they just last twice as long.........

To get the 12.5, you will have to go with 1.5 pill twice/day, unless you can get it dropped to just 10 mcg/day.......may or may not be an option.  

[allie12]

Thanks for the additional info. I am definitely going to ask to have synthroid raised to 75. That was actually supposed to be the starting dose the doctor was going to go with when she was first diagnosed 10 weeks ago but at the last minute the doctor changed the RX to 50. I know it will take some time but it doesn't sound like she will start to feel better until her free t's start to come up. I will let you know what her lab results are when they come back next week. Thanks again for your help, I really appreciate it.

[youstina1]

hello
the best ratio between T3 and T4 is 98%T4 and 2% T3.
you can get cytomel 5mcg and bill cutter .

there is a paper title
Removel of dental amalgam decreases anti_TPOand anti autoantibodies in patients with autoimmune thyroiditis.
the mercury in your mouth may be the cause of Hasshimoto

there are a test for mercury allergy

search in this way, get your information .the internet is easy to get more info .
good luck