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When is cytomel prescribed?
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When is cytomel prescribed?

I read on here how many use cytomel with their Levothyroxin (levothyroxine) or other thyroid medication. Why & When is cytomel prescribed? Is it something that makes your mind feel better? How do you know if it would help me or not?

Just curious..
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314 Comments Post a Comment
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657231_tn?1390151580
I take it as I have pituitary issues and I cannot effectively convert T4 to T3.
It makes me feel much better and oddly, when I had horrid skin issues, it cleared up my skin a bit (even though the doc argued with me that it could not do that!). It also make me feel better mentally and made my temperature more normal.
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280485_tn?1249017444
If your Free T4 level is high and your Free T3 level is low, you may have a conversion issue.  If you are tested and this is the case, your doc "should" perscribe T3 (Cytomel).  I say "should" because in general a T3 test doesn't always get run and lots of docs just aren't as up on it as they should be.  Also, conversion issues are not all that common.

And to answer your question more specifically, yes, if you need T3 and you add it to your Levo, then yes, you will feel better and think more clearly.
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451191_tn?1264436490
Levo is a T4 med and Cyto is a T3 med and is faster acting.  Most people can convert the T4 in Levo into T3, but others cannot (as rumpled mentioned above) and need to have it prescribed seperately.

I was on Cytomel briefly after my TT and before my RAI treatment.  It is faster acting and they can get you off of it quicker than Levo (withdrawl (withdrawal) for scans/treatments require you to be off your meds to elevate your TSH unless you doctor allows you to use Thyrogen which artificially elevates your TSH).  Generally, Endos do not prescribe a T3 med for ThyCa patients as monitoring blood levels is essential to cancer management and the additional T3 can mess with the tests.

Hope that was helpful!
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Avatar_f_tn
Thanks for the replies. I will look at my test results from Aug to see what my T3 was and then post the results here. I just want my brain back, i have no concentration at work no motivation what so ever....

My last TSH (done last week) was 5.19.
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451191_tn?1264436490
Well, you are hypothyroid which is why you have no concentration.  T3 might not necessarily be the answer for you.  What level of Levo are you on?
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Avatar_f_tn
For ten years I was on 200mcg

Then for the last two my dosage has been decreased

175, 150 , 125 , 100 , (dosage upped as of last week to 112).
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280485_tn?1249017444
What was your original dx?  I would ask for copies of your lab results for however far back you can from you docs office.  Have they run any other tests?  To go from 200mcg's for ten years then consistantly down seems to show there might be something else going on here.  I would ask why.  Unless something about you has drastically changed (excercise levels, weight, etc...) you should not be flopping all about in your need for thyroid hormone.  But yes, I would agree with Shannon in that you are currently hypo.
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657231_tn?1390151580
Are they changing your dose based just on TSH? I used to get mine done and the doc was bouncing me all over and I felt like poo.

I take 150 T4 and 15 of T3 now...
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Avatar_f_tn
I had TT due to graves/hyperthyroidism.  

My dosage is changed based on TSH level.

Here are results since April 08.  I had been losing weight without any diet changes since Jan 08.(I do not excersie).

April     08 -       2.19 125mcg
July      "   -       .5      125mcg
Aug.    "   -        .95    125mcg (regular PCP wanted to lower dosage, but endo said no)
Oct       08  -      .44    PCP lowered dosage to 100mcg
Dec      08  -        5.19  PCP increased dosage to 112mcg

Yeah, I feel like ****.....


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Avatar_f_tn
Your dosage should be based promarily on your Free T3 and Free T4 levels first THEN on your TSH....not the TSH levels alone.
Just as they say that it is best to keep the TSH below 2.0, some cant handle this (me included) and I function better when my FT4 is around the 16.5 mark, the FT3 around the 4.5 mark and the TSH around the 2.3- 2.5 mark.

Everyone is different and it is good to write down how you feel and your symptoms after every dose change and labs tests.
This is the way that I have been 'tweaking' my meds to get my levels stable.
Prior to that, I was going Hyper every 3 weeks on Thyroxin.
I havent been Hyper now for some time.

5.19 definately is Hypo and yes you will feel like **** ...watch your symptoms and although I am no expert, they say to balance the T3 out over the day (3 doses if possible).
Keep us informed how you go.
Good Luck.
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Avatar_f_tn
I go see my doctor 2morrow for issues I am sure is thyroid related. I go in the morning so I will let you know how it goes...

Thanks. for your replies...
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Avatar_f_tn
Good Luck Totie...let us know whow you go as everyone learns from our postings.
As I have learnt from your ones about the saliva glands.
Many Thanks
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Avatar_f_tn
Okay, had my appt. last Friday with my regular PCP. Lost 3 lbs., was at 101, now at 98. No I am not trying. She will not do anything as far as Cytomel right now until I get my TSH level retested again in another four weeks.

The reason I went in was due to my 3rd woman cycle in 30 days. She thinks I could be menopausal. I could be (38). She can not test me for it because I still get my cycles. She also thinks that it just maybe the dosage change (thyroid) has caused my cycles to go out of whack. I started my 3rd cycle on Jan.6, and here we are Jan 13 and still on it......:(

She is basically at a wait and see what happens mode. So until then, deal with the pain in the ovaries.....:((

On another note, I will go see a surgeon for the tumor in the abdomen. ..THAT they can not tell me what it is nor are they able to biopsy it....:((

Grin and Bear it....
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Avatar_n_tn
In a clinical sense, a smart doc will try T3 (Cytomel) when you've been on T4 a while and just aren't doing well.  You may have brain fog, or one of a cluster of about 60 other symptoms.

Blood testing may or may not be able to prove that you have a T4-T3 conversion problem.

I've been on T4 for a very long time, and am still not back to full health.  I also have low body temp, which indicates poor T4-T3 conversion.  (Many docs will poo-poo temperature as a diagnostic tool.  I think they're dead wrong.)  If your basal (waking) temp is below 98.2F, or your daytime temp is significantly below 98.6F, you probably aren't converting right.

Dosing with Cytomel is tricky.  I find that a small dose (e.g. 1/2 of a 5mcg tab) every few hours is much preferable to a large daily dose.  Or, you can try the compounded sustained-release T3 that is used to treat Wilson's Temperature Syndrome.
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Avatar_f_tn
First of all, I hope all you're going through has the best outcome.

Hope you were helped by a lot of what was said above.  Obviously everything has been directed at you to help you.  However, there are at least of a few things I'd like to address (that I can see are similar to what I just addressed in another recent thread).  One is that low body temperature is not indicative of poor T4/T3 conversion or of any problem relating to T3.  Another is that, at least from everything I've read from legitimate sources, there is no developed T3 therapy that is sustained-released or timed-release (that's why pill-splitting gets mentioned).  Yet another is that something called "Wilson's Syndrome" is not legitimate.

Again, all the best.
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Avatar_f_tn
My body temp.. I freeze during the day and get night sweats at night. They have yet to figure that out.

I can tell at this moment I am going hyper, just by the heart rate 100 sitting down, and the feel of my body being jittery and clamy.

I don't go back to my doctor for a while. I have yet to sit up an appt. for follow up. I think I am just getting frustrated.

I just now stopped (hoping anyway) my 3rd cycle, it lasted 12 days. Do I think I am menopausal, NO, but I am only the patient what do I know. She honestly does not know what is going on with me.
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649848_tn?1357751184
There is a condition called Wilson's Syndrome, which occurs when there is too much copper accumulated in the liver.  This is a bona fide medical condition and should not be confused with Wilson's Temperature Syndrome, which is not a recognized medical issue.  That's according to ATA.  

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314892_tn?1264627503
The disease caused by copper accumulation is Wilson's Disease (not Syndrome).

Just a clarification on the name. :)
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Avatar_f_tn
Thanks for replies. I will look it up...
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649848_tn?1357751184
Thought I saw it both ways.  
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499534_tn?1328707778
My internal medicine doctor uses a local pharmacy to compound cytomel into a time release version to make it easier for dosaging.
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Avatar_f_tn
Thanks for adding what you did.

I've seen the name stated both ways too, however kitty9309 is correct, it's called Wilson's Disease.

Take care.
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Avatar_m_tn
No argument -- body temperature is not diagnostic of thyroid state, in that it should not be used by itself to prescribe and medicate.  Its value is as an indicator, or symptom,  like many others such as fatigue, coldness, etc., but must be validated with the real diagnostic, which is a full panel of blood tests.  Body temperature  may have even more value than other patient symptoms, in that it is an objective measure, meaning that it can be measured  and assigned a number.  Other symptoms are subjective, since they can only be described in general terms such as heavy or light.  If we accepted that body temperature should be ignored, then similarly all other symptoms should be ignored, since they are not diagnostic either.
Body temperature was a much more valuable tool in past years when thyroid blood testing was less accurate than today and doctors considered any TSH reading under 5.0 as "normal".  
Of course body temperature, as well as the other symptoms, can be affected by factors  other than thyroid and metabolism levels, but this should not preclude any symptom from being considered as part of the overall picture.  Carefully checked, normal body temperatures, have  a high degree of correlation with metabolic rate.  This is a link to a study on that.
http://ajpendo.physiology.org/cgi/content/abstract/263/4/E730
In my own case many years ago, low basal temperature (96.9) and other symptoms led me to question the diagnosis of "normal", when my TSH was slightly below 5.0.  This eventually led to Synthroid (T4) medication, at a full daily replacement level of 200 mcg.  Even then it did not fully alleviate my symptoms and my basal temperature peaked at 97.2 or so.  Only after learning about the importance of free T3 testing, and requesting FT4 and FT3 testing, did I get a clue as to why.  Even though my total T4 level was at the very extreme of its range, my free T3 level was at the bottom of its range, due to conversion problems, which occur infrequently.  Since being switched to a T4/T3 med. 6 weeks ago, my free T3 has already increased to the mid-point of the range, my basal temp. has increased to about 97.6, and I feel the best ever.  My symptomatic low basal temp. did not indicate a free T3 problem, but it did help identify  for me that I still had a potential  problem of less than optimal metabolism,  which needed to be pursued through additional blood testing.  I still have one more slight increase in Armour thyroid to go.  Will be interesting to get to the full effect.
  
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Avatar_f_tn
I will look at what my temp was during the 5 nights I had to keep track of it due to my night sweats.
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Avatar_m_tn
I just found this when looking for a more effective treatment for my bipolar disorder. I was diagnosed with bipolar AFTER I had thyroid cancer, and nobody can tell me there is not a link. While I take Synthroid for thyroid function, I have not since being diagnosed 7 years ago been able to get the bipolar disorder under control, despite a variety of mood stabilizers (I'm still on Lamictal.)

I just found this article http://www.medscape.com/viewarticle/732977 which says Cytomel is effective in helping bipolar patients with thyroid dysfunction.

The only time I have been on Cytomel is when my doctor wanted to get me out of hypothyroid quickly after I had radioactive iodine treatments. I did not know you could take a low dose of Cytomel forever.

You can bet I'm asking my shrink about this next time I see her. If that doesn't work I'll hammer on my endocrinologist's door.

Have you noticed how much work we have to do ourselves. Thyroid doctors don't seem to care about your psychological symptoms, and shrinks don't care about your thyroid. I have not been able to find a doctor who will care about both simultaneously. They go together, I know they do. And I will keep working until I find a doctor who will actually help me feel like the old self who has never come back since 2005. I would like to see her again.
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Avatar_m_tn
Glad you found this Forum.  Welcome.  I share your dismay about doctors in general.    I seems almost impossible to find good thyroid doctors for our members.  I though you might find some useful info in these two links.


http://www.psycheducation.org/thyroid/introduction.htm


http://synthroidhaters.wordpress.com/2009/08/12/depression-explored-with-dr-barry-durrant-peatfield/
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