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Thyroid -Over medicated
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Thyroid -Over medicated

I'm 54 and have been taking thyroid medication for years - always hypo. My doctor put me on 50 mcg of cytomel and 50mcg synthroid. Then, recently I had my blood work done and results were TSH .05 and Free T4 -.44. My doctor took me off the cytomel today. He seemed confused with my blood work considering I've always been hypo. Could this indicate too much meds or pituitary glad problem. I seem to have brain fog, extremely tired,(at times- my speech is slurred. And I have osteoporosis. I've gained weight, and so tired.
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Avatar_f_tn
Do you have the range for your FT4?  Ranges are lab specific so have to come from your own lab report.  Did your doctor test FT3 as well?  What were you taking prior to the 50 mcg Cytomel and 50 mcg Synthroid?  When he d/c'd the Cytomel, did he change your Synthroid as well?

Sorry to ask so many questions, but need to know.
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Avatar_m_tn
Prior to 50mcg Cytomel I was taking 25 Synthroid - then last year in July he increase the dose to 50. No I don't see FT3 results just the TSH and Free 4.

Please don't appologize ... I appreciate your help. Thank you!

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Avatar_f_tn
The range we see on FT4 is usually somewhere around 0.8-1.8.  You didn't say what your range was, so I'll base my comments on 0.8-1.8 for the moment.  FT4 of 0.44 is very low, below range.  Your TSH of 0.05 LOOKS hypER, but it's not.  When you take T3 meds (Cytomel) TSH is often suppresed.  It doesn't indiicate  that you are hyper unless you have hyper symptoms.  However, it sounds like you still have hypO symptoms.

If I'm interpreting correctly, you were on 25 mcg Synthroid until last July when your doctor added 25 more, so you were taking 50 mcg Synthroid.  Then, at some point he added 50 mcg Cytomel (all at once?)

Your doctor should be testing FT3 every time you have labs regardless of which meds you are on since T3 is the most active of the thyroid hormones and correlates best with symptoms.  However, once you are taking T3 meds, I think it's inexcusable not to test FT3.  Before I comment further on the Cytomel, that is 50 mcg, not 5 mcg, you're sure?
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Avatar_m_tn
Let me clairify that statement - I was only on 25 Synthroid- then I was feeling tired etc. (july) and doc increased my synthroid to 50 mcg and gave 50 cytomel. I seem to tolerate cytomel better than synthroid.

I guess I was wondering if I was over medicated and that cause this problem?
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Avatar_m_tn
Yes 50 mcg (liothyronine) cyctomel , I just confirmed what is on the bottle

and I was taking 50mcg  levothyroxin (levothyroxine) -generic
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Avatar_m_tn
I have a copy of my blood work - is that something you would be interested in looking at or do you have any questions (like neutron% 43.3L*,Lymph% 49.H)

Years ago I went to weight loss clinic and they put me on cytomel to help me loose weight.
It went from 25mcg to 100mcg a day. Then years later when I had blood work done-they said go off the cytomel and I did. Then (2 years ago) I was tired couldn't lose any weight and the blood work came back Hypo and doctor put me on (he wanted me to take synthroid -not generic) but pharmacy said generic was fine. Until last month I only took generic.

PLEASE help me - I can't get in to see an endocrinologist until June.
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Avatar_m_tn
Thank you for your response - what would say are HypO symptoms are ? Both HypER and HypO  symptoms sound alike in some aspects. Mine are tired (especially when I get up in the morning and late evening), can't lose weight, brain fog (can't focus and my brain seems slow reacting) can't concentrate (better in the evening) I feel like I'm walking around in a daze most of the time. Depression. Is there a diet you recommend?

Thank you so much!!
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Avatar_m_tn
Can you tell me the best way to take cytomel and synthyroid medications. When I read that some people can take cytomel twice a day and don't have to worry about taking dairy products, vitamins etc.
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649848_tn?1357751184
Your symptoms seem to be hypo, but symptoms can be the same for either hypo & hyper.  With your FT4 as low as it is, I can't imagine your doctor giving you 50 mcg cytomel and not testing FT3 levels -- I agree with goolarra - that's inexcusable.  Without knowing your FT3 level it's very hard to say if you are hypo or hyper.

Yes, a lot of people take cytomel in more than one dose.  I used to be on 10 mcg and I took 5 in the morning and the other 5 around noon -- that kept me from burning out before the day was over.  It turned out that 10 mcg was too much for me, so I'm now down to 5 mcg/day.

Cytomel can be taken with or without food, but like synthroid or levo, should not be taken within 4 hours of taking vitamins/minerals, particularly calcium.  As for dairy -- I go ahead drink my milk or eat my yogurt - yes, dairy has calcium, but I don't think that's enough to worry much about.

Please do what you can to get your doctor to test your FT3 -- that's the most important of the thyroid hormones and without testing for that, you can't know where you are.  It seems to me that you would be better off with a higher dosage of synthroid, and less (or maybe none) cytomel, since cytomel is usually given mostly in cases where one does not properly convert T4 to T3.  

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Avatar_f_tn
50 mcg of Cytomel is a very high dose.  It's roughly equivalent to 200 mcg of levo.  However, I don't think you were overmedicated because of your FT4 level...it's way too low, I believe.  Do you have the range from your lab report?

You TSH is somewhat low, but that's because you're taking so much Cytomel.  Any meds with T3 in them will often push TSH below range.  If you don't have hypER symptoms, it doesn't mean you are hyper.

I'm not very good with bloodwork other than thyroid bloodwork, but you can post the rest if you like in case anything "jumps out" at me as something that commonly interacts with thyroid issues.

I'm amazed that you took 100 mcg Cytomel to lose weight (that's a ton of Cytomel).  Did you ever feel hypER when you were taking that much?

You're right about symptoms, many of them can "cross over" and be symptoms of both hypo and hyper, so it can be tough to figure out.  However, your symptoms sound very hypO to me.  Have you taken blood pressure and heart rate to see if either is elevated or depressed?

Others will disagree with me, but I see no reason to adjust diet as long as you eat a healthy, well diversified and balanced diet, or you have a demonstrated intolerance to a specific food or food group.

I think you should have FT3 tested as soon as possible (preferably while still taking the 50 mcg of Cytomel) to see what that level currently is on the Cytomel.  Before you make the change, you should know where that level is.  Do you split the Cytomel into more than one dose throughout the day?  

Don't forget to post your FT4 range...
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Avatar_m_tn
My labs are:  TSH        0.05
                    Free T4    0.44

I feel better when I take just cytomel. When I take synthroid I feel depressed, tired, brain fog, my body aches, and I feel sleepy most of the day. Another problem with synthroid medication is ... when I wake up in the morning I feel extremely tired.

I do like the idea of spliting up the cytomel I think that might help with being so tired in the evening.  I don't have enough energy to walk.

I don't know if this has anything to do with any of my symptoms - I believe I'm  insulin resistant. I've been on the New Adkins Diet - there is a ketos urine test to see if your body is in fat burning stage and I can't get into ketos. Would that be because of my thyroid levels?  I know I would feel a lot better if I could lose 10-15 lbs.

I've never been what you would call skinny even on the 100mcg of cytomel
I'm 135 - 145 pounds, I try to stay in the 1500 calorie range, which I thought would be low calorie intake but I'm not dropping weight.

I appreciate any advise you can give me.



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Avatar_m_tn
Please see my posted comment.
Thank you!
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Avatar_f_tn
On your lab report, next to the result for your FT4, there should be a "reference range" (normal range) near the result.  It's usually in parentheses and looks something like "(0.8-1.8)".  Can you look that up so we can be sure where your result falls in your range?

I definitely agree with Barb...you should be splitting your Cytomel so that you have less of a "high" just after taking it and less of a "crash" later in the day.  Since you take so much Cytomel, you might even consider splitting it into three doses throughout the day (this might mean you have to get some smaller dose pills).

There are a couple of things that could be going on with your thyroid hormones, but I agree once again that it's almost impossible to say without seeing some further testing.  FT3 is an absolute must, and as I said before, I think it would give a lot more information if you had that tested before discontinuing the Cytomel.  That will show your FT3 levels while taking a relatively high dose of Cytomel and indicate if you can tolerate very high FT3 levels.

It would also be a good idea to have RT3 (reverse T3 tested), which would indicate if you have RT3 dominance...a condition in which cells cannot use FT3 because RT3 is "blocking" FT3 receptors.  However, many doctors are reluctant to test RT3, so getting one to order it might be a challenge.  If your doctor won't order the tests, you can get them over the internet and have the results sent directly to you.

If you can't lose weight, that is another sign that you are hypO.  I was on Atkins several years ago, and I could only get into ketosis the first couple of weeks (when you can eat virtually NOTHING but protein and fats).  Once I reintroduced veggies, ketosis went out the window, and I stopped losing weight.  However, I have a friend who lost about 100 lbs on Atkins.  It's probably another case of "we're all different" and "what works for one person doesn't necessarily work for another".

When you were on 100 mcg Cytomel for weight loss, did it make you feel hyper at all?  Did you lose weight while on it?
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Avatar_m_tn
My labs:
TSH .34 - 4.82uIU/ml     mine was   0.05
Free T4  .59-1.61ng/dl    mine was  0.44

When the doctor increased my dosages  last July from 25mcg synthyroid to 50mcg and added cytomel 25mcg twice a day I did lose 3 or 4 lbs.

Since then I've put on those few pounds plus 4 (total 7-8)

I don't recall my blood test results when I was  taking 100mcg of Cytomel - I would have to say that I was down to 127-130 back then (I was 45). I don't know if this has anything to do with the medications but I stop having a monthly cycle when I was on that high of dose. And because I wanted to lose weight and couldn't without starving myself - I took doctor prescription diet pills.

Can I ask-is there a diet our there for hypO people?

Thanks so much!


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Avatar_m_tn
Something I forgot to mention - since last year my eye sight keeps changing.
I had lasek eye surgery 6 years ago (mono vision) everything was great! I was so happy I did it...worth every dime.
Since last fall my eyes just keeping changing - first it was +.50 then +1.00, then +1.50, now I have +2.00 and I'm ready still having problems.

Most of all, I get so frustrated because my short term memory is shot - I have what they call  CRS.... ha!  
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Avatar_f_tn
Ooops, I think you need to correct your profile...it says you're male!

In terms of losing weight, there is no diet for hypo people.  When we are hypo, it is difficult to impossible to lose weight because our metabolism is slowed down so much.  Once you get your thyroid hormones back in line, it's easier to lose weight.

Just guessing from the little I know about Lasek here, but I believe that vision continues to deteriorate from your forties through your fifties and then often stabilizes in your sixties.  It's not unusual to need a "touch up" Lasek procedure...one of the reasons I'm not considering it yet. My eyes are still getting worse, so I'll think about that when (if?) my vision stabilizes.

I can only encourage you to have the FT3 test.  Did you have any side effects last July when your doctor increased your Synthroid to 50 mcg and added 50 mcg Cytomel all at once?  Why did he add that much Cytomel?  Had he tested your FT3 before he did that?
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Avatar_f_tn
I should have added that your FT4 is much too low...it's below range.  If you d/c the Cytomel, you are going to have to add in more Synthroid since at the moment your FT4 level is not high enough to support conversion.  It would be best to do that by increasing Synthroid while simultaneously decreasing Cytomel so that the FT4 level has time to build before you lose the support of your Cytomel.  

Have you ever had antibody testing to determine the cause of your hypothyroidism?
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Avatar_m_tn
Something I forgot to mention - since last year my eye sight keeps changing.
I had lasek eye surgery 6 years ago (mono vision) everything was great! I was so happy I did it...worth every dime.
Since last fall my eyes just keeping changing - first it was +.50 then +1.00, then +1.50, now I have +2.00 and I'm ready still having problems.

Most of all, I get so frustrated because my short term memory is shot - I have what they call  CRS.... ha!  
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Avatar_m_tn
No, I've never had antibody or T3 tested.

Can too much T3 hormone such as Cytomel cause T4 to be low?

I realize that you're not my doctor but what amount or ratio of synthroid/cytomel would you suggest for me?

If you have too low of Synthroid (T4) hormone does that cause the tireness,brain fog, depression, weight gain? And, by making the change with the medications help me to loss some weight?

I was worried that the labs were showing that I was HypR and that I'm getting too much thyroid medication.

Thank you so much!!!!
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Avatar_f_tn
I think the absolute best thing you can do right now is have your FT3 tested...also TPOab and TGab (the two thyroid antibodies).  I can't even speculate on what your Synthroid/Cytomel ratio should be without seeing that, and, furthermore, your doctor can't either.  If he's had you on 50 mcg of Cytomel and hasn't been testing your FT3, then he's incompetent...period.  That is just plain negligent.

When FT4 is too low, yes, it can cause all the symptoms you mention.  Cytomel doesn't stay in your body for long if not used promptly, so you have to have high enough FT4 levels for conversion to take place.  Otherwise, all the symptoms you mention can happen.  

I think your labs are showing that you are not getting the right BALANCE of thyroid medication, not that you're getting too much.  But, I won't really be able to say that for sure without seeing FT3.  Please, try to get that done.

Were you put on 50 mcg of Cytomel last July because you requested it of your doctor for weight loss?
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Avatar_f_tn
I agree with goolarra in rgeards to the dosage of a T3 med......50mg is a LOT with 50mcg of a T4 med....usually the dosage is 4 to 1.
The tsh has crashed low because of the T4 not being an adequate dose.
I know you dont have your FT3 as the Doc hasnt done it and yes, it is irresponsible of the Doc not to do it.
BUT.....if you continue on 50mg of T3 (cytomel) and 50mcg of T4 (Levo) then you are asking for trouble in regards to heart problems.
I'm surprised you havent had palpitations, SVC's etc.
I think your Doc needs to be ducated more on thryoid medication dosing and the thyroid itself.
You would be better taking a lower dose of Cytome (T3)l and a higher dose of Levo (T4).
That way the levels will balance out and then weight loss will happen usually.
By your FT4 being low, you have no hope of losing any weight at all.
Both FT3/FT4 have to be balanced along with TSH to be able to lose that weight.

A 'fallacy' with most people is that if you are HYPER, you lose weight.
It is just that....a FALLACY.
I was Hyper and gained 17 kgs (approx 34 lbs) because my levels were 'out of whack'.

Sorry but my opinion is to see someone who knows what they are talking about.....not a Doc who knows nothing about T3 dosing.
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Avatar_m_tn
My answer to your weight loss question is yes. I know when I took Cytomel in the past that I would lose weight and have more energy.  

I don't know if this is all in my head but ...yesterday, I took 50mcg of lovothyroxin and cut the cytomel into 3 pieces and took them through out the day. I seem to have more energy last night.

This morning I (on my own) took 1 1/2 true synthroid (75 mcg) and a 3rd of a 25mcg of cytomel.

I found my labs work from last year July
T4 Free     Range (.61-1.12) ng/dl     mine was  0.80
TSH          Range (0.34-5.60) mint Unites/mL  mine was 3.88

Prior to lab work I was on 25mcg of synthroid - he increased it to 50 mcg .

Then in November I was still feeling tired etc. and he put me on 25mcg of cytomel twice a day. My world was much better.  (I just noticed something on the lab report that was overlooked) my doctor wanted me to have  a PTH test? Any comments?

Thank you so much!!!




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Avatar_m_tn

Because I have osteoporosis I had Reclass injection so I wouldn't have to take fosamax, then I have to take 2,000 Calium w/D3 daily and I take a multivitamin, (I was given Adderall (adderrall) XR 15mg to help me focus- I don't take this everyday but it helps me focus and curbs my appetite) and  I take Smarter Focus which is vitamin/mineral  to help with memory and focus  I'm not suppose to take this within 4 hours of my thyroid medications.

Calcium Levels in July 2009 was 9.7 (range 8.5-10.5) prior to Reclass
Calcium Levels April 2010 was 9.4  (range 8.5-10.1)

I was thinking the Adderall (adderrall) was causing the heart palpitations so that is when I started taking the Smarter Focus. (I didn't realize that the thyroid medication could cause palpitations until SmilerDeb mentioned it.  THANK YOU SO MUCH!!!

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Avatar_m_tn
Thank you for telling me that thyroid medications can cause heart palpitations - I had no clue. Can I ask you a question - have you had a DEXA Scan?

My blood pressure this week was 112/64  
Heart rate 68

Lab report:
Cholesterol (range 0-200) mine was 179
Triglycerides (range 30-200) mine 31
HDL (range 35-96) mine was 59
LDL (calculated)  114
HDL Risk Factor 3.0

Thank you so much!!!
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Avatar_f_tn
I agree with Deb that until both your FT3 and FT4 levels are balanced, you are going to find it hard to lose any weight.  You also need to find a doctor who understands thyroid disorders and will do adequate testing.

It is important (very) to lower your Cytomel dose...I didn't realize you were having palpitations.  Splitting the dose will help you to feel better throughout the day, but you also have to reduce the dose.  I'd still like to see what your FT3 levels are at the moment...I think it will be valuable information for you down the line to have that history.

It's also quite possible that once you get your thyroid levels balanced, you won't need some of the other meds you are currently on.  Some of your other symptoms may be more thyroid (or thyroid meds) related than you think.  

Do you have an appointment set up with a new doctor?  
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Avatar_m_tn
Yes, I have an appointment with an endocrinologist June 3.

Smilerdeb mentioned that generally it's a 4:1 ratio, I thought I would take it upon myself to adjust my medications- 75mcg synthyroid and cut back on the cytomel by cutting a 25mcg into thirds, and take it through-out the day. I actually did that today and I feel great! I realize I'm not a doctor but I know how I feel and since I have an appointment on June 3 -what could it hurt till then?

I too believe that my medications might be more of my problems. I hate the depression, brain fog, soreness, no energy etc.

Thank you so much for all your help and I will keep you posted.


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Avatar_f_tn
Yes, 4:1 is a good working ratio usually.  Some people find that an even smaller percentage of T3 also helps to relieve symptoms.  I urge you to be consistent, however.  You've just increased Synthroid to 75 mcg.  You have just a little over four weeks between now and your endo appointment, which is just enough time for your FT3 and FT4 to stabilize on that dose before your appointment in June.  Your new doctor will then be able to order bloodwork that will accurately reflect your current dose of 75 Synthroid and 25 Cytomel.  Don't make too sudden or too drastic changes...or too many.  

Best of luck with your new endo, and keep us posted on how you're doing.
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Avatar_f_tn
Yes I have had 3 DEXA Scans as Arthritis and Osteoarthritis runs in my family (mothers side).
My scans showed that my bone density was fine but that I did have a small fraction of arthritis ...which isnt surprising considering I am 50! lol.
As we get older our bones are not as strong ...hence I take Calcium every day (calcium/D3 combined).

I have worked with Aged Care and Disability and I see the Elderly with bone fractures etc ...this cant be avoided but would rather avoid the soft bone process if possible.

As for weight loss......as I said ealier, I gained 17kilograms from diagnosis with Graves and Hyperthyroidism then had RAI and TT.
It wasnt until my levels started to stabilise that the weight started to drop off.
Prior to that...I was on a teadmill every morning and night and would GAIN!

Please dont use Cytomel as a weight loss med as it can cause massive heart attack if the dose is too large and even damage the heart muscles.
Your Doctor is irresponsible in not telling you the risks of high Cytomel dosing.


I hope that answers your questions.
Good Luck :)

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Avatar_n_tn
FREE T4 IS 0.44 AND TSH IS 1.59,  WHY WOULD MY MD WANT ME TO TAKE SYNTHROID??????  
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Avatar_f_tn
First, let me just say that you'll get a lot more response if you start your own new question rather than adding to an old one like this.  Just go to the top of the age, hit the green button and follow instructions from there.

Although you don't provide your lab's range for FT4, I can see that yours is very low and almost certainly below range.  That's why your doctor wants you to take Synthroid most likely.

When you post your question, please include reference range for FT4 and tell us what hypo symptoms you're having.
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Avatar_f_tn
is 3.88 for thyriod too low im 25 week pregnant
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