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  • When is it time to add Cytomel to Synthroid ?

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    Old 01-16-2007, 04:19 PM   #1
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    When is it time to add Cytomel to Synthroid ?

    Hi. Is there any sort of time frame when a person should consider adding T3 to their regimen? Had RAI in September, am hypo now and on Synthroid 100mcg (.1mg) (dose has been adjusted twice). Just got my TSH and Free T4 results and they're just borderline in the range (my TSH needs to be lower and my Free T4 needs to be higher I think) They don't do a free T3 test here.

    Any input on how Cytomel is added, when, and what to look for? I see my dr. on Thursday and would like to request the change (Was on desiccated thyroid prior to all this happening...thought I was doing o.k. on it although was getting heart skipping sensations in the afternoon ) I've read where there is too much T3 compared to T4 in desiccated...that it is 4 times stronger and a very short half-life. My free T4 always seemed very low (way off the chart which would indicate HYPO but my TSH was always really low (.38).

    DO YOU THINK I SHOULD REQUEST A FREE T3 TEST? They have to send it away to a major city so have no idea if my Dr. will even do that? Am getting so sick of feeling like I'm putting someone out or being a complainer. You know if Docs would actually listen for 1 minute intially, alot of our problems would probably be dealt with satisfactorily!

    I don't know what to do, this is going to be a loonnnnng haul.

    go for MRI tomorrow of my brain and spine (to rule "out" or "in" and de-mylenating disease ie MS) because of tingling in body.


    thanks anyone

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    Old 01-16-2007, 05:40 PM   #2
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    Re: When is it time to add Cytomel to Synthroid ?

    Cytomel is synthetic T3 so an FT3 test would be the best to determine if you need additional T3. It is in your best interest to INSIST on tests to determine your FT3. You are NOT complaining or whining, you just want the best for your health, anyone else would want that too. I can't imagine your doctor would settle for less if it was his health involved--I bet he would have every test available to help himself feel better, AND whine, complain, call in every favor of every other medical professional until he got what he needed!

    It may be enough for you to just increase your dosage of synthroid. A dose of 100 mcg is not that high since you do not have a functioning thyroid. I have heard of many people who have had a TT or RAI who need a dose of at least 225. If it is difficult for your doctor to get an FT3 test done because of your location you could try an increase in just your synthroid. By increasing the synthroid you will be lowering your TSH and raising your FT4.

    If I were you I would get my TSH in a better place, perhaps around "1" ish. Then see how you feel, if you still have symptoms get an FT4 and FT3 test. Most people feel best when each of the frees are at least mid-range.

    I am also one who does not do well on dissected thryoid. I do much better with a synthroid/cytomel combination. (currently on 100 synthroid and 10 cytomel) Like you the ratio of T4 to T3 in dissected is too much for me. By using separate meds for T4 and T3 I can get a more customized dosage for my needs.

    Good luck and keep us posted to your progress!

    Old 01-16-2007, 09:15 PM   #3
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    Re: When is it time to add Cytomel to Synthroid ?

    If you had RAI in September, I'm guessing it took you at least a month to go hypo - maybe longer? You need to realize that's just a teensy blip in the thyroid treatment timeline. It takes time to find the right med and the right dose. Testing, tweaking, time, thyroid, T4, T3.... Lots of Ts.

    You would need Cytomel if your body doesn't convert T4 to T3 easily. Most people have some degree of difficulty in that area, but it's too soon for you to know if that's the case. Once you build your store of T4 to an adequate level - at least midrange - and you have remaining symptoms and still don't feel well, it might be time to seriously think about the possible need for some T3.

    You also should know that your TSH can remain low for a good long time following RAI. It isn't indicative of much at this point, and it shouldn't be relied on for med dosing. Much better to watch FT4 at this point, and perhaps push for FT3 in the future if the Synthroid doesn't do the whole job for you.

    Hang in there... It will get better... with time!

    Old 01-17-2007, 03:53 PM   #4
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    Re: When is it time to add Cytomel to Synthroid ?

    MidWest and Redmaple. Good lord, I just typed up an e-mail and when I went to send it the message said I had to "refresh" something or other...lost everything, am computer illiterate, sigh.

    In anycase, thanks to both of you for your valuable information. Will keep my fingers crossed that my encounter with the Dr. goes well tomorrow. I'm not sure how he is going to react to my not taking the Lugol's iodine solution he prescribed 8 weeks ago along with the Synthroid increase. I don't want to dabble in too many other things at the moment, until, like you said, my Free T4 is in a decent spot. test results were:
    TSH: 2.32 (0.27 - 4.2)
    Free T4; 12.90 (12.0-22.0)
    Total T3 : 1.3 (1.3-3.1)

    Looked over some of the lab results for the past several years (very sporadic) .My TSH was usually between .30 - 1.11 reference range (0.27-4.2) My Free T4, however, has always been way too low after reading so many posts 7.7 - 9.6 (ref range 12.0 - 22.0)

    Will keep you posted.
    Thank you again!

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