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NDT or Cytomel only

Today was another loop of confusion, at the Endo.  I hope someone can clarify which way to proceed.  Please, don't advise to find another Endo.  There is no other, in my area, or my network.
So, here at the labs:
October I was on 75 Levoxyl mcg & 15 Cytomel mcg
T3, free   3.3  (2.3-4.2 pg/mL
T4, Free 1.0 )0.8-1.8 ng/dL)
TSH  0.02  (mIu/L)

The Primary reduced:  Levoxyl 50 mcg & Cytomel 15 mcg
T3, Free   3.2
T4, Free   0.8
TSH        0.04  
T3, Uptake  35  (22-35)
Symptoms:  Weight gain, depression, 16+ hours sleeping.

So, a week ago, I switched back to  NatureThroid  97.5  + 1/2 of that tablet.  I am still unclear as to conversion.

In today's visit, he said he felt something was wrong, but did not know exactly what.  He said I could continue, and take 2 grains of NatureThroid  or Switch to Cytomel only at 25 mcg.

Currently, I am still very tired, am experiencing flu like symptoms, and swollen glands.  Also, the weight...
I do believe too much t4 causes weight gain.  

Prior to my partial thyroidectomy, at 200 mcg of Synthroid, I was 200 lbs.  I am 5''5'.  I am far too short for that much weight.  I am currently 151 lbs, when I was 130 in August 2014.  I am far too short for this amount of weight, as well.

If I was exhausted on 20 mcg of Cytomel in combination with 50 Levoxyl, how in the world am I going to feel on only 25 mcg of Cytomel?


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Avatar universal
I concur with Barb135 assessment.

You need to decide which way you want to go.  Either NDT or fully Synthetic.

Understand like Barb stated that if you go NDT route, you may also have to at some point add in some T4 in order to get your FT4 into reasonale range.  As NDT doesn't have much T4 in it.

Cytomel (T3) only is not generally recommended.  It is a very rare case and usually only a temporary time that T3 only makes sense.

Also remember that it is usually the best idea to ONLY change ONE medication dosage at a time.  So if you are on say NDT and some T4, then if an adjustment is made. Only make an adjustment to one of them and NOT both.  The reason is that whatever result you get, you won't know which one of the adjustments did what.  Wheras if you only change one the result is known what the cause was.
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649848 tn?1534633700
COMMUNITY LEADER
Why do they keep switching you from Synthroid it desiccated?  You need to get on one or the other and stay there... Also, you need just one doctor managing your thyroid - it never works to have 2 of them doing it...

I don't understand why your pcp lowered your Synthroid dose from 75 to 50, when your FT4 was already too low, at only 1.0... it wasn't even at the recommended 50% of range mark... Now at 0.8, it's on the floor of the range and they think putting you on cytomel only is a good thing?  Your FT3 is only at 47% of its range, when the recommendation is upper half to upper third of the range... you have a long way to go to get to the recommended levels for either FT3 or FT4, so it's no wonder your symptoms don't go away...

You've been consistently under medicated because your doctors, particularly, your pcp are paying too much attention to your TSH and not enough attention to your actual thyroid hormones...  When my pcp tries to decrease my meds due to low TSH, I simply tell him that my endo says my meds are fine the way they are...

It would seem that you probably need the 2 grains of NatureThroid (at least), and you'll most likely have to increase that, plus add some T4 only to bring up your FT4, since  many people on desiccated tend to have a too low FT4.  It looks like the endo is your best bet to get to adequate dosages...
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