Treatment Rundown

[gryscle]

Hi everyone,

These is my blood tests' history (FT3 is sometimes absent):

350 mg of Eltroxin per week:

TSH - 4.78 (range 0.55 - 4.78)
FT4 - 14.67 (range 11.5 - 22.7)
TT3 - 1.1 (range 0.92 - 2.79)

2 months later (525 mg of Eltroxin per week):

TSH - 1.84 (range 0.55 - 4.78)
FT4 - 14.84 (range 10.3 - 19.7)
FT3 - 4.82 (range 3.5 - 6.5) - that's 44% of the range
TT3 - 0.9 (range 0.92 - 2.79)

2.5 months later - 900 mg of Eltroxin per week (too big a raise of dosage in retrospect):

TSH - 0.02 (range 0.55 - 4.78)
FT4 - 22.1 (range 10.3 - 19.7)
FT3 - 6.39 (range 3.5 - 6.5) - 96% of the range
TT3 - 1.3 (range 0.92 - 2.79)

2 months later - 800 mg:

TSH - 0.21
FT4 - 16.31
TT3 - 1.2

2 months later - still 800 mg:

TSH - 0.33
FT4 - 17.78 (79% of the range)
TT3 - 1.2
FT3 - 4.66 (3.5-6.5) - 39% of the range

I'm still experiencing symptoms - mainly muscle stiffness and pain. There was about 50% improvement since I began the treatment (that was a year ago) and i'm still experiencing a slight improvement every month or so.

According to what I learnt - I know that's the ideal levels are very individual but that the guidelines are about 50% FT4 and 75% FT3.

What should I do? Find a doctor who will subscribe me cytomel in addition to the eltroxin and aim for the 75% of the range? Continue with the eltroxin for as long as I have these slight improvements?

Thanks!

[Barb135]

If you've been on the same dosage for quite some time and you still have symptoms, that's probably a pretty good sign that you should try something new.

If I'm reading your original post, here, right, you've been on the same dosage for 4 months and all it seems to be doing is driving up your FT4, without having much effect on FT3.

" Regarding the Cytomel treatment, you mention "as needed". Does that mean a combination of symptom relief and FT3 in the upper third of the range?"  It means symptom relief... Your FT3 might not have to be in the upper third of its range.  You might get symptom relief with it at mid range.  The rule of thumb is to have FT3 in the upper half to upper third of its range, but that's a target to aim for until you find your own best place.  

Cytomel is fast acting; gets in your blood quickly and is used up quickly, so it doesn't last long.  Many people will tell you they feel it immediately, I was on it for several months before I could tell that it really made a difference in the way I felt and before my FT3 started rising.  We're all different and I have absorption issues, with nutrients, so could have an issue with med as well.  I think, for the most part, you should feel a difference within a couple of weeks, if not sooner, but do understand that it's not likely for all symptoms to go away that quickly... just that you might start seeing improvement.  

If I were you, I might ask for 5 mcg to start and split that into 2 - 2.5 mcg doses - one in the morning, one around noon.  If you're real sensitive to med, you might want to start with only 2.5 mcg taken once/day and go up when tolerated.  But of course, your doctor has to agree with all this.  

[gryscle]

Forgot another question - how long does it take for symptoms' relief and blood levels' change to take effect after each dosage change of cytomel?

Thanks again!

[gryscle]

Yes, i'm taking the Eltroxin on a daily basis - 100 mcg per day, and 200 mcg on Saturdays (and indeed, I meant mcg, not mg).

- What should be a sufficient indicator that it's time to try a new approach (as in adding Cytomel)? Is a year of treatment with still much present symptoms a good enough reason/indicator? Or should I continue waiting?

- Regarding the Cytomel treatment, you mention "as needed". Does that mean a combination of symptom relief and FT3 in the upper third of the range?

Thank you very much.

[Barb135]

How are you taking the Eltroxin?  On a daily basis?  I think you mean you're on 800 mcg vs 800 mg, is that correct?

You're correct that rule of thumb for FT4 is about mid range (50%); however, rule of thumb is upper half to upper third of its range.  These are just "targets" to aim for until you find the level that's best for you.  

You may have a conversion issue.  FT3 should be higher in its range than FT4 in its.  If you start on a T3 med, such as cytomel, be sure to start out at a very low dosage (many start at 2.5 mcg/day) and work up, as needed.  Additionally, it's customary to decrease T4 med by 20 mcg/day when starting a T3 med.