TSH vs T3 testing

[lmdowdy]

I've been on cytomel for about 8 years but changed drs about two years ago. She continued to prescribe my cytomel and synthroid doing tsh checks every six months. Just about every time I went in she would talk about not understanding the cytomel prescription. I just went for another tsh test and she decided not to prescribe the cytomel and only the synthroid. I spoke with the nurse and asked if the test included a t3 test and were my levels off. The test did not include a t3 and they said that the tsh was enough and if it was normal they had no reason to do a t3 test. I recently had lap band surgery to assist with weight loss and have started to see some good results but I'm worried that everything is going to get messed up. I'm working with my lap band surgeon, a nutrionist and had to pass psych screening to receive the surgery. I work out and keep a food journal but it's not going to make a difference if my t3 is jacked. Right now I eat 800 to 1000 calories a day and walk 2-4 miles and lose about 2 lbs a week.
I'm going to look for a specialist in my area. Any insight or suggestions would be appreciated. I don't want to over react but I also know how I felt before and I don't want to go there again.

[goolarra]

Did he test FT3 as well as FT4?  

25 mcg of T3 is a pretty high starting dose.  T3 is roughly four times more potent than T4, so that's equivalent to adding 100 mcg T4.  If I were you, I'd ask my doctor to give me some 5 mcg tablets.  Start with 5 mcg (divided into two doses during the day) and increase from there as necessary.  Many doctors think you dose T3 meds the same way you dose T4 meds.  T3 has to be handled more delicately.  Often, 5 to 10 mcg er day is sufficient to relieve lingering symptoms.  You might ask him if he wants to rethink the dose.

[clydeine]

I was just at my doctor.  Free t4 was 1.3; tsh was .165.  He tried to convince me to lower the Synthroid.  I asked if he was just looking at the numbers and he said yess.  I told him I was(tired most of the time) exhausted at times, cold and had muscle weakness. He finally agreed to give me some T3 (.25) which I plan to split and take 4 times a day (.0825), but it was obvious he didnt know much other than to read the numbers and he is a D.O.  Anyway I asked to come back in a month for labs.  we will see

[lmdowdy]

I have an appointment for a fill with my lapband surgeon on Monday so I'm going to try and have him fill it until I can get to my appointment in September. Not sure if he will but I'm going to try. I've been out of cytomel for six days now. aagghh! I'm so upset with my primary physician. I definitely will be finding another primary...I had the best one in Missouri and hated that I had to find another when we moved. thanks for your input!

[goolarra]

I think you've made a good decision.  I cannot fathom why any doctor would do that.  It's one thing "not understanding the Cytomel prescription" (hello, where have you been?), but you have a long and proven track record of success with it.  It just doesn't make sense.  The beginning of September is not too far off.  How's your Cytomel supply holding up?  Is there another doctor who could refill your prescription to last until you see the new doctor in September if you explained the circumstances?  

[lmdowdy]

Thank you for your comments. I don't want to make a knee jerk reaction and find out it was the wrong decision for me later so I appreciate your post. I just made an appointment with a specialist but can't get in until the beginning of september but that's better than nothing. I'll keep you posted.
Again thanks!

[goolarra]

I would certainly NOT consider staying with a doctor who is changing what has worked for you for eight years.  Furthermore, she is changing it based on TSH alone, which in my opinion borders on irresponsible.  TSH testing for adjusting meds is simply not adequate.  Since you have been on Cytomel, FT3 testing is not an option...you have to watch the FT3 levels.  I'd find a new doctor.  Don't let her mess up what has worked so well for you.