Is it ok that my doctor is having me take so much Cytomel?

Hi, everyone. Just returned from my integrative doctor's appointment. Before this, my medication was 50 mcg Synthroid and 15 mcg Cytomel (I increased the Cytomel from 10 to 15 mcg on Friday). Now, the doctor wants me to do 50 mcg Synthroid and 25 mcg Cytomel on a daily basis. What do you all think? The only recent labwork is this:

(TSH range 0.40-4.50 // free T4 range 0.8-1.8)

07/07/11 TSH 2.91 -- Free T4 0.9

T3 Uptake 34 (Range 22-35 Percent)

Free T3 2.9 (Range 2.3-4.2 pg/mL)

Ferritin 51 (Range 10-154 ng/mL)

07/14/11 *****PUT ON 50 MCG of SYNTHROID, 10 of CYTOMEL*****

08/04/11 TSH 0.36 -- Free T4 0.9

08/12/11 *****PUT ON 50 MCG of SYNTHROID, 15 of CYTOMEL*****

WHY is my Free T4 not moving? Do you think it's ok that I am increasing the Cytomel this much? I don't quite get why he wants to increase the T3 and not the T4. He said something about some people not being able to produce one of the hormones or something about too much T4 could give you increased RT3.

What do you all think? Is it ok that I am taking so much Cytomel? He said that my free t3 was so low that he has plenty of room to add to it. I'm still sitting on the couch any downtime I have unless there's a pressing responsibility.

[goolarra]

Were you on 25 mcg Synthroid prior to 7/14/11?  If not when did you staret on 50 mcg?  Was any labwork done before your doctor increased to 25 mcg Cytomel?

[readyforwhat]

I was diagnosed August 1, 2010 with silent thyroiditis.

My stats are (Range: TSH 0.40 - 4.50 // Free T4 0.8 - 1.8)

08/01/10 TSH 0.03

08/09/10 TSH 0.01

09/23/10 TSH 0.41

10/28/10 TSH 1.36 -- T4 0.96

12/6/10 TSH 3.80 -- T4 0.92

12/28/10 TSH 0.99

02/11/11 TSH 2.45 -- Free T4 1.1
*****PUT ON 25 MCG of SYNTHROID*****

03/28/11 TSH 4.18 -- Free T4 0.9
*****PUT ON 50 MCG of SYNTHROID*****

04/28/11 TSH 0.6 -- Free T4 1.1

06/06/11 TSH 1.23 -- Free T4 1.2

06/14/11 *****PUT ON 25 MCG of SYNTHROID, 5 of CYTOMEL*****

07/07/11 TSH 2.91 -- Free T4 0.9

T3 Uptake 34 (Range 22-35 Percent)

Free T3 2.9 (Range 2.3-4.2 pg/mL)

Ferritin 51 (Range 10-154 ng/mL)

07/14/11 *****PUT ON 50 MCG of SYNTHROID, 10 of CYTOMEL*****

07/21/11 *****PUT ON 50 MCG of SYNTHROID, 15 of CYTOMEL*****


07/07/11 TSH 2.91 -- Free T4 0.9

T3 Uptake 34 (Range 22-35 Percent)

Free T3 2.9 (Range 2.3-4.2 pg/mL)

Ferritin 51 (Range 10-154 ng/mL)

07/14/11 *****PUT ON 50 MCG of SYNTHROID, 10 of CYTOMEL*****

08/04/11 TSH 0.36 -- Free T4 0.9

08/12/11 *****PUT ON 50 MCG of SYNTHROID, 15 of CYTOMEL*****

-----

The only labwork was what you see here.  The latest labs on 8/4 were by the endo who doesn't see a need to test free t3 (don't get me started).  It was the integrative doctor who suggested I do the 25 mcg Cytomel and 50 mcg Synthroid.

[goolarra]

So, your last labs were on 7/7/11...FT3-2.9, FT4-0.9 and TSH-2.91.  Since that time your doctor has had you increase Cytomel twice, once to 10 mcg, then to 15 mcg (which you did just last Friday).  Then you had TSH of 0.36 and FT4 of 0.9 and no FT3 on 8/4/11.  So, the integrative doctor has increased your Cytomel with no further FT3 test beyond 7/7.  Do I have all that straight?

To tell you the truth, that makes me totally uncomfortable...too many Cytomel increase without seeing FT3 labs.  

Your FT4 remains the same, but you haven't increased Synthroid, so that's logical.  Also, it's quite possible that your thyroid function continues to deteriorate.  

Before I assumed that your RT3 was too high and started treating you for RT3 dominance, I'd certainly want to test RT3.  Then you'd know for sure if that was an issue.

You've added a lot of Cytomel since FT3 was tested, and it wasn't THAT low prior to starting Cytomel (2.9...no great shakes, but not terrible, either).

I'd be very, very cautious about adding that much more Cytomel without testing FT3 first.  RT3 test would be a good idea, too.  I'm guessing that if your endo won't even test FT3, he'd roll on the floor laughing if you asked for RT3.  Any chance of getting those from someone else...your PCP, maybe?

[laura1967]

I agree that you need to see a thyroid specialist.(I know this can be a frustruating search) Your T4 level is too low. If you are given ample amount of T4, then you will naturally convert some of this to T3. Just giving you a high dosage of T3 is not allowing your body to do what it is suppose to do....Unless you have a conversion issue. Even then, you need to maintain a proper ratio of T4 to T3. You should have had your T4 increased, not your T3 this time. T3 meds will supress your TSH, so you need to be treated by your Free T4 and Free T3 results.
The other important thing I want to mention is that it takes 6-8 weeks for your levels to average out and labs should be done accordingly to this, before upping meds or changing meds!