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MoBound 04-22-2016 12:00 AM

Synthroid & Cytomel dosage question
Was diagnosed hypothyroid in Oct. 2014. Was started on Synthroid & Cytomel & have followed with labs every 3 months since then & adjustments made as needed.

In June 2015, I was taking 75 mcg Synthroid & 5 mcg Cytomel each morning. My labs were:

Free T4: 1.1 ng/dl (0.7-2.5)
Free T3: 2.7 pg/ml (2.5-6.5)
TSH: 0.8 uUml (0.5-3.0)
Anti-TPO: 53 IU/ml (0-70 normal, 71-150 borderline, 151+ high)

I felt like death warmed over & the burning/tingling had returned in my feet and hands. My doc consented to adding in a second 5 mcg Cytomel dose.

At the next lab check, I was feeling great, the tingling had gone away again & I even managed to drop a few pounds. My labs at that time were:

Free T4: 1.3
Free T3: 4.6
TSH: 0.4

No med changes were made & I was told to go 6 months before more labs.

Over the past few months, I've felt WORSE than death warmed over & just about every symptom I was having before starting ANY meds has returned! Latest labs are:

Free T4: 1.7
Free T3: 2.7
TSH: 1.2
Anti-TPO: 166 (Officially in this lab's Hashi's territory now)

It's obvious to me, since I was feeling so good back then, that the ranges I was in during my LAST blood testing (1.3, 4.6, 0.4) were my optimum. I'd like to get back there again so I'd like to know what dosage changes I should ask for. I was thinking maybe I should ask for a bump of my Synthroid from 75 mcg to 100 mcg and to also add in a third 5 mcg of Cytomel...making my new total dosages 100 mcg Synthroid and 15 mcg Cytomel. Sound reasonable???

levo 04-22-2016 05:04 AM

Re: Synthroid & Cytomel dosage question
You should probably have a increase in synthroid and definitely an increase in cytomel. Let me quote an article here.

"When my Free T3 levels reached the top quarter of the normal range, it was like magic. One by one my hypothyroidism symptoms disappeared. I felt so good I cried. Optimal Free T3 changed my life. Could it change yours?"

"What I tell fellow thyroid patients is that in this situation, the first thing you’ll want to think about is whether or not you might benefit from the addition of supplemental T3. Many thyroid experts believe that patients feel best when Free T3 levels are in the top half of the normal range, and even at the 75th percentile and above of the range."

"I have my labs done at Quest Diagnostics. The Free T3 reference range listed is 2.3-4.2 pg/mL. Now different labs use different units of measurement and they also use different ranges, therefore the reference range listed on your lab results may be different. Go by the numbers listed on your lab results sheet to the right of your Free T3 score. How do you calculate the top quarter of the reference range? Let’s see if we can keep this simple.

If the normal reference range listed for Free T3 is 2.3 – 4.2

4.2(top of range) − 2.3(bottom of range)= 1.9

1.9 x 0.75(.75 for free T3, .5 for free T4) = 1.425

2.3 + 1.425 = 3.725 (round off to 3.7)

So for the reference range 2.3 - 4.2, the top quarter of the reference range is between 3.7 and 4.2. Now you can do the same calculations with whatever numbers are listed as the normal reference range for Free T3 on your lab results."

Here are also some comments about suppressed TSH.

"Having a supressed TSH on T3 only is normal and nothing to be concerned about. If you feel great then don't lower the dose!!"

"When you take any thyroid hormone manually, whether it's T4, T3, or a combo, your TSH should drop. This does not mean you're overmedicated unless T3 and/or T4 are over the reference range and you have hyperthyroid symptoms: your heart rate should be high, you'd have diarrhea and feel hot all the time, and can't sleep, etc. Does this describe you? If you reduce your dose simply to bring TSH back up, you will most likely feel worse and all your symptoms, including weight gain, should return. It is nearly impossible to have a normal TSH and healthy T3 levels when dosing manually. You have to choose one or the other."

I did just see your previous posts so you know about optimal levels. Hopefully my quotes will help someone else anyway. Your doctor is just straight up wrong about TSH and endocrinologists aren't too much better since they're notoriously bad at treating the thyroid. They mostly seem to know about cholesterol or reproductive hormones where the big money is. You do need an increase especially in cytomel but I'm not sure if you'll get it.

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