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

[jolicat32]

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!! :)

[Barb135]

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.

[flyingfool]

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.

[valdab]

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.

[flyingfool]

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.

[valdab]

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.

[sissaphus]

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

[gayle502]

Hello Ladies,

Will taking 75mcg of cytomel cause lo FT4?

[goolarra]

Wow!  That's a very hefty dose of Cytomel.  Yes, it could cause low FT4.  Can you give us more background, labs, symptoms, etc.?

[gayle502]

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

[goolarra]

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?  

[gayle502]

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...

[Lupa40]

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

[goolarra]

Are you taking Cytomel ONLY?  No T4 meds at all?  

[marmar50]

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!

[goolarra]

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.

[marmar50]

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?

[goolarra]

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?        

[marmar50]

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 :)

[marmar50]

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

[goolarra]

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?

[marmar50]

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..

[goolarra]

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...

[gimel]

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

[Bella192]

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?).