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Incorporating Cytomel into Sythroid dosage
Hello, Doctor -- I had a thyroidectomy in 2008 and after years of lab ups and downs, have settled into 137 mcg of Synthroid 6 days/week (822 mcg total/week). I am still experiencing fatigue, depression, constipation, etc. but my endocrinologist is unwilling to discuss other prescription options.
My most recent labs:
T4 = 1.8 (range .7-1.7)
TSH = .21 (range .3-5.0)
T3 = 2.9 (range 2.2-5.0)
Thyroglobulin <20; .4 tumor marker
My primary doctor (not my endocrinologist) was willing to prescribe Cytomel to increase my T3 level in the hopes of taking me off of Bupropion XL (150 mg/day) and dealing with my other symptoms.
We changed my dosages to:
88 mcg Synthroid and 7.5 mcg Cytomel daily.
I have been taking this combination for two weeks and haven't seen much difference in my energy level, etc.
Does this dosage seem correct?
I have labs scheduled again in 6 weeks.
Thank you so much!
My most recent labs:
T4 = 1.8 (range .7-1.7)
TSH = .21 (range .3-5.0)
T3 = 2.9 (range 2.2-5.0)
Thyroglobulin <20; .4 tumor marker
My primary doctor (not my endocrinologist) was willing to prescribe Cytomel to increase my T3 level in the hopes of taking me off of Bupropion XL (150 mg/day) and dealing with my other symptoms.
We changed my dosages to:
88 mcg Synthroid and 7.5 mcg Cytomel daily.
I have been taking this combination for two weeks and haven't seen much difference in my energy level, etc.
Does this dosage seem correct?
I have labs scheduled again in 6 weeks.
Thank you so much!
I also was accused of "loving the high" by one endocrinologist, who ONLY went by TSH ( mine is historically low and on medication almost non-existant ) He said I shouldn't be on medication at all, after talking to me for about 5 minutes, even though I have nodules on both lobes of my thyroid, which is why I was given Synthroid in the first place. When I started to talk about my symptoms, he said he wasn't interested. When I said I didn't feel well without medication, he said (direct quote) "Well, sure. EVERYBODY feels better on speed." REALLY ? Even someone who'd recently been hospitalized for a panic attack that lasted for 4 days that even massive doses of Xanax wouldn't quell ? Funny how my "anxiety disorder" went away immediately when my PCP agreed to give me T3. Grrrrrrrrrrrrrrrrrrrr indeed.
I'm no doc, but deductively since T4 converts to T3 and your T3 is so low, wouldn't it make sense that you feel better when your T4 is high because it at least converted SOMETHING ? Have you ever had an rT3 test ?
Another tip that I found valuable for myself as I went along was to try to have my blood drawn at the same time of day (so I usually go to the lab rather than have it done in my doctor's office), to get copies of my lab reports to keep a file on myself, and to write the dose of medication I was on directly on the lab report for reference.
And thanks for the info, Barb.
I'm no doc, but deductively since T4 converts to T3 and your T3 is so low, wouldn't it make sense that you feel better when your T4 is high because it at least converted SOMETHING ? Have you ever had an rT3 test ?
Another tip that I found valuable for myself as I went along was to try to have my blood drawn at the same time of day (so I usually go to the lab rather than have it done in my doctor's office), to get copies of my lab reports to keep a file on myself, and to write the dose of medication I was on directly on the lab report for reference.
And thanks for the info, Barb.
Thank you all SO much for your input!
To clarify: I was taking 137 mcg 5x/week and 1/2 tablet 2x/week for a total of 822 mcg.
I had also read that Cytomel is 4x as powerful so that is how I calculated the reduction of Synthroid and the addition of Cytomel.
During all the years that I've been on Sythroid, I've always felt best with my Free T4 in the higher range (although my endo insists that I'm addicted to the "high" -- grrr). They want to keep my TSH below .3 because they found one (!) cancer cell in my thyroid and want to be sure that it doesn't decide to function on it's own (I did the radioactive iodine two times prior to my thyroidectomy).
I had NO idea that I shouldn't take my meds before my labs! I won't take them this time around. BTW - I insisted they check my Free T3 on these last labs. If I hadn't done the research, I would have never made the correlation. They just keep throwing other meds at me to counteract my low T3 issues.
I'm just getting a little nervous because I've actually gained weight in the last two weeks and feel no increase in energy. I don't want to go backwards!
To clarify: I was taking 137 mcg 5x/week and 1/2 tablet 2x/week for a total of 822 mcg.
I had also read that Cytomel is 4x as powerful so that is how I calculated the reduction of Synthroid and the addition of Cytomel.
During all the years that I've been on Sythroid, I've always felt best with my Free T4 in the higher range (although my endo insists that I'm addicted to the "high" -- grrr). They want to keep my TSH below .3 because they found one (!) cancer cell in my thyroid and want to be sure that it doesn't decide to function on it's own (I did the radioactive iodine two times prior to my thyroidectomy).
I had NO idea that I shouldn't take my meds before my labs! I won't take them this time around. BTW - I insisted they check my Free T3 on these last labs. If I hadn't done the research, I would have never made the correlation. They just keep throwing other meds at me to counteract my low T3 issues.
I'm just getting a little nervous because I've actually gained weight in the last two weeks and feel no increase in energy. I don't want to go backwards!
COMMUNITY LEADER
One reference:
"once you do decide to add T3, don't reduce the T4 by 50%, as was done in the research study. Instead, maybe cut it down by 12.5 or 25 mcg, and add 5 mcg T3 initially."
That from:
http://thyroid.about.com/b/2003/10/30/recent-thoughts-on-the-t3t4-debate-from-richard-shames-md.htm
I know there are other references, as well, plus that's what my endo told me and which we did, when I added the T3 med, because the cytomel is so much more potent than the T4.
"once you do decide to add T3, don't reduce the T4 by 50%, as was done in the research study. Instead, maybe cut it down by 12.5 or 25 mcg, and add 5 mcg T3 initially."
That from:
http://thyroid.about.com/b/2003/10/30/recent-thoughts-on-the-t3t4-debate-from-richard-shames-md.htm
I know there are other references, as well, plus that's what my endo told me and which we did, when I added the T3 med, because the cytomel is so much more potent than the T4.
FReebird, Barb is SO right, you did say 7 days a week now, I'm so sorry. Tired at the end of a long day. Thanks for catching my error, Barb !
Barb, can you tell me where to look for that information on the 25 mcg reduction ? I don't want to be putting out bad information for other patients and I have been adjusting my own dosage based on being told to calculate total load, with Cytomel/T3 being 4 X stronger than T4.
Not challenging at all, just curious. The 4X formula turned out to be right for me, especially when I got down to the last minute tweekings of plus or minus 5mcg T3 with concurrent lowering or raising of T4. I was working with 112, 125, and 150 mcgs of T4 along with 25, 30, and 35 mcgs of Cytomel and trying to get the T4 to carry as much of the load as possible. It was amazing to me how such slight changes made such a big difference in how I felt and also how the lab tests varied. I am now on 150 mcg T4 and 30 mcg Cytomel with FREE labs stabilized in mid-range for T4 and in the upper 3/4 range for T3. Feeling pretty good, but it took a lot of testing to get there.
Just a reminder that we shouldn't take our medication before our blood draw, especially with T3.
Best to all.
Barb, can you tell me where to look for that information on the 25 mcg reduction ? I don't want to be putting out bad information for other patients and I have been adjusting my own dosage based on being told to calculate total load, with Cytomel/T3 being 4 X stronger than T4.
Not challenging at all, just curious. The 4X formula turned out to be right for me, especially when I got down to the last minute tweekings of plus or minus 5mcg T3 with concurrent lowering or raising of T4. I was working with 112, 125, and 150 mcgs of T4 along with 25, 30, and 35 mcgs of Cytomel and trying to get the T4 to carry as much of the load as possible. It was amazing to me how such slight changes made such a big difference in how I felt and also how the lab tests varied. I am now on 150 mcg T4 and 30 mcg Cytomel with FREE labs stabilized in mid-range for T4 and in the upper 3/4 range for T3. Feeling pretty good, but it took a lot of testing to get there.
Just a reminder that we shouldn't take our medication before our blood draw, especially with T3.
Best to all.
COMMUNITY LEADER
It's customary to decrease T4 med by 25 mcg for every 5 mcg of T3.
If I understood correctly, you DID take the 137 mcg only 6 days/week, which equaled 822 mcg/week; now you take the 88 mcg synthroid with 7.5 daily (7 days/week), which is 88 X 7 = 616 mcg T4, plus T3 of 7.5 X 4 = 30 X 7 = 210 mcg T3, for a total of 826 mcg/week (616 T4 + 210 T3). I think that might have caused some confusion.
Pretty close to the same dosage, just less T4 and more T3, which hopefully, will bring your levels to a good point.
Studies show that T4 does not correlate well with symptoms.... T3 does. But for some of us, even T3 doesn't have an immediate impact.
If I understood correctly, you DID take the 137 mcg only 6 days/week, which equaled 822 mcg/week; now you take the 88 mcg synthroid with 7.5 daily (7 days/week), which is 88 X 7 = 616 mcg T4, plus T3 of 7.5 X 4 = 30 X 7 = 210 mcg T3, for a total of 826 mcg/week (616 T4 + 210 T3). I think that might have caused some confusion.
Pretty close to the same dosage, just less T4 and more T3, which hopefully, will bring your levels to a good point.
Studies show that T4 does not correlate well with symptoms.... T3 does. But for some of us, even T3 doesn't have an immediate impact.
I also am not a doctor. I am a patient who also takes T4 plus T3. As Barb noted, the doctors do not comment on the forum.
I'm a little confused by your doctor's dosages because your total thyroid load is now much lower than it was when you were "settled in" on 137 mcg of Synthroid. According to your labs your TSH was slightly below average range (equals hyper for some but not all, and you don't mention hyper symptoms) and your T4 is slightly high. In the meantime your T3 is pretty low and could go up to as much as 3.6 in that lab range. I will say that the ranges your lab uses are unfamiliar to me, mine uses more narrow ranges. But here on the forum, most people report that they feel the best when their FREE T4 is in the middle of the range or slightly higher and their FREE T3 is from 2/3 to 3/4 into the upper normal range.
Cytomel (T3) is four times stronger than Synthroid (T4). Therefore instead of taking 137 mcg of thyroid hormone, you are now taking 118 mcg total. That works out like this :
7.5 mcg Cytomel X 4 = 30mcg plus 88 mcg Synthroid = 118 mcg total thyroid hormones per day.
You state that you take your medication only 6 days a week, and that your previous thyroid hormone intake for those 6 days was 822 mcg. Your 6 day weekly intake is now 708 mcg, quite a significant difference.
I would have thought your doctor might have given you 100 mcg of Synthroid plus 7.5 mcg of Cytomel = 30 mcg, which would have put you at 130 mcg total hormones, more near to the amount of medication you had "settled into"....and then tested after 6 weeks to see if your TSH and FREE T4 had slightly reduced while bringing your FREE T3 level up. Of course you will want the T4 to carry as much of the total load as possible because it stays in the body longer, but to take enough T3 to make up for tissue resistance or lack of conversion. Perhaps your doctor will do that after your next blood test. You must NEVER take your T4/Cytomel before your blood test or it will skew the results high. It's best not to take either of your meds until after the test.
Usually lab results like yours tend to indicate a conversion problem, therefore necessitating the use of T3 as well as T4. The reason this correlates with depression is because T3 is the hormone that carries seratonin across the synapses in the brain. If there is not enough T3 to do the job, seratonin cannot get through and the patient cannot feel at ease, if not "happy".
Wish you all the best. It took a while for me to adjust the FREE T3 levels, but it has made all the difference. No more depression and no more panic attacks either.
Cytomel (T3) is four times stronger than Synthroid (T4). Therefore instead of taking 137 mcg of thyroid hormone, you are now taking 118 mcg total. That works out like this :
7.5 mcg Cytomel X 4 = 30mcg plus 88 mcg Synthroid = 118 mcg total thyroid hormones per day.
You state that you take your medication only 6 days a week, and that your previous thyroid hormone intake for those 6 days was 822 mcg. Your 6 day weekly intake is now 708 mcg, quite a significant difference.
I would have thought your doctor might have given you 100 mcg of Synthroid plus 7.5 mcg of Cytomel = 30 mcg, which would have put you at 130 mcg total hormones, more near to the amount of medication you had "settled into"....and then tested after 6 weeks to see if your TSH and FREE T4 had slightly reduced while bringing your FREE T3 level up. Of course you will want the T4 to carry as much of the total load as possible because it stays in the body longer, but to take enough T3 to make up for tissue resistance or lack of conversion. Perhaps your doctor will do that after your next blood test. You must NEVER take your T4/Cytomel before your blood test or it will skew the results high. It's best not to take either of your meds until after the test.
Usually lab results like yours tend to indicate a conversion problem, therefore necessitating the use of T3 as well as T4. The reason this correlates with depression is because T3 is the hormone that carries seratonin across the synapses in the brain. If there is not enough T3 to do the job, seratonin cannot get through and the patient cannot feel at ease, if not "happy".
Wish you all the best. It took a while for me to adjust the FREE T3 levels, but it has made all the difference. No more depression and no more panic attacks either.
Thank you for your response!
Those are my Free T3 and T4 results.
Yes, in order to switch from only Synthroid to a combination, we lowered the Synthroid to 88 and added the Cytomel. My doctor originally suggested 125 mg Synthroid with the 7.5 of Cytomel but (from all the info that I read) I thought that might be a little much. I've been through the panic attack phase and don't want to take a risk of it reoccurring.
I'm trying to be patient, but I'm beginning to fear that my T4 is going down (fatigue, weight gain, etc.) after we finally got it in the upper range (where I feel pretty well -- considering!).
I have also been splitting my dose like you suggested.
I'm on 2000 mg Vitamin D daily, but the B12 . . . no clue.
Those are my Free T3 and T4 results.
Yes, in order to switch from only Synthroid to a combination, we lowered the Synthroid to 88 and added the Cytomel. My doctor originally suggested 125 mg Synthroid with the 7.5 of Cytomel but (from all the info that I read) I thought that might be a little much. I've been through the panic attack phase and don't want to take a risk of it reoccurring.
I'm trying to be patient, but I'm beginning to fear that my T4 is going down (fatigue, weight gain, etc.) after we finally got it in the upper range (where I feel pretty well -- considering!).
I have also been splitting my dose like you suggested.
I'm on 2000 mg Vitamin D daily, but the B12 . . . no clue.
COMMUNITY LEADER
There is no doctor that monitors this forum. We are all fellow patients.
Please verify that the T4 and T3 are Free, not total. I believe they are, but it's important to specify. The range for T3 is awfully broad and your level is right near the bottom. It's understandable that you don't have a lot of energy.
You said you had settled into a dose of 137 mcg synthroid. Was that just reduced to the 88 mcg when the cytomel was added? If so, I think your dose is pretty reasonable.
I didn't have an immediate reaction when I started on cytomel, either. Even though cytomel is considered to be fast acting, it took several weeks before I noticed much difference in the way I felt, then it was minimal. I've been on generic T3 since early 2009 and it's just recently that I actually feel a lot better. Patience is a key to dealing with thyroid issues.
Some people find that splitting their dose of cytomel into more than one, makes a difference. I, too, am on 7.5 T3 and I take 5 mcg in the morning, and 2.5 around noon. That 2.5 helps get me through the afternoon and I don't feel like I need to go to bed at 6:00.
I might suggest that you get your vitamin B12 and D levels tested. Deficiency in either can cause lack of energy/fatigue.
Please verify that the T4 and T3 are Free, not total. I believe they are, but it's important to specify. The range for T3 is awfully broad and your level is right near the bottom. It's understandable that you don't have a lot of energy.
You said you had settled into a dose of 137 mcg synthroid. Was that just reduced to the 88 mcg when the cytomel was added? If so, I think your dose is pretty reasonable.
I didn't have an immediate reaction when I started on cytomel, either. Even though cytomel is considered to be fast acting, it took several weeks before I noticed much difference in the way I felt, then it was minimal. I've been on generic T3 since early 2009 and it's just recently that I actually feel a lot better. Patience is a key to dealing with thyroid issues.
Some people find that splitting their dose of cytomel into more than one, makes a difference. I, too, am on 7.5 T3 and I take 5 mcg in the morning, and 2.5 around noon. That 2.5 helps get me through the afternoon and I don't feel like I need to go to bed at 6:00.
I might suggest that you get your vitamin B12 and D levels tested. Deficiency in either can cause lack of energy/fatigue.
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