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adding Cytomel after 5 years on Synthroid
Hi all, so I am 5 years post total thyroidectomy and have been on 125 of synthroid. For the most part, I have felt pretty good and have been able to be very active. Last year I even ran my first 1/2 marathon. But, over the last 10 months or so, things have slowly been creeping downhill. I have a terrible time waking in the morning and either need naps or go to bed early. I have gained about 10 lbs despite my continued exercise program and very healthy diet. And my skin is insanely dry no matter what I put on it. I take all the recommended supplements (fish oils, vitamin, extra D, extra Bs, etc). Anyway, my thryroid doc has recommended that I lower my synthroid and begin taking cytomel along with it. She said that sometimes TT patients do not convert as well after some time. Has anyone else with a TT taken both meds? Did you feel better? I'm just so nervous about changing it up, even though clearly something is going on.
Thanks!
Thanks!
You need to get your doctor to understand that TSH does not correlate with either Free T4 or Free T3, much less with symptoms. Since you are taking thyroid meds, you need to be tested for both Free T4 and Free T3 every time you go in for tests.
A good thyroid doctor will treat a hypo patient clinically as I described above. That is what you need from your doctor, so you should push for it. Also, hypo patients are frequently to low in the ranges for Vitamin D, B12 and ferritin. Deficiency in either can cause symptoms that mimic hypothyroidism Low D or low ferritin can adversely affect metabolism of thyroid hormone. So you need to test for all three and you can supplement on your own to optimize. D needs to be about 55-60, B12 in the upper end of its range and ferritin should be 70 minimum.
A good thyroid doctor will treat a hypo patient clinically as I described above. That is what you need from your doctor, so you should push for it. Also, hypo patients are frequently to low in the ranges for Vitamin D, B12 and ferritin. Deficiency in either can cause symptoms that mimic hypothyroidism Low D or low ferritin can adversely affect metabolism of thyroid hormone. So you need to test for all three and you can supplement on your own to optimize. D needs to be about 55-60, B12 in the upper end of its range and ferritin should be 70 minimum.
Also, now after 2 days on the 88/7.5, I feel odd. Great in the early morning and then a headache and sluggish, almost like withdrawal. Tomorrow I'm just going with 100/7.5 and see what happens.
Ok, I was wondering about that. The thinking was since my T3 level was low normal, that the extra cytomel would bring it up and since my T4 was high normal then lowering the dose would even it out. I honestly don't know much except how I want to feel! I still have 2 months of the 100 synthroid, I'm thinking about just taking that with the split doses of cytomel and see what happens. Then tell my doc if that helps me. Thanks for the advice, it's frustrating feeling like just a bunch of numbers!
Well, you were still having some symptoms with the 1005 dosage. Now you have changed to 88/7.5 mcg, which is not a lot different . One mcg of T3 hs been shown to be approximately the same effect as 3.3 mcg of T4. So your increase of 2.5 mcg of T3 would be about the same as 8 mcg of T4. So not only have you not really increased your total dosage to further improve symptoms, you actually regressed since your T4 dose was decreased by 12 mcg.
Your doctor is trying to maintain TSH within a narrow range that is going to prevent raising your meds enough to relieve symptoms. There are several scientific studies that conclude that hypo patients taking medication adequate to relieve symptoms frequently find that their TSH is suppressed below range. That does not mean the the patient has become hyper, unless they have hyper symptoms due to excessive levels of Free T4 and Free T3, which will not be the case with your new dosage. Free T4 needs to be around the middle of its range, at minimum and Free T3 in the upper third of its range, or as necessary to relieve symptoms.
So you are going to have to work on your doctor to get him to understand TSH is totally useless as a diagnostic by which to medicate a hypo patient. If needed I will be glad to give you some links to scientific studies that might influence how the doctor responds.
Your doctor is trying to maintain TSH within a narrow range that is going to prevent raising your meds enough to relieve symptoms. There are several scientific studies that conclude that hypo patients taking medication adequate to relieve symptoms frequently find that their TSH is suppressed below range. That does not mean the the patient has become hyper, unless they have hyper symptoms due to excessive levels of Free T4 and Free T3, which will not be the case with your new dosage. Free T4 needs to be around the middle of its range, at minimum and Free T3 in the upper third of its range, or as necessary to relieve symptoms.
So you are going to have to work on your doctor to get him to understand TSH is totally useless as a diagnostic by which to medicate a hypo patient. If needed I will be glad to give you some links to scientific studies that might influence how the doctor responds.
Ok, so I was put on 100 of synthroid and 5 of cytomel. I started to feel a bit better, but not optimal. I requested the Free T4 and Free T3. My t4 was 1.2 and my T3 was 2.8. My dr said it was normal but I told her that most feel better with a higher T3 and lower T4, and requested that my T3 dose be raised. She agreed to do that if we lowered the synthroid. So, now I will try 88 of synthroid and split the cytomel to 5 in the morning and 2.5 in the afternoon.
It may well be that you need some T3 added to your meds; however, I can't understand how the doctor could make that decision without even testing for Free T4 and Free T3, just TSH. TSH is a pituitary hormone that is affected by so many things that at best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of the biologically active thyroid hormones, Free T4 and Free T3.
Scientific studies have also shown that Free T3 correlated best with hypo symptoms, whle Free T4 and TSH did not correlate. Further, when already taking thyroid medication, TSH is basically a wasted test. Hypo patients taking thyroid hormone frequently find that taking enough med to relieve symptoms often suppresses TSH below range. So trying to medicate a hypo patient by TSH level does not work.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results. Many members say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range. You can get some good info from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Also, hypo patients re frequently too low in the range for Vitamin D, B12 and ferritin. D needs to be 55-60, B12 in the upper part of its range, and ferritin should be about 70 minimum. You should get the B12 and ferritin tested and supplement as needed.
Based on testing and treatment so far, you need to find out if the doctor is willing to do the testing and then treat clinically, as described above. If not, then you will need to find a good thyroid doctor that will do so.
Scientific studies have also shown that Free T3 correlated best with hypo symptoms, whle Free T4 and TSH did not correlate. Further, when already taking thyroid medication, TSH is basically a wasted test. Hypo patients taking thyroid hormone frequently find that taking enough med to relieve symptoms often suppresses TSH below range. So trying to medicate a hypo patient by TSH level does not work.
A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results, and especially not TSH results. Many members say that symptom relief required Free T4 at the middle of its range, at minimum, and Free T3 in the upper third of its range. You can get some good info from this link written by a good thyroid doctor.
http://www.hormonerestoration.com/Thyroid.html
Also, hypo patients re frequently too low in the range for Vitamin D, B12 and ferritin. D needs to be 55-60, B12 in the upper part of its range, and ferritin should be about 70 minimum. You should get the B12 and ferritin tested and supplement as needed.
Based on testing and treatment so far, you need to find out if the doctor is willing to do the testing and then treat clinically, as described above. If not, then you will need to find a good thyroid doctor that will do so.
My tsh is the only thyroid my endo has run and its at .94, we like to keep it around 1 so it's in a good range, my vit D is 35 which is better than what it was (23) I take 5000 iu of Vit D daily. She has not run other labs. The fact that the tsh is ok but that I'm still having symptoms is what led her to believe that I may need the T3 as well.
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