too much cytomel?

[vixie007]

Hello, I  was diagnosed three years ago with Hoshimotos. I was put on a very low dose of cytomel 5mcg which I take half in the am and half in the pm. My levels have been stable, Ill post below with ranges.  My issue is that I am unable to keep weight on. I have to eat five or six times a day to not feel faint and I look like a stick. People comment on my hollow eyes all the time. I've always wondered why I was put on t3 if my symptoms seem like hyperthyroid symptoms . Im wondering since my levels are "ok" am I possibly no longer in need of the cytomel as a stabilizer and is it now speeding me up too much? I was thinking of tapering off and seeing how I feel however I do have heighted antibodies. I do not have a doctor at this time to answer this as I have moved away.

REVERSE T3 10 - 24 ng/dL 13
ANTI-THYROGLOBULIN AB 0 - 40 IU/mL 95
ANTI-TPO AB 0 - 34 IU/mL 14
TSH 0.55 - 4.78 uIU/mL 1.08
FREE T4 0.9 - 1.8 ng/dL 1.1

[vixie007]

thank you :)

[goolarra]

I agree with your folks.  Both the reproductive hormones and the thyroid hormones are controlled by the pituitary.  So, it's a logical place to start.

I know it's confusing.  Your symptoms do sound like hyper symptoms, but if they're not improving as your levels drop, then I have my doubts.  Some thyroid symptoms can cross over, and people have basically the same symptoms whether hypo or hyper.  

I think it's good that you stopped both meds.  Now you'll have a chance to see where you are without either.

Good luck with the specialist.      

[vixie007]

I don't know. I'm confused. All I know is I was taking T3 for years and it seemed to work. Hyper to me means fast heart rate, insomnia, feeling like I can't move my mouth fast enough to speak my words, hair loss. All of those things I'm feeling. I'm going to do nothing for a bit and see if I settle. Im off the estrogen and T3. My parents and doctor want me to see a specialist, one who also specializes in the pituitary b/c there seems to be a connect with all the hormone imbalance.

[goolarra]

Yes, you should listen to your symptoms, and that's precisely what I'm trying to impress upon you.

TSH causes NO symptoms.  It is nothing but a messenger from your pituitary to your thyroid to tell it to produce more hormone.  In a perfect world, TSH accurately reflects FT3 and FT4 levels and symptoms.  In reality, any number of factors can throw TSH off.  

So, your T3 and FT4 have both come down significantly, BUT your symptoms have gotten WORSE.  So, tell me why you think they're hyper symptoms?  Hyper symptoms would get better as T3 and FT4 levels fell.  FT4 is still a little on the high side, but it's fallen so much.  If symptoms are getting worse as levels fall, don't you think you might want to bring the levels UP, not down some more, or at least give them a chance to stabilize?  

[vixie007]

i see what your saying but judging by the fact that since I began the estrogen and had the swing in my TSH things the heart rate and sleep loss has gotten worse and the hair loss began again. I'm concerned that I should listen to the symptoms as well. But yes Id prefer not to add another medication. Last night I was so frustrated at 5:00am b/c once again i didnt get a wink of sleep, I tore the patch off. OK, thank you for your thoughts once again :) I'll see how things go from here.

[goolarra]

Your FT4 has come down a lot, from 2.1 to 1.5.  T3 has also dropped.  So, you are less hyper than you were in your previous labs.  Estrogen should lower your thyroid hormones, which it seems to be doing.  

I wouldn't worry about your TSH at all.  It's obviously not tracking your FT3 and FT4.  Your TSH should have gone up, not down, as your FT3 and FT4 came down.  I'd say something is making your TSH unreliable.  I also think both FT3 and FT4 might continue to come down as you increase your estrogen dose.  

I really don't see a need for methimazole here.  Your FT4 is a little high still, but it's also moved down nicely.  T3 is right at midrange.  If you go lower on those, you could start feeling hypo.

[vixie007]

Date: Thu, 2 Apr 2015 23:50:06 -0400



The results are in (below). TSH is still in the gutter. The t3 and t4 seem a little less elevated without the cytomel. In my research I'm finding that if I am to have any future in hormone replacement (estordial and test) I'm going to be dealing with a hyperstate. As I've explained I do not want to loose the estrogen. I'm wondering if
it is ever a possibility that they will put me on something to stabilize me from going into hyper such as a very low dose of methimazole.

I am now working with an MD who knows nothing about Thyroid, a NP whose prescribing me hormones (whom I've explained to that i need to be on the most minimal dose possible). I'm getting on a wait list to see a specialist. I don't know how long that will take. In the meantime I'm going to talk to my MD about options but I"m pretty sure he's clueless.


What do you think about the methimazole?

Tisa



TSH

0.55 - 4.78 uIU/mL

0.01



FREE T4

0.9 - 1.8 ng/dL

1.5




T3

60 - 181 ng/dL

120

[goolarra]

It is frustrating.  Every action has an equal and opposite reaction.  Unfortunately, messing with any part of the endocrine system causes ripples throughout it.  

With T3 pretty high in the range and tachycardia, I tend to agree with you that you don't need to be taking T3 right now.

I'll look forward to seeing the results of today's testing.

Hang in there; you'll get it all figured out...

[vixie007]

I'm back. My HR has been out of control even after I cut the estrogen patches in half. I told my dr. I'm 98-100 resting HR and even when trying to sleep and up to 193 running on the treadmill and he was very shocked. I"m very fit and athletic so these numbers don't make sense. I did read that if you have low bp (which I do) and a high heart rate, it's a sign of Thyroid disease. I also read that estrogen can throw off your thyroid  hormones which I swear I felt very soon after I placed the patch on as you recall that same day I got my blood checked at things were wacky for the first time in a long time. I'm getting retested for my levels tmrw. At this point I have cut my patches into four pieces. I am determined to find a level that I can handle. I want to feel like a female again b/4 I actually hit the proper age for menopause.  I found this little bit online:

"While healthy women experienced no significant changes in their thyroid function while on the estrogen therapy, about 40% of women taking the thyroid hormone had decreases in their blood levels of thyroxine, levels low enough to trigger hypothyroid symptoms, such as low energy and feeling tired, sluggish, and cold, or to put them at risk for regrowth of thyroid cancer. Their thyroxine dose was increased to compensate for the effects of the estrogen. This dose adjustment in thyroxine allowed them to continue taking estrogen to combat menopausal symptoms while keeping their thyroid disease in check."

I"m not sure what this means for me since I went off my T3. Maybe I should have stayed on?mI'm feeling ok aside from the fact that my heart races. I"ll see what the numbers say tmrw now that I"m on a low dose of Estrogen and no T3. It just made sense to me that T3 would speed me up.


Its frustrating trying to fix a problem but it only causes another. Hope you're well.

[goolarra]

You're very welcome.  A lot of people helped me when I was first here.  I'm returning that favor, so you don't owe me anything.

Glad to hear you're feeling better.  It's often better to start out low and increase as needed and tolerated.  Do try to figure out why your T3 and T4 are both on the high side, though.

My husband was born and raised in Eugene, so we still have ties there.    

[vixie007]

i lived in portland for a year and then moved to fall creek outside of Eugene for three years.
I find that Drs are much more willing to listen to me on the west coast. There are also many more NDs out there which I also prefer.

I've been off the t3 since wednesday and i have cut my patches in half (dr approved). I feel much better. It was just too much for me. Maybe I can work my way up to one patch. It will be interesting to see if I gain weight now that I'm off t3. That would be wonderful!

I may move back to oregon. It depends on work factors. Thank you for being a life line. I wish I could do something to return the favor.

[goolarra]

TSI is a simple blood test, just like your TPOab and TGab tests.  

I don't think we know if the estrogen had anything to do with your level.  I doubt it did, first because you were already having the weight symptom (which is a hyper symptom) before you started estrogen, second because you'd only been on the estrogen for a very short time before the blood was drawn.  T4 is very long lasting and takes time to build in your blood, so I suspect your FT4 was already high before the patch.  However, the patch might help to lower your levels now, but that won't happen immediately; it'll take time.    

I'm in Sisters.  Where did you live in OR?

[vixie007]

i have discontinued the T3. Quite honestly I don't want to give up on the hormones but it's not looking good. I don't feel well. I asked my gyno if I could cut down on the dosage of the estridol. She said that was fine. The doctor that's helping me with the hormones isn't the same doctor that's monitoring my thyroid. I'm sort of searching for a new thyroid doctor. I've tried to see a specialist in town years ago but they were not helpful and turned me away and the weight list is long.  I was put on t3 by a doctor in Oregon and now i"m back in NY. I will ask my primary care to schedule this TSI test.  I'm not sure how that works. I understood that I had Hoshis, and in the past the only time I have these big swings are when I add something in conjunction with the T3. This happened once when my doctor added T4, it was too much. You say "Estrogen should interfere with (lower) the production of thyroid hormones" but it seems its doing the opposite. Correct?

[goolarra]

Estrogen should interfere with (lower) the production of thyroid hormones.  That's a big change in just two months.  

What has your doctor suggested?  Has she scheduled a TSI (thyroid stimulating immunoglobulin) to rule out Graves'?  Your TPOab is in range, but your TGab is elevated.  TGab can be elevated with Graves' as well as Hashi's.  It looks like you're either in a hyper phase of Hashi's or you have Graves'.

Have you discontinued T3?

[vixie007]

first lab 1/20
second 3/18

The only thing that's changed is my estrodial patch. I was still taking the T3 when I had my blood taken on 3/18 and it was the second day of the patch.

[goolarra]

So, there's been a huge change in your FT4, from 1.1 to 2.1 with the same range.  You are now over range.  FT3 is at 69% of range, which actually is pretty good.  TSH is low because of your high FT4.

How long was it between the labs you posted in your original question and these current ones?  

[vixie007]

TSH  0.55 - 4.78 uIU/mL 0.01
T3 60 - 181 ng/dL 144
FREE T4 0.9 - 1.8 ng/dL 2.1

T3 is fine but looks like T4 and TSH are off. I'm not sure what to make of this.

[goolarra]

Estrogen interferes with the production of thyroid hormones.  So, it's likely that the estrogen you are taking will lower your FT4 level more.

How you feel is most important, but the numbers have a place in the total picture as well.  Some symptoms can "cross over" and be both hypo and hyper symptoms.  For example, some people gain weight hypo or hyper, some lose it hypo or hyper.  Heart arrhythmias are very common with both hypo and hyper.  So, symptoms are important, but you have to make sure you're interpreting them correctly.  

Unless your FT3 level is quite high without meds, 5 mcg of Cytomel isn't going to do much to speed you up, and discontinuing it isn't going to do much to slow you down.  So, if you feel better without it, perhaps you should ask your doctor about discontinuing it.  

I'll be interested to see if your FT3 sheds any light.

[vixie007]

i had my t3 levels checked yesterday b/c for some reason that was skipped last time. I will hopefully have results by the end of the day. They did not test FSH with hormones.

In the interim my obgyn put me on .1mg estrodiol and did not want to put me on testosterone right away even though my results were almost non existent. She said something about it possibly going up on it's own after I get some estrogen in there. I'm not sure I understand that theory. I refused birth control as the solution although that is what she wanted to put me on.

The good news, I feel like I can think straight again. I feel more "alive." however... my heart rate has been elevated since being put on the estrodial patch and I can't sleep. I happen to have a heart monitor and at rest I'm in the 90's even when trying to sleep. I'm thinking there is an adaption period, as with most new drugs. I'm wondering if T3+estrodial is too much stimulation. And from all the articles i've read it would make sense that if i'm trying to slow down t3 is not what I need anymore.  I did an experiment b/c I didn't know what else to do. I did not take my T3 last night or this morning as I usually do. My  heart rate seems slower and I feel less over stimulated.

My hope is this... The T3 was needed as a temporary aid to bolster my thyroid and perhaps I'm strong enough where I don't need it or maybe just not as much.  Now that I"m eating well etc... Im trying to learn the correlation between thyroid and sex hormones. I've found articles but some of them, quite frankly I can't comprehend. I'm afraid that the T3 is competing with my bodies ability to make it's own hormones.    

http://www.ncbi.nlm.nih.gov/pubmed/7867556

I should have my t3 results by end of day. I'm interested to see if they are elevated. But all in all shouldn't i go by how "I feel" rather than numbers?

I'd be interested to know your thoughts on all of this.
Thank you :)

[goolarra]

What was your FT3 and its reference range?

Did they test FSH as part of your hormone testing?

[vixie007]

HI there. Well it turns out my t3 is fine and I'm having some other hormonal issues. Didn't suspect these at 34 years of age. We tested my hormone levels and they came back a bit low:

Testosterone,Free LC MS/MS           0.2
RANGES     0.3 - 1.9 ng/dL

Testosterone,LC-MS/MS          15
RANGES     8 - 60 ng/dL

Estrone                12.4
RANGES
Females:
Pre-menopausal: Early follicular <150 pg/mL
Pre-menopausal: Late follicular 100-250 pg/mL
Pre-menopausal: Luteal 214 Tanner Stage 5: 34-170



I go in wednesday to discuss my options with Dr.

[vixie007]

I see my new dr. next week. I was living out in Oregon and it was a lot easier to find someone to work with me on this. Now Im back in NY. I was put on Armour or a generic version of it very briefly which I believe is both t3/t4 and I reacted poorly. felt like a car that couldn't switch the clutch into the correct gear. I will certainly take all this info to my new doctor b/c frankly I think you know a lot more. Thank you so much. I will be in touch. This website is a lifesaver.

[goolarra]

Five mcg of Cytomel really isn't much.  If everything else were normal, your body could probably easily compensate for that amount by converting less.  

There's a phenomenon that sometimes occurs when FT4 starts getting low.  The body overcompensates for a while by producing too much T3.  With your FT4 as low as it is, that could be what's happening.  Obviously, the body cannot sustain that for very long without totally depleting FT4.  You could be in the process of becoming hypo.

I agree with you that you have to have T3 tested and see where it is.  You don't really have to taper off 5 mcg of T3; you can just stop taking it.  Have you considered starting on T4 meds?  Your FT4 really is too low.

Briefly, here's how it works:  Your pituitary is your master endocrine gland, and it controls all the other endocrine glands.  In the case of thyroid, it secretes TSH when it senses that your levels of thyroid hormones have fallen too low.  TSH stimulates your thyroid to produce hormones.  

T4 is all made in the thyroid.  It's the "storage" form of the thyroid hormones.  It basically floats around in your blood until your cells need thyroid hormone.

However, before cells can use it, T4 has to be converted to T3, the "active" form of the thyroid hormone.  This happens in the cells that need the T3 and in the liver.  

So, we have a couple of things going on here.  The production of T4, which is a thyroid process, and the conversion of T4 to T3, which is a metabolic process and really quite separate from the thyroid.  

Typically, as your FT4 level falls, FT3 level will fall with it.  As I mentioned above, there are some instances where that doesn't happen...temporarily at least.

I hope that helps some or generates more questions.  Anyway, since your FT4 level is on the low side, and you're having hyper symptoms, I think the first thing you need to do is pin down your FT3 level.  While your at it, I'd have FT4 and TSH retested so you have the whole set of labs on the same draw.

[vixie007]

Thank you. I don't take anything else just cytomel. Maybe its time to come off? I was put on the meds at time when my diet was poor etc and now I'm eating enough to feed an army.  I have had two ultrasounds. I have  small nodule that has grown a mm over two years which I was told was not a lot. Im going to have my doctor check my t3. If it's high I'll taper off... ? Again this is not the person Im used to dealing with. I'm guessing it's high b/c I"m taking the cytomel. I'm trying to grasp how it all works but I"m not sure I do 100%. I'm trying to keep everything in my life as balanced as i can so my hoshi's doesn't flip flop. Thank you for your time and thoughts on this.