Aa
1st time poster- Cytomel question
I need some guidance as to how to proceed with some recent dosage (and medication) changes I've made.
First off, vitals: I'm a 38 year old male, who has had Hashimoto's for approximately 6 years now. Over this time frame, I've tried a varied amount of medication and dosages (Levothyroxine, Synthroid, Armour, Naturethroid, Armour + T4, Levoxyl, and due to the recall Synthroid again, and now Cytomel) and I believe that I have discovered the limits of medication that my body can tolerate (no more than 25 mcg T4, and I don't seem to be able to tolerate T3).
My last blood test (7/20/2013) revealed:
TSH- 6.070 mIU/L (Range: 0.270-4.200 mIU/L
FT4- 1.00 ng/dL (Range: .93- 1.70 ng/ dL)
FT3- 2.81 pg/mL (Range: 2.00- 4.40 pg/ mL
My Endo originally advised me that the TSH was high, to go ahead and double the synthroid to 50 mcg.
Since I've been down that road already, and had the worst experience of my life at the time, I informed him that I didn't want to do that again. Back in 2008, 50 mcg of Synthroid gave me horrible panic attacks, tight chest, racing thoughts, flushing, sleep disturbances, and heart palpitations. I found that reducing the T4 to 25 mcg erased all of these side effects. The issue is that I have never been able to shake my 2 least favorite symptoms: foggy brain and lowered enthusiasm/ mood. No dose of T4 alone seems to fix this for me. I've tried different meds (generic, Synthoid, and Levoxyl) with varying degrees of success (Levoxyl seemed to work best shortly before the recall, but it was still lacking), and as I mentioned- different doses. Any time I got above 25 mcg T4, I experienced side effects. These side effects were in direct relation to the strength of the dosage. For example: in 2010 I tried 37.5 mcg. Within 2 weeks I was feeling flushing (annoying), which led to agitation/ anxious feelings, which led to sleep disturbances (waking and not being able to go back to sleep). Once my sleep gets disturbed, I realize that something is wrong and I don't wait anymore like I did in 2008. I change the dosage. Similarly, I tried 31.25 mcg T4, to the same; albeit lesser, results as the 37.5 mcg dose. That one was interesting, it hit me as anxiety first...I was sitting at home, enjoying some silly Sci-Fi show, and all of a sudden, for no reason, I start getting panicked. I had to relax- but couldn't. I started getting freaked out by a show that I watch all of the time. Sheesh...
With the natural, I never found that it worked well for me- even though I believe that it is easier on the body than the synthetics. Blood tests revealed that I never received enough T4, so I would increase the dosage of Armour, only to begin to suffer from the side effects of T3 (sleep disturbances, anxious in a.m. after dose, chest tightness) at dosages above 30 mg (4.5 mcg T3- another ceiling).
OK, so I've found my limits of T4 (25 mcg). Apparently, I found my limit of T3 (4.5 mcg).
But after my Endo recommended a dosage increase last week because of the TSH, I asked to try with Cytomel. He is a great doc, and since he had already wrote me an RX for Cytomel last year (which I never tried out of fear), he wrote again with no issue.
Last Thursday, to be as conservative as possible (I've learned to respect the thyroid hormones), I kept my 25 mcg Synthroid dose and simply added 1.25 mcg Cytomel (I cut the tablet into 1/4).
I noticed both good and bad with this dosage:
Good: practically immediate perfection (yes, perfection) in mood, and mental clarity. I was calm, happy, and thankful. My 2 biggest nemesis, erased with 1.25 mcg T3.
Bad: Some minor sweating of hands and feet (willing to write it off as it was the 1st day), slight chest tightness/ discomfort, at the end of the day I could not fall asleep, and woke up shortly after (3:00am) and it took a solid hour and a half to fall asleep again (not willing to write that one off).
So last Friday (7/19) I called my doc, and asked since the T3 brought good, but that there was (still) bad, could I cut the T4 down by 25%? He agreed, and I gave 2 days with no T3 to just let my system come down (Saturday and Sunday) with a lower dose of T4 (18.75 mcg). This seemed wise as I didn't sleep through the night until Sunday night, yet still felt mentally great both Saturday and Sunday.
Monday (7/22) came, I felt like I was really coming down, so I did 18.75 mcg T4 & reintroduced the Cytomel at 1.25 mcg.
Monday was a wash, as I felt defeated as all day I felt like crap. Tuesday morning I tried again, and to my chagrin I felt better, my chest felt great, my body pretty good (I had been feeling stiff on T4 alone), and though not as good as on Thursday, my mood and mental function were good (felt I could use a tiny boost, but good).
I felt as though I may have arrived.
Tuesday night arrived, and although I was able to get to sleep good, I couldn't stay asleep (woke at 3:00am again. What is it with 3:00am?). And it seemed harder to fall asleep as it did on Thursday.
Defeatedly, I called my doc and asked how to proceed. He called back late in the day when I had stepped out, and told me that if I was still having effects after having dropped the T4 then to drop the T3 altogether.
It made me wonder though (hence this long post):
1.) do I just need to stick it out? (i.e.- this is a temporary adjustment and I need to deal with it?)
2.) should I try again with a lower dose of T4? Maybe 12.5 w/1.25 T3 as a last resort?
3.) should I switch back to a low dose of Armour (15 mg), and add some T4?
4.) am I just not able to tolerate T3 and maybe move to nighttime dosing of T4 only?
Thank you for getting this far if you have. T3 seems to be the only thing that alleviates my mental fogginess and improves my mood, but now it doesn't seem that even at the lowest dose I could take (1/4 of a 5 mcg pill), that it work with my body.
I appreciate any guidance.
First off, vitals: I'm a 38 year old male, who has had Hashimoto's for approximately 6 years now. Over this time frame, I've tried a varied amount of medication and dosages (Levothyroxine, Synthroid, Armour, Naturethroid, Armour + T4, Levoxyl, and due to the recall Synthroid again, and now Cytomel) and I believe that I have discovered the limits of medication that my body can tolerate (no more than 25 mcg T4, and I don't seem to be able to tolerate T3).
My last blood test (7/20/2013) revealed:
TSH- 6.070 mIU/L (Range: 0.270-4.200 mIU/L
FT4- 1.00 ng/dL (Range: .93- 1.70 ng/ dL)
FT3- 2.81 pg/mL (Range: 2.00- 4.40 pg/ mL
My Endo originally advised me that the TSH was high, to go ahead and double the synthroid to 50 mcg.
Since I've been down that road already, and had the worst experience of my life at the time, I informed him that I didn't want to do that again. Back in 2008, 50 mcg of Synthroid gave me horrible panic attacks, tight chest, racing thoughts, flushing, sleep disturbances, and heart palpitations. I found that reducing the T4 to 25 mcg erased all of these side effects. The issue is that I have never been able to shake my 2 least favorite symptoms: foggy brain and lowered enthusiasm/ mood. No dose of T4 alone seems to fix this for me. I've tried different meds (generic, Synthoid, and Levoxyl) with varying degrees of success (Levoxyl seemed to work best shortly before the recall, but it was still lacking), and as I mentioned- different doses. Any time I got above 25 mcg T4, I experienced side effects. These side effects were in direct relation to the strength of the dosage. For example: in 2010 I tried 37.5 mcg. Within 2 weeks I was feeling flushing (annoying), which led to agitation/ anxious feelings, which led to sleep disturbances (waking and not being able to go back to sleep). Once my sleep gets disturbed, I realize that something is wrong and I don't wait anymore like I did in 2008. I change the dosage. Similarly, I tried 31.25 mcg T4, to the same; albeit lesser, results as the 37.5 mcg dose. That one was interesting, it hit me as anxiety first...I was sitting at home, enjoying some silly Sci-Fi show, and all of a sudden, for no reason, I start getting panicked. I had to relax- but couldn't. I started getting freaked out by a show that I watch all of the time. Sheesh...
With the natural, I never found that it worked well for me- even though I believe that it is easier on the body than the synthetics. Blood tests revealed that I never received enough T4, so I would increase the dosage of Armour, only to begin to suffer from the side effects of T3 (sleep disturbances, anxious in a.m. after dose, chest tightness) at dosages above 30 mg (4.5 mcg T3- another ceiling).
OK, so I've found my limits of T4 (25 mcg). Apparently, I found my limit of T3 (4.5 mcg).
But after my Endo recommended a dosage increase last week because of the TSH, I asked to try with Cytomel. He is a great doc, and since he had already wrote me an RX for Cytomel last year (which I never tried out of fear), he wrote again with no issue.
Last Thursday, to be as conservative as possible (I've learned to respect the thyroid hormones), I kept my 25 mcg Synthroid dose and simply added 1.25 mcg Cytomel (I cut the tablet into 1/4).
I noticed both good and bad with this dosage:
Good: practically immediate perfection (yes, perfection) in mood, and mental clarity. I was calm, happy, and thankful. My 2 biggest nemesis, erased with 1.25 mcg T3.
Bad: Some minor sweating of hands and feet (willing to write it off as it was the 1st day), slight chest tightness/ discomfort, at the end of the day I could not fall asleep, and woke up shortly after (3:00am) and it took a solid hour and a half to fall asleep again (not willing to write that one off).
So last Friday (7/19) I called my doc, and asked since the T3 brought good, but that there was (still) bad, could I cut the T4 down by 25%? He agreed, and I gave 2 days with no T3 to just let my system come down (Saturday and Sunday) with a lower dose of T4 (18.75 mcg). This seemed wise as I didn't sleep through the night until Sunday night, yet still felt mentally great both Saturday and Sunday.
Monday (7/22) came, I felt like I was really coming down, so I did 18.75 mcg T4 & reintroduced the Cytomel at 1.25 mcg.
Monday was a wash, as I felt defeated as all day I felt like crap. Tuesday morning I tried again, and to my chagrin I felt better, my chest felt great, my body pretty good (I had been feeling stiff on T4 alone), and though not as good as on Thursday, my mood and mental function were good (felt I could use a tiny boost, but good).
I felt as though I may have arrived.
Tuesday night arrived, and although I was able to get to sleep good, I couldn't stay asleep (woke at 3:00am again. What is it with 3:00am?). And it seemed harder to fall asleep as it did on Thursday.
Defeatedly, I called my doc and asked how to proceed. He called back late in the day when I had stepped out, and told me that if I was still having effects after having dropped the T4 then to drop the T3 altogether.
It made me wonder though (hence this long post):
1.) do I just need to stick it out? (i.e.- this is a temporary adjustment and I need to deal with it?)
2.) should I try again with a lower dose of T4? Maybe 12.5 w/1.25 T3 as a last resort?
3.) should I switch back to a low dose of Armour (15 mg), and add some T4?
4.) am I just not able to tolerate T3 and maybe move to nighttime dosing of T4 only?
Thank you for getting this far if you have. T3 seems to be the only thing that alleviates my mental fogginess and improves my mood, but now it doesn't seem that even at the lowest dose I could take (1/4 of a 5 mcg pill), that it work with my body.
I appreciate any guidance.
COMMUNITY LEADER
How long have you been staying on each dose? Seems like you're doing a lot of changing... It takes 4-6 weeks for a T4 med reach full potential in your blood and it also takes quite a bit of time for it to leave your system, because of it's long 1/2 life. If you're not giving each dose (of T4 med) at least 4 weeks (often takes longer), you aren't getting the benefit of the change.
It's also not unusual for symptoms to worsen(or new ones to appear), once med/dosage has been changed.
T3 med is faster acting, so will be in/out of your system within a couple days.
Some of us have used some pretty creative ways to increase slowly. One is to alternate dosages - I've done that with several different dosages.
It's also not unusual for symptoms to worsen(or new ones to appear), once med/dosage has been changed.
T3 med is faster acting, so will be in/out of your system within a couple days.
Some of us have used some pretty creative ways to increase slowly. One is to alternate dosages - I've done that with several different dosages.
There are some patients that are very sensitive to thyroid (and other ) meds. That could always be in play for you. Also, it is possible that you need to start with a very low dose and then increase very, very slowly.
As for no. 3, since both your Free T4 and Free T3 are low in the range, there is no evidence so far that you do not convert T4 to T3 adequately, so it might be best to start with T4 only.
Another possibility comes to mind which causes me to ask if you have been tested for Vitamin D, B12 and ferritin. Hypo patients are frequently too low in the ranges for those important vitamins/minerals. If you have been tested for those, please post results and their reference ranges.
One further question is whether you have ever been tested for adrenal function.
As for no. 3, since both your Free T4 and Free T3 are low in the range, there is no evidence so far that you do not convert T4 to T3 adequately, so it might be best to start with T4 only.
Another possibility comes to mind which causes me to ask if you have been tested for Vitamin D, B12 and ferritin. Hypo patients are frequently too low in the ranges for those important vitamins/minerals. If you have been tested for those, please post results and their reference ranges.
One further question is whether you have ever been tested for adrenal function.
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