Cytomel withdrawal

[grams2]

I have  had Hashimoto's for about 20 years.  For the first five or six years I took synthroid only.  After reading an article about Cytomel and speaking with my endocrinologist, he added Cytomel to my treatment.  Recently he decided to reduce my Cytomel dosage by 1/2.  Since that change, I have less energy and can't seem to stay awake.  Could the lower dosage be the cause?

[gimel]

In an untreated patient there is a continuous low flow of thyroid hormone that creates a balance among Free T4, Free T3, and TSH.  Free T4 and Free T3 are the biologically active thyroid hormones (not the same as Total T4 and Total T3).  Even in that situation TSH does not correlate well  with either FT4 or FT3, much less correlate with symptoms.  When a hypothyroid patient takes a significant dose of thyroid med all at once, it drastically affects the equilibrium and scientific studies have shown that hypo patients taking thyroid med adequate to relieve hypo symptoms usually have a resultant suppressed TSH.     That does not mean the patient is hyperthyroid unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3.  So, although not understood and accepted by most doctors, TSH should not be used to determine thyroid medication dosage.   A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being influenced by resultant TSH.  Symptom relief should be all important, not just test results, and especially not TSH.  So your Cytomel dosage clearly should not have been reduced.  Are you taking any thyroid med other than T3?  Were you symptom free before dosage change?  Have you been tested for Free T4 and Free T3?  If not, you should make sure those are done every time you are tested.  

You can read all about this in the following link.  I highly recommend reading at least the first two pages and more if you want to  get into the discussion and scientific evidence for all that is recommended.  Note especially Rec. 10 on page 13, dealing with suppressed TSH.

http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf

In the link you can also note Sugg. no. 4 on page two that lists important tests.  Among those, if not tested for Vitamin D, B12 and ferritin, those should be done and then supplemented as needed to optimize.  D should be at lest 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.

[Kellikacz]

I'm  feeling the same way right now. I was on 10mcg of cytomel split into 2 doses daily. In 8 weeks my TSH went from .44 to .03. The doctor dropped my dose in half. It'll be two weeks tomorrow and I feel horrible. Is this normal and how long could it last? I'm lethargic, everything aches and I feel like I have the flu. Feel feverish but no fever.

[gimel]

No question that a reduction of T3 med would have that effect.  What was your dosage?  Why did he reduce the dosage?  Was it because of a suppressed TSH level that he decided meant that you were hyperthyroid?  If so, that is incorrect.  You are hyper only if having hyper symptoms due to excessive levels of Free T3 and Free T4.

Please post your last couple of rounds of  thyroid test results and reference ranges so that we can have a look, and better understand the doctor's actions.