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Correct Dosage
Hello! I had a total thyroidectomy in February. I went through a bad patch the few weeks after surgery as my levels dropped and they introduced Synthroid into my system. I was (and still am) very tired, lethargic, exhausted. I have gained almost 15 lbs and my hair is falling out at an alarming rate. They had me on 125 mcg of Synthroid, taking an extra 1/2 tablet on Sundays. This week the MD has prescribed 5 mcg of Cytomel twice a day. Prior to the Cytomel my labs were: Free T4 1.35 / Free T3 2.8 / TSH 0.03. I have read pages and pages and blogs and boards and everything else I can get my hands on about thryoid meds and am so confused. I feel marginally better taking the Cytomel but dont know when to take it, with or without food, with or without my Synthroid. Im back to work now and looking for a routine that I can keep to as far as taking the meds, some energy back in my life and the right questions to ask the MD or requests to make about medication changes. Im thinking more Cytomel because it began to make me feel a little tiny bit better? Please help. Single mother of two teenagers, I need all the energy I can muster!
Well, at least he did write you a script for the Cytomel.
TSH is often suppressed by meds. Some people find that TSH drops immediately upon starting T4, others don't see a real drop until they start T3. I suspect your doctor is focusing way too much on your TSH, which is very low. T3 is probably going to further suppress it.
Was your TSH low before surgery?
The T3 you're now taking may do it for you. T3 is much more fast acting than T4, but it still takes some time to build levels. And you can't forget that once levels are good, your body still has to heal from being hypo. That can take some time and often correlates with the length of time you were hypo.
If your TSH drops further, I worry that your doctor will want to reduce, not increase, meds. Be prepared to present your case for treating symptoms, not numbers.
If you get your FT3 up to a better level and are still experiencing symptoms, I'd suggest some vitamin and mineral testing.
TSH is often suppressed by meds. Some people find that TSH drops immediately upon starting T4, others don't see a real drop until they start T3. I suspect your doctor is focusing way too much on your TSH, which is very low. T3 is probably going to further suppress it.
Was your TSH low before surgery?
The T3 you're now taking may do it for you. T3 is much more fast acting than T4, but it still takes some time to build levels. And you can't forget that once levels are good, your body still has to heal from being hypo. That can take some time and often correlates with the length of time you were hypo.
If your TSH drops further, I worry that your doctor will want to reduce, not increase, meds. Be prepared to present your case for treating symptoms, not numbers.
If you get your FT3 up to a better level and are still experiencing symptoms, I'd suggest some vitamin and mineral testing.
I never took any thyroid medication until after the surgery so this is all new to me. I did ask my endo if he would be willing to treat my symptoms and not my numbers early on because I had read about people having that issue with their MDs and initially he said yes but now he says he doesn't want to over treat me and he begrudgingly put me on the Cytomel...He said my numbers are good and I'm where I should be but I told him this can't possibly be normal for me I'm struggling through my days. Ugh.
The key to this disease is staying informed. You can usually get what you need out of most doctors (although some are not worth the fight), but first you have to know what it is you do need. Keep reading...
So, you were on thyroid meds before your TT, or was your thyroid producing some hormone still?
So, you were on thyroid meds before your TT, or was your thyroid producing some hormone still?
You are a wealth of information!!! I've been non stop reading these forums but nothing really applied to me specifically... This is the first time I've asked a question and already I feel better and informed. ....I am a 53 yr old female and have had nodules on my thyroid for about 20 years. ... They got to the point that I was having difficulty swallowing and suffering from hypo symptoms..... Many fine needle biopsies were inconclusive and due to the duration of time I'd had them they decided to take it out.
Your FT4 is at 40% of range, and the guideline (until we each find where we feel best) is 50%, so that was a little bit low. FT3 was 22% of range, and the guideline here is upper half to upper third of range.
So, your FT3 was on the low side, BUT when on T4-only meds, it often takes some time for everything to rebalance. FT3 can continue to rise once FT4 levels are stable.
Since you just started Cytomel this week, I'd advise patience for a while to give everything a chance to settle. I think it would be worthwhile to have another set of labs to see what the addition of Cytomel has done before you make any further changes. When you have blood drawn again, be sure not to take your Cytomel before the draw (unless, of course, your doctor advises you otherwise). That can artificially inflate FT3 level.
Balancing thyroid hormones is a process that requires some patience (I believe Job was hypo!).
Why was your thyroid removed?
So, your FT3 was on the low side, BUT when on T4-only meds, it often takes some time for everything to rebalance. FT3 can continue to rise once FT4 levels are stable.
Since you just started Cytomel this week, I'd advise patience for a while to give everything a chance to settle. I think it would be worthwhile to have another set of labs to see what the addition of Cytomel has done before you make any further changes. When you have blood drawn again, be sure not to take your Cytomel before the draw (unless, of course, your doctor advises you otherwise). That can artificially inflate FT3 level.
Balancing thyroid hormones is a process that requires some patience (I believe Job was hypo!).
Why was your thyroid removed?
Hi Goolarra....thank you for replying! Ranges: Free T4 0.78-2.19 ( I am 1.35) TSH 0.46-4.68 (I am 0.03) Free T3 2.4-4.2 (I am 2.8). These results were before I started Cytomel, approximately 8 weeks post op. Any help/suggestions would be appreciated!
What are the reference ranges on your FT3 and FT4? Ranges vary lab to lab, so you have to post ranges with results.
Most people take their first dose of Cytomel (T3) along with their levo first thing in the morning. The second dose is usually anywhere from noon to 3:00 pm. Any later than that can disturb sleep. That's a place to start, and then you can play with timing to see what works best for you. You don't have to take T3 on an empty stomach like you do T4. If you find your energy lagging in the afternoon, you can move the time of your second dose to earlier to avoid the "crash".
I'll comment on your meds choices once I see reference ranges.
Most people take their first dose of Cytomel (T3) along with their levo first thing in the morning. The second dose is usually anywhere from noon to 3:00 pm. Any later than that can disturb sleep. That's a place to start, and then you can play with timing to see what works best for you. You don't have to take T3 on an empty stomach like you do T4. If you find your energy lagging in the afternoon, you can move the time of your second dose to earlier to avoid the "crash".
I'll comment on your meds choices once I see reference ranges.
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