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Cytomel and Major Depressive Disorder

Since 2000 I have suffered through varying degrees of Depression up to a Suicide attempt in mid 2007.
---interesting side note is that in 2000, when all this started, my weight ballooned to 242 (from what I previously hovered around 185-200-ish). I'm a 37yrd old  5'6" white male.

Since 2003 I have tried over 24+ different anti-depressants, all to limited/no success.(even with very aggressive/high dosages)  Effexor is the closest to "lacking depression", and lasted about 6-months. No other anti-depressant  helped to alleviate the depression. Essentially I was diagnosed with treatment resistant depression, but my Psychiatrist continued on with me because I refused to consider ECT-Electroconvulsive Treatment.

The one and only saving Grace was taking Adderall 30mg 2x day. In addition to Ginko Biloba and excessive amounts of B12 vitamins.  I found that if I could rev. myself up, the depression, anxiety, etc. went away.

Several months the Suicide attempt, I began investigating ECT-Electroconvulsive Therapy.Upon expressing my reservations with the ECT Dr., I explained the symptoms I exhibited (listed below) and what I felt was very odd that the only treatment methodology that made me feel close to normal, involved the Adderall/Ginko/handfuls of B12 vitamins.

She said, "Have you discussed Cytomel with your Psychiatrist".  They viewed my medical chart from a previous visit and found my TSH levels were on the high end (but not outside the boundaries). I believe It was a 5

Over the years, my TSH levels have always been in the 4-5 range.

On November 4th, my Endocrinologist blood test came back with.

TSH---4.995 ---ref range of 0.350-5.50
Free T4--1.30 ---ref range of 0.61-1.76

-=the Endocrinologist failed to pull a Free T3 profile.

The Endocrinologist advised everything is "normal"--DESPITE THE FACT that every single symptom I explained involved Hypothyroidism.

After doing extensive research on the web, I approached my Psychiatrist about the Cytomel suggestion.

On November 9th, 2007 my life changed.  

November 9th started taking 5mcg/day
November 29th upped the dosage to 25mcg day.
I have my energy back and feel normal (when taking Ginko/B12 I had false energy--felt "buzzed" instead of normal).
I no longer take any anti-depressants or Adderall.
I now work out 3+hours a day / 6 days week.
I quite literally have DOUBLED the amount of weight I was exercising with in 2004-5
I feel rejuvenated and refreshed after working out--instead of exhausted and fatigued
I wake up feeling "refreshed" and "rested" and have no trouble getting up out of bed in the a.m.
The "Cognitive Fog" is almost completely gone.

On December 12th, 2007, I had my Cardiologist pull my TSH numbers when taking blood.
The results came back
TSH--3.30 ---ref range of 0.49-4.67
Free T4--0.98 ---ref range of 0.59-1.17
Free T3--549 *HIGH* ---ref range of 230-420 pg/dl

as a side note, the Cardiologist test results came back

“Total protein”  7.5 ---ref range of  6.0 -8.5 g/dl
Cholesterol—182 ---ref range of 55-200
Triglycerides—125 ---ref range of 35-160
Note, my Triglycerides were 201 on 05/25/2007—Pre Cytomel.
HDL—39 ---ref range of 39-85
LDL—139 ---ref range of 0-130

Now, here is my Question.

Am I in a "safe mode" on my Thyroid Levels.
What is the "ideal" numbers to have for TSH, T4, T3?.
Unfortunately, I have no pre/post T3 levels to compare, but both my TSH and T4 are down

Why would two different labs have different ref ranges? If a blood test is supposed to be a scientific measurement, how can the levels of "normal" differ depending on the Lab? The reference level should be Static to be Scientific!!!

I read that the AACE changed the ref ranges to 0.3 to 3.04, why are Labs/Doctors failing to acknowledge this change?

Could I still be Hypo, since my TSH range is 3.30 and is considered "High" on the new AACE ranges.  The only pre-symptom I have post Cytomel is a slight bit of Cognitive Fog remains...but it's 90% better.

Ultimately, I realize I'm 100% in charge of my own health, I'm convinced that Cytomel is the magic bullet for me, but I want to be in the safe ranges.

Pre-Cytomel symptoms over the years I've exhibited / and frequently complained to my Primary Care Dr's / Psychiatrist / Neurologist /ENT / include:
Exhaustion in every dimension–physical, mental, spiritual, emotional
Inability to eat in the mornings--
No Appetite
--I quite literally never "get hungry". I eat one meal a day and never "clean my plate".
Weight gain
--I'm about 60lbs over weight, however there's no rational reason. My caloric intake and caloric burn are in range for someone who should be "average" weight.
An Inability to lose weight
--One noted exception. In 2004-2005 when I was succeeding with Effexor, I would work out 1.5 hours day/6 days week. I lost 60lbs in about 9 months, however  it never helped me feel "rejuvenated".
"Cognitive Fog"--I've had experiences where it would literally take me 10+ seconds to answer a question as simple as what my date of birth is.
Lacked Stamina
Lacked Sex Drive
High cholesterol
Essentially, I can answer "Yes" to 24 of the items on this list.
4 Responses
314892 tn?1264627503
Just quickly, I want to say how great it is that the t3 is helping you and you are off antidepressants.
My psychiatrist is of like mind regarding thyroid meds to treat depression. I had anxiety at a TSH that increased to 6.0 from 3.8. She said that level was nor normal for ME.

I need to read your post more thoroughly, but different labs use different analyzers and samples to come up with a reference range. I work for Quest Diagnostics in the lab. There is definately room for your TSH to come down a bit. Have you asked about t4 meds as well. They can work together. The dr. just needs to then adjust the t3 dose.

You are a sucess story and hope for others in the same situation, though everyone responds differently.
97628 tn?1204465633
Avatar universal
Thank you both for your replies.
Question about the T4 advice.  I've spent probably 80+ hours researching on the web for Hypothyroidism. My perception is that the common theme is that T4 dosage is a waste of time. The theory most discussions center on (1)FDA not allowing changes in T4 dosages, (2) since T4 is the mechanism that regulates T3 most people are more successful going straight to T3.(3) When people are on T4 most Dr's refuse T3 treatment (to the detriment of the patient), and it's not until a T3 therapy regime is followed until Hypo's are feeling better.

I have the best Psychiatrist in the world. He's shown more than enough patience and been more "experimental" than I could ever have hoped for. (i.e. trying off label/augmentation therapies--From what I understand, Adderall treatment for depression is fringe off label). Had he not put me on Adderall *nothing* we tried would have worked. The only two therapies he suggested and I adamantly refused were Lithium (did not want the excessive weight gain) and the ECT suggestion.

So based on Paragraph 1 above--I know I have to be the aggressive one, and continue to "fire" Doctors that even refuse to consider open discussion on extensions to therapy.

For reasons (not appropriate for discussion in a Medical advice forum), I firmly believe It's against a Doctor's best interest to do anything more than conservative/down the middle/whatever a Pharmaceutical Rep/Medical Diagnostic Lab  tells them to do. Whenever you doing something out of the norm, it "costs" you more--either time, energy,effort,monetary, etc..You let someone in front of you in traffic, it "costs" you more time as you get pushed back in line. I know that  Doctors are not in the "cure" business, they are in the "treatment" business. Which I completely understand and accept.

However, with that said.  Do you know where I can find a list or a resource, of Endocrinologists who are more open minded?   Where can I find reputable Scientific Endo data to review?--besides the obvious....New England Journal, etc.

Does there exist a scientific target for TSH  fT3  fT4 level?
It appears no, since even different labs can't agree upon a standard reference range.

It simply boggles my mind that a scientifically measurable factual consistent reference range does not exist between labs. It seems that if you are pulling blood (to obtain a Scientifically factual number), why would the range differ from one Lab to another?  That, above all else, calls into question the validity of the test in the first place. If the establishment can't agree on a Reference range, how can they agree on Treatment Methodology??

It appears to me that seeking accurate Medical Thyroid advice/Treatment, is nothing more accurate than seeking Psychiatric advice/Medication.  It's nothing more than a guessing game until you get it right FOR THE PATIENT (and NOT measure against a "norm").

Since my Psychiatrist is treating me, I know it's important that I take upon myself to monitor my levels. I realize it's not is expertise.

What I find unbearable is that The American Association of Clinical Endocrinologist, their own Medical Governing board, changed Medical Standards and most Doctors  and Labs fail to acknowledge this.

It's a sad state of affairs that a PATIENT has to bring MEDICAL JOURNALS into his Doctor's office to get the help the Patient needs.
314892 tn?1264627503
I can give you some references, but there are rules against posting the websites on here w/o permission.

Send me a message and I can give you some interesting links.

It is obvious that t3 worked for your psychological symptoms, but I don't know how often t3 is used alone. Maybe that explains your high free t3 level.

Many references state that once on treatment meds for hypothyroid, the TSH should be between 1 and 2. Of course some people will feel better above or below this value.

T4 is converted to t3 in the body by nearly everyone, except in rare cases of conversion problems. T4 is sent out by the thyroid (or by taking the t4 meds) to the body where it is converted into t3, which is the active hormone.

Everyone has their own personal TSH range that does not normally vary by more than 0.75. With a wide reference range, a normal reading for one person may not be normal for another. Too bad there isn't a test to determine our normal set point, then doctors would know what # to aim for.

The AACE is coming out with new guideline in mid-late 2008. This debate is fairly new, so I think while there will eventually be a consensus, it will take a while. I'm sure the same thing happened with what is a normal cholesterol, blood sugar level, etc.
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