What would make my T3 low and my T4 on the higher range?
He told me to start the Wellbutrin and Cytomel and skip one day of my Synthroid during the week.
I don't understand why your doc is decreasing your Synthroid dose when your FT4 is already low - what you can do is to say "no way, it needs to be increased" Cytomel will make your FT3 rise - but you need to be careful with it - often doctors prescribe high doses to start with that can cause trouble. And indeed you need to get FT3 tested - not those stupid useless total/uptake/index tests.
You haven't had the best thyroid tests. The TSH and free T4 are good, but you need free T3 done as well. The test you had is total T3, not as accurate as free T3. Ditto for total T4.
The other tests you had are not accurate at all and are basically worthless. Your (total) T4 is definitely not "high". It's probably too low, given the 20% inaccuracy rate it carries. Its level reflects itself in your low-normal free T4. Yes, your free T4 is too low... as is your TT3; that means you do need the Cytomel, but you likely need a bump up in your Synthroid as well. (You don't say how much Cytomel you were prescribed. That would make a difference in where the Synthroid dose needs to be.)
Your liver and other tissues apparently don't convert T4 to T3 very well, and that's why the T3 level is low. About the only thing I'm aware of that might help that conversion is selenium, at least 100 mcgs/day. But when that fails to help, T3 supplementation - as you've been prescribed - is a must.
Your depression might indeed be caused by low T3. Speaking only for myself, I wouldn't even consider taking an antidepressant until my thyroid levels were optimal. The AD can create its own huge set of problems. Why even go there if it's not needed in the first place?
My Doc also lowered the Synthroid when he added the Cytomel. I "believe" 5mcg Cytomel is equivalent to 20mcg Synthroid but the Cytomel acts faster. I am now taking 10mcg Cytomel but both 5mcg tablets together in the morning with the Synthroid as per instructions.
New dose will be 88mcg*6days (528) +5mcg (*4)*7days(140)=668/week
So in effect, you have an increase already. This is the way it was explained to me on this board earlier.
True. I believe that is because the Cytomel is fast acting. I actually have just asked my Endo (left a message) if he is willing to up my Cytomel again as my FT4 is so low. 2.7 (2.3-4.2) If he agrees, maybe I can take 2 in the morning and one in the afternoon (that is what my GP said to ask him). I am hoping he will go by the FT's rather than the TSH, as the TSH is good.
Ginger, your TSH will drop because of Cytomel so you need to go by freeT's and symptoms. You can start with 2,5 mcgs once a day and increase the dose in a week or two. Referring to Hopalong's calculations "a total increase" of about 50 mcgs a week will very likely not be enough in this case (it's like 7 mcgs a day! - certainly not a lot when you could possibly need a daily increase of 25 mcgs of just T4) - I would stay on those 88 mcgs of T4 a day and see if I needed a change later.