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Old 03-10-2011, 09:23 AM   #1
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Figuring out t3 dose

For those out there who know about t3 , I have a question.

I had previously been on synthroid only and I felt best at something a bit shy of 100mcg. I wanted to try t3 cytomel and my dr. scripted a tiny dose 2.5mcg to see how I would tolerate it. My synthroid was lowered to 85mcg a day when I took the 2.5mcg. of cytomel. I told the dr. I was feeling sluggish.As the add on of cytomel was so tiny , she said we could raise the cytomel to 5mcg a day, and do labs in 6wks as the dose change is so tiny.

Ok...now my cytomel dose has been moved up to 5mcg. AND the dr. said to take 88mcg a day. I am concerned that with the 88mcg synthroid combined with the 5mcg cytomel that I will be over the dose that is comfortable for me.

If you count the cytomel 5mcg as equal to 20mcg synth. and then add in the 88mcg synth . she wants me to take , I would be at a total of 108mcg t4 and that is too much for me based on past experience.

Wouldn't I be better off with a dose of synthroid around 80mcg with the cytomel 5mcg IF I could only tolerate a dose near 100 mcg of synthroid?

I hope this was clear enough. I hate going hyper and would rather under shoot a bit and then add in more if needed.
Azuree
**I am doing these odd doses of synthroid e.g. 80mcg by cutting pills in 1/2 and taking 88 for 6 days and 1/2 88 on the 7th day.

 
Old 03-10-2011, 09:40 AM   #2
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Re: Figuring out t3 dose

I wouldn't do too much of counting T4 and T3 are two separate things, both with their own jobs. Do try a lower amount of T4 but don't get too fixed on "equivalence"

 
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Old 03-10-2011, 09:53 AM   #3
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Re: Figuring out t3 dose

Hi FinnMaid--Thanks for your reply. Yes, I was wondering just how much stock to put in the equivalence thing .

Hey--are you feeling good with your new dose? I had to laugh about your recent spring cleaning discussion and cd's response...asking whether it was the cytomel talking???

That made some sense to me as I know with dose changes things can definitely go a bit strange .
Azuree

 
Old 03-10-2011, 09:59 AM   #4
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Re: Figuring out t3 dose

Honestly I've put no stock on the equivalence thing and it's worked just fine for me (Just start on a low dose of T3 and decrease T4 only if needed - not "just because it's supposed to be done")

I'm actually doing pretty good, thanks I've noticed that I'm starting to fall asleep a bit sooner which is great No it wasn't just T3 talking (although it sure helps to think straight when you have the right amount of thyroid hormones going around )

 
Old 03-10-2011, 10:17 AM   #5
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Re: Figuring out t3 dose

FinnMaid you wrote...
(although it sure helps to think straight when you have the right amount of thyroid hormones going around )

You have hit on what should be considered the "First Rule Of Thyroid Replacement"--
get the patient able to think straight again. Though this is easier said than done.
Azuree

 
Old 03-10-2011, 01:10 PM   #6
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Re: Figuring out t3 dose

I'm just getting caught up to speed on here today and was cracking up as I was reading this thread. The "cytomel talking" comment was based upon a member from another forum telling me how she used to bite her husband's head off when titrating up on her dose.
Admittedly, I had one fleeting moment of irritability about 1/2 hour after one dose.

Anyhooo, I agree with FinnMaid - it's basically an educated guess.

I was taking 75mcg levo and my FT3 needed improvement - I was a little chicken about starting Cytomel so opted for a levo dose increase to 100mcg for a week and then back down to 88mcg.

Well, I "crashed" (hypo symptoms back with a vengeance) after a week on 100mcg and decided to try Cytomel after all.

My doctor brought me back down to 75mcg levo and started me on 5mcg Cytomel (which I divided into two doses)

First set of labs after this: FT3 was where I needed it to be but FT4 dropped....now I'm taking 88mcg levo with my 5mcg Cytomel - lol

I get labs tomorrow - am feeling awesome but will ask to get either dose adjusted if my numbers indicate a need. This is my plan in attempts to stave off the development of symptoms - we shall see if it works

And, most definitely, get the patient thinking straight!!! Sometimes I wonder if doctors prefer to keep people hypo so they don't argue as much
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Last edited by cd37; 03-10-2011 at 01:12 PM. Reason: typos

 
Old 03-10-2011, 01:30 PM   #7
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Re: Figuring out t3 dose

Quote:
Originally Posted by cd37 View Post
I'm just getting caught up to speed on here today and was cracking up as I was reading this thread. The "cytomel talking" comment was based upon a member from another forum telling me how she used to bite her husband's head off when titrating up on her dose.
Admittedly, I had one fleeting moment of irritability about 1/2 hour after one dose.

Anyhooo, I agree with FinnMaid - it's basically an educated guess.

I was taking 75mcg levo and my FT3 needed improvement - I was a little chicken about starting Cytomel so opted for a levo dose increase to 100mcg for a week and then back down to 88mcg.

Well, I "crashed" (hypo symptoms back with a vengeance) after a week on 100mcg and decided to try Cytomel after all.

My doctor brought me back down to 75mcg levo and started me on 5mcg Cytomel (which I divided into two doses)

First set of labs after this: FT3 was where I needed it to be but FT4 dropped....now I'm taking 88mcg levo with my 5mcg Cytomel - lol

I get labs tomorrow - am feeling awesome but will ask to get either dose adjusted if my numbers indicate a need. This is my plan in attempts to stave off the development of symptoms - we shall see if it works

And, most definitely, get the patient thinking straight!!! Sometimes I wonder if doctors prefer to keep people hypo so they don't argue as much

 
Old 03-10-2011, 01:37 PM   #8
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Re: Figuring out t3 dose

Cd ---If you have had only 1 fleeting moment of irritability in the thyroid hormone replacement process , you should count your blessings! Many of us here have had quite a different experience...pity our poor husbands/mates.

I hope you will let us know how your labs go.
Azuree

 
Old 03-10-2011, 01:54 PM   #9
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Re: Figuring out t3 dose

Thanks, azuree - I DO count my blessings. I think the reason I fared so well is that I had partnered with a "good" thyroid doctor after I went off anti-thyroid drugs for my Graves' and before I needed replacement meds. I didn't need my levels to go up as much as many others have needed theirs to go up.

It was a rocky road for awhile with the return of hypo symptoms as I worked to find my setpoints (my former endos never helped in that regard when I was taking ATD's).

If anything, my mate and family had to deal with an over-emotional cry baby - lol

I should get my results on Monday - thanks for your interest - I am quite curious myself since I tend to feel my levels after I "hit" them. (which is another reason why I insisted to my doctor that she increase my levo dose last month when my FT4 dropped a tad....yes, I was feeling VERY good after starting Cytomel but had some very, very minor hypo symptoms "left"....we all know it can take awhile for symptoms to dissipate *but* I learned I feel best with my FT4 at the very top of the range.....so I asked her to increase my dose to get it back there).

I am very curious - very curious indeed

Wishing you the utmost success as you move forward with Cytomel - it was truly the "missing link" for me - SO happy I'm taking it.
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Last edited by cd37; 03-10-2011 at 01:57 PM. Reason: typos

 
Old 03-10-2011, 02:33 PM   #10
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Re: Figuring out t3 dose

Cd--Yes, I hope cytomel is my "missing link" too. I have been working out my dose for the past 4yrs. Hashimoto's with its relentless , though sporadic thyroid destruction didn't make it easy at all. It was working with a moving target. Now that my thyroid is totally destroyed, things should get somewhat easier.

Now that you have been on t3, does your dr. only look at the free t's to determine dosing or does he/she also take into account your tsh? The reason that I ask is that some have said that taking t3 will suppress your tsh and that the tsh should therefore no longer be used to determine dosing.
Azuree

Last edited by azuree; 03-10-2011 at 02:33 PM.

 
Old 03-10-2011, 03:07 PM   #11
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Re: Figuring out t3 dose

I can't imagine dealing with what you poor Hashi's sufferers deal with. My biggest thyroid problem was finding a doctor that knew how to medicate.

Funny you should ask about TSH - that was the bane of my existence with my former endos. You see, the Graves' antibodies suppress TSH and clueless endos would overmedicate me with ATD's in their efforts to bring my TSH into the "normal" range.

My current doctor has said numerous times "we know not to look at TSH in Graves' disease"....my TSH has always been below-range, thanks to the antibodies.

Those antibodies have now made me hypo even with that below-range TSH - that is why I am so thankful for my current doctor.

She did give me a scare once, early into the replacement game, and mentioned something about a "balance" with the TSH. But, as quickly as she said it, I never heard about TSH again.

Now, since I've been taking T3, my TSH is undetectable - she didn't say "boo" about it after my last labs and still agreed to the T4 dose increase.

I have lots of great information to back up not having TSH when taking T3. Truly, any doctor worth his/her "salt" should know to look at the actual thyroid hormone levels when dosing with thyroid hormone....and ignore the pituitary hormone - TSH.

Makes sense to me when one "component" (aka thyroid) of the HPT (hypothalamic-pituitary-thyroidal) feedback loop isn't "talking right" anymore .
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Old 03-10-2011, 03:43 PM   #12
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Re: Figuring out t3 dose

cd--Thanks so much for the helpful information about tsh.

You said you have lots of information that states that tsh should be ignored when using t3.

Could you suggest the books where I can find this info. I haven't seen it in Thryoid for Dummies, K. Blanchard's book. While Blanchard discusses use of T3, I didn't see any info on how to read labs when using T3.

Thanks
Azuree

Last edited by moderator2; 03-10-2011 at 04:29 PM.

 
Old 03-10-2011, 03:55 PM   #13
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Re: Figuring out t3 dose

Another member on here posted the following thread before I even joined this board - I somehow found it while reading around on here and bookmarked it...it references the appropriate endo journals - what more could one ask for?

http://www.healthboards.com/boards/showthread.php?t=597479&page=8

Also, in reading another thread on here, someone mentioned an endo in CA - Theodore Friedman - as having a great site with this type of info.....we're not allowed to post links to sites on here but I found him quite easily by Googling. Good stuff on there.

At the end of the day, in light of a malfunctioning HPT feedback loop, doctors should be looking at the THYROID hormone levels when Rx'ing THYROID hormones.

Why knock on the neighbor's door when you know your friend is home?
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Old 03-11-2011, 01:23 PM   #14
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Re: Figuring out t3 dose

cd--Did you dr. tell you anything about taking your synthroid and cytomel prior to your blood draw? What did you do?

When just taking synthroid , I took my synthroid on the day of the blood draw as usual...and had labs done around 9am. Now with taking the cytomel daily in 2 divided doses around 8 am and 1pm...I don't know what I should do. Probably my blood test will be around 9am as I usually do.
Azuree

 
Old 03-11-2011, 01:27 PM   #15
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Re: Figuring out t3 dose

My doctor said nothing about lab timing....nor dose timing....nor splitting the Cytomel.

I made my decisions about all based upon research and thyroid forum member input.

I take my levo at 11PM at night.....you already know my Cytomel 8AM/2PM schedule

I always lab around 1PM.....this way, my results are consistent from month-to-month and the immediate effects of Cytomel are almost out of my body by then....and the long-term effects should be still evident.
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Last edited by cd37; 03-11-2011 at 01:28 PM. Reason: typos

 
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