Aa
New to Cytomel - Need some support
Hello! I just changed doctors and was put on generic cytomel. I was being treated by my family doctor for years for hypo. I would have periods of doing ok but for the most part I was not doing well at all. Horrendous mood swings, brain fog, lack of concentration, insomnia, weight gain and hairloss. My numbers have been all over the place. Last visit, I was told based on my labs that they wanted to increase my Synthroid from 100 to 112. I was already experiencing heart palpitations, sleep issues and weight gain. I did some research and did not like the fact that I was getting an increase in Synthroid when my T3 was low.
TSH: 3.4 (0.5-4.7 range)
FT4: 1.07 (.73-1.95 range)
FT3: 1.9 (2.3-4.2 range)
The new doctor put me on 5 mcg twice a day (total 10) and reduced my Synthroid to 75 (please note that I have only been doing the 75 for 2 days and was still on the 100 for about 4 days till I picked up the rx for the 75).
I feel bad. Chest tightness, palpitations, severe neck and shoulder tension, brain fog, lack of concentration and fatigue, a odd feeling all over my body and a dull headache. Ever so often I will get a brief clearing of the fog but then it comes right back, I am sleeping ok. I have read that I should give it two weeks but I am not sure I can take this. The new doc also had me start magnesium at night and adrenal support vitamins which I take in between my thyroid meds.
I was so excited that I was going like so many others who got on Cytomel and life changed for the better. Any thoughts???
TSH: 3.4 (0.5-4.7 range)
FT4: 1.07 (.73-1.95 range)
FT3: 1.9 (2.3-4.2 range)
The new doctor put me on 5 mcg twice a day (total 10) and reduced my Synthroid to 75 (please note that I have only been doing the 75 for 2 days and was still on the 100 for about 4 days till I picked up the rx for the 75).
I feel bad. Chest tightness, palpitations, severe neck and shoulder tension, brain fog, lack of concentration and fatigue, a odd feeling all over my body and a dull headache. Ever so often I will get a brief clearing of the fog but then it comes right back, I am sleeping ok. I have read that I should give it two weeks but I am not sure I can take this. The new doc also had me start magnesium at night and adrenal support vitamins which I take in between my thyroid meds.
I was so excited that I was going like so many others who got on Cytomel and life changed for the better. Any thoughts???
Went back to the doctor yesterday. Synthroid will remain at 100 mcg (where as I was before I saw the new doctor). Discontinued Cytomel last Friday. Based on my reaction/symptoms to Cytomel, she is thinking that there is an adrenal factor in there. I have ordered a saliva test and we will see from there. She also ordered more thyroid testing and I will get those results in a day or two. She started me on some adrenal support vitamins and DHEA.
T4 med would be reduced if it were higher than necessary. That isn't the case for you. Your Free T4 is only at 28% of its range, when it should be at 50% at minimum. Your Free T3 is not at 21% of its range, as I mistakenly said late last night, LOL. Your Free T3 is terribly low, even below range. The doctor should have increased your T4 med, along with adding the T3. Both meds should be increased gradually to reach the middle of the range for Free T4 and into the upper half of the range for Free T3, as needed to relieve hypo symptoms.
In addition you need to test for Vitamin D and ferritin and get those supplemented as needed to get D to 55-60 and ferritin to about 70 minimum. Both are very important for you. Low ferritin or low cortisol can sometimes cause reactions to increasing doses of thyroid med. So I also suggest testing for morning serum cortisol.
If the doctor should express concern that raising your meds might suppress TSH, you can tell the doctor that is a common occurrence when taking adequate thyroid medication and should not be a concern. For example, here is a quote from a scientific study, with a link following.
"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 and data showing discordant responses between the pituitary and peripheral target tissues in patients treated with l-triiodothyronine.5 We assume that secretion of TSH is driven by maximal stimulation, with no further increase occurring with greater severity of hypothyroidism. Therefore, the biological effects of thyroid hormones at the peripheral tissues—and not TSH concentrations—reflect the clinical severity of hypothyroidism. A judicious initiation of thyroxine treatment should be guided by clinical and metabolic presentation and thyroid hormone concentrations (free thyroxine) and not by serum TSH concentrations."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143526/
In addition you need to test for Vitamin D and ferritin and get those supplemented as needed to get D to 55-60 and ferritin to about 70 minimum. Both are very important for you. Low ferritin or low cortisol can sometimes cause reactions to increasing doses of thyroid med. So I also suggest testing for morning serum cortisol.
If the doctor should express concern that raising your meds might suppress TSH, you can tell the doctor that is a common occurrence when taking adequate thyroid medication and should not be a concern. For example, here is a quote from a scientific study, with a link following.
"We found no correlations between the different parameters of target tissues and serum TSH. Our findings are in accordance with a cross sectional study showing only a modest correlation between TSH and the percentage of positive hypothyroid symptoms4 and data showing discordant responses between the pituitary and peripheral target tissues in patients treated with l-triiodothyronine.5 We assume that secretion of TSH is driven by maximal stimulation, with no further increase occurring with greater severity of hypothyroidism. Therefore, the biological effects of thyroid hormones at the peripheral tissues—and not TSH concentrations—reflect the clinical severity of hypothyroidism. A judicious initiation of thyroxine treatment should be guided by clinical and metabolic presentation and thyroid hormone concentrations (free thyroxine) and not by serum TSH concentrations."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC143526/
My D had dropped again (don't have results with me but I thought it was like 40 something) despite taking daily dose of 6000-8000 units. Not a huge drop but it had dropped despite regular intake. Ferritin was not tested. Cortisol not tested. My B12 was too high.
Called doctor on Friday afternoon with symptoms. Was told to stop cytomel and see her on Tuesday. I slept a good portion of yesterday (only took synthroid 75) and surprisingly felt a bit better. The terrible neck and shoulder pain was mostly gone and the heart palpitation were about the same. Once I got up and did something I felt OK. I have gained 3 pounds in one week despite restrictive diet. Also I was only on the reduced synthroid two days when I posted.
I thought you were supposed to reduce synthroid when starting cytomel. The current Doctor I am seeing came highly rated as one of the best for thyroid in the area.
Called doctor on Friday afternoon with symptoms. Was told to stop cytomel and see her on Tuesday. I slept a good portion of yesterday (only took synthroid 75) and surprisingly felt a bit better. The terrible neck and shoulder pain was mostly gone and the heart palpitation were about the same. Once I got up and did something I felt OK. I have gained 3 pounds in one week despite restrictive diet. Also I was only on the reduced synthroid two days when I posted.
I thought you were supposed to reduce synthroid when starting cytomel. The current Doctor I am seeing came highly rated as one of the best for thyroid in the area.
To start, your Free T4 and Free T3 are far too low in the range. Your Free T4 is at only 28 % of its range, when it should be 50% minimum. Your Free T3 is only at 21% of its range, when it should be n the upper third of the range, or as needed to relieve symptoms. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results.
So your doctor needs to keep increasing your T4, not reduce it, and also increase your T3 med as needed to relieve symptoms. Along with that hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin. Low levels can cause symptoms. Low D or low ferritin can also adversely affect metabolism of thyroid hormone. D should be 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum. If not already tested for those you should do so and then supplement as needed to optimize.
It may be that some of the reactions you were feeling are due to the reduction in T4 med and the addition of the T3 med. If so, things should settle down over the span of a week, I think. Another possibility is that some of the reaction could be related to low ferritin or low cortisol. If you continue to feel the same way you may want to get these tested.
So your doctor needs to keep increasing your T4, not reduce it, and also increase your T3 med as needed to relieve symptoms. Along with that hypo patients are frequently too low in the range for Vitamin D, B12 and ferritin. Low levels can cause symptoms. Low D or low ferritin can also adversely affect metabolism of thyroid hormone. D should be 55-60, B12 in the upper end of its range, and ferritin should be about 70 minimum. If not already tested for those you should do so and then supplement as needed to optimize.
It may be that some of the reactions you were feeling are due to the reduction in T4 med and the addition of the T3 med. If so, things should settle down over the span of a week, I think. Another possibility is that some of the reaction could be related to low ferritin or low cortisol. If you continue to feel the same way you may want to get these tested.
Not sure. My GYN had run a thyroid panel when I was in pentimento pause (7-8 yrs ago). Discovered then. Mother had history of goiter.
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
