my doctor added cytomel / synthriod

[blondee028]

I have been taking 112mcg synthroid for 3 yrs now, I have pretty much crossed over to hyper, my tsh is 0.037,  T4 13.1
my t3 free  is  low 2.7,   free t 4  1.83 . Seems like my body isn't converting my t4 into t3,  So today my doctor added cytomel 25mcg, should he have lowered my dose of synthroid? Is it ok to take the same dose with cytomel? I have hypothyroidsim and hashimotos.

[ttmoni9]

My doctor lowered my dose of T4 when he added T3. From what I've read, it should be lowered.

[pep88]

I can't remember the exact conversion but I think the conversion rate is something like 25mcg of T4 to 5mcg's of T3.  If it's not that, it something close.  And yes he should have lowered your T4 if you're somewhat hyper right now.  25mcg's of cytomel is a lot to add to your existing dosage.  

I take 10mcgs every morning, but in addition to 175 of Levothyroxine that I take at night.  Just to give you an idea, I was taking 200mcg of T4 when I took just T4 on it's own.  Please call and double check b4 taking this combo.

I will say that I don't now, nor have I ever, had Hashimotos, so it's not my area of expertise.  But this dosage of meds would definately make you more hyper than you currently are.

[stella5349]

He may not be looking at the TSH right now and tweeking your meds to adjust the Free T3's

When are you testing again? Is he spreading out the Cytomel through the day?

I believe your doctor is looking at to see if your conversion values are messed up. Are you still symptomatic of hypothyroidism symptoms with that low of a TSH?

[blondee028]

I am going to take my labs tomorrow so I get a definate baseline. those labs were done mid december. I was still having symptoms fatique, brain fog and terrible joint pain., plus palpuations.At one point they had boosted me up to 125mcg and it caused shortness of breath probably because it was took much t4 and my body was not converting it.
I took 100mcg of synthroid this at 6am this morning. At 9 am I took cytomel BUT I cut the pill in quarters and only took one quarter. It has only been about a hour, I seem to have more energy already but maybe its in my head.

[shannon828]

Dr. Lupo said yesterday to reduce Synthroid or Levo by 25 for every 25 of Cytomel that you add.  You are lucky.  My Endo won't prescribe it.  Says it's not good for cancer management :(

[pep88]

I have to strongly disagree with your (ok, supposedly from Dr. Lupo's statement) conversion of T3 to T4 dosage as 1 to 1 (or 25mcg Cytomel to 25mcg of Levo/Synthroid). Maybe this was a typo or perhaps a misunderstanding on your part??  I went back and looked for where he could have possibly said such a crazy thing (as I missed this thread live), and the only referance I found was this:

Dr. Lupo: WE DO AS WELL -- USUALLY 5MCG ONCE OR TWICE A DAY -- IF THERE IS A DEFINITE BENEFIT THAT IS SUSTAINED (IE MORE THAN 3-6 MONTHS) THEN WE STICK WITH IT. REMEMBER TO DECREASE THE T4 DOSE (20MCG FOR EVERY 5 MCG OF CYTOMEL ADDED) WHEN DOING THIS.

I've been all over the map on my Cytomel to T4 dosage, so I've had some experience with this topic.  I stated earlier on this thread that I thought my doc had said it was something like 25 to 5, Levo to Cytomel.  Also for an alternate resource, here's the URL for the Armour site where they give a conversion table, albeit an approximation.  

http:// www .armourthyroid.com/con_faqs.aspx

I know everyone is effected differently by Cytomel as it is a function of how their specific body converts T4 into T3 and whether or not there is a conversion problem in that individual to begin with.  However... I don't think ANY website or doctor would give a 1 to 1 ratio of T4 to T3 as a conversion table.  

Case in point, After my TT, I was put on 25mcg's of Cytomel per day which was insufficient for me to function correctly.  I was changed to 50mcg per day which was a little high, but worked.  After RAI and trying several combo dosages (which I've since gone back to) I did try T4 alone and my dosage was 200mcg's.  If I went on 200mcg's of Cytomel, I'd be DEAD!  I was taking 137 of Levothyroxine when I was taking 25 of Cytomel.  It reduces your dosage by that much!

Also Shannon, did your doctor add anything to that "It's not good for Cancer management" statement?  I've never heard of that.  I can't imagine a senario where it would be a negative, as any combo suppresses TSH which is the necessary component in the equation.

Blondiee028:
How are you feeling?  Did you call the doctor?  Do you have lab reference ranges for your free T's?  At a TSH of .037, 25mcg's of Cytomel is TOO MUCH to "just add" to your existing dosage of T4!  Please call back and check with your doc as some of your symptoms can reflect a hyper-thyroid state as well as hypo.

[shannon828]

Whoooopsie, I misread Dr. Lupo's comment, that is the one I was referring to.  Sorry Charlie :)

My Endo basically told me that Cytomel messes with the TSH readings (which can effect the Tg readings) so that you are not getting an accurate number.  I wish he believed otherwise BELIEVE ME.  Obviously, he was referring to those that CAN convert the T4 in Synthroid into T3.  Since I'm so early on in my case, we don't believe that I am having trouble converting, it's just a matter of me being able to tolerate being hyperthyroid which makes me tired, irritable, etc. etc.

Sorry to get you all riled up :)

[pep88]

K, so not really "riled up", but I was and am very concerned about Blondiee028.  I didn't want her to be mislead and think the additional 25 of Cytomel was A-OK and gulp it down...  then feel like cr@p.  I truely think this needs further investigation by her and doc.  I think he may just have had other things on his mind and forgotten to lower her dosage of T4.  Any way you slice it, she will be "hyper" as a kite if she swallows that script.  I don't think I would have gotten so "riled up" if she'd been perscribed a 5mcg dose to gulp down with that TSH, but 25mcg's is A LOT!  And a typo like that one to one conversion rate, could have her in the hospital lickity-split.  Thus the "riled up" clerification.

As for the cancer supression thing, I'd get another opinion if I were you and you still feel bad.  I go to what I consider, the top endo in Seattle.  Ever since my TT, he's almost pushed the Cytomel on me.  I mentioned above that I did try T4 alone... That was at my request!  After trying several combos of T4/T3, I just wanted to try T4 alone and see what would happen.  I didn't like it.  He would have never perscribed T4 by itself if I hadn't pushed him into it.  I have subsequently reverted to his way of thinking and accepted the Cytomel back into the equation.  At a reduced (for me) Cytomel dosage.  Good luck.

[shannon828]

My apologies to you and to Blondie :(  I thought I was helping and I just typed too fast.  It sounds like she has some really good advice from you since you have so much experience with this topic.

As for my Endo, I trust him implicitly.  If it gets to a point where I have to tell him that I want/need the Cytomel and he won't prescribe it, then I won't hesitate to find someone else.  At this point we are still dealing with my detectable Tg and I want to get that all squared away before I start adding any additional medication.  I definitely felt better on Cyto (I was on it after my TT) but I also had quite a bit of remnant thyroid tissue at the time, so it's hard for me to know what was the Cyto and what was regular old Thyroid hormone from my actual thyroid, you know?

Anyway, thank you for your experience, strength and hope.  I apologize if my comment seemed flippant, was just trying to make light...

[pep88]

I just have to say that in re-reading my answer to you... I re-iterated "riled up" no less than three times!  Ugh!  Sorry.  I didn't mean to make you uncomfortable, nor did I take offense to or consider anything you said, flippant.  You usually have great advice and I am by no means, the expert here.  I've just tried all ranges of Cytomel and consider myself pretty well versed.  I knew it was a typo, but wanted to clerify for Blondee's sake.

But I do wonder about the Tg you're still getting...  Have you had that second scan yet or still on LID?  And if you see your doc soon could you ask for a clerification about the Tg and Cytomel thing?  I'd love to have more info on it.  After my last scan (which was clean btw...), as it has always been, my Tg was <0.1.  But I've almost always been on some dosage of Cytomel.  It'd be great to have some more info as I don't see my doc for another couple of months with that clean scan under my belt.

[blondee028]

I really appreciate all your help today,
I took the 100 mcg ,( at 6am) which was 12 mcg less than what I was taking. I took the 25mcg cytomel and cut it in quarters . I took the tiniest quarter at 9am.  I felt of kinda had a boost of energy for a few hours and it made my mind sharper. no palputations, no shortness of breath and not fatigued at all. I am going to take my blood in the morning and will have the results early the next morning. I am only going to take the quater of pill for a while.  My doc was out of town when he called this in for me , I have to touch base with him and recheck this dosage. Thanks to you guys here because I was going to take the whole dose in the am synthroid something told me to check online first.
Its 4;30 pm here and I am fine. I will probably do the same thing tomorrow. I will keep you posted. The board is the greatest!

[blondee028]

I did my labs today and will get results tomorrow. BUT I did go over the phone message with my doctor. He sent me a text message, I told him that he knew my t4's were running high  ( hyper now) but it seems like my body is not converting it into t3's. (still low) Therefore I am hyper and hypo at the same time.  I told him I read about cytomel and asked him what he thought about it. HE SAID HE TAKES IT HIMSELF . He told me to lower my dosage to 100 mcg.and add the 25 mcg of cytomel Then I asked him again do I stop the synthroid ? he said NO you take them together! Maybe cytomel is only t3? I am still scared and taking only 1/4 of the pill.  Advise is appreciated

[pep88]

I'm glad he lowered your T4.  And yes, Cytomel is only T3.  Some people don't tollerate Cytomel at all.  Makes them very jumpy with heart racing, etc.  Others do find, don't even really feel the effects... That's why most docs start their patients with ultra low doses.  I would do as you're doing.  Take small dosages and see how you feel.  It's a fast acting/fast fading drug.   If it works, you'll know it.  If you need another quarter, take one.  They tend to only last about 4 hours in the body, so it's an easy fix if you start to feel weird.  But taking a quarter all at once might just be too much for you.  It's hard to know.

[blondee028]

I got my lab results and I think I am going to go back to my 112mcg synthroid, without cytomel
tsh 0.374 , usually almost always undectable, now climbing
t4   free 1.33  was 1.76 range   0.61-1.76
t4 10.0  was 12.0 range 4.5-12.0
t3 free 2.5  was 3.0 range 2.3-4.2
t3  100  range 85-205
why is my tsh climbing, I have joint pain again, plus headaches. should I just take the whole 25 mcg cytomel at once??
totally confused

[laura1967]

blondee- your Free T3 level is low...like your dr suggested, I think you would benefit from taking the cytomel he prescribed to you. Just make sure you lower your synthroid as dr instructed. Usually cytomel is broken into at least 2 dosages....I would take half in morning and half 5-6 hrs later. Or if you are a little nervous (don't be), you can start with 1/4 am with your synthroid and 1/4 in afternoon and build up to 1/2 and 1/2. Never know...you might feel a lot better!
If you feel good on the cytomel, ask your doctor to find a compounding pharmacy to put the cytomel into a time release formula for you so you don't have to take so many times per day. Good luck!

[blondee028]

your probably right.. I took the tiny quarter this morning and really didn't feel anything, I called my pharmacy to see if they were sustained release but they aren't. I have just read so much about peoples hair falling out, its scarey. I don't want to sound paranoid but I felt this way once and it was pneumonia, it made me very tired and short of breath. Getting old is terrible. I am going to give the cytomel a shot for two weeks

[blondee028]

I tried 1/4 of the cytomel, I went to bed at 10 pm, I woke up at 2am and never did go back to sleep. ( even after taking ambien). I haven't taken the cytomel again. Is that normal?.  shortness of breath is gone, I found out I was eating peanuts and I am highly allergic, I stopped the peanuts and I can breathe fine now.

[pep88]

I only ever take the Cytomel first thing in the morning because of that very problem.  You may also still be a little high on the T4.  Weren't you just starting to lower your dosage from being hyper?  If that's the case, the Cytomel will make you too hyper to sleep.  But I will still defer to my pal Laura1967 for more info on Hashi's and T3.

[Barb135]

When I saw my new endo last week, he added cytomel to my synthroid as well.  I was at 75 mcg synthroid, which he lowered to 50 and added 10 mcg cytomel.  He told me to take it all at once in the morning, but from reading posts on here, I decided to split it into 2 doses (the tabs are 5 mcg/ea), so I take one in the morning with my synthroid about 3:30 am and the other as close to 9:30 am as possible.  That keeps me going good until I get home about 3:00 when I can start winding down to get sleepy by around 7:00 -7:30 pm.  I have had some problems staying asleep, but it's getting better as my body adjusts to the meds.

I feel better and have more energy than I have at any time since way before I was dx'd hypo in June 08.  

I wish you luck with it.  

[stella5349]

YEAHHHHHHHHHHayyyyyyyyyyyyy

for barb!

[laura1967]

Blondee- You probably will feel a little racey at first until your body adjusts....but make sure your doctor lowered your T4 med enough when he added the cytomel. It will take a little while for your T4 level to lower a bit.

Pep- Thanks!  :)

[katie21919]

I am new to this site.  I have had very fluctuations in my TSH while on synthroid alone.  I was on .225 mcg and yesterday my TSH came back as 22.  It has gone all over the place.  I can't remember the other numbers except the my free t3 was off.  My doctor call today (wanted to confer and investigate)and changed to 150 mcg sythroid and 50 of cytomel.  Just said to take in am with lots of water and not to eat for an hour.  Do you think I should split the cytomel into two doses?  I have gained 30 lbs in the last 4 months.  I am so tired that I literally have to push myself to move one foot in front of the other.  I have hopes that this will help.  

[magpieannie]

STOP!!! SOMETHING DOESN"T SOUND RIGHT HERE!!!! TOO MUCH CYTOMEL PRESCRIBBED I THINK!!! It looks like he reduced your synthroid from 225mcg to 150mcg ( reduced it by 75 mcg). If it is recommended that t4 (Synthroid) should be reduced by 20 mcg for every 5mcg of t3 (Cytomel) that is added and he has added 50 mcg of Cytomel, then he would have lowered your Synthroid by 200 mcg. if you do the math! Then that means you would be on like 25mcg of Synthroid  with a dose of 50mcg of Cytomel! 50mcg of Cytomel just sounds like FAR too much! If he reduced your Synthroid by 75mcg then you should be on far less t3 Cytomel (like 15 or 20 mcg.) if using Dr. Lupos formula. And t3 should be divided 2 to 3 times per day!
I really hope that you did not take 50 mcg of Cytomel all at once yesterday???? You have to begin (add) t3 very slowly or you can end up in the hospital! I hope you are not already there. SOMEONE ELSE PLEASE JUMP IN HERE and let me know if I'm doing the math right. I'm afraid I am!!

[blondee028]

My labs are fine I am now on 100mcg synthroid and 10 mcg cytomel a day in two divided doses.  For the first time in years in many many years. It pays to find the right doctor and I finally have. I have been on it for two months now ( don't know what my labs are now) I have to do them in October but it dosent matter what they are I feel great , no aches no pains lots of energy and most of all no brain fog.  This doc goes by your symptoms he treats that not the numbers. Plus I have lost the 10 lbs I couldn't get rid of, no more belly flab. And surprising that I am sleeping better than I can remember.
what this doc did he left me on the 100mcg and added 5mcg cytomel for the first two weeks and then had me increase the cytomel to another 5mcg at 1 pm, so its in two divided doses. to everyone out there just keep doctor hunting till you find the right one. I actually went online and type in the top thyroid doctors where I live. Even though hes a interal medicine doc his name popped up, I read the reviews and finally made a appointment > I am so happy I did! I will keep you posted when the new labs come in.