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!! :)

[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 :)

[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 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]

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]

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]

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