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Starting Cytomel

Just had blood work done:
TSH 3.78   Range 1.8 -3
TT4  6.5    Range 6-12
TT3  93     Range 110-180
FT4  1.9    Range  1.0 - 1.5
FT3  2.6    Range  3.0 - 4.0
At the time of labs I was on 75 mcg Tirosint.  My Endo feels its not thyroid issues I'm having (depression, anxiety, lack of energy/motivation, body aches and joint pain head pressure and inability to concentrate).  She feels I need depression meds.  I stopped the 75mcg Tirosint for 10 days because I was having horrible insomnia and anxiety.  I just started taking 50 mcg Tirosint and 5mcg Cytomel two days ago.  I am so depressed right now.  Does anyone have any recommendations or thoughts as to whether and when the cytomel with the Tirosint will help with the issues I'm having?  Any thoughts are greatly appreciated.  
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Avatar universal
I just sent a PM with info.  To access, just click on your name and from your personal page, click on messages.
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I live in Boynton beach fla 33437
Please recommend a great doctor❤️
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No, T3 would not cause the lower T4 number.  Yes, you do need to raise the T4 med.  You can do it in small increments to make sure it goes well.
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Does T3 lower T4 number along with TSH number?  So are you saying I may need to add more T4 back in?  The 75mcg Tirosint by itself made me feel awful.  

I still have that doctor's name.  Insurance is changing here so afraid to switch right now but may have to.  Thank you for your input.  
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Just reviewing your test results, and in consideration of your symptoms, your Free T3 is too low.  Needs to be brought up to the middle of the range and then increased until you get relief from symptoms.  Along with this, your Free T4 is way too low.  It needs to be at the middle of its range, at minimum.  Your ferritin is at a minimum level, so you could add 25 mg of a good iron supplement for that.  Don't know what your Vitamin D is, but it should be about 55-60.  If not tested for B12, that would be a good idea also.  

I don't know what dose of T3 will be required for you, since I don't know how much it will take to raise your Free T3 into the upper part of its range.  
Since your just added 5 mcg, you will get the full effect on serum levels in about a week.  The effect on symptoms tends to lag behind changes in serum level of thyroid hormone.  So you should give it several weeks, to see how you are feeling with that change, before considering any further increase.  I always say that hypo patients should not medicate themselves, but I don't know how you are going to get this done with your current doctor.     I previously gave you the name of a doctor for you to consider.  Did you check that out?
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Avatar universal
Just had blood drawn again.  Different lab than previously discussed:
FT3  2.9   Range 2.5 - 3.9
FT4  0.7   Range 0.6 - 1.5
TSH  2.24  Range 0.4 - 5.0
I've been on 50mcg Tirosint and 10mcg Cytomel since November 17th. Endo feels I am fully regulated and wrote a prescription for Prozac 20mg.  
I don't feel I'm fully regulated and Wednesday this week raised cytomel to 15mcg.  Taking the Tirosint and 10mcg at 640am and another 5mcg Cytomel at 11am.  What are your thoughts.. I feel you know more than my endo.  I am taking D3 and Fish Oil.  Ferritin was 52 Range 15-150.  B12 was not tested.  Am taking a multi vitamin.  Any thoughts again are greatly appreciated.  What is the average dose of T3 (Cytomel) for symptom relief.  I know if varies by patients but there must be some average.  THANK YOU.  
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Avatar universal
Although a week is a fairly short time for the full effect on symptoms, I was sure from the start that 5 mcg would not be enough, since your Free T3 was so low in the range.  It is hard to say what dosage will be adequate to relieve hypo symptoms.  It varies form one person to another.  You just need to coordinate with your doctor and raise the daily dosage every couple of weeks until you get your Free T3 up to at least the middle of its range and then very slowly make small changes as necessary to fully relieve symptoms.  

Along with that you need to get your Vitamin D, B12 and ferritin tested and supplement as necessary to get D up to middle of its range, B12 in the high end of its range and ferritin around 70.
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Avatar universal
Still feeling fatigued/depressed and anxious.  Its been a week at 50mcg Tirosint and 5mcg Cytomel.  I was hoping I would have some symptom relief by now.  When you stated you didn't think 5mcg Cytomel would be enough to raise my T3.  What amount do you think will be enough?  Do you feel the Tirosint can stay at 50mcg or will it too need to be adjusted up?  I know to raise slowly as I am very sensitive to dose changes.  
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Just sent you a PM with doctor candidate for you to consider.  To access, just click on your name and go to your personal page.  Then click on messages.  
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I am in Omaha, NE.  Thank you for any and all recommendations,
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With T4 meds it takes about 4 weeks for serum levels to reflect most of a dosage change.  I think I would wait about 3 weeks before adding some more T3.  Then another 2 weeks to see how you are feeling and then also to re-test your free T3 and Free T4.  And don't forget to get tested for Vitamin D, B12 and ferritin.  Each is very important for a hypo patient.  Needless to say this is just my opinion.  You should be in the care of a good thyroid doctor.  If you will tell us your location perhaps we can recommend a doctor based on patients' experience.  
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Thank you for your response.  How long should I hold at 50mcg Tirosint and 5mcg Cytomel? I know I don't want to rush to make changes as I am very sensitive to thyroid medication.  But I've also read not to stay at a level too long.  Also, would I be adjusting Cytomel only as my FT3 is below normal?Thank you again.
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Avatar universal
How could your Endo look at your lab test results and consider your symptoms and tell you it is not thyroid related??????   I think he needs to go back and take remedial Endocrinology 101.  

Everything points to your being hypothyroid.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, like yours. And your Free T3 is below range.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

It takes about 4 days for the full effect of a change in T3 meds to show up in serum Free T3 levels.  Symptom relief may lag somewhat behind serum changes.  In addition, I fully expect that the 5 mcg will not be enough to raise your Free T3 high enough in the range.  Free T3 has to be raised enough to relieve symptoms.  Changes should be made slowly and allow time for full effect on symptoms.

Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, you need to test for those as well.  Low in the range levels of each can cause symptoms as well as affect how thyroid hormone is metabolized.  
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