Hypothyroid- Levels not responding to medication

[Lissa499]

I am a 39yo female that has been on medication for hypothyroidism for a year so far. I currently take 10mcg Cytomel & 100mcg Synthroid. I recently had my blood work done. I have had my vitamin & iron levels checked & everything was fine except for B12 & I now do shots for that.

TSH = .84    MIU/L  0.40-4.50

Free T4 = 1.1   NG/DL  0.8-1.8

Free T3 = 2.6   PG/ML  2.3-4.2

When I had my blood drawn 6 weeks the doctor increased my Cytomel from 5mcg to 10mcg that I am currently on. The Synthroid was left the same at 100mcg. The blood levels I just posted have not changed since last time even though I had a dosage increase. I go through periods where I feel great right after the dosage increase & then gradually it dissipates to feeling crummy again until they increase again. I am very frustrated that I haven't reached that perfect dosage yet after a year of treatment. Your thoughts?

[ahmee]

Sounds like a smart approach. Your FT3 looks unlikely to raise significantly from such a small synthroid increase, but no harm in being cautious. You will find out at your next blood test how much of an effect that has on your FT3 & FT4 levels and symptoms. Feel free to repost here when you get those results, it would be interesting to compare.

[Lissa499]

The doctor called today and decided to have me alternate 100mcg Synthroid with the 5mcg Cytomel then take 112mcg Synthroid with the Cytomel the next day and so on. I will be starting that tomorrow so I hope that helps.

[Lissa499]

She mentioned what you did that the test results were still not optimal. She told me to take the split dose of Cytomel for a week or so and let her know how I feel. I appreciate your input.

[ahmee]

I'm sure splitting the dose will help you, but your levels of FT3 and FT4 are still not optimal, seeing as you are still symptomatic. The rule of thumb is to aim for 50% of range for Free T4, and yours is at 30% of range. FT3 is even worse at 16% of range, and it is FT3 that has been shown to correlate best with symptoms. In my opinion you are ready to have your synthroid dose bumped up a bit. The hope is that your body will absorb some of that T4 and convert it to T3, so both numbers will rise simultaneously. But in reality, your FT3 is so low still that I would not be surprised if you still need to raise your cytomel dose after raising synthroid. It's just best to go slow and only change one variable at a time. What did your doctor say about these test results?

[Lissa499]

I have been feeling better than I started out last year but I usually feel better when the doctor changes the dosage and then it gradually gets crappy. (tired, achy, feeling cold)  This time I stayed relatively stable. Right before last Thurs when I got my blood drawn I didn't feel great but not as horrible as I usually feel by the time I'm due for a blood draw. So the doctor called me today and told me to take one 5mcg Cytomel in the am then take 5mcg of Cytomel at 2pm. Currently I'm taking both tablets in the morning. So it was exactly what you mentioned! Thank you for your response. I'm hoping this helps keep me on an even keel.

[flyingfool]

What are your symptoms?  How are you feeling?

Do you take your T3 in a single dose or do you take half in the morning and half in the afternoon?  Since T3 is used up in hours so many people do better by taking Cytomel in split doses of at least twice a day.  Helps to keep the energy level up to the end of the day. Rather than a big rush in the morning and then peter out by the end of the day.