Withdrawal symptoms from decreasing Cytomel dose?

[KellyHushin]

My boyfriend has been overdosing on Cytomel for years. He is now trying to lower the dose and having terrible side effects he describes as "head fog." He says he can't focus, can't get work done, etc. He really wants to go back up but I am concerned the higher dose will be bad for his health in other ways. Can anyone offer any advice/help?

[flyingfool]

I would recommend you start a new thread.  ANd please go into some resonable detail as to your past history and what medications and dosages you tried and their results.

I'm confused as to exactly what you were on.  Are you saying you were on 50 mcg of T3 (Cytomel) a day and that you now have gone to nothing?

T3 only treatment is rare and usually only used to "clear out" a Reverse T3 problem and that is usually only temporary time.  So I'm a little confused as to exactly the dosage you were on and what you are currently at.

Please post your latest lab results along with the reference ranges and includ your current symptoms.

with all that info more people will be able to help you out.

[whatsthedealio]

Hi everyone... I just joined this thread and am very interested.  I am also on Cytomel and tried to come off.  I titrated slowly and came off without the horrible side effects I had before but now I'm back to where I was before I went on.  I've gained 15 pounds, I'm cold all the time, constipated and lack energy.  My reasoning for wanting to come off is similar to the question above.  I'm taking 25 mcg  BID (50 mcg total per day).  I felt great when on it but didn't want to stay on forever and felt that seemed high.  My doctor agreed to allow me to try to come off but I'm considering asking to go back on.  I've been completely off for 2 weeks now.  What do you think?

[Barb135]

Total T3 and T3 uptake are both quite obsolete and of little value, but looking at the other labs, your boyfriend does not appear hyper, and I do believe him about the brain fog.  He's actually probably a bit hypo, and brain fog/inability to think clearly is a major symptom of being hypo.  

Just because his TSH is very low (mine runs < 0.01, all the time), does not mean he's hyper or overdosing on medication.  5 mcg Cytomel is a very small dosage, and his FT3 still has room to go up before going over the edge.  

With his FT4 being at the very bottom of the range, he doesn't have anything to convert to T3, so the cytomel was probably what was keeping him going.  

I, too, would be interested in how he came to be on Armour, plus synthroid and cytomel.  I'd also be interested in knowing whether the labs were done before or after stopping the cytomel.  

In my opinion, your boyfriend is a bit hypo and could benefit from an increase in either the synthroid or the Armour.  

[flyingfool]

I've never ran across someone who is on all three. You are right that is quite a cocktail.

I can't remember the whole thread.  Do you know his history as to how he came to this most interesting cocktail?  Does he know he has a conversion problem.  Or did he start out with the T4 med only, then they added the Armour to get his T3 up, and then finally a last ditch effort to further tweak the T3 by adding of Cytomel?

Are the lab tests posted above, Prior to or post stopping of the Cytomel?

Thyroxine free I believe is FT4.  And it shows it to be at the very bottom of the range.

Based solely on the lab results. I would tend to want to get the FT4 up some more by increasing the synthroid.

Since he is reporting feeling worse,And his FT4 levels being so low, there may not be enough T3 for him to feel well.  Maybe this is a conversion problem.  But with the FT4 levels so low, I would think it might make sense asking for an increase in the synthroid (T4) and then have to wait about 6 weeks to see if he begins to feel better.  If the T4 converts and his FT3 numbers come up.  It may just be just a matter of tweaking the synthroid levels to allow him to get symptom free.  

And this may be possible with eliminating Cytomel.  Which I understand is a fairly expensive drug.

These are just my thoughts.  I'm not a Dr.  I'm just here to learn more and help make my wife feel better.

[KellyHushin]

Hi Barb,

Yes, he does have Hashimoto's. Here are his results from a recent lab:

T3 free: 3.3 (range: 2.3 - 4.2)
T3 total: 132 (range: 84 - 172)
T3 uptake: 28.0 (range: 23 - 36)
Thyroxine free: 0.89 (range: 0.89 - 1.76)
TSH: 0.01 (range: 0.35 - 5.50)

As you can see - his T3 and T4 are normal, but the TSH is very low. This is the dosage of medication he was taking up until a few weeks ago:

1 grain of Armour - 37 mcg of T4 and 9 mcg T3
1 pill Cytomel - 5 mcg T3
1 white pill Synthroid - 50 mcg T4

He recently came off the Cytomel and is feeling pretty bad. Very bad head fog, depression, etc. The worst symptom seems to be the head fog - he can't focus or get anything done - so he says. I don't say that like I don't believe him - just that this is what he tells me. He has tried to talk to doctors in the past and they don't seem to believe him when he talks about his head fog. He wants to go back onto the Cytomel but I am concerned that he is taking too much of something with this cocktail and feel like maybe he should just give it a little more time and see how he feels. If he has to go back on the Cytomel, I feel like maybe he should drop the Armour and up the Synthroid or something? Doctors don't seem to want to spend much time analyzing this and determining dosages so that's why he's taken it partially into his own hands.

Both of your words of wisdom and advice are very helpful.

Thanks,
Kelly

[Barb135]

Can you post the most current lab results, along with the reference ranges from the lab report.  Reference ranges vary from lab to lab, so must come from his own lab report.

What flyingfool is saying is correct.  Without knowing the FT3 and FT4 results, we have no idea if your boyfriend is hyper or hypo.  

Do you know if he has either Graves Disease or Hashimoto's Thyroiditis?

[flyingfool]

The term "free" means that the hormone is NOT attached to a protein.  Both T3 and T4 can get attached to a protein. And once it gets attached it becomes worthless as the body cell receptors can not accept it with the protein attached.

Yes both Free T4 and Free T3 can be tested.

There is also a think known as "reverse T3".  This is a molecule that is the mirror image of the T3 molecule.  And I believe that the body can accept the reverse T3 molecule, but it doesn't do any good because it doesn't work.  So you can also have a test done to calculate reverse T3.  Problems with reverse T3 is more rare but does happen.

Bottom line, the FREE T3 is what the body uses.  That is why it is so important to test.  Probably the most important thing to test for. Unfortunately that is not what most Dr's will even test for.

The symptoms people have most closely track the Free T3 levels.  There was NO correlation or the least correlation with TSH.  And little correlation with free T4.  

Why more Dr's don't know this but a novice like me can find all this out never ceases to amaze me.

And I say "truly Hyper".  Because often times TSH is suppressed and Dr's will "think" the person is Hyper based on this nearly useless test.  But in reality they are Hypo.

Again most people seem to relieve symptoms when their free T4 (FT4) is about mid range and free T3 (FT3) is in the UPPER 1/3 of the range.

Again even Dr's that do the FT4 and FT3 only will medicate to somewhere in the "normal" range.  But if kept in the lower range of the FT4 you will likely will still have and still be Hypo.  But most Dr's are perfectly happy keeping the patient in that state.  And they write off the patients symptoms and tel them that they are "normal" and that it is all in their heads!

Glad to hear that Dr's are involved.  It sounded like you were doing this all on your own.

[KellyHushin]

He has not been doing this all on his own, we have had doctors involved. The problem is that doctors seem to look at numbers and that's it, they doesn't seem to understand/care about his symptoms. He complains of head fog and they just tell him he needs to lower his medication. He says he doesn't feel good and they say he needs to lower his medication. Can you tell me what you mean by Free T3? Can they test for that? And when you say, "If truly Hyper," does that take into account all the measurements or is that just TSH?

[flyingfool]

You need blood labs. Self medicating and self adjusting is not the way to go here.

It is odd that he is on all three medications at least at one time!

Without the FREE T3 & FREE T4 (not TOTAL but Free) it will be very hard to determine what to do.

Synthyroid is a pure T4 medication.  Armour is a natural Thyroid product and it contains BOTH T3 AND T4 components.  Cytomel is a pure T3 med.

Your body only uses Free T3.  The T4 in your body is converted to T3 before it is used.

If truly Hyper cutting the T3 components would make sense.

But again you need a Dr and the proper lab tests to help do this.

[KellyHushin]

Hi,

I am pretty sure that he was testing his TSH, T3 AND T4 and that the labs showed he was overdosing. He was taking Synthroid, Armour AND Cytomel for years. For a while he was on a VERY high dose which made him sweat profusely at night and gave other clear symptoms that he was overdosing. He sort of put himself on that high a dosage because he was convinced he needed it.

Then after experiencing these side effects and losing weight profoundly, he realized he needed to cut back. He lowered the dosage of Cytomel, but still felt he was overdosing...so finally he has stopped taking the Cytomel completely and is only taking the Synthroid and Armour. It's been just about two weeks and he's still having the head fog.

I believe this is all compounded by the fact that he is generally a very anxious person and is very nervous about all of it. I am just wondering if he should give it another two weeks or so and see how he feels? And if he doesn't feel better, should he try going back on the Cytomel and stop taking the Armour? I'm just concerned about him continuing to take both the Armour AND the Cytomel and feel one of them should be cut back.

Thanks for the help!
Kelly

[flyingfool]

What makes you believe that he was being over medicated?

Do you have the blood tests including Free T4 & Free T3.

If they are stating that he was over medicated solely on the basis of the TSH they are almost assuredly wrong.  Because especially people that take T3 med (which Cytomel is) it will almost certainly suppress TSH making that test virtually and utterly useless as a diagnostic tool.

In fact TSH is almost worthless to begin with.  But Dr's rely on it like it was the gold standard.  And maybe it was 50 years ago.  But now we know better.  Unfortunately nobody has told all the Dr's out there of this fact.

Brain fog, is a common symptom of being Hypo (low thyroid) so if they lowered the meds, it is possible they just dumped him inty Hypo land because they were looking at the wrong blood labs.