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Old 05-04-2011, 03:22 PM   #1
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Lightbulb Is This Normal With Adding Cytomel/Liothyronine.....

I just started taking Liothyronine (T3) the beginning of April. So I take 5 MCG of Liothyronine along with my 100 MCG of Levothroid in the morning. I was wondering if it is normal to see a drop in my Free T4 level when adding the T3 medication? Isn't it best for both the Free T3 and Free T4 to be in the upper range? I am still waiting to for my Free T3 blood results to come back in, but here is what my blood tests results have been so far:

TSH (.10-5.50): 3-1-11: 1.5
4-1-11: 1.3
5-2-11: 1.23

Free T4 (.8-1.7ng/dL)
3-1-11: 1.5
4-1-11: 1.3
5-2-11: 1.1

Free T3 (210-440)
3-1-11: 270

I had asked to add more Liothronine 2 weeks after I had started taking it because I felt that it helped to take quite a bit of my achiness and fatigue away for several hours. It didn't take it all away, but alot. So I thought that if I could take another dose of it in the afternoon it would help me to have longer relief, but my doctor is VERY cautious and told me that she does not want me to overdose on this and put me into atrial fibrilation. I have not had any hyperthyroid symptoms since beginning the T3 meds and am hoping that I may be able to add a little more if the doctor ok's it. I would like to see my Free T3 and T4 numbers in the upper range and hopefully I will feel better. I am just concerned over my Free T4 level dropping instead of increasing. Any advice or opinions would be GREATLY appreciated!

 
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Old 05-04-2011, 04:59 PM   #2
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

I don't know if it's "normal" to have the FreeT4 level drop after starting Cytomel but, it happened to me.

Quite frankly, your FreeT4 level had already dropped by the time you started Cytomel - some doctors lower the levo dose when adding Cytomel....some leave it the same - I suspect the decision is based upon the FreeT4 level at the time Cytomel is added.

It's really hard to know just what will happen with the FreeT4/T3 levels when adding Cytomel. You basically need to see "what" the addition accomplished and adjust both meds doses based upon the FreeT4/T3 levels moving forward from there.

I started 5mcg in January (only I divide my dose into two/day.....8AM and 2PM - this was based upon my research and advice from other thyroid forum members). My FreeT4 was at my "sweet spot" when I started. (my doctor didn't lower my levo dose for whatever reason - I was comfortable with this)

4 weeks after starting Cytomel, my FreeT3 level rose to my "sweet spot" but, my FreeT4 level dropped. I asked my doctor to increase my levo dose, which she did.

I've had to continue increasing my levo at each monthly appointment because I feel best with my FreeT4 level at the top of the range.

Looking at your FreeT4 level, it seems you would benefit from a levo dose increase.

We really need to see your FreeT3 results before commenting about what you might want to consider moving forward in regards to your T3.

The beauty of taking T3 and T4 meds separately is that we can adjust each med to "accommodate" each level (FreeT4 and FreeT3)

And, yes, most people feel best with their FreeT4/T3 levels in the upper third of the range but, not everyone. There's really no one that feels well with either level below mid-range. And, there are those of us (me, for example) that need both levels at the very top of the range.
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Last edited by sammy64; 05-04-2011 at 05:08 PM.

 
Old 05-04-2011, 05:13 PM   #3
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Thanks for your reply Sammy64. Yes, I did get my Free T3 level tested, but for some reason this one blood test takes longer to get the results. I am anxiously waiting to hear what they are and will post them as soon as I know the results. My endo also kept my Levothroid the same when adding the Liothyronine (T3). I tried splitting my Liothyronine in half to take 1/2 in the morning and 1/2 in the afternoon, but I didn't get any relief at all with this small of a dose. The only logical reason that I could think of as to why the Free T4 level drops when adding a T3 med is that the body sees that it does not have to convert as much T4 into T3 so it produces less. That is just my thinking though.
Another test that I had done was my Ferritin level. Back in 3-1-11 I tested low, 6. Normal is 22-291. I started taking liquid iron supplements and it only went up to 11 on 5-2-11. I am wondering if thyroid meds can effect the results of this test? I also take birth control pills and wonder if this can effect my test results as well? Does anyone know anything about low ferritin and hypothyroidism? I think I will also post this as a separate question.

 
Old 05-04-2011, 10:23 PM   #4
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Hi Jenny--
Perhaps the reason that your t4 level dropped is the supplemental iron that you are taking.

This happened to me with supplemental iron that I was taking to deal with low ferritin. So, while on the iron my dose of t4 had to be increased to compensate for iron blocking absorption of t4. In Thyroid for Dummies, Dr. Rubin specifically mentions that iron will block absorption of t4. Note...I made sure to take the iron at least 12 hrs. away from synthroid and still I had to up my dose of t4 while on iron.
Azuree

 
Old 05-05-2011, 12:18 AM   #5
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

When you add T3 your pituitary gland notices it and produces less TSH, that makes your thyroid work less (most of us still have some function left) and that can make your FT4 drop - this is my theory When I started T3 treatment I had just increased my levo T dose by 25 mcgs and my TSH dropped from 2.68 to 0.1 and my FT4 changed from 19.7 to 19.1 - the former levels before the increase, the latter with the increased dose and added T3. There is obviously less conversion when on T3 too.

 
Old 05-05-2011, 08:50 AM   #6
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Azuree, I didn't even think that the iron supplement could cause this to happen. It makes alot of sense! I have been taking the iron at least 4 or more hours after the thyroid meds, but I will try spacing it out even more.
FinnMaid, did you notice quite a bit of improvement(decrease in hypothyroid symptoms) when you added the T3 and if so, how soon after starting it?

I got my Free T3 blood results back. It looks like Kaiser sent it out to a different lab the second time because they are using different values than the 1st time I had the test:
Free T3(210-440) 270 on March 1, 2011 (42%)
Free T3(2.3-4.2) 2.7 on April 2, 2011 (42%)

I would really like to try adding a little more T3 med to see if my symptoms improve even more. I am hoping that my doctor will agree. Doesn't it look like it would be safe to add a little more T3 med? I have not had any hyper symptoms at all.

 
Old 05-05-2011, 09:36 AM   #7
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

I'm confused....you said you got your FreeT3 results back but, the most recent one dates to April 2nd - isn't that when you started T3?

My 5mcg starting dose brought my FT3 right where it needed to be....and it's held steady ever since.

You really need to get a more current FT3 level to decide what to do with your T3 dose. Especially since it's clear you need an increase in your FT4 level.

An increase in your levo might just take care of things.
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Old 05-05-2011, 09:43 AM   #8
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Quote:
Originally Posted by Jenny95123 View Post
FinnMaid, did you notice quite a bit of improvement(decrease in hypothyroid symptoms) when you added the T3 and if so, how soon after starting it?
Well it took some time to feel significantly better - a couple of months (my dose was 10 mcgs then) but I've been on T3 ever since, over five years (been on 30 mcgs a few years).

 
Old 05-05-2011, 09:44 AM   #9
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Quote:
Originally Posted by sammy64 View Post
I'm confused....you said you got your FreeT3 results back but, the most recent one dates to April 2nd - isn't that when you started T3?

My 5mcg starting dose brought my FT3 right where it needed to be....and it's held steady ever since.

You really need to get a more current FT3 level to decide what to do with your T3 dose. Especially since it's clear you need an increase in your FT4 level.

An increase in your levo might just take care of things.
I'm so sorry! I wrote the wrong dates. These are the correct dates of my Free T3 blood tests:

Free T3(210-440) 270 on March 1, 2011 (42%)
Free T3(2.3-4.2) 2.7 on May 2, 2011 (42%)

 
Old 05-05-2011, 10:46 AM   #10
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Jenny- My situation has been a lot like yours. But, when I first added in the iron supplement I was only taking t4-synthroid around 88mcg and as the iron blocked the thyroid med, I then had to go up to 100mcg and 112 just on Sunday. So, even taking the iron supplement 12hrs. later my dose of t4 had to go up.Then when I stopped the iron supplement , I had to decrease the synthroid. (My ferritin project goes on but I won't go into it further now)

Your ferritin at 6 and now at 11 is considerably lower than my level that was at 35. In your first post on this thread you mentioned the fatigue and aches that you are feeling. I am thinking that quite a bit of that could well be from your very low ferritin level.

I recently added in cytomel to my regimen. Started at 2.5mcg to take it slow due to a prior bad experience with cytomel. The 2.5mcg worked out fine and then my cytomel was raised to 5mcg. I took the 5mcg cytomel in two split doses and my generally great bp had spikes. Now I take the 5mcg in 4 split doses and no longer have the spikes.

Anyway....dose changes get more complicated when adding in t3 AND even more complicated when taking an iron supplement at the same time.

If you want to talk further about your ferritin situation, perhaps you would like to put a post on the anemia board. I will check over there to see if you post anything.
Azuree

 
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Old 05-05-2011, 01:20 PM   #11
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Quote:
Originally Posted by Jenny95123 View Post
I'm so sorry! I wrote the wrong dates. These are the correct dates of my Free T3 blood tests:

Free T3(210-440) 270 on March 1, 2011 (42%)
Free T3(2.3-4.2) 2.7 on May 2, 2011 (42%)
I was hoping there was a mix-up (except this means the addition of T3 really didn't accomplish much except keep you from going more hypo)

I would definitely push for an increase in both your T3 and levo based upon your most recent labs.
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Old 05-05-2011, 01:50 PM   #12
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Quote:
Originally Posted by azuree View Post
Jenny- My situation has been a lot like yours. But, when I first added in the iron supplement I was only taking t4-synthroid around 88mcg and as the iron blocked the thyroid med, I then had to go up to 100mcg and 112 just on Sunday. So, even taking the iron supplement 12hrs. later my dose of t4 had to go up.Then when I stopped the iron supplement , I had to decrease the synthroid. (My ferritin project goes on but I won't go into it further now)

Your ferritin at 6 and now at 11 is considerably lower than my level that was at 35. In your first post on this thread you mentioned the fatigue and aches that you are feeling. I am thinking that quite a bit of that could well be from your very low ferritin level.

I recently added in cytomel to my regimen. Started at 2.5mcg to take it slow due to a prior bad experience with cytomel. The 2.5mcg worked out fine and then my cytomel was raised to 5mcg. I took the 5mcg cytomel in two split doses and my generally great bp had spikes. Now I take the 5mcg in 4 split doses and no longer have the spikes.

Anyway....dose changes get more complicated when adding in t3 AND even more complicated when taking an iron supplement at the same time.

If you want to talk further about your ferritin situation, perhaps you would like to put a post on the anemia board. I will check over there to see if you post anything.
Azuree
I just posted a new thread/question on the anemia board! Thank you for all of your help!

 
Old 05-05-2011, 01:54 PM   #13
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

Quote:
Originally Posted by sammy64 View Post
I was hoping there was a mix-up (except this means the addition of T3 really didn't accomplish much except keep you from going more hypo)

I would definitely push for an increase in both your T3 and levo based upon your most recent labs.
Sammy64: No it is not an error. My Free T3 level did not go up at all with the addition of the T3. I am wondering if taking the liquid iron supplement has anything to do with it. I make sure that I take it at least 4-6 hours after my thyroid meds, but it could still be interfering with it. I bet you are right though, if I didn't take the T3 I probably would have become even more hypo. I just posted a new thread on the anemia board in regards to low ferritin level and my symptoms too. Thank you for all of your help!

 
Old 05-05-2011, 03:40 PM   #14
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

I don't believe T3 is affected by iron the way T4 is....maybe someone can chime in along these lines...
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Old 05-05-2011, 11:34 PM   #15
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Re: Is This Normal With Adding Cytomel/Liothyronine.....

I agree with Sammy. Maybe you don't absorb your T3 very well for some other reason. Some people need significantly higher doses to get their FT3 up (I'm currently on 175 of T4 and 30 of T3).

Last edited by FinnMaid; 05-05-2011 at 11:39 PM.

 
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