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Is it OK to Add Cytomel T3 but NOT adjust Synthroid T4 and Hair Loss / ...
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Is it OK to Add Cytomel T3 but NOT adjust Synthroid T4 and Hair Loss / Breakage Questions Related to adding Cytomel T3?

My Doctor Prescribed T3 today….(Cytomel). He said to take 5 mg 1x per day. He did not reduce my Synthroid, which has been 100MCG for the past 5 months (lowered form 133 mcg on 6/21/11).

Based on what I read, I feel as though my doctor should have reduced my Synthroid to 75 or 88 mcg and given me 10 mg Cytomel 2x per day instead.

I dont know about how I feel about taking the Cytomel without having a lowered Synthroid T4 dose, because I had serious hair breakage on the Synthroid (which has gotten "MILDLY" better because I am taking so many supplements to counteract it)....but I have heard that taking Cytomel, has the same side-effect (ie. Hair Loss/Breakage), if your thyroid is thrown out of balance (?)

I have also read that adding Cytomel T3 can HELP a hair loss / breakage problem, too!!  All of this has made me seriously confused.

I cannot risk any more hair loss. Hmmm. NOt sure what I should do here….

My October 9th labs were FT3 (2.5), FT4 (1.57), TSH (1.36)
My November 2nd labs were FT3 (3.0), FT4 (1.67), TSH (.826)

…..Do you think 5 mg of Cytomel is enough? Shouldn’t I lower my Synthroid? I know that adding T3 Cytomel makes your TSH go down anyways. I want my FT4 in the mid-range and my FT3 in the mid-to-high range, based on what I have read as "optimal", although I know a lot of adjusting one's thyroid depends on the side effects and how one feels, first and foremost.

I am interested in similar experiences and also comments about the hair loss/breakage topic and non-adjustment of the T4 upon prescribing T3.

Thanks!! :)
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42 Comments Post a Comment
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649848_tn?1357751184
Please post the reference ranges from your lab report for the FT3 and FT4, as these vary from lab to lab, so must come from your own report.

Once we know the ranges and can compare your values within them, we will be able to answer your questions more fully.

I addressed the hair loss issue in the poll you posted; however, here are my comments again:

Hair loss/breakage is a symptom of being hypothyroid.  It's not the cytomel or synthroid that causes the symptom, it's the fact that thyroid hormone levels are not where they need to be, and you  are still experiencing hypo symptoms.

Many people find when adding/increasing a medication, symptoms get worse for a period of time, while the body adjusts to having hormones it's not used to having.

If you would post your  most recent thyroid test results, which should, at the very least, include TSH, Free T3 and Free T4, but also maybe antibody tests, members would be able to help assess your situation and comment more fully.  

When posting lab results, please be sure to post the reference ranges listed on your lab report, since these ranges vary from lab to lab and must come from your own report.
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Avatar_m_tn
Couple of thoughts.

First I believe you have a typo.  Are you really taking 5 mg or is it 5 mcg.  There is a HUGE difference between the two!

1000 mcg (micrograms) = 1 mg (milligram).

I've never heard of a person on 5 mg which would be 5000 mcg.  However it is relatively common for people to get on 5 mcg of Cytomel (T3).  So I am assuming it was a typo.

Next I agree with Barb, we need the reference ranges. I agree further that your hair loss is a result of being Hypo, not medicine.  Although I have read several people report that initially they may have lost more hair, which like you they believe is a side effect of the medicine.  But it probably is just the shock to your system that you ACTUALLY have hormone now and your body is trying to adjust.

Third did the Dr recommend that you take the Cytomel in two dosages of 2.5 mcg each?  If not that would be something that I would recommend or at least you talk to your Dr about.

The Dr may not decrease your T4 medication if you need to raise your FT4 levels some more.  By adding in the T3, that would result in less T4 needing to be converted which would then result in your FT4 levels to increase.  And that may be what the Dr is attempting to do.  But without the reference range information we can't determine that.
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Avatar_f_tn
I was started on 20mcg of Cytomel and didn't reduce my T4. Some three months later my numbers are off the scale - I'm severely hyper and I'm dealing with a whole heap of different symptoms.
My T3 has now been reduced (slowly) down to 5mcg and my T4 from 150mcg to 100mcg. The symptoms are certainly not as bad as they were, but I certainly don't feel right yet.
I had another blood test today.
Don't mean to be negative; just sharing my experience.
Good luck.
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Avatar_m_tn
Adding a T3 med would do nothing to reduce your T4's.  In fact I would expect them if anything to be raised.

20 mcg of T3 is a HUGE dose.  No wonder you went Hyper.

I hope you did NOT take your T3 meds before you had your blood drawn.  Since T3 is almost immediate it would affect your blood test showing it higher than otherwise would be.  T4 meds it doesn't matter because it is such a slow acting medicine.  But T3 (Cytomel) is immediately available.

Please post your labs including the reference ranges when you get the results back.
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Avatar_f_tn
I didn't expect the T3 to reduce the T4 - rather that I feel I should have been told to reduce my T4 when I went on to T3.
I now realise  I was started on way too high a dose.
I have just posted another question regarding the necessity of me being on T3 in the first place.
I am still questioning the advisability of remaining with my current Endo.
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Avatar_f_tn
Cytomel 10 was added to 100mcg T4 and my T4 wasn't reduced. I was concerned about it initially, but my doctor said we could go either way with my T4.

He was right. Over four weeks later I feel about 10% better, but still have many hypo symptoms.

One of the things that I think my have improved is that I think I'm losing less hair. I hadn't realized how much hair I'd lost recently since I have/had a lot of it, but now I  know that I have lost about 2" diameter if I hold it in a tight ponytail and I use five less rollers when I set it last. I was really surprised by this and realized that I vacuum an awful lot of hair up and lose loads in the shower. In paying more attention to it - I think I'm losing less with the addition of Cytomel. I hope it's because my T3 is getting closer to the upper 1/3 of the range. It has always been at the bottom or below range.

I hope this helps
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2015931_tn?1328560585
Hello Ladies,

Will taking 75mcg of cytomel cause lo FT4?
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Avatar_f_tn
Wow!  That's a very hefty dose of Cytomel.  Yes, it could cause low FT4.  Can you give us more background, labs, symptoms, etc.?
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2015931_tn?1328560585
Hello,

Thank you for answering me! Thats the whole thing..I feel great, I dont have any symptoms of anything. The only reason why I even checke my blood work was because I thougth I was pregnant. They only wierd thing that happened was that I got my period twice in a month so i thought I was pregnant which I am not. Now I am understanding it's because of my thyroid.
My TSH was always within referance, however I had all symptoms of being hypo. Weight gain, facial hair, diarrhea, tiered, you name it, I had it. So my doctor decided to put me on Cytomel to help my thyroid. To be honest with you, he told me to take 10mcg and I just increased it myself because i thought the more I will take the faster it will help me. I know, I know, please do not kill me.
Ok so I just got my results back today

TSH- 0.050 Range 0.270-4.200
T4 Total- 3.8 Range 4.5-12.0
T4 Free- 0.61  Range 0.83-1.62

Everything else on my bloodwork is in range..What do these results mean. Please help
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Avatar_f_tn
Nope, no lectures...you seem to have lectured yourself already!

Of course, you know that it's important to test FT3 as well as FT4...doubly so when your taking Cytomel, which is T3.  You really should repeat FT4 and TSH and have FT3 tested at the same time.

I may be telling you what you already know, so forgive me if that's the case.  

Your thyroid produces T4 mostly and a little bit of T3.  T4 is the "storage" form of the thyroid hormones.  It basically circulates in your bloodstream until needed.  T3 is the "active" form of the thyroid hormones, the only form your cells can use.  T4 has to be converted into T3 before your body can use it.  This happens mostly in the liver, but also at other sites ubiquitous throughout the body.

Your pituitary senses your T3 and T4 levels.  If they're too high, it puts out less TSH, if too low, more.  So, when you take a very high dose of Cytomel, your FT3 levels rise.  Your pituitary senses the high level and puts out less TSH.  So, your thyroid produces less T4.  I think that's what's happening to you.

Do you know why your doctor put you on Cytomel rather than a T4 med or a combo T3/T4 med?  Going directly to T3-only therapy is a bit unconventional.  Have you ever had antibody testing or otherwise know the cause of your hypo?  
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2015931_tn?1328560585
ok, now I am even more confused. Here are my blood work results

T3 toal 161 ref 80-200
Thyroglobulin 61.1  ref <55.0

I never had antibody test.
I dont know why my doctor does what he does. No clue. He told me to take Cytomel and it would help me with loosing weight but i am not loosing weight. i only loose weight if i don't eat. So i dont know what to do. My doctor thinks my results are normal, but how are they normal if they are not normal. Based on my results, i think i should be 100lbs by now because i am not in hyper states..correct? I am confused...
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Avatar_f_tn
I have thyroiditis been taking T3 Cytomel 25mcg x 2 and half my tsh go back to normal from 5.6 to 0.45 no hair loss still trying to loose weight but very slowly
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Avatar_f_tn
Are you taking Cytomel ONLY?  No T4 meds at all?  
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Avatar_f_tn
Hi everyone!
Here is the past two years of my battle. I could not loose weight and slowly gaining with healthy eating and traning 6x week. So finally doctor tested thyroid which was high TSH 4.6 and I showed anti bodies as well.

I was extremely fatigue and cold, finger numbing, eye brow thinning ecttt..
I started on Synthroid from .5mg-1.00mcg dosages. I would get swollen I would look one day normal next day 8months pregnant I would also have hard time with breathing when I would do my cardio classes. They thought I had asthma I knew there was something else. I was also extra tired so I decided to stop taking it for 6weeks, felt great! my exhaustion was no longer there, I can breath when doing my cardio classes. But then my tiredness and weight kept raising.
So I told my doctor I wanted to try Cytomel. So my doc took me off of Synthroid and now I am only taking Cytomel 25mcg for the past two weeks. Everything feels great, All my symptoms no longer exists I even lost 5lbs for the first time in 2years!!!!!
EXCEPT I have hairloss now. I am worried that i'm going to go bald at this rate. Please help!
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Avatar_f_tn
One of the keys to feeling well (i.e. symptom free) with this disease is striking an appropriate balance between FT3 and FT4.

Do you have recent labs to post?  If so, please include reference ranges.  

T3 (Cytomel) only therapy is seldom used on a long-term basis.  We need both T3 and T4 to feel well.  T3 is very fast-acting, so in the short term, it can make you feel much better much faster than T4 meds.  It might have been a better idea to try adding some Cytomel to your T4 than eliminating it completely.

Also, each manufacturer adds different fillers or binders to their tablets.  Some people are allergic or sensitive to those.  Sometimes just switching brands can make a huge difference.
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Avatar_f_tn
Thank you goolarra for responding!!!!

lab
First ever TSH 4.8 only (.20-4.0)mU/L
Started Synthroid .5mcg prescribed

Then adjusted to .75mcg
TSH 1.37 still felt all the symptoms

Then adjusted to 1.00 of Synthroid

TSH .61  and Anti TPO 227 (<50) kU/L
with this weight gain of 13lbs within 8months (Heaviest ever in life)
-----Until this point I also had low Iron 6 (12-300) ug/L

In the last week of taking the Synthroid I went to see a different doctor and she did new lab work here were the results:

Free Triiodothyronine         4.9      (3.5-6.5)mmol/L
Free thyroxine (Free T4)     17      (9-23)mmol/L
Anti-TPO-                         748      ref <35 IU/mL
Anti TG                            374       ref <40 IU/L
SO at this point I stopped taking Synthroid (I use the brand Synthroid itself)

5weeks after here are my blood work

Iron                   17 (12-300) ug/L
TSH                   2.23 (.20-4.0)
Free T3              4.3 (3.5-6.5)
Free T4              13.3 (9.0-23)
AT this point I saw Endocrinologist 2 in total and they thought i'm perfectly normal! no need for any meds!

After this blood work and within these six weeks I started to get few symptoms back which seems numbers are getting out of balance
and I now started Cytomel. No blood work yet on Cytomel my doc said in 6weeks.Its been 2weeks so far.....
My question is what are the ratios normally for Free T3, Free T4, and TSH inorder to know whats working and what is not?



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Avatar_f_tn
Before I forget, let me mention the iron.  Iron is essential for the metabolism of thyroid hormones, so since yours is still low (but improving,) that might have had an impact on how your thyroid meds worked for you.  Also, iron deficiency can mimic the symptoms of thyroid, and you're still low enough in the range on iron for it to be a cofactor.

FT3 should be higher in its range than FT4 is in its.  The rule of thumb (targets we use until you find your own personal optimal levels) is FT4 at approximately midrange (16 in your 9-23 range) and upper half to third of range for FT3 (5.5+ in your range).  Some people are happy lower in the ranges, some higher, but that balance is an important one.

In both the labs you post above, FT4 is higher (as a percentage of range) than FT3.  Often that indicates a conversion issue and the need for adding a little T3 to the meds.  However, many of us have found that it takes a while for conversion to ramp back up once we've been hypo for a while and FT3 can "lag" FT4.  I was on a stable dose of T4 meds and had stable FT4, but my FT3 continued to go up for months afterwards.

You will find that most of us on this forum pay little attention to TSH.  TSH is volatile (can change 70% just based on the time of day the blood was drawn) and, since it's a pituitary hormone, it's a very indirect measure of thyroid status that can be affected by any number of variables.  FT3 and FT4 are a direct measure.

Well, your latest labs are "in range", but that's the best that can be said about them.  FT4 is at 31%, so a long way to go to get to 50%.  FT3 is at 27%.  You can see that the profile is a little upside down, with FT3 lower than FT4.  However, it's not a lot lower.  It could be one of those that resolves over time.  

Cytomel is much more fast-acting than Synthroid.  You really don't have to wait all of 6 weeks if you're not taking any T4.  Perhaps you can have your lab work done a little earlier than your doctor suggested?        
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Avatar_f_tn
Thank you so much, I am finally starting to understand all thi slowly.....And Yes! I am going to go this week it will be 3 weeks and I think I need my T3 up a bit as well. From how I feel. I will keep you guys posted!

Mar :)
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Avatar_f_tn
Hi
I got my lab results!
so.....
Iron                     35 (12-300) ug/L
TSH                   .08 not a typo (.20-4.0)
Free T3              6.0 (3.5-6.5)
Free T4              6.3 (9.0-23)
So this explains hair loss. I decided to reduce Cytomel to 20mcg from 25mcg. my doc is on holidays for the next three weeks. I'm going to give blood in three weeks and see the change. I like where t3 is sitting but T4 dropped and TSH massively? My doctors knowledge on cytomel is not so great this is all from my research:) I'll keep you posted, thank you for the info, Mar
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Avatar_f_tn
Your FT3 is right up there at 83% of range, but your FT4 is way below range, much too low.  

T3 meds often drop TSH to almost nothing, and it often stays there.  Once on meds, and especially any meds with a T3 component, TSH really becomes very unreliable.

Are you planning to try to add some T4 soon?
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Avatar_f_tn
I want to add T4 however, being on Cytomel and since it is 4x I am trying to see what amount of T4 I should take....Right now I like where my T3 is sitting if I can just bring up my T4 a bit then we are good to go..
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Avatar_f_tn
The rule of thumb is to add about 25 mcg of T4 for every 5 mcg of T3 you decrease.  Of course, if you convert at all (which we all do, albeit some of us slowly), some of that T4 is going to be converted to T3.  So, the best thing to do is probably to add it in slowly.  Your FT3 does look good now.  Don't forget that when taking T4 meds, it takes 4-6 weeks for them to reach their full potential in your blood, so while you will experience a more or less immediate decrease in FT3 when you decrease Cytomel, the T4 won't be there immediately to take up the slack.  It's often best to add in some T4 and wait a week or so to decrease the T3.  Your FT4 is so low that you have quite a ways to go...
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Avatar_m_tn
Understand that I haven't had time to read this entire thread.  Just wondered if the iron test you listed was for serum iron or ferritin, with which I am more familiar.   Also, thought this link might add some importance to assuring that your  iron levels are high enough in the range.

http://coolnurse.healthology.com/hair-loss/hair-loss-information/article3502.htm
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Avatar_n_tn
Hi there, hoping you can help...for past 2 weeks, I've been feeling horribly Hypo (low temps, fatigue, mental fogginess), and just in past 4 days, my thyroid gland has swollen to the point where it hurts to turn my head or swallow.  

Here's my history:
Previously taking 100 mg Synthroid and 10 mcg Cytomel.  I felt fine, weight was good.  

Changed doctors, and she changed meds as follows 3 months ago:
112 mg Synthroid and 20 mcg Cytomel.

Here were my test results from today (feeling BAD and swollen thryroid):
T4 Free - .76 (range: .58-1.64)
T3 Free - 2.8 (range 2.5-3.9)
TSH - .328 (range .34 - 5.6)

My previous test results (when I felt fine, BEFORE Synthroid and Cytomel was increased):
T4 Free - .55 (range .58-1.64)
T3 Free - 3.4 (range 2.5-3.9)
TSH - .584 (range .34 - 5.6)

In your opinion, are my symptoms caused by the increase in Synthroid or the Cytomel, (Or BOTH too high?).

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Avatar_m_tn
Your Free T3 and free T4 are definitely not too high, if you are having hypo symptoms.  Have you been diagnosed with Hashimoto's Thyroiditis, which is the most common cause of diagnosed hypothyroidism?  
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Avatar_f_tn
I agree with gimel, neither is too high.

However, what I do find interesting is that your FT4 increased with the increase in Synthroid, as expected, but your FT3 took quite a dive with the increse of T3 from 10 mcg to 20 mcg.  It was nicely up in range in your previous labs (64%), and it's now at 21%.

On your previous labs, I undersand why your doctor increased your T4 from 100 to 112 since your FT4 was below range.  I'm not quite sure what her rationale was for doubling your T3 at the same time...your FT3 was already in the upper half of range.  Furthermore, you said you were feeling well...never let them mess with your meds when you feel good!  LOL

I have no way to justify what I am about to say scientifically.  Your FT3 went down considerably on an increase of T3 meds which is almost unheard of.  20 mcg of T3 is a fairly hefty dose.  The only advice I can offer is to go back to the dose you felt well at.

You do split your T3 into two half doses?    
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649848_tn?1357751184
Had you taken your cytomel, prior to the first blood draw, when your FT3 was higher?
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Avatar_f_tn
Excellent question...
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Avatar_n_tn
No, I didn't take my thyroid meds before blood test.

Yes, I split the Cytomel dosage into 2 doses.

Do you think it's more important that I keep the 112 mcg of Synthroid to try to boost my T4?  My doctor reduced it to 100 mcg yesterday, but kept me on the 20mcg of Cytomel.

Can't decide if I should continue the higher T4 and reduce the T3/Cytomel back to 10mcg....

As you can tell, this MD doesn't know what she's doing with Thyroid meds.  My long term/previous doctor passed away last month (Daniella Paunesky), and I feel like I'm lost in space.  Feel more horrible than I've ever felt, and now my Thyroid gland is swollen and painful.  Can't think clearly, am agitated, fatigued....
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Avatar_f_tn
If she has a rationale for doing what she's doing, I kind of fail to see it, but maybe that's because I don't have an M.D. after my name!  Did she give you any idea of what she wanted to achieve and how she planned to do that?

Tough question on what to do with your meds.  Do you have any prior labs to these two when you felt well?  I'm looking for a trend or other FT3 and FT4 levels when you felt well for comparison.

Sorry to hear about your doctor.  My endo and I are about the same age, and he will most likely retire (getting close) before I no longer need his services.  So, I'll be breaking in a new endo at some time, too.  
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Avatar_f_tn
I'm copying this question from another thread for Bella192 since there seem to be some MH navigation problems going on.

"Goolarra,  In your opinion, if I am currently taking 112 mcg of Synthroid and blood tests show positive for the Thyroid Antibodies for Hashimoto's, what would be the new dosage of Sythroid I should try?

I have to hold my doctor's hand and tell her what to look into regarding Thyroid issues, so I want to be prepared with some idea what would be an ideal higher dose to discuss when I see her on Monday."

Dosage is not related to antibodies.  Dosage should be based on symptoms first, then FT3, FT4 and TSH, in that order.

Dosage changes should be made in 12.5 to 25 mcg increments.  After 4-6 weeks, labs sould be repeated, symptoms re-evaluated and further adjustments made if necessary.  We all react differently to meds changes, so it's important to move slowly.

Looking back up to your labs, however, what worries me is the big drop in FT3 from 3.4 to 2.8 despite a 10 mcg INCREASE in T3 meds.  This is virtually unheard of, and it makes me wonder if something else isn't going on.

How long after the increase did you start feeling very hypo?  How long ago were the prvious labs you posted above?
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Avatar_n_tn
12/2/11 - Taking 100 mcg Synthroid & 10 mcg Cytomel.  Felt extremely fatigued.  Test results on this date:

12/2/11:
TSH: .58 (range .34 - 5.6)
T4: .55 (range: .58-1.64)
T3: 3.4 (range 2.5-3.9)

12/2/11, doctor raised cytomel to 20 MCG, Synthroid remained 100 mcg.

12/29/11 - taking 100 mcg synthroid & 20 mcg cytomel. Felt good.  Test results on this date:
12/29/11:
TSH: .20
T4: .88
T3: 2.6

6/19/12 - when these test were run, i was still on 100 synthroid and 20 cytomel, felt fine:
6/19/12:
TSH: .47
T4: .96
T3: 2.8

6/19/12, However, doctor felt my T4 was too low, and on this date, raised Synthroid to 112 mcg.

10/10/12 - Had now been on 112 Syntrhoid for 4 months, and still 20 cytomel.  Felt the worst hypo I've EVER felt, including swollen and painful thyroid when these tests were run, symptoms had been ongoing for about 2 weeks when these test were run:
10/10/12
TSH: .32 (range: .58-1.64)
T4: .76
T3: 2.8

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Avatar_f_tn
Very confusing labs as they relate to meds and symptoms...

On 12/2/11, your Synthroid dose remained the same (100), your Cytomel dose was raised to 20 from 10, yet by 12/29/11 your T3 had taken a nosedive (from 3.4 to 2.6), and you felt better.  FT4 had come up to 0.88 from 0.55.

On 6/19/12, you were still feeling well with labs that had hardly changed since 12/29.  Your doctor raised your Synthroid to 112, keeping Cytomel the same.  

By 10/10/12, you felt the worst ever, although FT3 had remained exactly the same.  FT4, however had fallen a lot (20% of range) on an INcrease in Synthroid.

So, how to explain all these contradictions???

It's possible that you are losing thyroid function continually.  If your thyroid is producing less and less as time goes on, it could explain the drop in FT4 despite the increase in Synthroid.  Your meds increases aren't keeping up with the loss of thyroid function.  

You've felt well before with FT3 in the 2.6-2.8 range, but it would seem that you start not feeling well when your FT4 goes below somewhere around 0.8.  That's not far from where you are right now.  

If I were you, I think I'd ask the doctor for a slight Synthroid increase, probably in the vicinity of 13 mcg, bringing you to 125.  For the time being, I wouldn't change the Cytomel.  Whether you feel well or not, I'd retest in 4-5 weeks to see what effect the increase has had on your labs.  You can then re-evaluate symptoms and go from there.  It appears your condition is changing too fast at the moment to let 4 months go by without having labs, especially after a change in meds.  You should always have labs 4-5 weeks after a change to evaluate your response to it.  
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Avatar_m_tn
Didn't know where else to post this and you seem to know a lot....

I was diagnosed as hypothyroid in March of this year and my levels were:

FT3- 2.64 and FT4- 1.25...low, but not terrible. I was put on Armour Thyroid and after a few months of persisting symptoms (tired, weight gain) I stopped taking them cold turkey per another doctor's advice who said I didn't have a thyroid issue.

Flash forward to October and I was still experiencing weight gain (was 117lbs in Feb and am now up to between 128 and 134), tired, hair loss, dry skin, puffy face, etc. Cortisol levels normal, have gluten allergy but endoscope showed no celiac, very low vitamin D, vitamin B levels good. Was put back on thyroid meds....this time Levothyroxine 50mcg and Liothyronine 10mcg. After 2 months, symptoms hardly improved so dosage was increased to Levo 100mcg and Lio 20mcg. Energy levels had been much better but still gaining weight though it seemed to slow down...hair loss still, but that slowed down as well. Started having rapid heart beat and other signs of hyper. Got levels retested a couple weeks ago and they are now FT3- 4.64 FT4- 1.12 TSH 0.020

Any thoughts on what could be happening? Doc now wants to decrease Lio back down to 10mcg and increase Levo to 150mcg. Does this all sound right? I feel like maybe I have an adrenal issue but Cortisol (morning only was tested) was normal.

The FT3 level range printed on the lab is 1.50-4.10 but the doc has had written she likes to see them at 3.5-5.0 (mine was 2.64 to start and is now 4.64)

FT4 printed range is 0.89-1.76 doc wants them at 1.3-2.0 mine was 1.25 to start and is now 1.12.

My most recent Vitamin D level was 17...lower part of the range is 25. My level 17 was while taking 10,000 (yes 10,000) iu of vitamin D3/day.

Haven't had glucose or any other tests besides morning cortisol.




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Avatar_f_tn
My first thought is that your doctor is changing both your T3 and T4 doses in much too big increments.  A T4 increase/decrease should be in the range of 12.5-25 mcg at a time, and FT3 should be 2.5-5.  

Just as an aside...don't worry about your suppressed TSH.  That often happens once people are on meds, especially meds with T3 in them.  You will probably pretty much have to ignore TSH (and convince your doctor to do the same).  

I have to say that your doctor's ranges for FT3 and FT4 are much more reasonable than the usual lab ranges.

i don't understand her logic, though.  Your FT3 is at 4.64, a little high according to the lab range, but right on target according to your doctor's range.  However, you are having a few hyper symptoms though some hypo symptoms still persist at a reduced intensity (is that a correct summary of how you feel?).  Your FT4 is at 1.12, not too far from her 1.3 target.

If I were you, I'd be more inclined to want to drop my T3 intake just enough to stop the hyper symptoms...something like 5 mcg.  I'm a big believer in only changing one thing at a time if possible so you can really isolate and evaluate what that does.  My guess is that you're getting very close to an optimal dose for you.  You might have to add a little more T4, too (I'd want my doctor to add about 12.5 mcg to start).  If you decrease the T3 first, since its effects will show in your blood work in a couple of weeks, you can evaluate what that's done (see if the hyper symptoms go away) and see if you still think you need to add some T4.  

50 mcg changes in T4 and 10 mcg changes in T3 are much too big.  Your doctor will having you bouncing back and forth from hypo to hyper on those changes.        
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5619138_tn?1371052713
I am taking 200mcg Levothyroxine for thyroid replacement.  My thyroid was ablated back in 2001 with radioactive iodine therapy.  Since then I have switched to a 2nd endocrinologist who I have currently been seeing for about 7 years.  Dilema: I cannot get my weight under 200#.  I walk, I run 5k's, I am on a low-carb 1200 calorie diet, I drink well over 100 ounces of water daily, I do not drink soda's, coffee, tea or alcohol.  I have never smoked or drank.  I started taking 10,000mcg Biotin to help with the never-ending peeling fingernails and my hair sheds worse than a dog.  My DR doesn't understand why at such a large dose of Levothyroxin (levothyroxine) that I still struggle with weight.  I see her every 6 months and it's the same story.  I used to be on 325mcg of Levo but she started gradually reducing that amount (because of lab results).  Would I benefit weight-wise if I could convince her to switch me to Armour, or at least add Cytomel?  I've already been thru menopause 11 years ago (I'm only 53 yrs old), so that is not the reason for my weight issues.  Thanks for any and all advice.
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Avatar_f_tn
The answer to relieving your symptoms almost has to be in your FT3 level.  Is your doctor testing that?

Please post any recent thyroid labs you have and include reference ranges (they vary lab to lab).

Whether you would benefit from adding T3 (either Armour or Cytomel) to your labs would depend on your FT4 level relative to your FT3 level.

If you haven't been in the habit of getting a copy of all your labs, you might call your doctor's office and ask for the most recent.  If you're in the U.S., they have to provide them on request.
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Avatar_f_tn
I was a Graves patient but it took 3 years for me to be correctly diagnosed - one doctor diagnosed me as in menopause without a single test - and by the time I was correctly diagnosed I was in Thyroid Storm.  The worst time of my life.  At first propothyoricyl (sp?) worked like a charm until 2 years later and I again became severely hyperthyroid and finally an endo ablated the little rascal with radioactive iodine.  I was then exclusively on Synthroid - 123 mcg at the final dosage.  But after 5-6 years, I did not feel well, lousy in fact.  "Your blood work is perfect, the numbers are right where they should be, you're fine".  (They only took TSH into account)  It took me another 7 years to find someone who treats the patient and not the lab tests.  At that point I was the heaviest in my life in spite of eating practically cardboard, hair falling out and none on arms or legs, body felt like it was made out of lead, I had the energy of a slug, my body ached so badly that I felt like screaming (but didn't have the energy for it), a depression that really made me hit rock bottom, total brain fog, but the best was a pulse (with white-coat syndrome) of 34!!! and yet I kept being told "you're fine, there's nothing wrong".  And then I found Dr. Hurlock who just rolled her eyes at my symptoms and immediately started me on Armour 60 mcg in the morning and 60 mcg at noon.  After 4 weeks, with no adverse symptoms,  the morning dose was raised to 90 mcg and noon kept the same.  With no adverse symptoms after 4 weeks of that, the noon was raised to 90 mcg and so on until a year later when I topped out at 240 mcg Armour morning and at noon.  I had lost 40 pounds effortlessly (amazing what a metabolism will do), hair had grown back and stopped falling out, skin was no longer dry, pulse was up there at 59, aches and pains significantly subsided and I had a renewed zest for living again.  3 months later I did start having some slight hyper signs so the noon dose of Armour was replaced with 350 mcg Synthroid.  In spite of what may seem to be high doses, 6 months later I feel reborn and I cannot tell you how my heart goes out to anyone who doesn't feel this good.  My hybrid medication is working like a charm - although TSH is at .011, T3 and T4 are right where they should be.  Zero hyper symptoms, and believe me, I would recognize them in a nanosecond after being in Storm.  She listened to me, she took all my symptoms into account and she trusted me to listen to my body and to know when things were off.  Oh, and my pulse is now a racing 71.  Life is good.  My mantra is: you know your body better than anyone else and if you think something is wrong , keep searching for the physician who will listen and who is open to thinking outside the box.  It can change your life!

And now with the help of the information in this forum, I'm hoping to get help for my cousin who has all the symptoms of hypo too.
Deb
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Avatar_f_tn
You're preaching to the choir when it comes to TSH testing.  It's totally insufficient to manage meds.  Both FT3 and FT4 have to be tested...every time labs are drawn.  TSH is, at best, a screening test for asymptomatic individuals.

I had the same, although opposite, problem you had.  My TSH wouldn't budge from around 20.0, no matter what FT3 and FT4 were doing.  All my PCP could say was "need more thyroid"  I kept telling her I was asymptomatic...didn't matter...my labs weren't "right".  Turns out I have a little pituitary issue going on, so my TSH probably never will budge.

Am I reading correctly?  You take 240 mg of Armour in the morning and 350 mcg of Synthroid at noon?  If your FT3 and FT4 are good, there's nothing wrong with that, but one does have to wonder where it's all going.  It's obviously not all getting absorbed.  Once again...nothing wrong with that...all that matters is what's absorbed.

I agree we know ourselves best and symptoms trump everything else when it comes to treatment.
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Avatar_m_tn
In May, I was on Armour (90 mg) and these were my results:
TSH .179
T3  4.7

They switched me to Levothyroxine (100mcg)

In August my results were:
2.37 Free T3
1.21 Free T4
1.04 TSH

My doctor now wants to add Cytomel.  
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Avatar_f_tn
I had been taking Levoxyl for years and then had to quit because of the recall.I have been put on every other med with no help. I  have gained weight, am tired, weak, foggy minded, depressed, digestive issues, dry skin, no hair on my legs , thinning hair on my head, dry straw hair ... Blood pressure going up. feel like i am going to die. Started a compound of 25 t4/ 5 t3 three times a day. Been a few days but still do not feel well. I want my LEVOXYL BACK....at least i was stable...last tes showed reverse T3 at 633 ( usually means atuo immune) Ifeel best when my TSH is 1 or less...any higher i feel like carp. everyone is different, we react to meds differently. I just ant to feel good again
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Avatar_f_tn
This is an old thread, and you'll get more attention to your individual concerns if you start your own new thread (click "post a question" button at top of page).

When you do, please give us some more information:

How much Levoxyl had you been taking?

Please post recent labs with reference ranges.  What was your FT3 and FT4 when your RT3 was 633?

RT3 isn't an indicator of autoimmune disease.  If you want to know if you have Hashimoto's thyroiditis, you should ask your doctor to run the two antibody tests that are markers for it...TPOab (thyroid peroxidase antobody) and TGab ((thyroglobulin antibody).  If either or both is elevated, Hashi's is indicated.

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