Benefit of adding Cytomel to Synthroid?

[Rhonda264]

I am hypothyroid since January 2013.  It is almost November and my TSH is still 6.050(range .450-4.5), T3 is 79(range 71-180), FT4 is 1.26(range .82-1.77). When Synthroid meds are increased, my TSH goes down slightly, but T3 and FT4 go down as well.  Shouldn't T3 go down if I'm converting the T4 properly?  I asked endo if I could try T3 and she said given that I have had palpitations with Synthroid, I wouldn't like the addition of T3 because of the way it would make me feel.  Yes, I have had palpitations with the increases in Synthroid, however they subside in 1-2 weeks once my heart can get used to the increase in metabolism.  I continue to have symptoms and obviously will until the meds are at the right dosage.  I went to see my endo a week ago and she put my 'health issue' as abnormal weight gain.  I have gained 2.2 lbs since my previous appointment in early July.  However, I was wearing sandals & a sundress in July verses jeans, boots, long sleeves and a fleece vest in October when my last weight was taken.  I complained of still have same symptoms of muscle/joint pain with most recent pain in left hip that keeps me up at night.  I saw an orthopedic surgeon a week before and he took x-rays and advised bones look great and didn't see any reason for pain.  My endo referred me to a dietician.  I sent her an email requesting a trial period to try Cytomel.  I haven't heard anything back as of today.  My next appointment with endo is 4 months away.  Seems like a long time in between appointments when my numbers are not optimal.

[Rhonda264]

Thank you, too, for responding!

[Rhonda264]

Thanks for the response.  My visit with the endo last week was only my second appointment with her.  I hate to switch doctors, but I hate when my health concerns are dismissed or passed off.  I have gained weight, but she is only aware of the 2.2 lbs and they are probably, like I said, due to heavier clothing.  I'm actually excited about seeing the dietician so I can take in my 4 years of journaling my meals and extensive notes so they can report back to the doctor that I do eat healthy.

[flyingfool]

I agree 100% with goolarra!

Bnormal weight gain. HA!  I could put on 2.2 pounds by going out to a big dinner the night before and having a beer.  Let alone 2 pounds over several months.  I laugh at that!  But what it does sort of indicate to me is that your Dr. doesn't believe you and is not considering that thyroid is the issue. Sending you to a dietician etc looks like the Dr is trying to push you off to someone else.  Depending on hhow your Dr has been with you on issues etc these may be signs for you to look for another Dr.

When increasing T4 dose you say both your FT4 and total T3 decline.  Well that T4 in the medication has to be going somewhere. And the T4 can ONLY do one of two things.  Convert to T3 or convert to Reverse T3.  

Reverse T3 is biologically inactive and some say even worse. It looks so much like Free T3 hormone that IS active, that the cell receptors will accept the biologically inert Reverse T3 hormone and thus leave no room for the ACTIVE Free T3 hormone.  Keeping you Hypo.

So on your next testing. You might want to demand both Free T3 for absolute sure. And you may also want to test for Reverse T3.  

Expect huge resistence by your Dr about testing for reverse T3.  It is a fairly expensive test and many Dr's don't even believe in Reverse T3 dominance etc.

[goolarra]

Your FT4 looks pretty good.  It's at 46% of range, and 50% is the target for FT4.  Unfortunately, that's a total T3 test, which doesn't provide nearly as much information as FREE T3.  That being said, your TT3 is very low.

If you are converting properly, FT3 should go up as FT4 goes up and down as FT4 goes down.  Ideally, FT4 should be around 50% of range, and FT3 should be higher in its range than FT4 is in its.

I think a trial of Cytomel is an excellent idea.  Unlike Synthroid (T4), which is very slow acting, Cytomel (T3) is fast acting.  It's true that T3 can affect your heart more easily than T4, but the beauty of T3, with its short half life, is that it's out of your system within a number of hours.  So, if you have unpleasant side effects, you don't have to wait days or weeks for them to subside.  Expect it to take a little getting used to, though...

Four months is much too long.  Not only are your labs not optimal, but you still have symptoms.  If that's the best your current doctor can do, you might want to start shopping for a new one.