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Saw New Endo Today! Opinions, Please!
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Saw New Endo Today! Opinions, Please!

Hi all! Went to see new endo today and just a refresher...still not feeling well after TT Dec 09. On Synthroid 125mcg. Showed her my latest bloodwork from beginning of September and she said she thought it was fine. I explained my symptoms...tired, anxious, depression, brain fog..(I think the depression comes from sick of being sick!), dizziness at times.

When I explained and showed her that the T4 is 1.6 Range is 0.8 to 1.7 (high end of range) and T3 Total is low @ 91 Range is 104 to 260....she said that the T3 Total was irrelevant and she is going by the FREE T3 which is 2.89 and Range is 1.76 to 3.78, so she said it was fine. I said if it's fine, why do I feel like crap? She stated that it could be any number of things and everyone who has their thyroid out always thinks when something feels wrong..it has to do with not having a thyroid! I need to mention the T4 number that i posted was FREE T4.

I'm at a crossroads because in her opinion..if I felt better taking 112 mcg then that's what I should take. My TSH is 0.470 Range is 0.400 to 4.000 and she said some people feel better with their TSH a bit higher like 1 or 2.

My question is the old endo said to take 112mcg and 2.5 Cytomel total throughout the day and the new endo says she doesn't see the need for Cytomel at all???? Who do you think is right here?

I told her I take a multi vitamin and 2000 units of VitD and she said that was fine. She doesn't seem to be so into vitamins, as the last endo. She wasn't concerned with B12 as my level is 535...old endo wanted it at 600.

Also, here are the things she is checking on my next set of labs...

AMA Comprehensive Metobolic Panel
Magnesium
ANA (whatever that means)
CBC w/ Differential
VitB12/Folate
FREE T4
FREE T3
TSH
8 AM Serum Cortisol
24 hr Urine
VMA, Metanephrines, Catecholamines & Creatinine

I am not gluten sensitive and they do not do 24 hr saliva test.

What do you make of her/all this? Do I take the 112mcg by itself or with the Cytomel? As I said, she thinks I don't need the Cytomel. Please advise and thank you!    
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17 Comments Post a Comment
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393685_tn?1325870933
I think the new endo is nuts. While this new endo says everything is being based off the Free T3 and not the total T3 - you clearly are low and not in optimal range.

I think you need to increase the Cytomel - not eliminate it and then retest in 6 weeks to see if that level improves.
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393685_tn?1325870933
and her logic of saying poeple just think this way due to not having a thyroid anymore is silly.
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393685_tn?1325870933
Sorry - I am hitting this post for the third time - as I was thinking...

Stick with the old endo and the change in meds as they suggested for sure seems better at this stage of your labs...

You may even want to call them - based off the new labs and suggest even more decrease on Synthroid - (around .100 mcgs) and go to .5mcgs Cytomel - then retest on 6 weeks.

You should try to raise the FT3 to relieve you.
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734073_tn?1278899925
I would not use the new endo. at all! Go back to the first one and stay with the t3 med. My daughter has no thyroid gland and she did not do well on t4 onlt Synthroid. She had a hard time converting it into enough t3 as there is no gland to help with this so allthe burden falls to the liver and the gut, Many with hypothyroidism have slow intestinal issues and gut issues with further hamper the t4 to t3 conversion process. Add to that toxic overworked livers due to things we are exposed to on a daily basis and that further interfers with the t4 to t3 conversion process. I feel that people with no gland just need the addition of t3 in one form or another as t3 is the active thyroid hormone that must be uptaken into the cells for everything to work properly within the body.  Stay far and clear from the new endo. She will not help you.
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649848_tn?1357751184
The only thing I agree with the new endo on, is that she should go by the Free T3 and not the Total.  Not even sure why she tested for total as that's considered obsolete and of very little value.

At 2.89, with a range of 1.76 - 3.78, you are just above mid range, so you have room to go a bit higher, and since you still have symptoms, I don't see how she can think you are "fine".  

You should also keep in this in mind:  while she says some people feel best with TSH at around 1-2, there are those of us have totally suppressed TSH, and feel fine. You shouldn't even really be looking at the TSH.  FT3 and FT4 are much more important.

In addition, I don't agree that your B12 levels are good at 535 - when mine were still in the 500's, I felt like dog doo........

I think you might want to stay on your current dose (112 mcg levo and 2.5 cytomel) for a while longer and see if you improve further; if not, you might want to do as Stella suggested - drop the levo to 100 mcg and do 5 mcg cytomel.   Even though cytomel (T3 med) is "fast acting", meaning that you can tell a difference in the way you feel, it still took quite a few months before my FT3 levels actually came up on the blood work.

I agree with the others - stay with your old endo, at least he was willing to recognize that not everyone can make it on just a T4 med.
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393685_tn?1325870933
I like Barbs first thought of staying at .112 with the 2.5 Cytomel - but then U still lean to right away going to the lower .100 mcgs and bumping up the Cytomel to .5mcgs ( splitting it 2xs through the day) right away. I don't see these labs not being able to adjust the the added T3 immediately.

Its a horse a piece and that it up to you and your doctor but as for eliminating T3 - no way... don't go back to see that endo that suggested that
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1211076_tn?1303523040
Thank you all so much for your advice. You don't know how I appreciate having you guys to talk to and give me some guidance...as you see, one endo says one thing and the other, something totally different.

I just wanted you all to know that I am still taking the 125mcg Synthroid and no Cytomel because I wanted a second opinion and I didn't want to change my current dosage until I saw what this new Dr had to say. So, tomorrow I am going to start the 112mcg with a total of 2.5 Cytomel..even if I break that bit in two. When I first tried the Cytomel on 125 as first Endo suggested, I had chest pain for 4 days and stopped. It took him FOREVER to get back to me about what to do...(one of the reasons I was searching for a new Dr)...their staff is HORRIBLE.

I'm guessing the Synthroid being at 125 was to high with the Cytomel and that's why I had that reaction? Anyway, I will start the 112mcg tomorrow and go from there, along with the 2.5 total Cytomel. How do you think that will pan out? At least it's a start. I'm thinking though, that it's going to end up to be 100mcgs (that's what I felt best at) and the .5 Cytomel. Neither one said about dropping the Synthroid to 100 so I will have to start here.

One last question...the new (fired) endo wanted me to have those labs done soon and then gave me another slip for FT3 FT4 and TSH only for 6 weeks from now. Do you think I should just have them done for the heck of it? I never did a 24hr urine, etc. I never had my records switched over to the new Dr..I just brought her in my last 3 lab reports and that's what she was going by. At least I had enough sense not to burn my bridge with my old endo. He will never know if I get those labs done. Do you think I should?

Thanks for all of your advice. I'm sticking with the old one and if things get really bad..hey, it's not like I'm married to him. Haha. Thanks again!    
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1211076_tn?1303523040
I also wanted to ask about the B12. Is there some way I can raise it without getting the nervous energy that the shots gave me? Like in a supplement form? And should it be a B complex or just B12? And how much daily?

Thank you!
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1211076_tn?1303523040
Sorry to post again..can't tell I have some brain fog, huh? I wanted to ask also, about how to take the Cytomel. I know not to take it later in the day. I take my synthroid around 7 or 8 in the morning everyday, then wait an hour before eating or drinking. I guess I'll try splitting the 2.5 for now since I will be on 112mcg. What times do you think I should take it? Does it matter if it's on an empty stomach or not? Also, I wait 4 hours to take my vitamins...so I usually take them around noon. Thanks!  
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649848_tn?1357751184
With your one dose of cytomel (2.5 mcg), I think I'd probably take it around mid morning, unless you need it to "kick start" your day.   Make sure you stay on the same dosage for several weeks to give your body time to get used to it and stabilize.  Then, if after a few weeks, you find that you drag in the afternoon, you could add that other 1/2 of the tablet, but don't take it after around 3 PM (depending on your personal schedule) or you won't sleep at night; and if you add the other 1/2 of cytomel, make sure you drop the levo dosage.  

According to the instructions that came with my med, Cytomel does not have to be taken on an empty stomach like levo does; however, you should still separate the cytomel from vitamins/minerals (particularly calcium, etc) by 4 hrs.

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393685_tn?1325870933
The choice to split the 2.5 mcg probably will work. You may benefit very well after taking your Synthyroid at 7am to take the first dose of Cytomel around 9am - then about 4 hrs later take the second dose. Try to also reverse your eating habits while you are in this trial.

Eat a bit heavy in the morning and taper it off through the day and stop eating around 4 or latest 5pm.

Reversing your vits and supplements may help to taking them at night before bed vs juggling your dosages of meds and them too. On the B supplement taking that at night may not be good but B's will not interfere with your meds either.

I'd go for the B-complex and a high quality not filled with a ton of cellulose. Cellulose binds alot of things.
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Avatar_f_tn
ANA is anti nuclear antibodies ...usually to test for Lupus and any other autoimmune disease.
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1211076_tn?1303523040
Ok..does this make sense? I took the 112mcg of Synthroid at 8am, Then broke that little 2.5 of Cytomel in half..which it looked like I was just taking a crumb of medicine..and took it at 10am and ever since then it feels like I had 3 pots of coffee! It's awful! How could that be? I know it's very powerful, but even at such a miniscule dose? I had a banana, piece of toast and scrambled egg for breakfast. In fact, i can't wait for it to wear off! I don't like this feeling. I'd rather be tired. Does it just take some time to get used to? The biggest thing I don't like throughout all of this is the anxious feeling that i get and that's just how I feel now. My head feels weird..I can't explain it. I don't want to take the other piece to equal a total of 2.5..even though I know that's what I'm supposed to do. Any advice? i know I need to get the T3 up..but i just have this weird sensation in my body that I can't explain. Help, please!
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649848_tn?1357751184
It's probably going to take a while to get used to the T3 med.  You can try taking just 1/2 of that 2.5 mcg for a few days and let your body adjust to that tiny "crumb", then add in the other 1/2 of the 2.5.

You must either be super sensitive to the med or you are super anxious about it.  Fear of your reaction to the med can trigger even worse anxiety, which might make you feel like you drank 3 pots of coffee.  

Just try to calm down and go about your business as though you feel great... Or, you can send me that other 1/2 of your cytomel and I'll take it for you............LOL
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1211076_tn?1303523040
LOL Barb! I know some people would kill for Cytomel, I'm sure! I think I'll do what you advised until I am i used to it. It's no secret, I do get anxious about meds, health issues, etc...after all I've been through medically. But I wasn't anxious about taking this at all. In fact, I was pretty excited because I thought...ok..lowering the Synthroid and adding Cytomel..maybe I'm going to head in the right direction, finally!

You will be happy to know that because of that miniscule piece...I was able to do lots of laundry, clean my whole house and put my summer clothes away and get the winter ones out and arrange my closet! LOL

I'm telling you..it was like a nervous energy, though...which I hated! I think maybe I'm more stabilized on this 112 Synthroid..maybe my body will adjust better!

Thanks, Barb!  
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393685_tn?1325870933
putting in the T3 medication - especially if you were a-symptomatic with horrible symptoms can definately take some time. 2 weeks for most people until you build a tolerance to it so your body realizes you are doing the right thing and then you move on to the next phase of getting well with adjustments of the meds.

T3 regardless is very supercharged and that is why doctors and members that are familiar with it tell others to go super slow with dosing. Cytomel actually in my opinion is much easier to control than taking an NDT combo med because the dosages can be individualized more on synthetics than with natural thyroid. You and your doctor control the dosages more with T3 only in addition to using T4 seperately - more than NDT combos. There is still huge benefits in NDT with the other porcine hormones and calatonin involved but I believe its little and that's why all forms of thyroid treatement is good to learn.

I seriously feel a drop in the T4 is needed while you are in this new T3 stage of treatment. It wouldn't hurt to call the doctor and lower that intake of T4 to .88 or .100mcg until you have this time to adjust to the T3 easier. Your body is still converting the T4 into T3 so this "crumb" could put you a bit high until you adjust right to it.

Slow.... Steady.... wins the race!
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1211076_tn?1303523040
This may sound funny but when I saw GP today and told him about the differing opinions the 2 endos had  about taking Cytomel..(one says I don't need it, the other says I "might" have a conversion problem)...He looked at my labs showing FREE T3 and said it was within range @ 2.89. Range is 1.76 to 3.78. He said I did not need it, as a good endo will go by the FREE numbers because that's the most accurate, not the Total. That's also what you guys believe on here, correct? When I told him my T3 was low and not in range..he said it is the FREE T3 that's most relevant. Cytomel not needed. What do you think? I took it today and was fine with that half of a 2.5. Do I really need it or don't I? Do you have to take it everyday or can you take it if you feel you need a jolt? I'm very confused because the FREE T3 is within range and that's the number to go by, right? Not TOTAL. Help again, please!

Also, he said my high end FREE T4 will go down once my lowered dose of 112 Synthroid kicks in.

Please advise...thanks!  
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