Dr. keeps lowering synthroid after adding cytomel

[sandt]

I am a 56 yr old female and had RAI at the age of 24. Did not start taking synthroid until my 30's even though I had all the symptoms of being hypo. Last year after seeing a new Dr. I added cytomel. I was taking 150 synthroid and she put me on 137 synthroid and added 10mcg of cytomel (5 twice a day). Began to feel much better, started to lose some weight (while trying) and felt really good. Checked blood again and said my TSH was suppressed, lowered synthroid to 125, then a few months later lowered synthroid to 112 (current) and stayed with the 10 cytomel. Well, now feeling exhausted, gaining weight and cold all the time. She said my #'s for all tests were in the normal range, but decided to up the cytomel to 15 (5 mcg's 3 times a day) in hopes that I would have more energy. I really don't feel that much better and I don't know why she keeps lowering my synthroid. I have been reading that once on cytomel the TSH will be suppressed. Should the synthroid of stayed at 137-even though tsh was suppressed?

[sandt]

Hi, Yes my doctor only took my TSH, because she felt the T-3 and T-4 were recently fine. I felt better when I was taking a slightly higher dose of synthroid 125 or 137 with 10 cytomel. I will keep track of things and hopefully get to the right amounts. Thanks-

[LazyMoose]

To sum it up,...you dont feel well now. Your latest lab looks like 2-8-13       with a TSH of 0.508 , but I dont see any FT3 or FT4 results.

FT3 and FT4 should be taken every time TSH is measured via blood draw.

Due to the more active T3, do not take your meds right before your thyroid blood draw. It will read a temporary high FT3. Try to be consistant in timing your blood draws like early AM, then take your meds after.

I see nothing major, but you dont have current "frees" to comment on. You need these.

Trying different doses is part of the learning game. Make a good thyroid journal for future use.

[sandt]

Thanks for your thoughts. All these years and I'm still trying to figure this all out.

[sandt]

Thanks for your reply.

[sandt]

My ranges are TSH 0.340-5.600
Free T-4 0.61-1.81
Free T-3 2.3-4.2

I think that is the ranges.
Thanks again

[alfonsina]

I personally think that the body needs to adjust to changes and it takes time. That is at least my experience. I have noticed on myself that the less I move between doses the better I start to feel in the long term. But that is personal and if you feel you need it...As LM says you did not post the ranges, I am not sure what would be the range for FT3, I have the feeling it could be in the upper side of it.

I did not do very well on Cytomel. I feel better when my FT4 is a little higher and my medicine has more T4 than T3. I had palpitations, anxiety, did not want to eat, etc on Cytomel, and I am taking about tiny doses. I tolerated better T3 in dessicated though. We are all different.

I also asked my doctor to check for other things: Vitamin D, Vitamin B12, Zinc and iron, per example. I was very low in vitamin D and zinc. I am taking supplements now and my skin, for example looks much better. My concentration is much better, and my anxiety more regulated.

I also started a gluten free diet because I started to see a nutritionist. I have also been doing good on that. I drink only lactose free milk for example and try to avoid dairy in general. I increased my protein intake and I feel also more energized.

What I mean by all these is that for me it was beneficial to start testing other things that might be causing me to feel not really good. Good luck and I hope you find your optimal dose soon:)

[LazyMoose]

We still dont know what your Free t3 and Free t4 ranges are, just your results.

That said , with the exception of FT3 from 2.0 to 3.7, none of your labs have changed very much.

The trick to managing thyroid symptoms is to gain understanding of your labs, your med of choice, and your symptoms at the time. Make a log of this for your personal benefit to look back at in the future.

[sandt]

Thanks again,
Labs:
TSH
2-8-13       0.508
11-18-12    0.719
6-12-12      0.265
3-16-12      0.173  Feeling good from late Fall.2011 - May 2012
1-27-12      0.161

Free T-4
11-18-12    1.17
8-30-12      1.29
3-16-12       1.29

Free T-3
11-18-12     2,8
8-30-12      3.0
1-27-12      3.7
7-21-11      2.0

In July of 2011 my Dr. added cytomel. Lowered my synthroid from 150-137 and 10 cytomel (5 twice a day).   By Jan lowered synthroid to 125 and same cytomel-still feeling ok then lowered to 112 (current) in August and same cytomel and have been exhausted, gaining weight, trouble sleeping and not wanting to do anything. I do work part time-teaching I started seriously eating low-carb in Nov of 2011 and lost 23 pounds by May 2012-feeling really good during that time, Have been gaining weight back since Nov 2012 and will soon gain it all back. Just not myself-cold all the time too. Not sure the third 5mcg of cytomel is helping, but it has only been a few weeks. Thanks for your thoughts.

[Marie0456]

Remember also that cytomel is twice as strong as synthroid medication. I have been hypo for 28 years. Last fall was the first time I had to start taking cytomel. 5mg once a day. At the same time I was diagnosed with a tumor on my pituitary gland. Don't rule out that there might be something else going on in your body. I was on .112 for twenty years before my body started changing. Remember it takes several months for your body to regulate itself with the medication.

[LazyMoose]

Hello again. There are more than several Free T3 and Free T4 lab ranges, this depends on the type of lab instrumentation used. So anyone needs to see the ranges as well as your values for an opinion. Its easier to post per line as opposed to sentences for ease of comparing.

TSH value is not as important as the pattern it shows.

Do you have lab values with ranges from the time you felt best? - This should be your base line to work from.

Some people are still tired at optimal thyroid treatment possibly due to many other things. But you first have to reach optimal thyroid health before looking at other possibilities. Poor sleep (a hypothyroid issue) cant be looked over either. Certain food allergies can make you sleepy.

[sandt]

Hi, Thanks for responding! My latest TSH on 2-8-13 was 0.508, On 11-8-12 my TSH was 0.719, Free T4 was 1.17 and Free T3 was 2.8. On 3-16-12 (when I was really feeling good at 137 synthroid and 10 cytomel) my TSH was 0.173, Free T4 was 1.29 and Free T3 was 2.9. I have had more labs done than this in between these months but as my TSH changed my synthroid was lowered. Because I have been terribly tired and cold and gaining the weight I lost, my Dr. added another 5 mcg's of cytomel. I have a little more energy in the afternoon, but still feel tired and I can't get going or get anything done. My Dr. never said anything about it being normal that the TSH would go down when adding cytomel, she just keeps lowering the synthroid. I should add that after RAI, I have had a weight problem and am constantly working at losing weight and exercising for years!! I am mostly eating low-carb, and staying away from processed food. I also have had uveitis for the last 8 years. Thanks for you help.

[LazyMoose]

"I am a 56 yr old female and had RAI at the age of 24. Did not start taking synthroid until my 30's even though I had all the symptoms of being hypo"
- wow


"Should the synthroid of stayed at 137-even though tsh was suppressed? "

-How much T4 med (synthroid) and T3 med (cytomel) someone takes depends on the individual.

We really need to see your lab reports with Ft3 and Ft4 (with ranges) to comment - in addition to your symptoms. Do you have copies?

Ranges are meant for the average population. What works for one, might not for another person. It does not mean that just because your in range that your symptoms will be gone. Need to fing your range with in the "normal range".  Why Drs dont get this baffles everyone else that understands it..

T3 supplementation does seem to suppress TSH in many people.