ADDITION OF CYTOMEL TO SYNTHROID

[Liz1900]

Hi Dr. Lupo,

    Your advice on my case has been on target in the past months.  After going off of Armour after 40 years because of heart palpitations I have been on Synthroid since mid-March and have felt awful the whole time.  I was on .88 mcg and saw my endo on Wednesday, 21st.  My blood results were within normal range after 4 weeks on .88 mcg and all of my symptoms continued.  He added 1/2 of a 25 mcg tablet of Cytomel ONCE a day and lowered my Synthroid to .75 mcg.  I just started yesterday and after reading some things on the internet, I decided to take the half of pill - one half at a time - morning and afternoon.  So, I am taking a little over 6 mcg twice a day.  I don't want to get any heart palpitations and hoping the Cytomel can help me feel better.  I am basically exhausted, just feel flu-like, hard to function or want to do anything.

    My questions are:
1.   Do you think this is the best way for me to take the Cytomel?

2.   Do you think the reduction in Synthroid is a good one - enough?

3.   I have read that you can take Cytomel with food to cut down on the "rush" or possible heart racing - the instructions with the Cytomel don't say you have to take it on an empty stomach.  Do you recommend that?  I have heard that that would make it more like a time-released version of T3?  I just started the Cytomel yesterday and "think" at times I feel racy heart - but don't know how quickly it works?  May just be nerves.

4.   How long do you think it takes for me to know if I will feel better?

Although my endo says my blood results were in normal range - I think my Free T3 is on low side - comment?

T4  Total                  10.0      (4/5-12.5)
T3  Total                   144       (60-181)
T3 Free                     258       (230-420)
T3 Uptake                  30.4 %  (27.8-40.7)
T4  Free Calculated    3.0        (1.6-3.7)
TSH                           0.75       (0.40-4.50)

Thanks for any insight and advice.
Liz

[Mark Lupo, M.D.]

the other questions --- there is no long acting T3 (although some compounding pharmacies claim to be able to make one....) and it is better to take thyroid meds without food for better absorption in most cases.  You will know within a week if the T3 is helping.

[Mark Lupo, M.D.]

Your labs are normal currently.  The trial of T4/T3 combination has not been shown to be better than T4 alone according to several studies, but some patients do seem to feel better.  Cytomel is about 4x as strong as T4 (synthroid) so for every 1mcg of cytomel, the synthroid dose is decreased by 4mcg....

There is a 5mcg tablet that may be more appropriate - if I try patients on cytomel, we usually ask them to take 5mcg in the am along w/ T4 (at a decreased dose) and see if there is a positive response -- then consider 2x/day at 5mcg from there.

Remember - the likely culprit of the palpitations in the past was the T3 in the armour -- you may experience the same thing with cytomel.

[CarrieRene]

A related discussion, Cytomel - very POSITIVE addition to Synthroid was started.