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4274823 tn?1388529098

Synthroid versus Cytomel or both?

I have hypothyroidism and I am currently not on medication. I go to the lab for bloodwork tomorrow morning for the following tests: TSH, Free T4, Free T3, sodium, potassium, chloride, magnesium, and am cortisol. I asked for the cortisol testing because I have been under chronic stress.

The doctor has again recommended Synthroid.(0.025 mg to start). He made no mention of Cytomel. I have read that some people take both. I haven't take any pharmaeuticals since 1993 and the thought of having to take one for the rest of my life is unsettling!

How does the doctor decide whether to prescribe Synthroid, Cytomel, or combination of both?

On December 9, 2013 my Ferretin was 39  ug/L and the reference ranges for reduced iron stores is 31 - 79 ug/L. Normal iron stores is 80 - 300 ug/L. My other results from the same day are as follows:

TSH 10.43 Reference range: 0.35 - 5.00 mIU/L
Free T4 13 Reference range: 12 - 22 pmol/L
Free T3 4.2 Reference range: 2.6 - 5.7 pmol/L
46 Responses
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4274823 tn?1388529098
Thank you.

And lentils are also a good vegetarian source of protein and fiber.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I don't think increasing your iron levels is going to have much effect on your thyroid levels, at this time, because damage has most likely already been done and damaged thyroid tissue can't regenerate, but I wish you all the luck.
Helpful - 0
4274823 tn?1388529098
I just found out that lentils are a good source of iron. According to the nutrition facts on a package of dried red lentils they have 40% of one's daily value for iron in 3/4 cup (100 g). I plan to start eating them more regularly.
Helpful - 0
4274823 tn?1388529098
Thank you for the info. I only have the results I posted previously. Supposedly both were tested once, but I don't have numbers. I hope my doctor will agree to check my B12 and 2 thyroid antibodies levels with the other thyroid tests in late April.I also hope I can get him to do an iron panel (at the very least a ferretin level).
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Do you have results for a TGab test?  If  not, you should ask for it, because some people have one or the other (TPOab or TGab) and some have both.  If you haven't been tested for TGab, you may have been misdiagnosed.

Yes, I see you're getting quite a bit of B12 and if you don't have PA, which apparently, you don't have, your levels should come up over time.  I don't mean to beat a dead horse, but that's still not going to bring your thyroid levels into an acceptable range.

Wishing you the best of luck.
Helpful - 0
4274823 tn?1388529098
Thanks for your post.

Might be worthwhile to retest antibodies

According to the lab requisitions I have my last test for both antibodies was done December 13, 2011.I was told the results were OK, but I don't seem to have a copy of them. I do have a result for Anti-TPO from April 4, 2011 of <10 with reference range <35 (don't know the measurement though).

I'm currently taking 1,000mg of sublingual B12 three times per week and 100mg of B Complex three times per week as well as 25 mcg (1,000 IU) of Vitamin D three times per week.Plus I eat yogurt or Kefir daily and eggs occasionally.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Even on your latest blood work, your TSH was too high.  If you look at the range of 0.3-3.0, it's even more out of range.  Your FT4 was a very dismal 10% of its range and your FT3 was at 48%, which isn't "horrible", but lower than the upper half to upper third of range that most of us need.  The thing to note, there, is that as your FT4 falls, so will your FT3, because you will have no FT4 to convert to FT3.  

Yes, it might be worthwhile to retest antibodies, just in case they hadn't ramped up yet on the first test. How long has it been since you had antibody testing and did you have both antibodies tested?  In addition, it would be worthwhile to have a thyroid ultra sound to determine whether or not you have nodules or a goiter (swollen, inflamed thyroid), both of which are very common with autoimmune thyroid disease.  We have had some members diagnosed with Hashimoto's based only on nodules and goiter, with negative antibody counts.

Another thing to keep in mind is that when the thyroid doesn't produce adequate thyroid hormones, the adrenal glands kick into gear and try to take up the slack.  Over a period of time, this can wear the adrenals down, so they no longer work properly either.  Having a thyroid issue is one thing; adding an adrenal issue can bring about major challenges.

I fully understand your desire to feel better "naturally", by diet/exercise; however, there are just some instances in which no amount of healthy eating is going to make you well and refusing to take medication can actually cause issues with other organs.  It wouldn't be worth that, for me.

That said, your latest B12 (in Dec) was actually quite low, also, even though the range is > 220.  B12 is one of those things, like thyroid hormones, that's not good enough just to be "in range".  Some countries consider anything less than 500 as deficient, so 572 would be barely in range.  I have to keep my levels in the 900-1100 range in order to feel well and that's "with" taking both T4 and T3 thyroid hormones.  I can't imagine what I'd be like if I had to get by without any one of those 3.

Last, but by no means least -- you still have symptoms, so that shows that what you're doing isn't working the way you want it to.

Lest you get upset and think I'm trying to tell you what to do, rest assured, that is not my intent at all.  My purpose here is to offer support and help educate people, so they know what options are available, as well as possible consequences of their action/inaction. The final decision always rests with the individual.
Helpful - 0
4274823 tn?1388529098
Thank you for sharing your experience.So you are currently taking Synthyroid and sublingual B12. Have you ever had an issue with ferretin/iron?
Helpful - 0
4274823 tn?1388529098
01/31/14
TSH is 6.57. Reference range 0.35 - 5.00 mIU/L
T4 Free 13 Reference range 12 – 22 pmol/L
Free T3 4.1 Reference range 2.6 – 5.7 pmol/L

Last time 12/09/13
Vitamin B12 572 Reference range >220 pmol/L

I was tested for antibodies once. Do they consider retesting if it was negative, some time has passed, and one still has symptoms?
Helpful - 0
Avatar universal
Just sharing my experience. Throughout the years I wasn't diagnosed, I supplemented with B12. I have Hashi's, so as the years went on, I slowly got worse. I would compensate by taking more and more sublingual B12. After realizing that I was taking 2500mcg in the morning, and 2500mcg in the evening, I quit cold turkey. I realized that even though it helped, I was getting worse, and needed an actual medical opinion. I didn't take any supplement for 6 weeks, and then had the doctor run all sorts of blood tests.

I was pretty sure B12 had something to do with it, as the week leading up to my appointment I was terrible! The 11 or so hours of sleep I got didn't help me at all. I was so exhausted I couldn't move. I just wanted to sleep. My brain fog was so bad, I couldn't think. I couldn't read or watch TV. I just laid there, dead. In fact, I remember lying face down on the floor some times and literally waiting for death to come for me, but he never did. I could feel the room spin at times, whether walking, standing, sitting, or lying down, which never has happened to me before. Clearly I had a B12 issue.

I somehow managed to drag myself to my doctors appointment. After blood was taken I immediately went home and took my B12. It took about a day or so, but I felt much better. Clearly I needed it. When the results came back, I was surprised to learn that my B12 level was actually elevated! And my TSH, which was normal (1/11 and 12/11), was now elevated (6/13). Not realizing how pointless TSH tests were, I thought that this must've been something new, since I was supposedly fine before.

I know the synthroid must be helping somewhat, because, even though I felt the same as before, since my B12 was elevated, my endo made me stop supplementing for 6 weeks. I didn't feel as bad as before, but my blood pressure was borderline low, and I felt weak. Just 6 weeks off of B12, and my level was back down to a normal range. But since I know that it does help, and there's no toxicity level, you just pee out what you don't use, I just take one 2500mcg sublingual at night.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
TSH can vary by as much as 75% even intraday, so a drop from 7.43 to 4.61 over a 4 month period doesn't tell us much of anything.

As far as your B12, at 359, your level was still too low.  Most ranges are 200-1100... your lab is saying that anything over 220 is sufficient, when, in fact, it's still very low.  If I were to let my B12 level get that low again, I wouldn't be navigating. Was that the last time you had vitamin B12 tested?  

I still think the fact the drop in your TSH level when your B12 level came up was a coincidence, which could be born out, by the fact that, presumably (hopefully), your B12 is higher than that, now, and your TSH in Dec was back up to 10+ and your thyroid levels are way too low.  

If you haven't had antibody tests done, you should do so, to confirm/rule out Hashimoto's because if you have it, no amount of supplementation, or healthy diet, is going to make it get better.  As it progresses, you thyroid will continue to produce less and less thyroid hormones, as the antibodies destroy healthy tissue.

Of course, everyone has a choice, whether or not to take medication, but from experience, it's usually best to get started on it "before" the symptoms get so bad, they can't be controlled.
Helpful - 0
4274823 tn?1388529098
Maybe

Thank you for your post.Here are some old lab results (note the positive change in TSH). Unfortunately at that time the doctor was not testing Free T4 and Free T3. I know now that TSH alone is not a good indicator of thyroid function.

04/16/12
TSH 7.43
reference range 0.35 – 5.00 miU/ L

B12
170
reference range 148 – 220 pmol / L insufficiency


08/13/12
TSH 4.61
0.35 – 5.00 miU/ L

B12
359
reference range > 220 sufficiency
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Yes... maybe you have Hashi's which can be characterized by periods of hyper, hypo, normal in early stages.

Vitamin B-12 really has nothing to with thyroid function.. maybe your thyroid function didn't even improve, but you felt better, because you have more than one issue?
Helpful - 0
4274823 tn?1388529098
So you think it is just a coincidence that when my B12 level increased through a sublingual supplement that my thyroid function improved somewhat?
Helpful - 0
4274823 tn?1388529098
I did forget to include raw hemp seeds in my list of foods that contain iron that I eat regularly. If my approach doesn't bring my level up enough I will consider an iron supplement.
I find some people are too quick to swallow a pill because it's easier than the effort to make healthy lifestyle changes to improve their health and well-being. Of course there are some conditions for which medication is essential even with the willingness to try healthier choices regarding diet, exercise, stress management, and good quality supplements for common issues such as Vitamin B12, Vitamin D, and iron deficiencies.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I acknowledged that the foods you listed "contain iron"; my point was that they may not contain enough to maintain high enough iron levels.  

Of course, everyone is entitled to choose for themselves; I didn't mean to imply otherwise.  Again, I was merely pointing out that while the foods you listed contain iron, it may not be sufficient, without eating very large quantities.

And of course, it's certainly your choice whether or not to go on medication.

Best of luck to you.
Helpful - 0
4274823 tn?1388529098
I stated that the list of foods contain iron. I don't eat red meats and liver because I choose to be a vegetarian. I do eat leafy greens such as spinach and kale. I may have missed listing something. If I eat a variety of foods with iron more often it will surely help increase my level unless I have an absorption issue. Everyone is entitled to choose for themselves. For me medication is a last resort if everything else isn't enough (diet, exercise, stress management, and good quality supplements).

April
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
I wasn't sure how your thyroid function increased by correcting your B-12 deficiency, because there's really no connection that I've found, between the two, other than B-12 deficiency and hypothyroidism share a couple of symptoms, so I didn't comment on your previous post. My B-12 deficiency was corrected also, and that was supposed to "cure what ailed me", but when it didn't, my doctor pegged me as a hypochondriac... it was an entire year (of shear misery) before I got thyroid testing to determine hypothyroidism.

Iron, on the other hand, is necessary for the metabolism of thyroid hormones, so I can appreciate the idea that increasing your iron intake might have an impact on thyroid function.  Unfortunately, I wouldn't expect it to be a lasting solution, since my ferritin is above normal and my iron is normal.  

The foods you listed, previously, as being significant in iron intake are, typically, those considered to be high in protein and B-12, but not necessarily high in iron, though they may have some.  The foods highest in iron are red meats and liver, spinach (kale comes close); those are the ones you don't eat. An extra large egg has only 4% of your daily iron needs.

Of course, I understand that you are in Canada and your nutrient guidelines are not the same as ours, though I wouldn't think it would be that different.  

I can only assume that you determine your diet, based on the amounts of each nutrient you need.  

I'm always perplexed at the willingness to take supplements to increase levels of nutrients, but not a willingness to take thyroid medication to replace thyroid hormones.  Neither are "natural".  
Helpful - 0
4274823 tn?1388529098
I feel increasing iron in my diet is helping my thyroid function. I hope to confirm this through bloodwork this spring. I continue to take Vitamin B12/B complex and Vitamin D supplements.
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4274823 tn?1388529098
Please note I found the following online about iron deficiency posted by a M.D. http://www.thewayup.com/newsletters/081504.htm Thanks.
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4274823 tn?1388529098
I know when I corrected the Vitamin B12 deficiency my thyroid function improved some. So I am hoping this will also be the case with the reduced iron stores. So if increasing my iron intake through food or supplement does not change my level then it might be an absorption issue.

I am eating more beans (black, mixed ...), chickpeas, lentils, nuts (hazelnuts & almonds), eggs, pumpkin seeds/pepitas, tahini (sesame seed), blackstrap molasses (cooking - combo of fancy & blackstrap), potatoes, kale, quinoa, and yogurt that contain iron according to Canadian Nutrient File. I am doing my best to include Vitamin C foods when I eat the iron foods such as peppers, tomatoes, broccoli, and citrus fruits.Also according to the Canadian Nutrient File, Our bodies better absorb non-heme iron (plant sources) when taken along with a source of Vitamin C.
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649848 tn?1534633700
COMMUNITY LEADER
I wonder if you're putting too much stock in the iron levels.  While it's true that iron is necessary for the metabolism of thyroid hormones, the thyroid has to be able to them and it would seem that yours isn't producing adequate amounts.

Additionally, it's important to find out why your iron level is low; it's not always because you don't take in enough iron.  

I've also read that a thyroid condition can, actually, cause low iron levels, so that could be a double edged sword.

What foods are you eating that contain extra iron?
Helpful - 0
4274823 tn?1388529098
Thanks for your posts. I wish to address the iron/ level first and see the impact on my TSH, Free T4, and Free T3. The doctor won't do a ferritin level for three months.when he retests my thyroid. Wonder if I should try an iron supplement because my stores are "reduced" or just continue to increase my iron intake through my vegetarian diet. I can post later the specific foods.
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649848 tn?1534633700
COMMUNITY LEADER
I looked back and I see in your original post that the doctor had offered 25 mcg Synthroid.  Will you be starting that, or have you already?
Helpful - 0
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