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Avatar universal

Best time of day for cytomel?

I have been taking levothyroxine 175 mcg every day plus levothyroxine 25 mcg every other day, and I am still experiencing some hypothyroidism symptoms, so my endocrinologist is letting me try T3 (Liothyronine) in addition to Levothyroxine to see if that helps with symptoms.

He has prescribed 150 mcg levothyroxine daily and 2 x 5 mcg liothyronine daily, which I am supposed to split up, but on the bottle it just says take two daily.

For those of you with experience with liothyronine/cytomel, is there a good time to take it if you are taking it twice a day?  One of my biggest hypo symptoms is afternoon fatigue, but I'm assuming I should take the second dose in the evening to spread it out as much as possible?  (Again, this is a trial to see if it helps symptoms, hopefully just adding some T3 at any time of day is going to help).

And... should I wait one hour after taking levothyroxine to take liothyronine when I take the morning dose?  I believe my endocrinologist said to take them together, but I've found conflicting information on this on the internet.

Any advice would be much appreciated!  Thanks.
6 Responses
Avatar universal
Goodness, It's been awhile, since I took Cytomel T3.  I was prescribed 1x5, but split pill in half.  I always took first dose with T4, wait a few  hours, take 2nd dose.  Let's say I take first dose 8am, I'd take next dose after lunch approx 2pm,.  Suggest not taking any T3 after 6pm or close to bedtime.  Good luck, wishing you well.    
1 Comments
Thank you so much for your advice.  
649848 tn?1534637300
COMMUNITY LEADER
Hi Sarah... Typically, the first dose of a T3 medication, such as Cytomel or Liothyronine is taken with one's Levothyroxine in the morning and the second dose around noon/early afternoon; however, there's nothing carved in stone, so you can experiment with the timing and do what works best for you.  T3 does not have to be taken on an empty stomach, like Levothyroxine does so there's more leeway in the timing.  It can be taken with lunch, just before or just after.  

When I was taking 10 mcg T3 (2 X 5 mcg),  I was getting up at 3:30 am to be at work by 5:30 am.  I took my T4 on an empty stomach when I got up, but if I took my T3 that early, the first dose was worn too early in the day.  In view of that, I waited and took the first one sometime around 7:00 am.

I took the second dose around noon or 1:00 pm.  This helped keep my Free T3 levels more stable throughout the day, but allowed them to drop sufficiently as to not interfere with sleep since I had to go to bed by around 7:30 pm.  Of course, most people don't go to bed that early, but it's typically recommended that one not take T3 meds after about 3:00 pm or they could interfere with sleep.  

It all depends on the person though and what works for your schedule.
2 Comments
Thanks Barb , this makes a lot of sense with the timing.  I have afternoon fatigue most afternoons around 2-4, so I will try the second dose around 1pm and see if that helps.
If taking it around 1:00 doesn't help the 2:oo-4:00 fatigue, you might try taking it a bit earlier (like noon) to give it time to kick in before the fatigue sets in.  I find that once the fatigue sets in, it's harder to get rid of it, but if I can prevent it to begin with, I'm okay.  Some days it feels like you're walking a tight rope, but once you get a schedule that works you shouldn't have any trouble (unless the dosage isn't high enough).  

I also found that some days I'd get busy and forget my afternoon dosage... in order to prevent this, I kept an alarm set on my phone since I was never without my phone handy.  That seemed to work out quite well.
Avatar universal
have you checked your vitamin B12 levels.  This can cause fatigue as well.

I personally take a B12 sublingual (gummies at the moment but they don't seem to work as well as the sublingual B12) at around 2PM or so.  This seems to help me with later afternoon and early evening fatigue.

My wife and daughter take their T3 between 2Pm and 3PM.

Nothing seems to be able to affect my wife's ability to sleep.  She can fall asleep anytime, anywhere for the most part.  And she is on fairly high doses of both T4 and T3.  That said, her sleep quality is not the best.  And no she does not have sleep apnea, (checked twice in sleep clinic).

Be aware and prepare your Dr that your next test may very well suppress your TSH!  This may freak out your Dr as it does almost every single doctor and they will want to dramatically cut your dosage.  REGARDLESS of whether you feel better or not.

It seems that T3 seems to be able to overwhelm  the pituitary and it will cut back TSH production as a result.  While possible on any therapeutic value of thyroid medication if large enough dose of even T4.  But T3 really seems to have an effect of suppressing TSH.  So just be prepared n case that happens to you.

Many a person who was just starting to feel well and on the road to recovery, gets the rug pulled out from them as their Dr freaks out at a suppressed TSH, and cuts the dosage, and crashes the patient and they feel like crap again.  Don't let that happen to you!

3 Comments
Thanks for your response.

I take a Vitamin B12 around lunch time (12-1pm) every day - I used to take sublingual but I am currently taking the gummies - maybe I will switch back to sublingual as well and see if that helps.   I was very hypo in October 2018 (2 months after my thyroid removal completion surgery) and I was experiencing odd breathing and tingling problems while running (not heart rate related at all, according to my watch) and found out B12 might be involved with that, so I started supplementing.  I'm not a vegetarian, but I don't eat meat that frequently, so I've kept up with taking B12.  At least my breathing while running and the tingling issue went away.  

I also take a Calcium and D3 supplement as recommended by my doctor, so I will  move the calcium supplement to later in the day so it doesn't interfere with T3.  (I also take iron supplements during certain times of the month, so I'll have to think about when to take those so it doesn't interfere with Calcium or thyroid hormone absorption).

I'm aware T3 usually drives people's TSH down to very low levels.  I'm not sure how my doctor will react to that if that happens, but at least he was willing to try switching to T3.  It sounded like he has let several people try T3, and that they usually say it works for about 6 weeks and stops working for them and they switch back just to levothyroxine, but that it works for some people longer than that.  I don't know if he was trying to talk me out of trying T3 or what, but that seemed like a weird thing to say to me.  If he tries to cut my dose while I'm still experiencing a lot of hypo symptoms based on TSH and refuses to listen to my symptoms, I will need to find a new doctor.  I am hoping, though, that since he is letting me try T3 based on symptoms I have, he will listen to my symptoms as well as looking at the hormone levels after the next blood test when determining whether to change the dose or not.

My goal for the appointment was either to get the doctor to test for free T3 or at least let me try T3 for a period of time, so I guess it was a successful appointment, but I left feeling somewhat defeated and frustrated because both the resident and my endocrinologist were pretty dismissive of my hypo symptoms (I kept complaining about them until he finally said I could try T3).  Doctors seem to have a hard time believing patients when they describe their hypothyroidism symptoms.  I have a lot of sympathy for other people on here that have to go through the same thing - it's very demoralizing.
You should check the ingredients of your B-12 gummies... most of them have a lot of sugar to make them taste good - mostly for kids - and (I've read) tests have shown they don't always have the amount of B-12 (or other vitamin/mineral) stated on the label.  It's important to take vitamins/minerals from a reputable company in order to make sure you're getting what you think you are.  B-12 sublinguals are typically best, because they're absorbed directly into the capillaries under the tongue, in which case, they by-pass the need to be absorbed by the gut and don't affect the absorption of thyroid medications like chewables and pills/capsules would do.

You only need a 4 hour separation between thyroid medications and calcium and other minerals.  If you're taking your last thyroid med at noon/1:00 pm, you could take iron and vitamin D (D needs to be taken with a meal containing fat since it's fat soluble) at dinner time and calcium and any other minerals at bedtime.   Be aware that iron is best absorbed with some vitamin C, which can be in the form of citrus fruit, vitamin C supplement, etc.   Whole fruit is recommended over fruit juices.

Any doctor allowing a patient to take a T3 medication should be willing to test for Free T3, so keep insisting on that test because things can get out of hand quite easily.  

I wish I had a nickel for every time I've left a doctor's office feeling defeated and/or frustrated with a doctor for being dismissive of my hypo symptoms.  That seems to be what they're taught in med school, along with a healthy dose of arrogance.   They seem to believe they know better than we do how we feel, but then we sometimes run across those who simply don't care how we feel.  

As discussed, T3 (and often simply adequate doses of thyroid hormones in general) will cause TSH to be low or suppressed.  Mine has been suppressed (< 0.001) since I began taking thyroid hormones, in spite of an original TSH of 55.5 (that's not a typo).  

Here's defeated and frustrated for you as well as the height of arrogance for a doctor... My last endo told me in no uncertain terms that she did not care how I felt or what symptoms I developed, she would decrease my hormone dosage(s) until she obtained "measurable" TSH.  That (according to her own words) was her single goal, no matter what.  She began by taking away my T3 med, then began dropping my T4, after she changed me from the Levoxyl that I do best on to generic Levothyroxine that I don't do well on... I'd already had some hypo symptoms prior to her dropping my T3 med, but she refused to acknowledge that they were caused by hypothyroidism...

I'll spare all the details, but needless to say, she's no longer my endo.  The sad part was that she came highly recommended and I'd actually been referred to her by my ENT whom I greatly respect.  I'd even waited 6 months for my first appointment with her.  I saw her for nearly 2 yrs thinking she'd realize that she couldn't use TSH as the marker for me, but she refused to believe that.  The last straw was when she declared that technicians at imaging facilities were not trained to tell the difference between thyroid nodules and shadows - because she was angry that someone else had  sent me for an ultrasound after she refused to do so.  I guess she forgot that imaging facilities also employ radiologists to read ultrasounds and they "can" tell the difference... Anyway, she was a total waste of time for me...

My primary doctor is now managing my thyroid and although he's a bit scared of my suppressed TSH and refuses to increase my med dosages, he did put me back to what I was before the endo from he!! started decreasing my meds... He's willing to let my TSH live in the basement and realizes that he has to look at my Frees instead of TSH, although he puts more emphasis on Free T4 than Free T3, which he "somewhat" believes isn't all that important, but he does order it every time he orders blood work.  I'm constantly on the lookout for someone who will be willing to treat aggressively enough to resolve my symptoms but I'm at an age at which most doctors are reluctant to provide adequate levels of thyroid hormones, so until I find that person, I'll stay where I am.

If you can't get adequate treatment from your current doctor, don't wait to start looking around.  Good thyroid doctors can be hard to come by.
Thanks for sharing your experience and advice.

I will switch back to sublingual B12 and see if that helps.  I don't know why I decided to try the B12 gummies in the first place except sometimes it is easier to just take a gummy, but if it's not as effective then that's not a good reason for the gummy.

I know I should take iron with food, but hadn't heard about taking it with vitamin C, and I will start doing that.  I have never liked fruit juice, but I like to have citrus fruits after dinner anyway, so sounds like that will work well.

I'm sorry you have to deal with doctors being dismissive as well.  I'm not sure what kind of training they get on thyroid hormones, my endocrinologist who is supposed to be a specialist in thyroid disorders seems a bit odd - I can't believe I am the first person he has seen with "normal" TSH and free T4 and still numerous hypo symptoms because I think that is fairly common, but he seemed doubtful I was experiencing symptoms.  

As for taking T3 - I'm on day 3, and so far the biggest changes I have noticed are I now have dry eye and a slight headache most of the time, and my mouth gets really dry when I'm running.  (Although all those things are not that big a problem if it can help with the fatigue).  Also it is more difficult to fall asleep at night, so far, but I think I will adapt.  I also think the T3 is helping with the fatigue a bit, which is really good.

As for the timing, I take the first one with the levothyroxine around 7:30-8am.

The second T3:
I took it at 12:45 pm day 1, then did activities when I'm normally fatigued, and I seemed to not be as tired until around 7:30pm.
I took it at 12:00 pm day 2, and still got fatigue around 3pm, so I decided to try it a little later again and see if that helps.
I took it at 12:45 pm day 3 (today) and so far, seems to be helping prevent my afternoon fatigue which is good.

I've also noticed the T3 seems to give me more stamina while I'm running in the morning, but that might just be a mental mind game going on where I think it is giving me more energy and then I run better.

I'm cautiously optimistic that T3 will help.
Avatar universal
Hi Sarah,
I think it is great that you are trying the T4-T3 combo, but I fear that you may be taking too much T4. Your previous average daily dose of 187.5 mcg T4 was very high and would be far too high for most people. Likewise your current 150 T4 plus 10 mcg T3 would also be too high for most people. It evident from your posts that you have done a lot of research on thyroid hormone replacement and if you have this covered, then just disregard my comments.

You may ask - why aren't you hyper if you are taking too much T4? Here is a brief explanation. T4 is normally converted to T3 and Reverse T3 (RT3) in approximately equal amounts. If you take excess T4 you will get a temporary rise in Total T3 (TT3) and FT3, but then your body's mechanism that prevents you from becoming hyperthyroid will start working. That is, your body will start converting a higher percentage of the T4 to Reverse T3 (RT3) rather than T3 so that TT3 and FT3 don't go into the hyper range. Your RT3 will go up above normal and because RT3 is not an active hormone like T3, you can actually experience hypo symptoms.

If you found that your FT3 did not go up as you increased your T4 dose, then the above could be the explanation.

I believe that if indeed you are taking too much T4, then adding the T3 will not improve your symptoms. It would be easy to prove if you are taking too much T4 by getting a RT3 blood test - if it is way above the reference range then you are taking too much T4.

It really would have been wise to get TSH, FT4, FT3 and RT3 measured prior to starting the T4-T3 combo - that way you can see what effect the Cytomel had when you get the next blood tests.

Unfortunately you cannot count on your doctor or endo knowing about these things. If your doctor/endo refuses to send you for blood tests then I would suggest you go to a private lab and pay to get the tests done. You can search for labs online at findlabtest.com.

Keep up the good work Sarah - you are doing the right thing in learning as much as you can about thyroid hormone replacement because you are going to have to live with it for the rest of your life and as you can see, doctor's training and knowledge on the subject is woefully lacking. You're an active person and it's your body and your life. I really think that you are doing the right thing for the long term by going to the T4-T3 combo - now you have to get it to the right dose. You might have to take the bull by the horns and get your own lab tests. Personally I set my goal to get all of my thyroid hormones to near the middle of the reference ranges (TT4, FT4, TT3, FT3, RT3 but not TSH).

2 Comments
Hi telus2,

Thank you for all the information on T4 and reverse T3.  I may indeed need to order my own blood tests because my endocrinologist refuses to order more than TSH and freeT4.  I had been waiting for my latest appointment to get all my numbers since October 2018 and need to put them in a file, but according to my endocrinologist, I might be a "bad absorber" of T4, and that's why I was/am on a high dose.

In November 2018, I was already up to 167.5 mcg levothyroxine a day, my Nov 21 blood test has TSH at 11.100 (0.4-4.00), freeT4 at 1.34 (0.8-1.8).  FreeT4 is above 50% of its range, but I still had symptoms and my TSH was still very high.  (Yes, I realize TSH isn't the best indicator of a thyroid problem, but in this case I think it was indicating I was still having a problem).

After 5 weeks at 175mcg, on Dec. 28, my TSH was 3.72 (normal) and T4 free was 1.61 (0.8-1.8) - moving up in its range but not at the top.  I had a whole host of hypothyroidism symptoms at the time and we upped my dose to the 187.5 (175mcg + 25 mcg) every other day at this point, probably because the TSH was still towards the high end.  (I know TSH isn't the best way to determine thyroid hormone problems, this is just what I was told to do.)  (I also think a TSH of 3.7 for me indicates a problem because I definitely was having problems when my TSH was at 3.4).

This freeT4 at 1.61 is the highest I have ever seen my freeT4, it is actually lower at my next two blood tests when I was at the 187.5mcg, (1.59 and 1.54), but there is probably some variability in these tests, and maybe I've hit some maximum T4 load.  Possibly I was taking too much at 187.5 mcg, and was converting some to RT3 instead of T3. I've also been training for marathons in 2018 and probably increased my muscle mass since starting the 187.5 mcg dose, I don't know what effect that has on thyroid hormone.

All I really know is at all of these doses of thyroid hormone while taking T4 alone, I never felt non-hypo or hyper.

To be fair to the endocrinologist, I have Hashimoto's which is an autoimmune disease, and he did an antibody test for Celiac disease (another autoimmune disease that a lot of people with Hashimoto's also have) because it was taking more T4 than what it should to bring my freeT4 up above 50% of its range, and that was one possibility of why.  That test was inconclusive because apparently I don't make enough IgA to be able to determine if I have Celiac disease or not, and to determine I would need an intestinal biopsy.  I don't have any symptoms of Celiac disease and at the time I was/still am more focused on getting to the right thyroid hormone level than getting more biopsies to find out if I have silent Celiac disease or not... maybe I should do this at some point.

What do I think?  I think I am a bad absorber, and I am probably a bad T4 to T3 converter or have hit that maximal dose where I am converting to RT3, but for me that happens at a higher dose of T4 than normal absorbers.  Does my endurance running play any part in this?  I don't know.  I would love to understand what part exercise has to do with thyroid problems - a lot of elite athletes have thyroid issues and take thyroid hormones, and I feel like there is some connection there, but I have no idea what it is.  I know not giving yourself enough time to recover can stress the thyroid, but I had my first symptoms (I didn't know at the time they were thyroid related) when I was 16-20 years old, well before I started running, and I have Hashimoto's, so it's not like I just magically gave myself Hashimoto's by running too much, I think it was always there.

I will see how I do on the T3 (liothyronine) and see if it helps - so far I haven't had any hyper symptoms.  I no longer have a slight headache (6 days in) (I think the headache was due in part to the new medication, part to PMS, and part to it has been very hot and humid and all those combined to give me a headache).  I still notice my eyes feeling drier and my mouth feeling dry on a run (it is a weird symptom, but I notice these things - not even feeling thirsty, but something is different), but these aren't "problems".  T3 seems to at least be lessening and/or delaying my afternoon fatigue, so that is a major improvement.  I still get tired, but it is not so debilitating.

I think I will eventually end up ordering some of my own tests, just because I like to understand what is going on and make sure I'm doing the right thing.  I'm never going to have a thyroid (unless we make some huge medical breakthroughs in the next few decades), so the more I understand and am able to ask for what I need, the better.  

This is already way too long, so I will add another comment with all my previous and current thyroid tests (and levothyroxine dosage).
Here are all the thyroid test results I have.  I only have one freeT3, and that was ordered by my PCP.  My ENT and my endocrinologist won't/didn't order freeT3 tests.

I will note symptoms if they've changed.  Before 1st test, I gained 30 pounds in 2015-2016 while running a lot and not overeating, but hadn't figured out it was thyroid related.  I have had hypothyroidism menstrual symptoms for years (very heavy and prolonged) but had thought they were due to marathon training and they gradually kept getting worse - eventually I found the lumps on my neck and realized my menstrual symptoms weren't just from marathon running.  (I lost the 30 pounds in 2017 by eating slightly less than I was burning and running a lot of miles, and have maintained a weight around 152-158 pounds throughout this whole thing, that is a normal weight for my height of 5foot9inches - since I was a normal weight my doctors seemed less likely to believe me when I said I was experiencing hypo symptoms).

March 22, 2018 - lumps identified on my neck, multinodular goiter, asked for Hashimoto's test but was told to wait for this thyroid hormone test.
TSH 3.4 (0.4-4.5)
freeT4 1.44 (0.82-1.77)
freeT3 3.2 (2.0-4.4)
Was told I was fine and had no thyroid hormone problem.  (Not true, but I had a bigger problem so focused my energy on getting my multinodular goiter addressed).

July 18, 2018 -- 4 weeks after thyroid lobectomy. Also, identified that I had Hashimoto's in late April, but by then I also had a nodule that might be cancer, so had a lobectomy June 21.    3 nodules were  thyroid cancer, so at this point I was scheduled for more surgery in August).
TSH 7.790 (0.4-4.00)
T4 free 1.08 (0.8-1.8)
I was put on 25mcg levothyroxine at the end of July/beginning of August.  This was probably not enough because I was feeling very sluggish by my next surgery a few weeks later.  Prime feeling very hypo time here.  Also, new hypothyroidism symptom - my hair started falling out a higher rate.  I have tons of hair, it is still falling out at an accelerated rate for over a year, but it is very thick and coarse and I'm not worried about losing hair, but I am tired of picking up hair all the time.

August 23rd, 2018 - 2nd thyroid surgery removing rest of thyroid.  No thyroid hormone test, but started new dosage on Aug. 24.
Dosage change: levothyroxine 125 mcg/day

September 18, 2018 -- 4 weeks after 2nd surgery.  New symptoms?  I don't know because surgery recovery I was feeling pretty good for just having had surgery, but I was already pretty hypo before I went in for surgery.
TSH 16.43 (0.4-4.00)
T4 free 1.20 (0.8-1.8)
Dosage change: 137.5 mcg/day (levothyroxine)

October 10, 2018  -- only "new" symptom was a tingling in my gums and finger tips about 11 miles in to a long run, plus breathing issues while running.  (no heart rate increase to indicate any heart problem, just  a breathing issue.  I started taking vitamin b12 at this point).
TSH 12.83 (0.4-4.00)
T4 free 1.24 (0.8-1.8)
Dosage change: 167.5 mcg/day (levothyroxine) (150 mcg every day + 25 mcg every other day)

November 21, 2018
TSH 11.100 (0.4-4.00)
T4 free 1.34 (0.8-1.8)
Dosage change: 175mcg/day (levothyroxine)

December 28, 2018
TSH 3.72 (0.4 - 4.500)
T4 free 1.61 (0.8-1.80)
Dosage change: 187.5mcg/day (levothyroxine) (175 every day + 25 every other day)

March 12, 2019 -- feeling less tired than the 2nd half of 2018, but still have same menstrual symptoms which are awful, and extreme afternoon fatigue.
TSH 0.276 (0.4-4.5)
T4 free 1.59 (0.8-1.8)
Dosage change: no change. I  struggled with best way to approach endocrinologist about testing for or adding T3, ended up deciding to approach it at my next appointment in person rather than email, thought this would be in May, I didn't know I would end up having to wait until August.  Symptoms were better than in 2018, but not feeling great.

I ran a marathon in May 2019, so in all appearances people think "I'm fine" and "not hypo".  (Running is one thing, even if I am really tired, if I can get my body moving in the morning helps me feel better later in the day).

August 1, 2019 -- still extreme fatigue, still menstrual symptoms, still hair falling out, still some brain fog and focus issues.  
TSH 0.388 (0.4-4.5)
T4 free 1.54 (0.8-1.8)
Dosage change:  Added T3 (liothyronine) 5 mcg x 2 daily, reduced T4 (levothyroxine) to 150mcg daily (started Aug 16)

I will see if symptoms improve.  So far seems to be helping, but is that just in my head?   I don't know.  

Was 187.5 mcg too high?  My T4free seems to have plateaued when I hit 1.60 at 175mcg, but I've also upped my running mileage from probably 25-40 miles a week to up to 40-65 miles per week during this 187.5 mcg period, and I'm not sure what impact that has on thyroid hormones. I guess I could just stop running and see if that helps my conversion (but I don't think I can completely "stop" unless I really had to for injury or illness).  I will cut back on miles after my Sept 21 marathon though.
Avatar universal
Sarah,
TSH: It is odd that your TSH took so long to decrease to a somewhat normal level. The same thing happened to a poster in 2017, but there wasn't any explanation. This is another good example of why doctors should not use TSH to guide the amount of T4 to take. Your TSH seems to be acting normally now though. However people who take only T4 usually do not go to such low TSH as you (0.276 - 0.388), so this is a clue to me that you were taking too much T4.

FT4: I agree that your FT4 flattened-out at 175 mcg T4 and above, which supports the theory that your body will protect you from becoming hyper. It is regrettable that your doctors didn't measure FT3 at the same time.

Poor absorption and poor conversion: Doctors seem to toss these words out when they can't figure out what is going on. I simply would not believe that unless they gave you some incontrovertible proof that was happening. For absorption, I am assuming that you allow enough time between eating and taking the thyroid meds both before and after meals. Your FT4 and FT3 were somewhat normal back in March 2018, so conversion was working then and I don't see any reason to believe that conversion is not normal now.

Based on all the info you provided I still believe that it is quite possible that 187.5 mcg T4 was too much and your current 150 T4 + 10 T3 dose is too much T4.

I think it would be good for you to nail down a game plan now. You ran the marathon in May on 187.5 T4. I think the 150 + 10 is better (but not necessarily optimum) so you should be okay for the September marathon. It takes 4 - 5 weeks for T4 to stabilize, which means it will also take that long for RT3 to stabilize. I would advocate getting new labs at 5+ weeks, which would put you in the week after your next marathon.

If your doctor only orders TSH and FT4 again, I believe they both will be somewhat similar to your last labs and nothing will be learned - he may say you're fine or there is no difference so just go back to T4. If he gets FT3 as well, I predict that it will roughly near mid range. Again, he will say you are fine and just carry on. The only way that you prove that you are taking too much is by getting RT3 - if it is very high, then you're taking too much T4. However you have a big problem - trying to explain that to an endo - not very likely. If you don't think the doc is going to get all those tests then start planning now to get them yourself and if you are going to do that, I suggest going for all of them (TT4, FT4, TT3, FT3, RT3,TSH). You may think that is going overboard. But the way I look at it is that you put 5 weeks of your time and effort into it, so get all the info that you can - really how else can you decide what to do next if don't get all the info you can on what you are taking now.

Ahead of the labs, try to be consistent on when you take the meds. Take your meds as normal on the day before the labs. If possible schedule your labs to be taken at the time that you normally take your morning meds (but do not take the morning meds before the labs are taken).

In the meantime, keep on jogging...
Avatar universal
Sarah,
TSH: It is odd that your TSH took so long to decrease to a somewhat normal level. The same thing happened to a poster in 2017, but there wasn't any explanation. This is another good example of why doctors should not use TSH to guide the amount of T4 to take. Your TSH seems to be acting normally now though. However people who take only T4 usually do not go to such low TSH as you (0.276 - 0.388), so this is a clue to me that you were taking too much T4.

FT4: I agree that your FT4 flattened-out at 175 mcg T4 and above, which supports the theory that your body will protect you from becoming hyper. It is regrettable that your doctors didn't measure FT3 at the same time.

Poor absorption and poor conversion: Doctors seem to toss these words out when they can't figure out what is going on. I simply would not believe that unless they gave you some incontrovertible proof that was happening. For absorption, I am assuming that you allow enough time between eating and taking the thyroid meds both before and after meals. Your FT4 and FT3 were somewhat normal back in March 2018, so conversion was working then and I don't see any reason to believe that conversion is not normal now.

Based on all the info you provided I still believe that it is quite possible that 187.5 mcg T4 was too much and your current 150 T4 + 10 T3 dose is too much T4.

I think it would be good for you to nail down a game plan now. You ran the marathon in May on 187.5 T4. I think the 150 + 10 is better (but not necessarily optimum) so you should be okay for the September marathon. It takes 4 - 5 weeks for T4 to stabilize, which means it will also take that long for RT3 to stabilize. I would advocate getting new labs at 5+ weeks, which would put you in the week after your next marathon.

If your doctor only orders TSH and FT4 again, I believe they both will be somewhat similar to your last labs and nothing will be learned - he may say you're fine or there is no difference so just go back to T4. If he gets FT3 as well, I predict that it will roughly near mid range. Again, he will say you are fine and just carry on. The only way that you prove that you are taking too much is by getting RT3 - if it is very high, then you're taking too much T4. However you have a big problem - trying to explain that to an endo - not very likely. If you don't think the doc is going to get all those tests then start planning now to get them yourself and if you are going to do that, I suggest going for all of them (TT4, FT4, TT3, FT3, RT3,TSH). You may think that is going overboard. But the way I look at it is that you put 5 weeks of your time and effort into it, so get all the info that you can - really how else can you decide what to do next if don't get all the info you can on what you are taking now.

Ahead of the labs, try to be consistent on when you take the meds. Take your meds as normal on the day before the labs. If possible schedule your labs to be taken at the time that you normally take your morning meds (but do not take the morning meds before the labs are taken).

In the meantime, keep on jogging...
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