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-   -   New labs, 6 weeks after adding Cytomel. Erg... (http://www.healthboards.com/boards/thyroid-disorders/911325-new-labs-6-weeks-after-adding-cytomel-erg.html)

LPD 07-25-2012 10:38 AM

New labs, 6 weeks after adding Cytomel. Erg...
 
For a brief recap, my labs in Dec 2011 (while taking 50mcg Levo' pre blood draw):
TSH 1.59
Total T3 - 82 (87-178) Below range
Free T4 - 1.0 (.5-1.6) 45% ? (elevated because I took my dose first?)

After begging, my Endo added 12.5mcg (generic) Cytomel about 7 weeks ago. This time, I knew not to take the meds, (thank you!) before the blood draw:
TSH 1.06
Total T3 - 71 (76-181) Below range
Free T3 - 2.5 (2.3-4.2) 1% ?
Free T4 - 1.1 (.8-1.8) 30% ?

Have I done my math right? ;) I'm hoping to talk with my Endo tomorrow morning. Suggestions? I'm thinking / hoping for a bump up in both meds, eh? Oh please, oh please ... I sure need something! HELP!

Lin

FinnMaid 07-25-2012 11:22 AM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
[QUOTE=LPD;5027182]I'm hoping to talk with my Endo tomorrow morning. Suggestions? I'm thinking / hoping for a bump up in both meds, eh? [/QUOTE]I think so too, your levels are SO LOW (your FT3 seems to need even more help than your FT4). Good luck with the endo :)

LPD 07-25-2012 12:13 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Hi FinnMaid, thank you SO much. {{{hugs}}} May I ask what you'd suggest I say to my Endo? An increase on the Synthroid to 75 or 100mcg, (up from 50) and an increase in the Cytomel to 25mcg? (up from 12.5) Or should I aim for a higher increase, and just gradually increase my doses every 6 weeks?

Lin (the zombie woman!) ;)

[QUOTE=FinnMaid;5027201]I think so too, your levels are SO LOW (your FT3 seems to need even more help than your FT4). Good luck with the endo :)[/QUOTE]

sammy64 07-25-2012 01:38 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Levothyroxine is usually increased in 12.5mcg-25mcg increments when the FreeT4 level is below mid-range. Your math is right, your most recent FreeT4 level is 30% of range.

Just so you know, not everyone can handle 25mcg dose increases (let alone a doubling of the dose) - especially if they accompany a Cytomel dose increase.

And, not everyone can handle a doubling of their Cytomel dose. (although, not many people could start with 12.5mcg, either :)) Most Cytomel doses are increased in 2.5-5mcg increments.

Increasing too much too soon just doesn't work since our bodies can only "process" so much new hormone at any given time. You're at risk of overshooting your goal and developing hyper symptoms.

Slow and steady wins the thyroid disease race.

I'd like to see you stop taking your Levo with coffee - that alone should help your FreeT4 level.

And, now that you have some information about standard treatment protocol, I hope you can use that for a meaningful conversation with the endo.

sammy64 07-25-2012 01:49 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
I'm posting this separately for clarity.

Just so you understand why I'm suggesting a slow and steady approach, I will share an analogy about adjusting doses that I picked up along the way.

The hypothyroid body is like a dried-up sponge. Just as the sponge cannot absorb its full capacity of water with one pour, the body cannot absorb its full needs of thyroid hormone.

If too much water (hormone) is poured onto the sponge (body), the top of the sponge (body) might absorb some of the water (hormone) but, much of it will pour off (cause hyper symptoms).

So, you wind up with a slightly wet but, still dry sponge (body that has a mixture of hyper and hypo symptoms).

If, instead, you pour on just as much water (hormone) as the sponge (body) can be expected to absorb, the sponge (body) will be able to fully absorb the water (hormone) and, eventually, the sponge (body) will be fully saturated with the right amount of water (hormone) and no overflow (hyper symptoms) along with no dry spots (hypo symptoms).

Yes, the meds titration process is painfully slow. However, any time I've seen a forum member have his/her dose titrated faster than appropriate, it always backfired and they had to start all over. Unfortunately, there are no shortcuts on the thyroid journey.

However, there is light at the end of the tunnel. If you take the direct route with the most efficient number of steps (follow established guidelines), you will get to the end of the tunnel and become free from thyroid symptoms.

LPD 07-25-2012 02:24 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Thank you SO much Sammy. {{{big hugs}}}

[I]After[/I] my blood draw on Monday, (so I would be comparing apples to apples for this test) I started taking my Levo around 2 or 3am (early morning / late night tinkle) so I could have my coffee when I got up at 4 or 5am. :)

Because of everyone's amazing advice here, when I started the Cytomel, I slowly titrated up ... starting at 1/2 for about a week, then 3/4th, and then the full 12.5mcg's about 2 weeks into it. I really didn't feel anything even remotely hypER.

Please forgive me for asking so many pesky newbie questions ... but (for when I talk with the Endo tomorrow morning) would you suggest I request an increase to 75 or 100mcg's of Levo, and (maybe) 25 of Cytomel? (where I'd slowly increase the doses over a few weeks) With the FT3 at 1% of the range, and the FT4 at 30%, I've got miles to go before I'm even anywhere near 50%, right?

Somewhere in my fog-horn brain, I think I recall a 1 to 4 ratio of T3 to T4, right? So that would be 25mcg T3 to 100mcg of T4??? Gosh, I know I need to go slow to win the race, but right now I feel like I'm in reverse. :(

And yes, now that I have the benefit of your and everyone's knowledge, I hope I sound semi-intelligent when I talk with the Doc in the morning. Wish me luck!

Lin

[QUOTE=sammy64;5027343]
And, now that you have some information about standard treatment protocol, I hope you can use that for a meaningful conversation with the endo.[/QUOTE]

LPD 07-25-2012 02:37 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Thank you again sammy. (we must have been posting at the same time!)

Yes, from earlier days, I remember your wonderful sponge analogy. (very helpful!) I guess, with the way things have been going for me, my body (sponge) has just soaked everything up, and won't release anything until there's enough to share, (?) which is why I've been feeling even worse.

With an increase in the doses ... maybe my sponge will begin to squirt out / release a smidgen of what I so desperately need? ;) Ha, being "established guidelines" impaired, I'm just not sure what that next step / increase should be.

Big hugs,
Lin

[QUOTE=sammy64;5027351]

The hypothyroid body is like a dried-up sponge. Just as the sponge cannot absorb its full capacity of water with one pour, the body cannot absorb its full needs of thyroid hormone.

Yes, the meds titration process is painfully slow. However, any time I've seen a forum member have his/her dose titrated faster than appropriate, it always backfired and they had to start all over. Unfortunately, there are no shortcuts on the thyroid journey.

However, there is light at the end of the tunnel. If you take the direct route with the most efficient number of steps (follow established guidelines), you will get to the end of the tunnel and become free from thyroid symptoms.[/QUOTE]

sammy64 07-25-2012 03:50 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
I really think you should talk to your doctor about your next dose sizes and come up with a plan that makes sense to both of you.

It might be a good idea to let him know you'd been taking your levo with coffee all these years. You could then let him know your new dosing time based upon what you've learned.

I'm just not comfortable suggesting Levo dose increases higher than the 12.5mcg my doctor ordered for me.

I was started on 5mcg Cytomel (and divided it into two doses) and that's the highest dose I ever took. Admittedly, my FreeT3 level was just under mid-range when I started and rose to 85% of range....it's stayed there ever since.

If I ever needed a dose increase, I know I wouldn't want to increase the dose more than 2.5mcg at a time. T3 is powerful stuff.

I'm also aware of many people having much difficulty when titrating up on Cytomel and some even when titrating up with Levothyroxine....and we're talking the smallest size dose increases.

I know you fared relatively well with Cytomel so far...maybe that's a sign you could handle a larger dose increase. Hopefully, your endo can advise you in that regard.

The words of my first-ever thyroid forum always play in my head and I continually repeat it here because it worked for me.....slow and steady.

As I've mentioned, you can expect the roller coaster experience at least until both your FreeT4 and FreeT3 levels are above mid-range.

Trying to take the rocket rollercoaster just doesn't work. Large dose increases can get you on the rocket rollercoaster line and there's no getting off the line until after you've been on the ride for 2 wks. (the amount of time it takes for a too-high levo dose increase to stop having effects).

Moving thyroid hormone levels just don't feel good.....and the more you try to make those levels move, the worse you can feel.

The roller coaster ride usually smooths out once levels are higher but, you're still on the ride - it's just that the ups and downs aren't as dramatic and the frequency/intensity of them can also be lower.

LPD 07-25-2012 05:14 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Thank you so much. {{{hugs}}} I truly appreciate your helping me get off of the: 'I need to hurry up and get there now', rocket ride. ;) It's just that I feel so ... er, um ... horrible/disfunctional, I was looking for a safe and fast way to wellness. But, as you say, slow and steady wins the race.

So, I'll talk with my new doc in the morning .... asking for his help and guidance. I'll be sure to let ya'll know what happens after I chat with my Endo in the morning. Wish me luck! :)

Lin

sammy64 07-25-2012 06:31 PM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
[QUOTE=LPD;5027511]I was looking for a safe and fast way to wellness.[/QUOTE]

This is completely understandable and I think we all felt/feel that way.

However, if you think about how long it took for you to get where you are today, it's unrealistic to think that it will be a quick fix to restore wellness.

Even though I had partnered with a thyroid-savvy doctor by the time I went hypo, it still took 15 months for my doses/levels to be optimized.

My journey was a bit longer than usual because my levels optimized twice during the meds titration process and I was symptom-free for 3 months each time. However, my levels eventually dropped so, I needed dose adjustments until my levels finally stabilized on the same doses.

I will not deny that it seems the longer a person was hypo, the longer it takes for them to feel better.....and, it's not uncommon for the person to have trouble adjusting to new doses.

These are just more reasons why the slow and steady approach is the best.

It was beat into my head by my first-ever thyroid forum and I've seen it played out (and not played out) for the past 5+ years on multiple thyroid forums.

I can't picture my advice ever changing on that one.

LPD 07-26-2012 04:47 AM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Thanks again sammy. I do have one more (for now!) quick question. ;)

Since my Dr. doesn't believe in the Free T3, I'm thinking he'll only pay attention to the Total T3.

Is it to be expected (because of it's short shelf life) that my T3 level didn't budge, even though I've been on 12.5mcg's for the past 6 weeks? In my novice brain, I assumed there'd be a slight improvement. Yes/No?

Lin

sammy64 07-26-2012 05:36 AM

Re: New labs, 6 weeks after adding Cytomel. Erg ....
 
Just because T3 has a short half-life doesn't mean that the FreeT3 level won't increase with sufficient amounts of T3.

You see, by taking exogenous T3, your body will eventually get as much T3 as it needs to function....you just need to slowly build up the dose so it will reflect in your FreeT3 level.

You were obviously very deficient in T3 so, the amounts you were taking thus far probably only helped with your body's immediate needs and didn't allow it to accumulate in the blood.

The thing with thyroid hormone is that, once you're taking enough to allow it to reflect appropriately (optimally) in levels, you don't want to take more than you need.

Just because 12.5mcg didn't accomplish much doesn't mean you will necessarily need 25mcg to optimize your levels.

I am aware of people who increased their T3 dose every 3 weeks and it wasn't reflecting in levels. Some got as high as 25mcg after doing this for 3 months.

All of a sudden, that T3 "showed up" and they became hyper....and had to lower their dose.

It's quite the process for the body to adjust to new levels of hormone.

The body runs through an "inventory" with hormone levels. It monitors how much hormone is in the blood stream....how many receptors are empty and what needs filling... what processing and system functions (digestion, metabolism, energy levels, body temp - all that happy stuff) are doing...

It keeps track of how much hormone is becoming available, and how consistently, either through gland production or supplementation. All the while, the body tries to maintain homeostasis.

Sometimes, the body just can't keep up with all the changes frequent or large dose adjustments can mean.

Even though you've been on 12.5mcg for 6 wks. and *should* show improvements in your levels, we don't know what your body has been doing as it's been "taking inventory"....only because you increased your dose more frequently before that.

There's also a chance you might be a person who just doesn't respond to synthetic T3 so your next labs will be very telling (if you get a Cytomel dose increase).

Please realize that the Total T3 test measures all levels of T3: FreeT3 and that which is bound to proteins.

We don't know what your FreeT3 level was before starting meds and the change in your TotalT3 level is nominal. In fact, it would be interpreted as pretty much the same as your old level.

Maybe your new TotalT3 level is comprised of more FreeT3 than your old one - no one will ever know.

That's why it's really important to get a FreeT3 test.

Your next appointment with the endo will also be very telling. If you don't get dose increases, it's clear you need to see a different doctor.

You might be able to achieve wellness with just TotalT3 testing but, I think you understand just how important the FreeT3 test is.

If you do have to find another doctor, I'd be sure he/she also monitors the FreeT3 level.

LPD 07-27-2012 05:10 PM

Re: New labs, 6 weeks after adding Cytomel. Erg...
 
Well, harrumph ... that's rather disheartening, but I guess I shouldn't be surprised.

The Doctor didn't return my calls Thursday, or Friday. I called his office one last time this afternoon, only to be told he's out of the office until Monday. But, (oh lucky me) he had his assistant inform me that my labs (FT3 1% & FT4 30% of the ranges) were just fine, and no changes were needed.

I tried my best to keep my composure, and told the gal - "No, my labs are not fine, and I believe I need to have a dose adjustment." As politely as I could, I asked her to talk with the Doctor, to see if he's at least willing to help me get to somewhere near mid-range. (A few years ago, I actually had brain & body function at 69%)

Perhaps an increase to 75mcgs of Levo, (up from 50) and 15mcg of Cytomel. (up from 12.5) Does that sound reasonable, or should I just try one thing (slow and steady) at a time?

So now I wait. She said she'd ask the Doc to call me Monday morning. Thank goodness I have another appointment scheduled next month with a new "thyroid specialist". Yipes!

Lin

FinnMaid 07-27-2012 11:11 PM

Re: New labs, 6 weeks after adding Cytomel. Erg...
 
[QUOTE=LPD;5028833]Perhaps an increase to 75mcgs of Levo, (up from 50) and 15mcg of Cytomel. (up from 12.5) Does that sound reasonable, or should I just try one thing (slow and steady) at a time?[/QUOTE]IMHO, if you're feeling like crap and have had no problems with your meds this far you could try bumping both (but I do think your FT3 is in greater trouble so if you choose to increase just the other then I think it should be Cytomel, and I have a feeling it could be bumped by more than 2.5 mcgs - 5 mcgs perhaps?). I hope your doc agrees with the dose increase :)

sammy64 07-28-2012 06:58 AM

Re: New labs, 6 weeks after adding Cytomel. Erg...
 
I know that some doctors will increase levo by 25mcg if the FreeT4 level is below mid-range.

And, just as FinnMaid suggested, a 5mcg Cytomel dose increase makes sense (that's a common dose increase size for people already taking doses similar to what you've been taking)

Hope you're able to get the doctor to agree! :wave:

No matter what, eliminating coffee with your levo should help....hopefully, a lot.


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