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Avatar universal

low thyroid

I had my thyroid removed 18 months ago for a large goiter. My TSH last dec was 0.01 and my doctor chose to leave the meds alone as I had no symptoms. However, over the last several months, I have begun to feel like I did before the TT. Exhausted, cold, but then when I have any exertion, I sweat profusely. I'm hungry all the time, and have gained 8lbs in the last 2 months, where previously my weight was stable. Now I'm not sleeping well, although I fall asleep easily, I just don't stay asleep. My TSH was repeated last week and remains at 0.01, however, now I'm wondering if it's time for a change in doseage, I'm currently on .125mcg Levothyroxine daily. I have an appointment with my GP today, should I ask about changing to Armour? Should I wait for more labs?
From reading all the posts, I think I definately need to ask for more labs. I appreciate any advice available.
22 Responses
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Avatar universal
While a lot of the information on here is good I would caution you about asking your MD to put you on a medication based on what you have been told here.  We do not know your total medical situation the other medications you may be taking or if the adrenals are functioning properly, do you have heart problems etc.  For more on cytomel please go to

http://www.drugs.com/cdi/cytomel.html
Helpful - 0
Avatar universal
First I would see an endocrinologist and not a GP.  They are better able to put all the pieces together for you.
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Avatar universal
I do take them on an empty stomach.
I take the synthroid first then when I get up around 6:15ish and I don't eat anything until I get to work at least an hour if not more later. I usually eat breakfast around 8, then take the Cytomel around 10:30 to 11. I don't usually eat lunch until sometime after noon if not later.  It's so odd to me that my FT3 didn't really change at all. I did not take any meds the morning before the labs were drawn but I expected it to be a little higher. Why would the Total T4 drop 3 points? Is that really even relevant?
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Avatar universal
My first reaction was to suggest that you could slightly increase your Cytomel to increase the level of FT3, in line with what we hear from many members who have had success in relieving symptoms by increasing FT3 to the upper part of its range and FT4 to at least midpoint.  Then I stopped and noticed that you are taking a hefty dose of meds already.  Are you taking the meds on an empty stomach and then waiting for a while before eating?  The reason I ask is that I am somewhat surprised that you levels are not higher already.  
Helpful - 0
Avatar universal
Finally got my newest labs;

TSH                               Ref Range
0.015                              0.465-4.650
Total T4
7.7                                  5.53-11.00
Free T3
3.03                                2.77-5.27

Not really much change in the FT3 but a substancial drop (I think) in the Total T4.

Why wouldn't the FT3 go up if I added the Cytomel 25? Still have some hypo symptoms but wasn't sure if the stress of the last few months was the cause or the labs.

Any suggestions on the next step? Should I just continue to wait and see if the FT3 will change? Ask for and increase in Cytomel?  


Help!!


Helpful - 0
Avatar universal
I also have 25 mcg pills of Cytomel that I am splitting.  I have had better success using my fingers, with thumbnail along the split line.  It is a little hard to do, but probably easier than with a knife.  If you got the first split into halves, the split into quarters should be easier.  

Yes, it can be noticed in that short a time because T3 is so much faster acting than T4, which goes into blood stream and builds up slowly over about 4-5 weeks, and also has to be converted to T3.   That is why many members suggest splitting the dose in half to try and even out the effect.  With Cytomel it takes about 4-5 days to build up to the maximum effect on your blood levels.  I would not suggest that you take the other half when you get home.  It definitely can disrupt your sleep.  

I would try again to split the pills in quarters and take 1/4 in am and 1/4 in mid-afternoon and monitor the effects over the first week.
Helpful - 0
Avatar universal
Is this possible? After trying to cut a pill in 1/4 and dessimating 2 of them, I opted for crossing my fingers and taking 1/2, that split I could manage. I did just fine, felt more energy and less achy in my joints. Well, I went off and forgot the other half and now, my joints are bothering me again and I feel like I need a nap. Could it really make a difference in just one dose? Is it more of a placebo feeling? I had zero negative effects from the 12.5, but would I really feel an improvement either?
Can I take the other half when I get home or will it disrupt my sleep? I don't need any more of that either!!

Thank you
Toni
Helpful - 0
219241 tn?1413537765
Yes! It can be related to sleep apnoea. Go to Dr Stephen Parks site on the web and read all you can about it. I have sleep apnoea and it has been investigated with a sleep study and the use of a CPAP mask.
Unfortunately for me it was not the cause of my thyroid problems, but his colleague has a great book out regarding the effects of sleep apnoea and TSH.
Helpful - 0
Avatar universal
Have a look at the thyroid doctors on this list, and see if any in your general area look promising.   Especially read the patient reviews.  They are very revealing.  If you see any that look interesting, then you can check them out by calling the office and saying that you are looking for a good thyroid doctor, but want to ask a few questions before making an appointment.  The questions to ask are:  1.  Is the doctor willing to treat a patient clinically, by testing and adjusting free T3 and free T4 with meds as necessary to relieve symptoms, without being constrained by resultant TSH levels?  2.  Is  the doctor  willing to prescribe meds other than T4 types.  If the answer to either question is no, then you keep on looking.

http://www.thyroid-info.com/topdrs/texas.htm
Helpful - 0
Avatar universal
Good idea, I did actually just ask for 5mcg.  I'll try slitting in in 1/4's and see how that goes at first. Unfortunately, I feel like there is not a good thyroid doctor any where near me. I had to "fire" the only "good" endo last year when he told me thyroid was not enlarged enough to be a problem. When I had to stop eating some food because I couldn't swallow them, the endo surgeon I work with did a scan and said it was 5x normal size and it needed to come out. She managed  my thyroid til just a few weeks ago when she wanted to leave me alone with my TSH at 0.01, not draw any further labs and when I reported my change in symptoms, responded with "well, you're a busy mom and nurse, of course you're feeling bad". I knew I needed help when the GP after that wanted a sleep study! I will look for a new doc, but at least in the meantime, this gives me something to try until I can get in. What a beating!! Do you think that even without a thyroid, the 125mcg will still be a problem?
Helpful - 0
Avatar universal
I don't think the doctor knows about Cytomel.  That dose is way too high for you.  The 25 mcg of Cytomel is equivalent to 100 mcg of T4 med.  Not only that but since it is so fast acting, it would make you very uncomfortable, real quick.  I don't know how you want to handle it, but I think I would either get a different prescription for 10 mcg, or I would split the 25 mcg into quarters and only take 1/4 in am for some days and see how your body reacts.  Then if okay you could add 1/4 in pm.  Even that is the equivalent of adding 50 mcg of T4, which is why I thought you should be reducing your T4 meds.   I'm even more convinced you need to see a good thyroid doctor.
Helpful - 0
Avatar universal
Well, as expected the nurse called. He has agreed to a 2 month trial of the Cytomel 25mcg however, he wants me to stay on the 125mcg of Synthroid also. The pharmacist said take it all in the am, but I think I will go with split dosing, I wonder if they realize that so many patients are splitting the dose??
Do you think the Cytomel dose is too high? I will see what happens tomorrow and go from there.
Thank you so much for all your help.
Helpful - 0
Avatar universal
I suspect that I will receive a call today that they either called it in for me or that they won't call it in. The person that I spoke to when I called was not a nurse, so, I'm pretty sure that a nurse or even the MD will call me back, either way. I agree, it's not a great idea to self medicate, but I figure that since skipping one dose a week was just 50mcg's above 100mcg daily, it wouldn't be to off. I will ask about that when they call.
I appreciate your expertise with this. I know you aren't a doctor, but most of the time patients who have been through the same situation are more helpful. I see it all the time as a nurse.

Thank you!!
Helpful - 0
Avatar universal
I wouldn't suggest that you self medicate.  I do think that you know the right general direction, and as long as you are with that doctor, you should openly discuss things and try to reach agreement.   If that becomes impossible, then you should find a good thyroid doctor that will treat you clinically (for symptoms), by testing and adjusting FT3 and FT4 levels as necessary to relieve symptoms.  

Helpful - 0
Avatar universal
Ok, well, I just caleld and asked for low dose cytomel. We'll see what he says, the office will call me back. I'm hoping he will be reasonable with a 30 day trial since I do have an appt early next month for follow up. I hope this does the trick. Besides really wanting to feel better, I would love to go in and tell him "I told you so"!! If I skip the 125mg Synthroid one day a week, it get's me pretty close to a dose of 100mg daily. Do you think that will be enough of a synthroid decrease?

Will keep you posted, again, thanks for the support.
Helpful - 0
Avatar universal
If it were me, I think I would reduce the Synthroid by 25 mcg and add 5 mcg of Cytomel.  I would split the Cytomel and take half in the morning and half in the afternoon.  I'd monitor symptoms carefully and see how you react.  If everything goes well I'd go back after 2-3 weeks, for followup testing of FT3 and TT4, to see what the change did for those tests.  If you still are having hypo symptoms, and have had no problems with the change, then you could consider a further slight increase in T3.  Since T3 has a half life of less than a day, it builds up far quicker than T4meds.  Symptoms tend to somewhat lag changes in blood levels of thyroid hormone, so you might have to be a bit patient with that.  
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Avatar universal
Thank You!
From my research, should by Synthroid level be decreased when adding T3?
Is Cytomel the T3 med? What would be a good dosage to ask for, because I'm pretty sure I'm going to have to be specific about what I want. I understand the best route is low dose and increase from there. When would I expect to see an improvement with the changes in my meds?

Again, thank you so much!!
Helpful - 0
Avatar universal
Your FT4 is near the high end of the range, yet your FT3 is near the low end of its range.  This is indicative of your body not adequately converting T4 to T3.  We hear of this a lot from members taking T4 meds.  FT3 is the most important thyroid hormone since it correlates best with hypo symptoms, of which you list a number.  

If it were me, I would want to slightly reduce the level of FT4 and increase FT3 as necessary to relieve symptoms.  There are several ways to approach this.  One would be to either add a small amount of T3 meds.  Another would be to go to a desiccated T4/T3 combo type med.  A third way that might be useful to investigate for longer term help is to test for selenium and see if your level is low.  We have some anecdotal evidence that selenium helps convert T4 to T3.  I have also seen some scientific data that seems to support this possibility.  So if your selenium is low, then you might want to consider supplementing with selenium.   Shorter term I think you need to revise your meds to include some T3.
Helpful - 0
Avatar universal
Ok, here are the results:

TSH                               Ref Range
0.015                              0.465-4.650
Total T4
10.70                              5.53-11.00
Free T3
3.00                                 2.77-5.27

He wants me to stay on the 0.125mcg Synthroid, I am currently doing the generic, same dose.
I go back in a month to discuss how I am feeling. If not improved he wants a sleep study??

What are you're thoughts?

Thanks so much to you both!!

Helpful - 0
Avatar universal
Thanks to both of you.
I did get FT3 and FT4 as well as repeat of TSH yesterday. He was reluctant to do the FT3, but he did agree. I did mention Vit D and B12 and he brushed both off. He said I should be taking Vit D and Calcium anyways, so start taking and don't worry. He brushed off the B12 because I never had pernicious anemia. He feels my symptoms are related to sleep apnea! Really?!?! I don't even snore!! He want to get the labs, see if I need a dose adjustment, change to brand Synthroid from generic and wait 30 days. If no improvement, he insists I get a sleep study!! I'm hoping to get the lab results this afternoon. I will post when I have. Thank you both so much for responding.!!
Helpful - 0
Avatar universal
I agree with thyroidhunter that you need more lab testing.  Specifically I suggest that you insist on testing for free T3 and free T4 (that's FT3 and FT4, not total T3 and total T4), along with TSH .  If the doctor resists, then you should insist and not take no for an answer.  Remember that you are the customer.  The doctor is providing a service for you.  

You might also ask for tests for Vitamins D and B12, along with ferritin.  

When the lab report is available, I suggest that you post results and reference ranges so that members  can help interpret and advise further.  

Helpful - 0
1425146 tn?1282761884
MORE LABS, ASAP. And ask a bunch of questions, and take some notes with you on exactly what's going on. Don't leave until you get answers you're satisfied with. If you can't get that, you may need a new Doc.

Best
Helpful - 0
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