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Trouble finding correct dosage (tirosint)
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Trouble finding correct dosage (tirosint)

Hello,

I am a lurker - have been stumbling upon this site for years as I  reasearched my hashi's situation.  Finally breaking down and registering so I can ask for insight :)

I have Hashis and still have my thyroid.   I was origionally put on armour, then armour plus cytomel and did this for 2 years never feeling well.  i suffered adverse affects from armour right from the get go but got to a level that wasnt optimal but at least wasnt horrible...then I crashed and we finally made a switch to synthroid with a little cytomel.  This was about 2 months ago.  Very quickly after starting synthroid, I started breaking out so we switched to tirosint as it is a bit more  "pure".  That at least solved the breaking out but I am still determining the right dose.

I seem to feel better initially after an increase in T4 (sometimes I might be foggy for a day or two until it settles), but then about 2 weeks later I seem to crash.   I'm now on 125 tirosint plus 10 cytomel.  My origional armour dose was 90 mcg armour (1.5 grains) plus the 10 mcg cytomel.

I might be due for an increase or not.  I guess I am afraid that the trend will continue - feel better for a few weeks, then worse again.  Has anyone run into this and have any idea why this might be and what I shoud do?

I am at a loss.  My doc wont test my thyroid levels for another couple of weeks and even suggested reducing my tirosint to 100 (not sure why other than he said he likes FT4 levels less than 1, which is odd, bc i thought FT4 levels were supposed to be closer to 70% of the range).

These are the latest test results (taken when I was on 125 synthroid and 10 mcg cytomel - I was only about 3 weeks in however.  I did not have my RT3 tests at the time but it came in recently at 22 (she didnt give me the range however).  Unfortunately I do not know what the latest is which is a shame since I think it would be more accurate as  Ihave been on tirosint 125 for a while


TSH .019 (.350-3.00)
FT4 1.41 (.89-1.80)
FT3 3.50 (2.3-4.2)
T3 total 99 (60-181)
Tags: tirostint, Thyroid, Hashimotos, dosage, trouble, crash
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649848_tn?1357751184
I'm happy to hear that your doctor isn't a TSH person.  Most of them tend to have a knee jerk reaction, whenever they see a low TSH, even when actual hormone levels are good, or even low in their ranges.

TSH is often suppressed when on a replacement thyroid hormone, particularly one with a T3 component, such as cytomel, but that doesn't have to do with whether or not your thyroid is still producing.  It has to do with whether the pituitary gland thinks there's enough hormones (no matter where they come from) or not; apparently, your pituitary is a happy camper.  When the pituitary senses adequate (or too much) hormones, it will stop asking the thyroid to produce more, which is what TSH does. Sometimes, the pituitary has plenty of hormones, but the rest of the body doesn't, which could leave you with peripheral hypothyroidism - I suspect this to be part of my own problem.

Yes, some people do crash after a couple weeks on a new med. As I noted above, it's not unusual for symptoms to get worse, or for new ones to appear, when you change doses/meds.  Also as both myself and flyingfool noted, your body has to have time to "get well" after the meds reach potential.  Each time you're changing the dosage/med, your body has to start all over again.

I know that crash is no fun, but sometimes you just have to ride it out for a bit to see if things get better. I, too, would be interested in your symptoms, when you experience this crash.

By the way - since it takes 4-6 weeks for med to reach full potential in your blood, taking labs at only 3 weeks into a dosage would not give you a full picture of the situation, because the med would not have had time to reach full potential/stabilize in your blood; given an actual 4-6 week time frame, your levels might, actually, be even higher.  I will be interested in the next ones, as well as symptoms.
44 Comments Post a Comment
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649848_tn?1357751184
Rule of thumb is that FT4 should be about mid range, with FT3 to be mid range to upper 1/3  of its range.  Your levels are actually very good; your FT4 is 56% of the range and FT3 is 63% of its range, though you do still have room to increase the cytomel.

Are you sure your doctor wasn't reacting to your TSH, which is lower than the reference range?  It's not unusual for TSH to be low/suppressed when taking a T3 med.

What symptoms do you have? It takes 4-6 weeks for a T4 med to reach full potential in your blood and it's not unusual to feel worse for a while before feeling better.  Even once the med reaches full potential it takes time for your body to "get well".  
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Avatar_f_tn
Thank you for your response.

No, my doc isnt a TSH person.  He isnt concerned bc he realizes it will be depressed.  Although is there such a thing as having a too surpressed TSH?  sometimes I worry

I was able to get my other dr to write me a script for labwork - so I did that first thing this morning.  I am sure I will not know what the numbers are until next week

I guess I am wondering - is it normal to feel better initially then crash?  Is that a sign I'm not on enough?  I just hate that that seems to keep happening...adjust: feel foggy for a day or two, then feel better, then crash....

When I took the labs above it was about 3 weeks into my dose.   I will be curious to see what this latest test shows
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Avatar_m_tn
i have read that there is a bio feeback loop that takes about 2 weeks.  So what you report seems to be consistent with that theory.  not sure what to do about it.

As stated above you levels by the numbers seem OK. But the true test is how you feel.

You call it a "crash" and feel worse.  What is it that you are feeling exactly?  What symptoms are you having?

After being hypo for an extended period of time, it takes a while for the body to heal once it gets hormones again. So you may be best served by not making any changes for a few more weeks and see what happens.  You may stabilize and even feel better once your body has a chance to settle out.  if you keep "shocking" your body with changes in dosages etc, it has to react to each of those changes.  So I advise slow and steady.

Having TSH be very low is no problem.  It would indicate that your actual thyroid gland probably is producing little or nothing in the way of hormone, and thus you are completely reliant upon your medication. Which for most people with Hashi's is where they end up eventually anyhow.  So I would not worry about a very low TSH.

Just my opinion.
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649848_tn?1357751184
I'm happy to hear that your doctor isn't a TSH person.  Most of them tend to have a knee jerk reaction, whenever they see a low TSH, even when actual hormone levels are good, or even low in their ranges.

TSH is often suppressed when on a replacement thyroid hormone, particularly one with a T3 component, such as cytomel, but that doesn't have to do with whether or not your thyroid is still producing.  It has to do with whether the pituitary gland thinks there's enough hormones (no matter where they come from) or not; apparently, your pituitary is a happy camper.  When the pituitary senses adequate (or too much) hormones, it will stop asking the thyroid to produce more, which is what TSH does. Sometimes, the pituitary has plenty of hormones, but the rest of the body doesn't, which could leave you with peripheral hypothyroidism - I suspect this to be part of my own problem.

Yes, some people do crash after a couple weeks on a new med. As I noted above, it's not unusual for symptoms to get worse, or for new ones to appear, when you change doses/meds.  Also as both myself and flyingfool noted, your body has to have time to "get well" after the meds reach potential.  Each time you're changing the dosage/med, your body has to start all over again.

I know that crash is no fun, but sometimes you just have to ride it out for a bit to see if things get better. I, too, would be interested in your symptoms, when you experience this crash.

By the way - since it takes 4-6 weeks for med to reach full potential in your blood, taking labs at only 3 weeks into a dosage would not give you a full picture of the situation, because the med would not have had time to reach full potential/stabilize in your blood; given an actual 4-6 week time frame, your levels might, actually, be even higher.  I will be interested in the next ones, as well as symptoms.
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Avatar_f_tn
Thank you guys!  My symptons for crashing are mainly extreme fatigue.  Is almost like I did intense physical activity the day before.  It's extremly difficult to wake up am get out of bed for work.  Coffee doesn't real,y get me going. My limbs feel heavy my eyelids are heavy. I move slow I feel as though I could sleep all day and just have low energy. Sitting makes it worse so I try to walks around the neighborhood

This newest blood test should show a snapshot of about 6 weeks or more on the same dose. I agree with you in saying I may want to ride this out to see if it improves instead of adjusting doses all the time.   I am wondering about the biofeedback loop as well   I will post my results as soon as I get them.

It will be interesting to see the results. Perhaps you are right and my levels are even higher - potentially too high (although I certainly do not feel hyper!)
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649848_tn?1357751184
Unfortunately, the fatigue you describe is one of those symptoms that can "cross over" and apply to either hyper or hypo, so it's hard to say just by that, that you are one or the other.

Please do be sure to post your new blood work, so we can see where you are with everything and maybe will be able to advise further.

Have you had vitamin B12 tested?  Deficiency in B12 can also cause the fatigue you're describing; that was much worse for me than thyroid related fatigue.  I might suggest that you get your B12 levels tested.
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Avatar_f_tn
Thank you! I take a B12 supp but I have not had my levels checked in quite a while. I try and stay on top of that and Vit D and get adequate iron in my diet.   Just covering y basis as much as possible ;)

I've thought about the cross over stuff- its what makes tihs so tricky. I could be feeling more fatigued bc I'm on too much for sure.  Or not...ha.  

I am super interestedin my results as well and will def be looking here for feedback suggestions.  Often times I like to get my results prior to going into the Dr so that I understand what the results are and am able to have a good discussion with my Doc about next steps/adjustmens etc.  Thanks in advance for any help!!!  
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649848_tn?1357751184
Taking a B12 supplement doesn't insure that your levels are adequate.  Some of us don't properly absorb B12, so you should have your levels tested to be sure. Same with vitamin D.

Will look forward to seeing your new labs and providing feedback.
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Avatar_f_tn
Hello!

I'm back :)

Here are my latest results as promised, ranges are in parenthesis:

TSH:        .015 (.350-3.0)
Free T4:  1.55 (.90-1.80)
T3 Total:  93 (60-181)
Total T4:  9.3  (4.5 - 10.9)
Freet T3 :  3.20 (2.3 - 4.2)
Reverse T3: 16.4  (9.2-24.1)  <--- want to note that my last results above didnt have the RT3 included as they didn thave the results at the time,  but I got them and it was 22 so it appears to have gone down)

Im unsure what to do - based on the labs I'm inclined to think adding perhaps another 5mcg of cytomel might be in order since my T3 is not in the upper end of the range - perhaps that explains the fatigue?  

My T4 is higher though which I THINK is good?  seem to get varying info on where FT4 should be. My doc is happy if its close to 1, whereas I read it should be about 60-70% of the range...my RT3 went down

However, if my FT4 went up, shouldnt my FT3 go up as well? esp as it looks like my RT3 went down a bit?   I'm very confused.

I'm holding off on making any changes until I speak to the Dr of course.  I also battled a nasty bug/cold since last talking to you so its hard to seperate fatigue from sickness (which honeslty could have contributed to my fatigue earlier  - maybe my system was busy fighting a bug in its early stages) from fatigue from meds.

If they do add cytomel, wouldnt I expect my FT4 to then drop?  

Looking for advise and opinions - thank you!


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Avatar_f_tn
"How do you sleep?" Was a question my doctor asked when I kept going back for what I thought was thyroid issues.  I said fine.

I still was exhausted, some headaches, and some muscle cramps.  She did a pulse ox recorder while I slept and found that my oxygen drops really low at night. Needless to say I was excited that my doctor didn't either 1.  Blame everything on thyroid and 2. Say everything is fine and send me away.

"It's extremely difficult to wake up am get out of bed for work.  Coffee doesn't really get me going" When I read that I thought of my own battle with apnea.  And you don't have to be overweight to suffer from any type of sleep apnea or hypopnea.
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Avatar_f_tn
Thank you - that is interesting and something I will consider.  I usually sleep quite well though and the times I've had trouble waking up where times when my thyroid dosage was off.  

Barbara - do you have any insight as well? Thank you!
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649848_tn?1357751184
Sorry, I was offline all day yesterday, so just now saw your new labs.

Just to clarify your question on where the labs should be -- you're backwards on the FT4....... as I noted farther up in the thread, rule of thumb is to have FT4 at approximately mid range and many find that FT3 has to be mid range to upper third of the range.  That means FT3 should be  higher in its range (around 67%), than FT4 in its range (50%).  

Your FT4 is 72% of the range, which is very high.  Your FT3, on the other hand is only 47% of its range.

If everything is working right, it's true that when FT4 goes up, FT3 should go up; however, if one doesn't convert adequately, that won't happen.

Are you still on the 125 mcg Tirosint and 10 mcg cytomel?

It's customary to decrease T4 med by 20-25 mcg whenever adding/increasing a T3 med.  You could talk to your doctor about dropping the Tirosint back to 100 mcg, which should bring your FT4 down to something reasonable.  

Are you taking the cytomel all in one dose or are you splitting it into multiple doses?  Typically, those of us on a T3 med find it best to split it into at least 2 doses/day.  For instance, I take 5 mcg in the morning, 5 mcg around noon....... that keeps the FT3 more stable throughout the day and I don't usually crash in the afternoon.

Have you had vitamin B12 tested, as suggested above?  That could be a major factor in your fatigue and if not properly addressed, you're not going to feel good no matter how perfect your thyroid levels get.  Same goes for vitamin D.
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Avatar_f_tn
Barb you are an angel - thanks for such a thoughtful message.

Yes - still on 125 tirsont (actually 126, bc I split the dose:   50mcg + 13 mcg pills twice a day), plus 10 mcg cytomel (split 5 + 5).  My Dr is very particular that I also split my T4 med bc he says it reduces RT3.  I origionally didnt do that and my RT3 was 22, I then started splitting it and a few weeks later took this recent test and the RT3 has dropped some so maybe he is on to something...)

I need to remember those percentages its extremly helpful that you spelled it out like that - thank you!

based on my first set of labs which I posted at the start of this thread, my dr wanted to decrease tirosint to 100 and basically said to increase my cytomel. I wasnt sure if that was the right move.  however, hearing someone else suggest it on top of even more recent results makes me more open to doing that.   I go to the Dr on Sat so will discuss.

So basically I'm going to go back and ask to be reduced to 100 tirosint plus 15 cytomel (which is a 5 increase from before). Is that too drastic though?  Bc doesnt your FT4 automatically dropp when you add in more FT3. Is it too agressive to drop that much?  He's gonna laugh though bc that was his origional thought before the labs.

I will ask to get my B12 test next blood test.  
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Avatar_f_tn
Also- this isnt such a huge concern as its just plain annoying - could even being higher cause resistent weightloss?   I'm thinking its about hormone balance more than anything, but every since I started gaining weight and then getting diagnosed with hashi's, i've never really been able to lose weight despite eating real whole unprocessed foods, exercising (riding bikes, walking, yoga) etc.  I havent had the energy to do High INtensity stuff, but I'm just curious if your experience here observing others is that sometimes being too high (like I am currently) would explain resistent weightloss.  

I'm just wiating to get to the right dosage so that my body does what its supposed to.  I dont have a ton to lose - just a size or two, but its frustrating (not to mention expensive due to not fitting into my wardrobe)

I've observed some people who seem to magically lose 10 pounds upon starting their thyroid med but is it possible for it to take months instead for the body to finally click and then do what its designed to do?

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649848_tn?1357751184
Really, splitting T4 doses is moot, because T4 takes so long to get into your system and stays for so long.... for instance, the FT4 in your system now, is what you took 2-3 weeks ago, not just today, or yesterday.  Of course, it doesn't hurt to split it; though it must be inconvenient, since T4 med is to be taken on an empty stomach.

No, FT4 does not automatically drop if you add more T3..... FT4 will continue to rise as long as you keep your dosage high.

Here's how it works....... Your body does not use FT4, directly; it must be converted to, either FT3 or RT3...... if you're adding/increasing a separate source of T3, you don't need so much T4 med, as it will only convert to RT3......

I'm not sure what you're talking about the "resistent weightloss (sic)".  

"I've observed some people who seem to magically lose 10 pounds upon starting their thyroid med but is it possible for it to take months instead for the body to finally click and then do what its designed to do?"

For some people, simply getting hormone levels where they need them, allows them to lose the weight they gained.  Some of us aren't so fortunate and we have to work harder at losing it.  I've been on thyroid med since early 2008 and haven't been able to lose my "hypo weight".  So you see, it can take weeks, months, even years.......  My sister also has hypothyroidism...... they overdosed her right off the bat and she lost every lb she gained + more......  I'm still struggling to get my levels high enough to not have to work my butt off to lose an ounce.
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Avatar_f_tn
Well my appt was interesting

I called my main thyroid doc sat morning to let him know I was making the adjustments I mentioned (which he recommended) as I need my perscriptions updated.  Anyways...

I still wanted my other docs feedback on sat. So when I saw her I told her what my other dr rec and she said based on my labs I am hyper! ?  I'm confused,  If only your TSH is high does that make you hyper?  My t3 and t4 are all within range.

It's odd bc out of them both I'd say she is more holistic ( she isn't a fan of synthetic drugs and actually would prefer me on a thyroid supp instead of prescription) so I was surprised by her paying close attn to the TSH    She basically made it sound like I was over medicated.  

As a background my tsh has always run low esp before hashis. . I went years with no bad side affects...Its always been slightly below 1.   I started showing hashi symptons and my TSH kept doubling eventually getting to almost 3. That's a 200% increase and I could barely function. Was literally about to take a leave of absence from work

When they found hashis my thyroid doc said my TSH was technically normal except my frees were too low and my rt3 too high hence the symptons. So he's always disregarded the TSH.  Once I began treatment even when my frees were barely going in the right direction my TSH plummeted drastically.  Not sure why but there seems to be something off in the feedback back loop. My sat doc even suggested I run some sort of pituitary blood test to see if there is something there (all I've run on that front is prolactin which came out great). Not sure what that will do/find

I was on a super low dose of synthroid (50) when I transitioned off the grain and a half armour and it was a brutal week.  As much as I'd love to reduce my meds it doesn't seem to work for me


I get so frustrated and confused with all these bc I hear so many conflicting points of view. Sometimes I think it would be easier to remove my thyroid so things stay consistent.  Has anyone done this and had a favorable experience?
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649848_tn?1357751184
"If only your TSH is high does that make you hyper?"  TSH is counter intuitive.  When TSH is high, one is typically, hypo; when it's low, one is, typically, hyper........... Except when on a thyroid mediation.

Your Saturday doctor was most certainly reacting to your TSH, which at 0.015 is quite low; however, you are also on thyroid medication and it's not unusual for TSH to low/suppressed.

I doubt seriously that there's anything wrong with your feedback system.  My TSH has been at < 0.01 for the past 5 years.  My endo doesn't like it, but neither does he believe there's anything wrong.  My theory is that my pituitary has great plenty hormones, so doesn't produce TSH to stimulate my thyroid, but the rest of my body doesn't have enough.

Sounds like you should let the Saturday doctor go by the wayside.  You have Hashimoto's; a "supplement" is not going to be sufficient to provide the needed hormones.
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Avatar_f_tn
Thank you for confirming Barb.  I agree   I am actually not used to having a Dr focus so much on the TSH so it threw me off...my other Dr doesnt even bring it up for discussion.

100 synthroid, and 15 mg Cytomel and I am still fatigued.  I made the change saturday.. I hate waking up feeling so completley tired and exhausted.  How long should I wait before asking my Dr if increasing somthing (cytomel?) is in order.
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649848_tn?1357751184
It takes 4-6 weeks for a med/dosage change to take full effect, and fatigue can be associated with both hyper and hypo.

While many people get an "instant" energy burst with T3 med, that never happened for me; I was on T3 for quite some time before I could feel that it really made a difference.

I don't really think you should be thinking about increasing dosage yet, at this point, as you've only been on the new dose for 4 days -- not nearly long enough.

Are you due to retest again in a few weeks?  

I really think you need to test your B12 and possibly vitamin D.
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Avatar_f_tn
Hey - yes,  I am hoping my Dr will test within a few weeks.

I am confident in my Vit D levels as I get plenty of sun, supp, and it was heading in the right direction last time we checked.  However, I will ask that we see what my B12 looks like

How much T3 are you on if you dont mind me asking?
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649848_tn?1357751184
I was on 5 mcg of T3 for several years, then I finally got raised to 7.5; over the past couple of months, I somehow ended up with extra pills, so I raised it to 10 mcg....... one 5 mcg pill in am, another around noon.  I see my endo in Aug and I'm hoping that when he sees that I feel better on 10 mcg/day, he'll write me a script for that.
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Avatar_f_tn
How soon should I retest and potentially adjust my levels?  A month?  Feeling tired so just want to look forward to a change ;)

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Avatar_f_tn
Hello!

I got my labs back (no Vit D or B12 though - he wouldnt run them and so I will have to do it myself).

I have been on the 100 tirosint plus 15 cytomel for 3 weeks and just ran the tests.  Looks like everything came DOWN some which explains why its been harder and harder for me to get out of bed in the morning.  My fatigue is crushing.  Now its even hitting me prior to bed.

I went from (T4) 1.4 , to 1.3
and went from (t3) 3.5 to 3.4

Not a huge change but obviously not in the right direction...

Is it appropriate for me to ask for an additional 5 of cytomel to see if it helps? should i reduce T4 med to 75 when I increase?  I'm asking my Dr but am curious what you think.

Thank you!
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649848_tn?1357751184
Are the reference ranges the same as the ones you posted on 7/11/13?

I'm confused, because on 7/11/13 you posted the following:
"Here are my latest results as promised, ranges are in parenthesis:

TSH:        .015 (.350-3.0)
Free T4:  1.55 (.90-1.80)
T3 Total:  93 (60-181)
Total T4:  9.3  (4.5 - 10.9)
Freet T3 :  3.20 (2.3 - 4.2) "

At that time, your FT4 was higher than it needed to be and FT3 was only 47% of the range.  If you are currently at 3.4 for FT3, you've come up from 47% to 57%, which is definitely moving in the right direction.

I think it's still too soon to ask for an increase.
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Avatar_f_tn
You are correct!  I was looking at my file of tests and it was out of order.   and yes the same lab ran them and they are the same ranges

So its only that my T4 went down a bit - could that explain the increase in fatigue?

My FT3 is only up a small amount.  If it stay the same what do you think the next bump up or down will be?  I only seem to be getting more tired as the days go on.  leave the T4 alone and add T3?  
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649848_tn?1357751184
Okay, I wanted to be sure I wasn't hallucinating or something...... lol

FT4 dropping that little bit, wouldn't increase your tiredness, because, if you remember, the body doesn't use FT4, directly, it has to be converted to FT3.  FT4 does not correlate with symptoms.

As I said before, I think it's too soon for any kind of increase; you have to give the medication time to work.  You were hypo, and it takes time to get well again. Making changes too quickly doesn't give your body time to get used the medication.

While your levels aren't totally awesome, neither are they "horrible", I think you should look at something, other than thyroid as the cause of your tiredness, particularly, if it's getting worse, instead of better. Can you describe the tiredness?  Are you eyes heavy,like you need to sleep all the time?  Or is it a "body tired", in which you simply don't have any energy?  Or both?

Why did your doctor refuse to test Vitamin B-12?
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Avatar_f_tn
Thank you.  Its usually just a generally tiredness - like lack of energy, although recently its turned in to heavy tiredness as well.  

I was frustrated about the b12 thing. Apparently he doesnt think the tests are accurate.  It was the nurse who told me  - she didnt clarify if it was just blood tests he didnt trust or what.Strange.

I am curious what my Dr suggests.   He wont really look at the whole tests I guess until the RT3 comes in (it usually has to go to a secondary lab so takes a while).  

Its crazy how different meds work.   When I was on my dose of 2 years (on which I never felt well and it really turned bad forcing me to switch). I was on 1.5 grains of armour plus 10 cytomel (originally I was a terrible FT4 converter so it got high along with RT3 but my FT3 never budged...then all of a sudden it changed)....

which if my calculations are correct meant I was on a combo of 57ish T4, and 23.5 T3....at that dosage - my FT4 had tanked and my FT3 was above range or near it (fluctuated)!

So its amazing to me that Im on 100 tirosint and 15 T3 and they aren't super high yet.  Crazy.


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Avatar_f_tn
One other med specific question since you are on a similar combo.

I currently take my tirosint and cytomel in split doses. I take the first half an hour before i get up and the next half about 6 hours later..would it be better for the morning dose, to only take the tirosint an hour early and wait to take my first dose of cytomel once I'm up?     Is that what you do?
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649848_tn?1357751184
I don't take any medicine before I get up.... Taking my Tirosint is the first thing I do every morning.  Typically, I wait a little while before taking my T3 (30 minutes to an hour), because I also take bp med and Lasix for fluid retention; however, sometimes I just take it all together.  I take my second dose of T3 any time between 11:00 & 1:00, but try to keep it around noon.

As I said before, there's no reason to split the Tirosint, because it's a very slow acting medication, which does not have an immediate effect.  

There are 2 ways to figure the equivalency of Armour to synthetics...... the way you did and the conversion chart.  According to the Armour conversion chart, 1.5 grains is equivalent to 150 mcgs of T4 or 37.5 mcg cytomel.

If your FT3 went over range on 1.5 grains of Armour and 10 mcg cytomel, why didn't you just cut the cytomel?
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Avatar_f_tn
Bc my FT4 was also low at that point and there was no way to increase without also increasing the T3. Plus it just never worked and anytime we played with adjusting my armour dose, I had horrible physical side affects (bloating, pain - couldnt walk at times ...it was awful..its one of the reasons I stayed on the same dose for almost 2 years...I basically got to the point where I wasnt in pain but didnt feel good but just ran with it bc I was afraid of messing with it)

Basically it just seemed easier to try something else and adjust them seperately
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Avatar_f_tn
Also. What have you heard about taking t4 med at night?  I'm wondering if its my med making me super duper tired in the morning.  The one time I took a fasted blood draw this week was the first time in a while that I was able to function well early in the morn. Perhaps I do better taking tirosint at night and the cytomel during the day?   Seems worth a shot
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Many of us find it easier to adjust FT4 and T3 meds separately, vs a combo.

As I've noted before, T4 meds, such as Tirosint, are not fast acting, so what you take today, isn't going to make you tired tomorrow morning. Aside from that, because Tirosint only contains, levo, water, glycerin and gelatin, there's nothing to react to.

That said, there are some who take T4 med at night and have good luck with it.  You have to be sure to eat dinner early enough to have an empty stomach when you take the pill.  Typically, it will take 3-6 hrs to empty your stomach, depending on what you eat for dinner. That's why it's usually easier to take the pill in the morning, because your stomach empties overnight.
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So I upped the cytomel to 20 per my Dr a few days ago. it helped a bit but not a lot -  I'm still tired.   Wondering what the next adjustment will be. I assume this increase will naturally decrease my FT4 numbers which were 1.3 last time.  Wondering if next adjustment will be to increase the tirosint to 113? or maybe even 125?

Taking the tirosint at night has helped some. i'm not AS tired when I get out of bed and dont feel as zombie like but I'm still tired.   I hate this. I hate to whine but I  just want to feel normal and energetic again.   i wish I just bounced out of bed in the morning like I used to.

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and this is a random question but does changing your thyroid meds ever affect your sinuses?  I've had terrible allergies/sinuses (never used to be a problem) ever since we started adjusting my meds (used tobe on the same dose of armour for years).   Is this common?
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Increasing your T3 med, should only lower your FT4 slightly and temporarily, as long as you keep taking the same amount of Tirosint.

I think you need to give your meds more time to work, instead of constantly adjusting doses, times, etc. Even though cytomel is fast acting, it still can take time for it to build in your system. I was on it for nearly a year, before I could tell it was really doing something for me.

Have you had vitamin B12 tested?  Lower levels of B12 can cause excruciating fatigue.
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I am currently on 125 mcg of tirosint and 5 mcg of cytomel.  In April I switched just t4 (synthroid) after about 2 months I got horrible joint aches, hair loss and anxiety. So bad that I had to stop running!  I don't have my exact labs and will try to post them tomorrow. My tsh is low and i am prett sure my ft4 and ft3 are subotimal in range though. I am probably hyper.  I think this may be a dosage problem.  I was started on the same dose. I don't know if I should stick with Tirosint maybe lower dose and increase cytomel or go back to synthroid and the old doses.  I was ok on synthroid not optimal though.  But no horrible symptoms just tired.  Is it bad switching bad?  I have 3 kids starting school and am worried something strange will happen!
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Just because TSH is low, doesn't mean you are hyper; your symptoms indicate hypo. You're only hyper if you have hyper symptoms and your FT levels are too high for you.

I'd have to see your exact labs, with reference ranges before I could make any suggestions.  Please post your labs so we can better assess your situation.

You can always switch back, if you want.  What do you mean that you're worried "something strange will happen"?
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Hi. I got my results
  free t3 2.8  1.7-3.7
Free t4 1.2.   .7-1.5
Tsh .33.   .35-4.94
My doctor thought I was over medicated.  She told me to drop the cytomel. I will try this because I don't think it will make a difference. Just to scratch that off the list.   I think I should decrease the tirosint and increase cytomel.  I am worried I will have more side affects if I go back.  Have you switched back and forth and had an adjustment period with bad side effects?  My symptoms seem more hyper. Everyone is different and wether you are hypo or hyper symptoms can cross over. Clearly I m out of balance.  I don't have the brain fog like I do when I am hypo. I am constantly hungry. Stomach growling hungry. When I am hypo I am not hungry. My metabolism is slow.  I m scared of switching back.
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FT3 should be higher in its range than FT4 in its.  Your levels are opposite.  Your FT4 is at 62.5% of the range, while your FT3 is only 55%.  Rule of thumb is for FT4 to be about mid range and FT3 to be mid range to upper third of the range.  

Absolutely, we're all different and yes, some symptoms can cross over and apply to either hyper or hypo.  Joint aches, hair loss and anxiety, typically, are all hypo symptoms, though anxiety often applies to hyper, as well. Slow metabolism is a hypo symptom.

I agree that you need to decrease the Tirosint and increase the cytomel.

I've been on Tirosint since shortly after it came on the market in 2009 and once I switched to it, I never considered going back to synthroid or generic levo.  I did have to adjust my dosage, once. I started Tirosint at 100 mcg and my FT4 shot up to the top of the range, but FT3 stayed on the floor.  We dropped the Tirosint back to 88 mcg and left my T3 med the same (5 mcg) for a while, to see if things would even out.  FT3 still stayed too low, so eventually, we increased T3 med to 7.5 mcg and earlier this month we increased it again to 10 mcg, keeping the Tirosint the same. My TSH lives at < 0.01 to 0.01, and I'm not the least bit hyper.

Do you split your T3 dosage into more than one dose during the day?  Most of us find that splitting T3 med into more than one dose keeps levels more stable throughout the day.  I take my first dose in the morning; second one around noon.  

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Hey Barb, I'm back :)

I was bumped up to the following meds since my last test

100 tirosint
12.5 and 10 (morning and afternoon dose) of cytomel....

Had another test done this past week and the results are

FT4 - 1.1  (DOWN from 1.30) which is 24% of the range
FT3 - 3.9 (UP from 3.4) which is 84% of the range

Based on my continuing fatigue, my Dr said to go ahead and add another 2.5 to my afternoon dose of cytomel.

I'm unsure why seeing as how my FT4 continues to drop and my FT3 is in a healthy range.  Is there another combo that makes more sense that I can counter?  He is of the mind that FT4 doenst matter and he says he isnt concerned with it as long as it doesnt drop below .6 (!!!!!)

Would it be reasonable to suggest something like increasing my tirosint to 113 or 125 and dropping my cytomel to 20 total (split 10 and 10 )?

I'm just trying to figure out the best thing to do.  Its still hard fro me to get out of bed and it the afternoon fatigue after about 5pm is intense.

To make matters worse, he has lost a Dr on his team so now I am on a wait list until NOVEMBER to get in to see him personally (right now I have to call and talk to him through his RN which is less than ideal). previously, the worst wait time was like 3 weeks (usually around the holidays when people are trying to use up their insurance funds).

I had a cortisol saliva test done and am in a healthy range so I know its not adrenal fatigue (if anything, Its telling me I might need to drop my final 5mg in the morning as its super high when I take it).

Still havent been able to get a b12 test...but thats never been an issue for me in the past when I was getting tested and now I'm a meat eater so it seems even less likely....





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Bump!   Does anyone have advice?  Thank you?
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Sorry to be a pest...does anyone have advice? I am due to see my Dr in person today (cancellation so I jumped at the appt...really cant wait until November!)...would love feedback help with the above.

Thank you!
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Well saw the Dr.

He upped (after much convincing on my part as he thinks 1.1 is perfect for FT4)...my tirosint to 112 but kept me the on the same cytomel (25).

for the last test which I posted earlier,  I was on 22.5 cytomel and it was nearing my FT3 on top the range, and then he upped it to 25  ...bc my FT4 drops with the addition of FT3 (it just always does, dont know why), i suspect that him upping my cytomel to 25 last time means that my tests now would  most likely show my FT4 as under 1 and my FT3 maybe even slightly out of range.

So I'm happy to have more tirosint bc its clearly needed (hope its enough?) but was a bit shocked he didnt tell me to reduce my cytomel down to 20 instead of keeping it at 25.  I'm concerned that additional tirosint will convert to FT3 and push me hyper..is that sound reasoning?  

Or should I chill, and keep everything as is? :)
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I'm sorry, I've been away for a few days, so haven't had much computer time.  

I'm not surprised that your FT4 keeps going down, when your doctor keeps raising your T3 med.  I don't really see the Tirosint pushing you to hyper, but I do see the T3 med, doing so.

Are your T3 pills 5 mcg each?  If so, you can always drop back by 5 mcg if you need to.  I think, that with your FT3 at 84%, it's silly for your doctor to keep throwing T3 med at you.  Have other causes for fatigue been checked out?  Or for that matter, has anyone considered that fatigue is a symptom of over medication, as well as under medication?

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