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Low T3 -- lower cytomel?

Just got labs done a few days ago:
TSH .186 (0.4-5.5) low, but not as low as 1/17, when synthroid was lowered from 137 to 88 & 10 cytomel added
T4 1.2 (.9-1.7) down from 1.8 in Jan 17
T3 1.8 (2.3-4.1) definitely low
I'm asking here b/c I've reported symptoms to my endo (muscle aches, very cold hands and feet, eyebrows disappearing, difficulty losing weight despite regular exercise and healthy diet), thinking maybe I need to raise my cytomel and/or lower my synthroid. But he said that my symptoms "must be from something else" and that T3 labs results are meaningless b/c cytomel artificially lowers them. That seems really off to me b/c the cytomel *is* T3 (right?), so should it raise it??
I should add that I have Hashimoto's. I've never been thrilled with this doc b/c I feel like he brushes off any self-reported symptoms and only cares about TSH. Most of what I've read makes it sound like getting my T3 into optimal range is key and it seems to me that more cytomel would be the way to do that. Any insights welcome!
3 Responses
649848 tn?1534633700
You're right that getting Free T3 into an optimal range (for you) is all important.  Any doctor who says it's meaningless is not a good thyroid doctor.

Do I understand correctly that these labs were taken when you were on 88 mcg Synthroid and 10 mcg Cytomel?  How long had you been on this dosage when you had this blood work done and how long had it been since you'd had your last dosage of either medication?

Not only is your Free T3 below range, but your Free T4 is less than optimal...  Most of us feel best with Free T4 at about midrange; yours is only at 38% of range.  Most of us also feel best with Free T3 in the upper half to upper third of range; Free T3 should be higher in its range than Free T4 in its.  Yours is below range.

My recommendation is to find a new doctor as soon as possible.
Avatar universal
To answer your questions:Yes, these labs were while I was on 88 mpg Synthroid and 10 mpg cytomel, but I hadn't taken either that day (it had been approximately 16 hours since my last synthroid dose and 20 since my last cytomel dose). I started this regimen in jan 2017 so it's certainly been long enough for them to have whatever effect they were gonna have!

I put a call in to a new doctor this morning -- one who listens according to other patients!
My computer autocorrected to mpg!! mcg
Avatar universal
your current Dr definately does NOT understand thyroid.  You are doing the right thing by attempting to find a new doctor.  You list symptoms that are 100% consistent with Low thyroid.  And you blood labs as Barb135 points out also indicate this. The response by your Doctor is an absolute clear indication that he has "immaculate TSH belief".  Your TSH is suppressed and he thus believes that you should if anything ought to be hyper, but you are presenting Hypo.  based SOLELY on TSH.  And this explains why "it must be caused by something else".

I concurr with Barb135.

What was your FT4 previous to the reduction to 88 mcg along with your previous FT3 level?

If my hunch is right, I would suspect that your FT4 was high and FT3 low.  And this would suggest STRONGLY that you are having an issue with conversion.  However, as Barb points out, you are not too high on FT4 now either.

you might want to try taking Selenium as it helps with conversion. But you also might want to check your Iron and Ferritin levels as well. As you need sufficient Ferritin to properly metabolize thryoid hormone.
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