New test results

[Lynnester]

I used to be on Levovly and due to the recall was changed to Synthroid. I was on 88mc Synthriod and 2.5 mg of Cytomel daily. It made me feel bad like I had too taken too much medication. I've always felt bad on the T4 meds alone but a little more energy when I've added T3. But not too much.These were the test results then.

Lab ranges the same for both test:
TSH  .450 - 4.50
Free T4   .82 - 1.77
Free T3   2.0 - 4.4

TSH  1.42
Free T4   1.35  
Free T3   3.0

I was changed to 75 mc Synthoid and 5mg Cytomel (2.5 taken in AM and 2.5 in early afternoon)



current results:

TSH   2.56
Free T4   1.29
Free T3   3.2

Still tired and not feeling very well so this is what the doctor is proposing. Continue on 75mc Synthroid and the 5mg (split between 2 doses) from Monday-Saturday. Then on Sunday take 1 1/2 of my 75 mc Synthroid with the cytomel.

Any thoughts on that?  Since I'm so sensitive to medications wouldn't it be better for me to take an 88 on Saturday and Sunday? I think it works out to the same dosage over the weekend??

Would love to hear what anyone thinks or if anyone adds more T4 just a day or two a week??

[Barb135]

Jackie's on a different med... I mentioned above that Levoxyl is back on the market... To my knowledge there was no reformulation, so if you felt well on that, you should talk to your doctor about getting back on it.  

You probably need to either kick CVS in the butt, or try to go somewhere else... I know people who are already getting it. You'll have to have your doctor rewrite your script.

[Lynnester]

Did you use Levoxly before the recall? I'm hoping they didn't change it. I don't really seem to feel better on either Synthoid or Levoxly but I seem to be able to tolerate Levoxly a bit better than this Synthroid. So I guess I keep checking my pharmacy. It's a CVS  and so far they have no clue when it will be in.

[Lynnester]

My pharmacy uses generic Cytomel made by Sigma Pharma. Googled it a lot of people seem to have complained about it. I have some left from the fall made by Paddock but it won't help me much if my refill will be by Sigma.

[Lynnester]

Thanks Barb! I started this weekend but will keep the full 5mg cytomel for now. Cytomel still makes me feel a bit speedy, weird, don't know how to explain it but I'm trying to hang in there as without it I can barely function with just the T4 even increasing to 88. Tried to take 100 but that was just way too much. As I said in an earlier post I'm very sensitive to these meds. Unlucky me!

[Jackie419]

LEVOXYL is back on pharmacy shelves as of today....go to Levoxyl ******* as they have info as to why it was recalled etc. Just FYI....good luck!

[Barb135]

The only way you're going to know whether the 75/88 2 days/week, with the 5 mcg cytomel will work, is to try it and see.

If you're taking a full 5 mcg/day of cytomel, maybe you could drop back to just 2.5 mcg/day and see if that helps.  Once you get used to it, you could add back in the other 2.5 mcg.  My generic T3 tablets are about the same size as the cytomel tabs.  I've never  had a problem with taking the generic T3 med, except from one manufacturer... I had to dissolve the pills in water before I took them or they didn't do any good.  I told my pharmacy not to give me those anymore.

[Lynnester]

She is looking at all the levels. I'm just not convinced raising my Synthroid 2 days a week will do the trick. I've taken 88 mcg alone and with Cytomel and it makes me too wirey if I take everyday. I've also alternated days but then my free T4 goes up around 1.5 or more.
They symptoms I still have are palpitations, an anxious feeling, very dry eyes (which I do have allergies and not sure I'm not allergic to some thing in the Synthroid), and heachaches (almost daily).

So here's the new schedule of meds:
M,T,W,TH, F  75mcg Synthroid and 5 mg Cytomel total (1/2am & 1/2pm)
Sat/Su  88mcg Synthroid and 5 mg Cytomel total (1/2am & 1/2pm)

I'm not sold on the Cytomel yet either. Been a hard adjustment for me. I have a constant dull headache all day since I started it and it's been since January 6. I do have the generic by Paddock but not sure switching will make a difference. I've read that brand name Cytomel can be stronger. It's amazing that the pill is so much smaller than the generic. Shows me how much filler is in there.

Funny as a trial I skipped  day and felt good...go figure!

[Barb135]

Since TSH neither causes nor alleviates symptoms, I'm having a hard understanding why your doctor is concerned about having it at a certain level.

Both of your frees are right at mid range.  Rule of thumb is for FT4 to be mid range and for FT3 to be in the upper half to upper third of its range.  Of course, these are only rules of thumb and everyone needs different levels.  These are simply targets to aim for, until one finds their own happy place.

If I were to change your meds, I'd probably go with an increase in your T4 med, which, presumably, would increase your FT3 via conversion.

By the way, Levoxyl is back on the market in some areas, though their web site says it will be back on March 4.  If you felt better on Levoxyl, you might want to think about switching back.

Is being tired you only/main symptom?  If so, maybe you should look into other causes, such as Vitamin B12 or iron deficiency.  

[Lynnester]

My endo is not targeting just tsh but would like to see it lower. In your opinion do you think my Free's look ok?
When I take the brand name Cytome. It  feels stronger than when I take the genetic by Paddock.

Where should they be for me too feel better?

[Barb135]

If your endo is only targeting TSH, she's going to keep you ill.  Trying to control hypothyroidism by TSH alone is like shooting a moving target, because TSH fluctuates greatly over the course of a day.

You have to go by the FT3 and FT4 levels.  FT3 correlates with symptoms while TSH and FT4 do not.  Additionally, TSH is often suppressed when one is on thyroid replacement hormones, particularly, one with a T3 component.

Increasing your T4 med would also increase your FT3 level, because FT4 is converted to FT3.  Because T4 med takes so long to reach potential in the blood, that would probably be your best bet.

I take generic T3 manufactured by Mylan.  I've been on cytomel, but can't see a difference between that and generic, though I did have an issue when the pharmacy filled my script by another manufacturer.  The only way I could take those was to dissolve them in water and take them as a liquid.

Hashimoto's, itself, has no symptoms.  The symptoms come from having over or under active thyroid or being over or under medicated.  

[Lynnester]

My endo would like to get my TSH between 1.5-2.0. She said though I'm in range with free's should like my TSH down. It was 2.56. Since I seem to be sensitive to Cytomel (brand name), she wanted to increase Synthriod a bit.

I am so sensitive to any increases and not sure I can handle increasing Cytomel. I have daily headaches with just the 5mg I'm taking.

BTW do you take brand name Cytomel or generic? I also have generic by Paddock that the pharmacy actually gave me at first but then I realized she asked for no substations and they refilled with the brand. I would just like to lessen my headaches. That is definitely part of my Hashi's symptoms too.

[Barb135]

You said in your original post:  "Continue on 75mc Synthroid and the 5mg (split between 2 doses) from Monday-Saturday. Then on Sunday take 1 1/2 of my 75 mc Synthroid with the cytomel."  That's only one day.

"I'm concerned jumping from a 75 to 112.5 even for one day would make me feel bad that day???"   I see that I added wrong in my calculation above, but T4 med doesn't get into your system quickly enough to make you feel badly for the day you took it.   The T4 in your system right now, is what you took a couple weeks ago.

Is your doctor only trying to get your TSH to a certain point?  Or is she trying to alleviate your symptoms.  FT3 is the hormone that correlates with symptoms and in order to alleviate all of them, that's the hormone you'll need to increase.  

Either way, you increase your dosage is going to increase your FT3 through conversion.  It's a matter for you and your doctor to decide.

[Lynnester]

Barb,
I was on 88mc with the 2.5 mg cytomel for since last fall. My Free T4 would go up and down from 1.7 down to 1.35. I guess because I have Hashi's (diagnosed 5 yrs ago) though the dr. thinks it's pretty much not functioning anymore I just can't seem to take higher doses of T4. I am really in between 75 and 88. Tried splitting both a 75 and 88 per day and that didn't work either and even alternated the two at full strength. I felt different each day and didn't like it.

So now back down to the 75 and increased the cytomel to the 5 mg cytomel split.


I think you misunderstood, the dr wants me to try 75 for 5 days and 88 for 2 OR 75 for 6 days and 112.5 (1.5 of a 75) on Sundays.

I'm concerned jumping from a 75 to 112.5 even for one day would make me feel bad that day???

Not sure what to do. I'm thinking the 2 88's might be smoother to handle since its only 13 mc higher for those 2 days.

Though my free's look ok I still have so many hypo symptoms. I can't handle my Free T3 much higher due to PAC's. She wants my TSH closer to 1.5 - 2.0 if I can handle it. That's why she wanted to add some more T4 since there is no way I can handle any extra T3.

What do you think? Do the Sat/Sun or just the Sun increase???

[Barb135]

Yes, there are people who take a higher dosage on one or two days of the week.  

75 X 6 = 450 + 88 = 535 mcg for the week.
75 X 6 = 450 + 102.5 (1.5 of a 75) = 552.5 mcg for the week

If you take just one 88 mcg pill, you will be getting only 10 mcg more for the week than you're getting now and 17.5 mcg less than if you do it your doctor's way.  The way your doctor wants you to do it, is really an increase of only 2.5 mcg/day

How long had you been on the 88 mcg/day when you started feeling badly again?  What were your exact symptoms?  There are some symptoms that can apply to, both, over/under medication.  

Your labs are really not bad at all.  Your current FT4 is at 50% of its range; rule of thumb is 50%, so it's right where we would normally target, until a person finds out what's right for them.  Your FT3 is also at 50% of it's range.  Rule of thumb for FT3 is upper half to upper third of its range, so you aren't too far off.   Sounds like all you need it a tweak.

You can try upping the way your doctor wants you to and see what happens.  Remember, though - it takes at least 4-6 weeks for a dosage change to reach full effect, then sometimes even longer for it to alleviate symptoms.