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Possible for both over-replacement and under-replacement at the same time?
This is partially and update, and partially a request for feedback!
My thyroid doctor determined high reverse T3, small amount of antibodies, and generally low range T3 and T4, TSH varied high to low. Gradually switched from synthroid to cytomel only, and after much better t3/reverse t3 ratio, added synthroid.
I'm taking 25mcg cytomel (half in AM, half in afternoon), and 25 mcg Synthroid. I don't have my recent labs, however my TSH was around 2, T3 in the top of the range and T4 in the very bottom of the range. Reverse T3 ratio was perfect. This was not much different from my labs on cytomel-only taken 2 months prior, and I feel better with the small amount of synthroid. Until a month ago, I was taking 20 mcg of Cytomel, but insurance changed and taking four 5 mcg pills a day was significantly more expensive than one 25 mcg a day. The doctor was cautiously okay with this.
My problem is that I now seem to be having some symptoms of over-replacement - hot when others are cold, am now underweight, hyperactive and a little anxious/obsessive. BUT I am feeling even more awake and capable than ever - I think and learn better, sleep soundly, can't recall the last temper tantrum.
I'm in the middle of switching bipolar medicine to one less effective but without the side effects of weight gain and fatigue, and decided to stop refilling my antipsychotic medicine. I'm not sure what symptoms there could be from all of this, but the antipsychotic is what I suspect caused the anxiety/obsessions.
Is it better to keep my T4 levels so low since I had reverse T3 problems? The doctor wasn't thrilled by it, but also didn't want to double the synthroid dose by moving up to 50 mcg. Other than feeling sad frequently there's no more mental symptoms of low thyroid, just physical symptoms. I started a new job in a new city which could be the cause. Things aren't bad right now, but something doesn't seem right. I fear telling my thyroid doctor because in a way I feel better and don't want the medicine decreased, and I fear telling the psychiatrist because she'll say I'm "manic" and I don't want that medicine increased!!
My thyroid doctor determined high reverse T3, small amount of antibodies, and generally low range T3 and T4, TSH varied high to low. Gradually switched from synthroid to cytomel only, and after much better t3/reverse t3 ratio, added synthroid.
I'm taking 25mcg cytomel (half in AM, half in afternoon), and 25 mcg Synthroid. I don't have my recent labs, however my TSH was around 2, T3 in the top of the range and T4 in the very bottom of the range. Reverse T3 ratio was perfect. This was not much different from my labs on cytomel-only taken 2 months prior, and I feel better with the small amount of synthroid. Until a month ago, I was taking 20 mcg of Cytomel, but insurance changed and taking four 5 mcg pills a day was significantly more expensive than one 25 mcg a day. The doctor was cautiously okay with this.
My problem is that I now seem to be having some symptoms of over-replacement - hot when others are cold, am now underweight, hyperactive and a little anxious/obsessive. BUT I am feeling even more awake and capable than ever - I think and learn better, sleep soundly, can't recall the last temper tantrum.
I'm in the middle of switching bipolar medicine to one less effective but without the side effects of weight gain and fatigue, and decided to stop refilling my antipsychotic medicine. I'm not sure what symptoms there could be from all of this, but the antipsychotic is what I suspect caused the anxiety/obsessions.
Is it better to keep my T4 levels so low since I had reverse T3 problems? The doctor wasn't thrilled by it, but also didn't want to double the synthroid dose by moving up to 50 mcg. Other than feeling sad frequently there's no more mental symptoms of low thyroid, just physical symptoms. I started a new job in a new city which could be the cause. Things aren't bad right now, but something doesn't seem right. I fear telling my thyroid doctor because in a way I feel better and don't want the medicine decreased, and I fear telling the psychiatrist because she'll say I'm "manic" and I don't want that medicine increased!!
We really need to know what all your levels are at. TSH, FT4 and FT3.
The reason it is often stated that when on cytomel (T3) the TSH is zero is because for many (not all) people TSH seems easily suppressed by T3 medication.
It is good your Dr looks at the whole picture. But I think you still must reinforce that TSH is the LEAST thing to be concerned with.
Some people can stand T3 only with their FT4 out of whack. Other people seem to need their FT4 level to be within reasonable range to feel their best. So it varies from person to person.
Remember that your cells primarily need proper FT3. So medication dosage is most important to do that first. And most people fee significantly better when this happens. Then tweak to feel the best (Optimized) for you. That may result in slight dosage changes.
You may be in the phase where you are getting much better, but still can improve with optimization of dosages. Again you have to be very patient in this phase.
The reason it is often stated that when on cytomel (T3) the TSH is zero is because for many (not all) people TSH seems easily suppressed by T3 medication.
It is good your Dr looks at the whole picture. But I think you still must reinforce that TSH is the LEAST thing to be concerned with.
Some people can stand T3 only with their FT4 out of whack. Other people seem to need their FT4 level to be within reasonable range to feel their best. So it varies from person to person.
Remember that your cells primarily need proper FT3. So medication dosage is most important to do that first. And most people fee significantly better when this happens. Then tweak to feel the best (Optimized) for you. That may result in slight dosage changes.
You may be in the phase where you are getting much better, but still can improve with optimization of dosages. Again you have to be very patient in this phase.
Oh! One other question - I had always been reading from you all that with cytomel, TSH is usually close to zero. The couple labs I've had since starting it have both been right around 2 (the most normal TSH I've ever had actually). My doctor is all about having ALL the levels of everything normalized, so even though she isn't fixated on TSH, she would not like it too low.
I have been splitting the dose - writing this all out, makes me realize that keeping T4 so low is probably not a good long term strategy. I will admit that I'm not the best at drinking enough water and waiting a whole hour before coffee and food with synthroid.
My first thought upon reading your post was exactly what Barb135 stated. That is to split the T3 in half and take twice a day. At least try that first and see how you react.
T3 is a really fast acting medication so you should be able to notice a difference within a few days I would think.
Glad to hear you're feeling better. If I remember, a while back you were pretty much a mess.
I would encourage you to still be patient. And to NOT try to change too many medications at once. Because they all interact and you won't know which action caused what reaction if you change more than one medication (variable) at a time.
T3 is a really fast acting medication so you should be able to notice a difference within a few days I would think.
Glad to hear you're feeling better. If I remember, a while back you were pretty much a mess.
I would encourage you to still be patient. And to NOT try to change too many medications at once. Because they all interact and you won't know which action caused what reaction if you change more than one medication (variable) at a time.
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Your over medicated feeling could be because you're taking all the cytomel at one time. You can split the 25 mcg cytomel pills and take 1/2 in the morning and 1/2 later in the day, so you won't get the initial over medicated feeling, then crash and feel hypo.
Additionally, once you've solved the RT3 issue, you should be okay balancing out the T4/T3 meds. If you need to increase the T4 med, but don't want to jump to 50 mcg, you could try alternating 25 mcg and 50 mcg for a 2-day average of 37.5 mcg........ you'd take 25 mcg one day, 50 mcg the next.
Additionally, once you've solved the RT3 issue, you should be okay balancing out the T4/T3 meds. If you need to increase the T4 med, but don't want to jump to 50 mcg, you could try alternating 25 mcg and 50 mcg for a 2-day average of 37.5 mcg........ you'd take 25 mcg one day, 50 mcg the next.
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