adding in cytomel , questions!

[itzjustme]

Hello,
I've recently added in cytomel (liothyronine) in with my synthroid in hopes of alleviating some hypo symptoms!

background:
hypothyroid since i was 25 (am now 30). generally i feel best when my tsh is around 1.5.  when it increases i get increased fatigue and tingling in my face and i usually just know.
for the past year i've had widespread muscle pain.  i've been fully checked out, there are no joint issues, it is the muscles that have pain.  it comes and goes.  the Dr is leaning toward diagnosing me with fibromyalgia.  i'm reluctant to be diagnosed because i feel it could be related to my thyroid not being managed adequately.  the Dr and pharmacist both said that 'muscle pain' is not a hypo symptom... but everything you look up has "muscle pain" on the list and the rheumy agreed with me.

so. in june. my tsh was 6.3 (ref range .27-4.2) . my free t4 was 16.2 (ref range 10.5-20) and my free t3 was 3.8 (ref range 3.5-6.5)
so after reading and somewhat understanding about ideal ft3 levels being in the upper normal, i asked the dr if i could try cytomel.  she said she doesn't really 'believe in it' but has lots of patients using it and loving it so she's fine if i want to try it.  (she's actually extremely nice and non judgmental and orders whatever tests i request.. she's just... honest haha).
so i start at 5mcg/day  (Split in two) and we increased my synthroid to 125 alt with 100mcg.  (from 100mcg daily)

after 6 weeks, my labs were: tsh .78 (ref .27-4.2)  ft4 15.2 (ref 10.5-20) ft3 4.4 (3.5-6.5)

over this time my muscle pain became less frequent, less intense and not lasting as long.  it's still very bad at times but not compared to where it was compared to 3 months ago.

so, that time we increase the cytomel to 5mcg twice a day and cut me back to synthroid 100mcg /day

fast forward 6 weeks, muscle pain slightly better, still experiencing rough days and nowhere near "normal", but certainly better than the excruciating almost daily pain i was experiencing before.  
labs last checked on sept 18 :  TSH .32 , ft4 14.6, ft3 4.6

so we just increased cytomel to 20mcg per day, split in two.  and decreased synthroid to 50mcg alternating with 75mcg.   so i will give that six weeks

so my question is, does what we're doing seem reasonable? still trying to increase the free t3.  and has anyone had muscle pain relief with cytomel?  i mean, maybe i do have fibromyalgia, but i'd rather explore this route before i settle into a diagnosis!  i wonder if the pain has been relieved over the summer because of the hot weather, positive thinking, that sort of thing.  perhaps coincidental with the cytomel.  ?  so just looking for input from others :)
sorry this is so long, figured i better cover the basics though

thanks!!! :)

[itzjustme]

Hi!  Thank you both so much :).

So barb. Are you saying you think we dropped my synthroid too Much last time? I understood cytomel was 4x as strong so we just trying to compensate for that.  But let me know what you think please! I really appreciate it.

I have not had calcium and mg tested recently, probably almost two years ago and they were normal. You're suggesting I have them tested again? I do take molasses every night for iron and minerals.
As for vit d, they generally don't test for it as it is a very expensive test.  I take 3000iu per day.  

Thanks so much for your input :)
And very helpful to know that your symptom relief/improvement took a long time with t3!!  Thanks!

[Barb135]

Some studies have shown Fibromyalgia to be untreated or undertreated hypothyroidism and once thyroid levels are brought up to adequate levels, most, if not all symptoms are alleviated.

Your dropping your Synthroid too low, which is allowing your FT4 to drop too low, as well.  You always plan to get some conversion from your FT4, so you don't want to let that get too low.  Rule of thumb is for FT4 to be around mid range; yours is at 43% of its range, so you really need to bring that back up some.  

Rule of thumb is for FT3 to be in the upper half to upper third of its range, so you still have a way to go to get there, but don't forget that it can take a while for it to come up, even taking a T3 med.  It doesn't always jump up there immediately.  Even more important, it can take a while for it to alleviate symptoms, because the body will heal the most important things first.  

Have you had magnesium and calcium levels tested?  deficiency in either can cause muscle aches/pain.  Even lack of exercise can cause muscle pain.

Vitamin D deficiency can also cause some hypo-like symptoms.  

I, certainly, wouldn't settle for a dx of fibromyalgia, but neither would I pin all my hopes on thyroid either, when there are other things that can cause your symptoms.  And don't expect immediate relief, because even with T3 med, it can take time.  I was on T3 for over a year before my symptoms started to abate - granted, I'm not on as large a dose and my dose of T4 med is higher, but do be patient.  Very few things in thyroid happen quickly, because it takes your body time to heal.

[Red_Star]

"Chronic widespread pain is associated with several medical and psychiatric disorders including, but not limited to, chronic fatigue syndrome, fibromyalgia, mood disorders, hepatitis, endocrine disorders such as hypothyroidism, and rheumatologic disorders such as rheumatoid arthritis." - Pain and the brain: chronic widespread pain. J Clin Psychiatry. 2009 Apr;70(4):e10.

Your free T4 and free T3 look too low and your symptoms are noted hypothyroid symptoms.

[itzjustme]

oh, also, my other big symptom is that i am cold all the time.  everyone around me will be in tshirts and ill need a jacket and scarf... ha... this has improved somewhat over the last couple months but also, it was hot summer!