Aa
Once again feeling blah
I had been taking cytomel 5mcg and synthroid 112 mcg a day and was not feeling well. My dr. Then increased my cytomel to 7.5 mcg once a day. I am still not feeling well. I have more energy but i continue to experience hunger, weight loss and hair loss.
My recent blood tests are as follows
T4 9.4 range of 4.5-12.0
T3. 85 range 71-180
Tsh 0.450 range of 0.450-4.500
Free t4. 1.33 range 0.82-1.77
Ferritin serum 56 range 15-150
Iron bind 243. Range 250--450
Iron serum 76 range 35-155
Vitamin d 35.3 range 30.0-100.0
When i discussed my symptoms with my dr a few weeks ago she told me to increase cytomel to 10 mcg. After increasing it i started experiencing heart palpitations. Once i reported that to my dr. Sne told me to go back to 7.5 mcg. Today my dr. Told me that she can slowly take me off the cytomel and increase my synthroid. Mr. Dr. Is not and endo but she is more willing to take my symptoms onto account a lot more than several endos that i have tried. Cant seem to find a good endo in my area. Grrr. Any input or suggestions are greatly
appreciated.
My recent blood tests are as follows
T4 9.4 range of 4.5-12.0
T3. 85 range 71-180
Tsh 0.450 range of 0.450-4.500
Free t4. 1.33 range 0.82-1.77
Ferritin serum 56 range 15-150
Iron bind 243. Range 250--450
Iron serum 76 range 35-155
Vitamin d 35.3 range 30.0-100.0
When i discussed my symptoms with my dr a few weeks ago she told me to increase cytomel to 10 mcg. After increasing it i started experiencing heart palpitations. Once i reported that to my dr. Sne told me to go back to 7.5 mcg. Today my dr. Told me that she can slowly take me off the cytomel and increase my synthroid. Mr. Dr. Is not and endo but she is more willing to take my symptoms onto account a lot more than several endos that i have tried. Cant seem to find a good endo in my area. Grrr. Any input or suggestions are greatly
appreciated.
COMMUNITY LEADER
Once you get the proper tests, please post them here, so we can help evaluate them.
"Dr. did decrease the synthroid from 112 to 100 when i started taking the cytomel 5 mcg." Note that T4 should be decreased by 20-25 mcg for every 5 mcg of T3.. yours was only reduced by 12 mcg. Maybe 88 mcg T4 would have been a better choice.
Always, only ever change one (1) thing at a time, otherwise, you have no idea which change is affecting you.
Keep in mind that I'm not a doctor, but it would seem that maybe something around 88 mcg T4 (taken in one dose) and 10 mcg T3, split into 2 doses of 5 mcg/day might be a good place to start now... run that by your doctor and see what she thinks, stay on that dose for 5-6 weeks to let your levels stabilize, then get tested again and see where you're at.
T4 meds take at least 4-6 weeks to reach full potential and T3 meds take at least 2 weeks (or more) to stabilize. If you change doses too often, you end up on a roller coaster that's really hard to stop.
Be sure that whatever dose of T3 you take, over 5 mcg, you split into more than one dose.
"Dr. did decrease the synthroid from 112 to 100 when i started taking the cytomel 5 mcg." Note that T4 should be decreased by 20-25 mcg for every 5 mcg of T3.. yours was only reduced by 12 mcg. Maybe 88 mcg T4 would have been a better choice.
Always, only ever change one (1) thing at a time, otherwise, you have no idea which change is affecting you.
Keep in mind that I'm not a doctor, but it would seem that maybe something around 88 mcg T4 (taken in one dose) and 10 mcg T3, split into 2 doses of 5 mcg/day might be a good place to start now... run that by your doctor and see what she thinks, stay on that dose for 5-6 weeks to let your levels stabilize, then get tested again and see where you're at.
T4 meds take at least 4-6 weeks to reach full potential and T3 meds take at least 2 weeks (or more) to stabilize. If you change doses too often, you end up on a roller coaster that's really hard to stop.
Be sure that whatever dose of T3 you take, over 5 mcg, you split into more than one dose.
Thank you so much for all your advice. It sounds like i need proper tests in order to determine what i need. I will do just that
COMMUNITY LEADER
Apparently, your doctor doesn't know that she should only ever make one change in medication, at a time, so increasing both T4 and T3 meds at the same time was a mistake, because you don't know which one is having the effect.
The Triiodothyronine T3 is total T3 and is obsolete, as is the T3 uptake and free thyroxine index, which are both a round about way to measure FT4. Much better to test the actual FT4, which you have, and the FT3.
Of your total T3, approximately 90-95% of that will be bound by a protein, which renders is unusable; the portion that's not bound, and therefore usable, is the "Free T3" and that's what we need to know. That said, looking at how low your TT3 is, with your FT4 where it should be, I'd have to say that you are probably converting some, but not adequately.
Also, taking T3 med at 10 mcg all at once would really give your body a jolt. Since you have hair loss, brittle nails, dry skin, etc on the 7.5 mcg, it's pretty clear that's not quite enough. Plus taking it for only one week would not have given your body a chance to get used to it.
Most of us find that splitting our dose into multiple doses works best, as it keeps our levels stable throughout the day. As I said, I take mine at 5 mcg in the morning, and 5 mcg around noon. You might have to work out which times are best for you, depending on your schedule, but it's usually recommended that T3 med not be taken after 3:00 pm, as it can interfere with sleep.
I have to get ready for an appointment with a neurologist, but when I get back, I'll see what I can find regarding a doctor that might be better for you, though I'm happy to see that your current doctor is willing to work with you.
The Triiodothyronine T3 is total T3 and is obsolete, as is the T3 uptake and free thyroxine index, which are both a round about way to measure FT4. Much better to test the actual FT4, which you have, and the FT3.
Of your total T3, approximately 90-95% of that will be bound by a protein, which renders is unusable; the portion that's not bound, and therefore usable, is the "Free T3" and that's what we need to know. That said, looking at how low your TT3 is, with your FT4 where it should be, I'd have to say that you are probably converting some, but not adequately.
Also, taking T3 med at 10 mcg all at once would really give your body a jolt. Since you have hair loss, brittle nails, dry skin, etc on the 7.5 mcg, it's pretty clear that's not quite enough. Plus taking it for only one week would not have given your body a chance to get used to it.
Most of us find that splitting our dose into multiple doses works best, as it keeps our levels stable throughout the day. As I said, I take mine at 5 mcg in the morning, and 5 mcg around noon. You might have to work out which times are best for you, depending on your schedule, but it's usually recommended that T3 med not be taken after 3:00 pm, as it can interfere with sleep.
I have to get ready for an appointment with a neurologist, but when I get back, I'll see what I can find regarding a doctor that might be better for you, though I'm happy to see that your current doctor is willing to work with you.
Hi Barb, thank you for your input. I will not give up on the cytomel yet but im not sure i am a great candidate for it as I dont believe i have any problems converting t4 onto t3. Having said my. Dr. did decrease the synthroid from 112 to 100 when i started taking the cytomel 5 mcg. she then started increasing both a little at a time. i did take the cytomel 10 mcg all at once with my T4 meds. I only took the cytomel 10 mcg for only one week because it gave me insomnia, i was shaking, and i had palpitations that were unbearable. However during this week my hair started falling less. With the 7.5 mcg of cytomel i have plenty of energy all day long but my hair is falling, its brittle and looks like straw, my nails are brittle and have ridges, my skin is dry but all else is great. To answer your question the t3 test is t3 uptake at 34% from a range of 24-39. Other tests given were the free thyroxine index 3.2 range 1.2-4.9. Also the thriiodothyronine t3 85 ng/dl range of 71-180.
As a side note i cant believe that i cant find an endo in my area with any good knowledge of the subject at hand. Hence i have to do my own research to provide to my GP. In the big scheme of life I am very grateful that she is open to assist me while endos where giving me the "come back in six weeks speech" without providing me much help.
As a side note i cant believe that i cant find an endo in my area with any good knowledge of the subject at hand. Hence i have to do my own research to provide to my GP. In the big scheme of life I am very grateful that she is open to assist me while endos where giving me the "come back in six weeks speech" without providing me much help.
COMMUNITY LEADER
Did you decrease your synthroid when you added the cytomel? It's recommended that T4 med be decreased by about 25 mcg for every 5 mcg T3 added; therefore, your 112 mcg should have been decreased to 88 mcg when you were put on the 5 mcg cytomel, and could be increased later if need be. From there, you might be able to increase cytomel by 2.5 mcg at a time without decreasing the synthroid.
Looking at your labs, is the T3 a test for Free or Total? It appears to be total, which is considered obsolete and of little value. That said, it's quite low in the range, and it would be assumed that your Free T3 would also be low in the range. You should ask your doctor for Free T3 tests from now on.
Your FT4 is at 53% of the range and target is mid range (50%), so you aren't in any danger of being over medicated or anything, at this point.
I don't think you need to go off the cytomel, just yet... how many days did you take it? Often with a dosage change, symptoms worsen or new ones appear, until we get used to the medication/dosage. So that "may" have been what happened.
Did you take the 10 mcg all in one dose? Most of us on a T3 med, find that splitting the total dose into multiples works better than taking it all at once. For instance, I'm on 88 mcg T4 and 10 mcg T3 (generic cytomel). I take my T4, first thing in the morning, wait about 30 minutes, then take my T3, along with my bp med. Around noon, I take the other 5 mcg T3...
T3 is faster acting and is out of the system much more quickly than T4 med such as synthroid. If you take the T3 dose all at once, you get a huge "surge" that can cause symptoms like those of over medication, such as the heart palps, though I had those when I was very hypo, then you run out later in the day and go back to hypo symptoms; when you split the dosage, your levels stay steady throughout the day. You might talk to your doctor about trying that to see how it works.
All of that said, your ferritin is too low in the range, indicating that you might not have adequate iron stores. Your serum iron is also low in the range, bearing this out. You iron binding capacity is non-existent (below range).. Your doctor didn't really think this was "okay" did she? Or maybe she did, because it's all "in range" except the TIBC (iron binding capacity).
Additionally, your vitamin D is too low in the range. Recommendation is that optimal levels are between 50 and 80. You should talk to your doctor about supplementing... Low vitamin D can cause many hypo-like symptoms. It's typically recommended that supplementation with 2000 IU is sufficient --- make sure you supplement with D3.
You don't need an endo to manage your thyroid; many endos specialize in diabetes and are not good thyroid doctors. It seems that your doctor is willing to work with you; you might be better off staying with her. You just have to learn and understand how it all works, then try to educate her.. It's unfortunate that we have to educate our doctors, but that's often the way it works out.
Looking at your labs, is the T3 a test for Free or Total? It appears to be total, which is considered obsolete and of little value. That said, it's quite low in the range, and it would be assumed that your Free T3 would also be low in the range. You should ask your doctor for Free T3 tests from now on.
Your FT4 is at 53% of the range and target is mid range (50%), so you aren't in any danger of being over medicated or anything, at this point.
I don't think you need to go off the cytomel, just yet... how many days did you take it? Often with a dosage change, symptoms worsen or new ones appear, until we get used to the medication/dosage. So that "may" have been what happened.
Did you take the 10 mcg all in one dose? Most of us on a T3 med, find that splitting the total dose into multiples works better than taking it all at once. For instance, I'm on 88 mcg T4 and 10 mcg T3 (generic cytomel). I take my T4, first thing in the morning, wait about 30 minutes, then take my T3, along with my bp med. Around noon, I take the other 5 mcg T3...
T3 is faster acting and is out of the system much more quickly than T4 med such as synthroid. If you take the T3 dose all at once, you get a huge "surge" that can cause symptoms like those of over medication, such as the heart palps, though I had those when I was very hypo, then you run out later in the day and go back to hypo symptoms; when you split the dosage, your levels stay steady throughout the day. You might talk to your doctor about trying that to see how it works.
All of that said, your ferritin is too low in the range, indicating that you might not have adequate iron stores. Your serum iron is also low in the range, bearing this out. You iron binding capacity is non-existent (below range).. Your doctor didn't really think this was "okay" did she? Or maybe she did, because it's all "in range" except the TIBC (iron binding capacity).
Additionally, your vitamin D is too low in the range. Recommendation is that optimal levels are between 50 and 80. You should talk to your doctor about supplementing... Low vitamin D can cause many hypo-like symptoms. It's typically recommended that supplementation with 2000 IU is sufficient --- make sure you supplement with D3.
You don't need an endo to manage your thyroid; many endos specialize in diabetes and are not good thyroid doctors. It seems that your doctor is willing to work with you; you might be better off staying with her. You just have to learn and understand how it all works, then try to educate her.. It's unfortunate that we have to educate our doctors, but that's often the way it works out.
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