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Question
Is it always necessary to decrease your Synthroid dosage when you start Cytomel? I'm on week 2 of the Cytomel but my doc did not have me decrease the Synthroid and feel kinda funky. My heart is pounding a little hard at times, my tongue is burning, and I feel very alert. Like a very heightened sense of "alert." Should I call the doc or have I not given it enough time yet?
I don't know a lot about free thyroxine index since we don't see that one very often. A quick google said that FTI is T3 Uptake X TT4. Since both T3 Uptake and TT4 are considered obsolete, I guess I'd have to consider this in the same category since it's based on the same information. But, no, it is definitely NOT FT4.
It most likely means you are not converting. If the numbers were frees, rather than totals, I'd take the "most likely" out of that sentence.
I agree on the sprints. If the T3 is not there for cell repair, you might want to take it just a bit easy on your muscles until you get your levels straightened out. No sense in causing more damage than is necessary until you know for sure what's going on. But, I'm so glad to hear that you are feeling better without the Cytomel. I'm sure you can add it back in, but you just have to decrease your levo at the same time. I think you do need the Cytomel, but you have to balance it with the levo.
It is frustrating, especially when you asked your doctor the direct question about reducing levo at the same time.
It most likely means you are not converting. If the numbers were frees, rather than totals, I'd take the "most likely" out of that sentence.
I agree on the sprints. If the T3 is not there for cell repair, you might want to take it just a bit easy on your muscles until you get your levels straightened out. No sense in causing more damage than is necessary until you know for sure what's going on. But, I'm so glad to hear that you are feeling better without the Cytomel. I'm sure you can add it back in, but you just have to decrease your levo at the same time. I think you do need the Cytomel, but you have to balance it with the levo.
It is frustrating, especially when you asked your doctor the direct question about reducing levo at the same time.
One more thought...
As long as you're requesting FT3 and FT4, and assuming you want to get on with this ASAP, you might also think about requesting RT3 (reverse T3). T4 is converted by the liver into both T3 and RT3. Sometimes, especially in patients on T4 only meds, the liver starts to convert more RT3 than T3 (it's the ratio of one to the other that's important). This is called RT3 dominance. It's treated differently than simple low FT3. It might be a bit premature to test this, but it might also save you some time to have all the information available now.
As long as you're requesting FT3 and FT4, and assuming you want to get on with this ASAP, you might also think about requesting RT3 (reverse T3). T4 is converted by the liver into both T3 and RT3. Sometimes, especially in patients on T4 only meds, the liver starts to convert more RT3 than T3 (it's the ratio of one to the other that's important). This is called RT3 dominance. It's treated differently than simple low FT3. It might be a bit premature to test this, but it might also save you some time to have all the information available now.
Thanks for the info. Can you just be my doctor? LOL! I'm gonna put in my call this morning and request to have the DOCTOR call me back. Wonder how long I'll have to wait for that one? Do doctors even do callbacks? I get so sick of the translation issue at that office. They make it so you put in a call to speak with the nurse, she calls you back 12 hours later and takes down your problem and sends it to the doctor. Then he reviews the problem and gets back to the nurse 12 hours later. Then 12 hours after that the nurse gets around to calling you back. Then half the time she didn't even tell him the problem correctly because she's a ding ****. I just want to scream that the whole process could have taken 15 minutes if the freakin doctor had just called me directly. Instead it takes 3 days. Ridiculous. My can of whoop-a$$ is opening today.......
I just saw my endo last week, and I love him more every time I see him (not young, not good-looking, and a bit zaftig). He is the only doctor who has ever called me back personally. It was when I was overmedicated and hyper. He was at a clinic in a different city, and he actually took the time to call me. And, he did it within half an hour of when I called his office. On the other hand, I recently had surgery, had some complications the evening after, and my surgeon was not to be found...ended up with the "on call" surgeon, who was an idiot, and took 45 minutes to call me back (with bleeding involved!). I ended up hanging up on her, since the best advice she could give me was "if you feel like you need to go to the ER, then you should". This is why I pay you the big bucks??? No ****, Sherlock. However, she actually DID call me back to tell me I couldn't hang up on her!!! No? Watch this!
My vent for the day...It is ridiculous. It's all for their convenience, we're just the vehicle by which they get paid.
My vent for the day...It is ridiculous. It's all for their convenience, we're just the vehicle by which they get paid.
Okay, my doc called me. Shocking! Here's what he says, tell me what you think...
First question on why he doesn't test Free T3......he said that he feels that the total T3 count is a perfectly adequate measure but if I would like my free T3 tested he would be perfectly willing to do so on my next labs and review the results with me. And this is what he wants me to do.....Remember that I take Synthroid 150 and 137 on alternating days.....
He wants me to take 137 of Synthroid for the next two weeks. Then after two weeks take 1/2 of a Cytomel everyday along with the 137 of Synthroid and then call him after 5 days. Depending on how I feel then he will add the other half of that Cytomel if needed after my labs. His main concern with me, he says, is cancer suppression and quality of life. He feels that my T4 needs to be as high as I can tolerate it because he doesn't want the cancer coming back. I asked him about cellular damage from low T3 and he doesn't think that's an issue (not sure what to think about that) but adding the Cytomel is a good thing. I was the one who brought up lowering the Synthroid dosage and he said "we could try." I was thinking 125 but he said he would go no lower than 137. He is just all up in the business of cancer suppression, and I understand and appreciate that, but I want to feel well too. So, of we go........
First question on why he doesn't test Free T3......he said that he feels that the total T3 count is a perfectly adequate measure but if I would like my free T3 tested he would be perfectly willing to do so on my next labs and review the results with me. And this is what he wants me to do.....Remember that I take Synthroid 150 and 137 on alternating days.....
He wants me to take 137 of Synthroid for the next two weeks. Then after two weeks take 1/2 of a Cytomel everyday along with the 137 of Synthroid and then call him after 5 days. Depending on how I feel then he will add the other half of that Cytomel if needed after my labs. His main concern with me, he says, is cancer suppression and quality of life. He feels that my T4 needs to be as high as I can tolerate it because he doesn't want the cancer coming back. I asked him about cellular damage from low T3 and he doesn't think that's an issue (not sure what to think about that) but adding the Cytomel is a good thing. I was the one who brought up lowering the Synthroid dosage and he said "we could try." I was thinking 125 but he said he would go no lower than 137. He is just all up in the business of cancer suppression, and I understand and appreciate that, but I want to feel well too. So, of we go........
Wow, you actually spoke to "the man"! There's an accomplishment to put on your resume'!
The goal in cancer suppression is to lower TSH (lower TSH, not raise FT4) as much as possible while still keeping you comfortable. The logic being that higher TSH levels might stimulate any thyroid tissue remaining to regenerate. We don't want that...so far, so good. Now his logic starts to fall apart. Your FT4 can be considerably over the top of the range, and if your FT3 is too low, your TSH will not be suppressed as far as it could be if FT3 and FT4 are more balanced. T4 is the "storage" form of the thyroid hormones. Your cells cannot use it. It basically circulates in your blood until your cells need T3, at which point your liver converts it to T3 (supposedly). If you're not converting well, your FT3 is going to remain low, and your TSH is going to remain higher than it could be if FT3 were higher. So, there is no logic to keeping FT4 high unless that also causes your TSH to be optimally suppressed. And that only happens indirectly if you are conveting well. Higher FT3 levels will do much more to suppress TSH than over-the-top FT4 levels.
At least he's agreed to test FT3 if that's what you want. I just don't understand why you'd test TT3, knowing that some of that is unavailable to your body for use, when FT3 tells you so much more. FT3 is not an expensive test. Why have to worry about what TT3 ISN'T telling you? TT3 is considered obsolete...so not just my opinion here.
Now, to the decrease...Going from alternating 150/137 to 137/day is lowering your weekly total by 45.5 mcg (6.5 per day). Then, he wants you to add in 1/2 of a 5 mcg Cytomel, 2.5 mcg Cytomel, which is roughly equivalent to 10 mcg levo. So, overall, you will still be increasing a tad, and that's before the second half is added. Whew...if it were me, I'd have a tough time with that. Once you add the first half of the Cytomel back in, you'll be taking a higher overall (levo and Cytomel combined) dose than you've already had a difficult time dealing with. The sign of insanity is to keep doing the same thing over and over and expecting a different outcome each time...
There is cell damage from low T3. This is why it takes most of us quite a while to heal (repair the damage) once our labs are stable. I don't know where this is coming from, either, as it seems to me he's basically saying "being hypo doesn't damage your body". Am I wrong? We all know better than that.
I don't think there's much doubt that you need to add some T3 meds, even without seeing FT3. I'm just trying to lay it all out and think out loud so you can see what you think about all this.
Did you even mention RT3? I can't blame you if you didn't...there's already enough going on.
Oh, and just for future reference...most people who take T3 meds split the dose, with half in the morning with levo and the other half sometime in the afternoon (you have to experiment with what time works best for you). This is fairly impractical if you're already splitting a 5 mcg pill, but once you're on the full 5mcg, I'd try that. It levels out the peaks and valleys that fast-acting T3 meds can create.
The goal in cancer suppression is to lower TSH (lower TSH, not raise FT4) as much as possible while still keeping you comfortable. The logic being that higher TSH levels might stimulate any thyroid tissue remaining to regenerate. We don't want that...so far, so good. Now his logic starts to fall apart. Your FT4 can be considerably over the top of the range, and if your FT3 is too low, your TSH will not be suppressed as far as it could be if FT3 and FT4 are more balanced. T4 is the "storage" form of the thyroid hormones. Your cells cannot use it. It basically circulates in your blood until your cells need T3, at which point your liver converts it to T3 (supposedly). If you're not converting well, your FT3 is going to remain low, and your TSH is going to remain higher than it could be if FT3 were higher. So, there is no logic to keeping FT4 high unless that also causes your TSH to be optimally suppressed. And that only happens indirectly if you are conveting well. Higher FT3 levels will do much more to suppress TSH than over-the-top FT4 levels.
At least he's agreed to test FT3 if that's what you want. I just don't understand why you'd test TT3, knowing that some of that is unavailable to your body for use, when FT3 tells you so much more. FT3 is not an expensive test. Why have to worry about what TT3 ISN'T telling you? TT3 is considered obsolete...so not just my opinion here.
Now, to the decrease...Going from alternating 150/137 to 137/day is lowering your weekly total by 45.5 mcg (6.5 per day). Then, he wants you to add in 1/2 of a 5 mcg Cytomel, 2.5 mcg Cytomel, which is roughly equivalent to 10 mcg levo. So, overall, you will still be increasing a tad, and that's before the second half is added. Whew...if it were me, I'd have a tough time with that. Once you add the first half of the Cytomel back in, you'll be taking a higher overall (levo and Cytomel combined) dose than you've already had a difficult time dealing with. The sign of insanity is to keep doing the same thing over and over and expecting a different outcome each time...
There is cell damage from low T3. This is why it takes most of us quite a while to heal (repair the damage) once our labs are stable. I don't know where this is coming from, either, as it seems to me he's basically saying "being hypo doesn't damage your body". Am I wrong? We all know better than that.
I don't think there's much doubt that you need to add some T3 meds, even without seeing FT3. I'm just trying to lay it all out and think out loud so you can see what you think about all this.
Did you even mention RT3? I can't blame you if you didn't...there's already enough going on.
Oh, and just for future reference...most people who take T3 meds split the dose, with half in the morning with levo and the other half sometime in the afternoon (you have to experiment with what time works best for you). This is fairly impractical if you're already splitting a 5 mcg pill, but once you're on the full 5mcg, I'd try that. It levels out the peaks and valleys that fast-acting T3 meds can create.
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