I'm new...I have a question about my t3 meds

azure7789

LM--if you look up cytomel and t3 on this board, you will see a discussion regarding t3 being 4x as potent as t4. If you use this equation for your 25mcg of t3....that would equate to a 100mcg dose of t4 PLUS you indicated you are also taking 25mcg t4. Thus you are getting a combined dose that would equate to 125mcg t4. For some reason it seems your dr. thought to replace the missing 25mcg of t4 with the 25mcg of t3...but it doesn't work like that.

So, this med. change would mean a doubling of your thyroid meds . This doesn't make any sense to me .

I think it would have made more sense to have introduced a small dose of 5mcg t3 and cut your dose of t4 back by 20mcg to compensate for the added t3.

Azuree

lincolnsmom16

Thank you! and yes, i have done some reading on here and elsewhere and that's why i am concerned. I started this 4-5 days ago and the first 2 days i was ok but the 3rd and 4th i felt like i had had 5 cups of coffee or something...don't get me wrong i have been feeling much better than i used to but i know my body pretty well and knew it was too much so i cut my dosage back today and took 1/4 of the pill at 7am and then 1/4 at noonish and 1/4 tonight at 6. I probably should cut it back to just a 1/4 in the morning and then 1/4 at 2pm or so.

One day i will get this right...

cd37

25mcg Cytomel is a high starting dose but, believe it or not, that's what is listed in the prescribing info.

Most people start out with the 5mcg tab....and most divide the dose into two/day.

Cytomel has a short half-life and dividing the dose helps reduce hyper symptoms after taking it and also helps prevent an afternoon "crash" when the effects of the med leaves the system.

Of course, it does have the long-term effect of the much-needed raising of the FreeT3 level.

Some people choose to start out with 2.5mcg/day (divided into two doses) for a week and then increase to 5mcg for 3 weeks....then lab to see what the new med/dose accomplished.

Do you have recent lab results to share? Truly, your FreeT4 level should be closer to the high end of the range before starting Cytomel.

I will tell you this much, Cytomel was my "missing link".....I started it when my FreeT4 level was 1.7 (range .8 - 1.76) but my FreeT3 level had dropped to 3.0 (range 2-4.4)....I need my FreeT3 level to be 4.0 for me to be without symptoms.

5mcg Cytomel brought my FreeT3 level up to 4.0 after one month.

I just had labs on Friday (after another 4 wks.)....my body is telling me I need a dose increase - my labs will tell me whether I need more levo, Cytomel...or both. I find out tomorrow.

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Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10

cd37

Me again

The fact that your GP is willing to Rx Cytomel is a VERY good thing - many doctors are reluctant to Rx this med.

Since your GP is willing to work with you, you just might want to stick with him/her....having a cooperative doctor is more than half the battle.

Another important thing to consider is working towards finding your setpoints - the "place" within the ranges of FT4/FT3 normal at which you feel best - for most of us, this is the upper third of the range.

This is accomplished by keeping records of your labs/meds dose/symptoms....you will begin to see a pattern.

Glad you decided to cut back on your Cytomel dose....and to divide it.

Still, you do need to make sure your FreeT4 level is "up there" as you work to raise your FreeT3 level.

__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10

midwest1

The majority of endos will not prescribe T3 at all. You certainly don't want to jump from the frying pan into the fire.
Work with the guy you have.

lincolnsmom16

Thank you CD!! I have my past 4 lab results since i jumped on this thyroid bandwagon

My first lab test: (11/19/10)
TSH was 5.030 (.45-4.5)
T4 1.09 (.82-1.77)

End result-doctor prescribed me 25mcg of levothyroxine

2nd lab test (1/10/11)
TSH 4.220 (.45-4.5)
T4 1.45 (.82-1.77)

End result-prescribed me 50mcg of levothyroxine

After about 2-3 weeks of taking the 50 i started to have hot flashes and sweating (however i was a little under the weather) and still had really bad anxiety. I went to a care clinic here and they said i had allergy issues and i asked if they could check my thyroid levels bc i had been really hot feeling the last few days and they complied.

My test results were: 1/28/11
TSH 1.83 (.40-4.5)
T4 1.1 (.8-1.8)
T3 73 (76-181) **Why did my t4 go back down after increasing my meds? and why didn't my GP ever test my T3 like this care clinic did?

They called me and told me that my results were normal and i asked what my TSH was and thought it had dropped a lot for having only taken 50mcg for two weeks so i thought i was going HYPER so i reduced my meds back to 25mcg which was a HORRIBLE idea!! Anxiety got worse and i felt awful again so i went to the care clinic and asked for my results so i could interpret them and i saw that i was still borderline hypo...not hyper.

My next lab results at my GP's office (2/18/11)
TSH 4.13 (.45-4.5)
T4 1.31 (.82-1.77) *Why is my t4 back up after reducing my meds and my TSH back up as well?? It doesn't make sense to me.

I don't have weight issues...i'm 135 and 5'8 and very active. I just came down with extremely bad anxiety and felt really weak and sore all the time...it got so bad i didn't want to leave the house which is not like me at all.

After reducing the cytomel the last two days i actually feel pretty good and I think this will actually do the trick!!

So now i am waiting for a good time to go get my levels checked again...i'm currently living out of state so i can't go see my normal GP-i will have to find another doctor when we move again and get settled in 2-3 weeks.

lincolnsmom16

You are right...it was a miracle that he let me pretty much prescribe myself the medicine--i guess he could tell i had been doing my research...plus my results were just a little off he thought so he was willing to let me try something else.

cd37

I will try to answer your questions in the order in which they were posed.

Our T4 (your results are actually the preferred FreeT4) will go down if the meds dose isn't high enough.

Also, it takes a good 4 weeks for a levo dose change to reflect in levels - you had your levels checked 2 wks. after the dose increase so, the FT4 level at that point was more indicative of the lower dose.

Even though TSH isn't reliable once we are taking the proper meds dose, when it rises, that is an indication that the thyroid needs to be producing more thyroid hormone to meet the body's needs for proper function.

Many doctors don't think to check the vital T3 (FreeT3 level is better)

You see, T4 is our storage hormone and the body converts it to T3, the active hormone - the one we feel.

There isn't much of a difference between FT4 1.1 and FT4 1.3....and, levothyroxine has a very long half-life so, even though you reduced your dose, the effects of the higher dose are still in your system and that probably accounts for the slight increase in your FT4.

TSH isn't a reliable indicator of thyroid function AT ALL.....once we start taking thyroid hormone replacement meds, all bets are off as far as TSH is concerned....this most especially applies to T3 meds since taking exogenous T3 impacts the HPT (hypothalamic-pituitary-thyroidal) feedback loop...not in a negative way - but TSH will be virtually undetectable.

TSH information is sort of like FSH (follicle stimulating hormone used to gauge menopause).....TSH levels out of the normal range aren't physiologically problematic - they're just telling you about stuff going on in the body.

Always better to evaluate thyroid function by looking at thyroid hormone levels which DO impact the function of the body.

Now, your most recent FT4 level indicates that it's still lower than optimal...most people feel/function best with FT4 level in the upper third of the range, if not towards the very top end of the range. Your doctor did the right thing in January by raising your levo dose to 50mcg when your FT4 came back at 1.45.

And, as I already mentioned, your FT4 dropping down again was a sign that 50mcg isn't enough....very few people take 50mcg as a regular dose - it's one step in the titration process.

Just to give you some idea - I started 25mcg levo back in March '10 and slowly increased my dose as labs and symptoms indicated. I started taking 5mcg Cytomel in January 'cuz my FT4 was 1.7 (range .8-1.77) yet my FT3 dropped and I had hypo symptoms.

After that, my FT3 rose to 4.0 (my setpoint) but my FT4 dropped so, my levo dose was increased to 88mcg.

I felt better after 2 weeks but, last week, some hypo symptoms returned - this is a sign that a dose adjustment is necessary.

It was time for my monthly appointment anyway (otherwise, I would have gone in sooner - not good to wait out symptoms) My doctor increased my levo to 100mcg, pending lab results due back tomorrow....my ultimate dose moving forward will be predicated on those results.

My setpoints are FT4 1.7 and FT3 4.0....either/both meds dose will be adjusted depending on the results.

__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10

lincolnsmom16

wow, this just got a little more complicated...so my tsh doesn't mean anything anymore. Only my t4 and t3 results do...

cd37

exactly

Truly, your TSH didn't mean much to begin with - it's just that doctors erroneously put too much stock in it.....again, this all goes back to the invention of the TSH test back in the 1970's and doctors being taught to use it as a standard for Dx and treatment. Then, as medicine advanced with the invention of thyroid hormone testing, care should have advanced as well. The doctors that stayed up on things are those who provide the best care. Those still in the dark ages (and there are many) are the ones who still rely on the TSH test.

Before all of these tests were invented, doctors Dx'd and treated based upon symptoms.

Not sure if you've done any reading on hypothyroidism but, some good books are:

"Thyroid for Dummies" by endo Dr. Alan Rubin
"What Your Doctor May Not Tell You About Hypothyroidism" by endo Dr. Ken Blanchard
"The Thyroid Solution" by endo Dr. Ridha Arem

While my doctor is "with it", I still had to advocate for proper dosing - especially when it came to maintaining my setpoints. If I was feeling good at the time of a particular lab (yet my FT4 and/or FT3 had dropped a little), she was content to let me stay on whatever dose I was taking - I knew I needed to tweak my dose to get my levels back to my "sweet spot".

I would remind her that I don't always "feel" my levels right when they hit (this is because the body can take awhile to "re-set" itself)....and also remind her that symptoms take a long time to dissipate once they manifest and meds dose is adjusted (this is because of the long half-life of levo).

She would then agree to a dose adjustment...in fact, I no longer have to remind her of these things - yay!

This is where finetuning things (setpoints and dosing) comes into play if we want to feel our absolute best while having thyroid disease.

__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10

BelovedPugsley

I've had a partial thyroidectomy and my system functions only with the other half. I have been told by doctors for 15 years now, that I'm within 'normal range'. I have since developed heart stuff; fibromyalgia; endocrine stuff; etc. and feel it has a lot to do with malfunction of thyroid.

I finally found a doctor that had a more open mind with that. He suggested that perhaps those ranges are too broad for some. He gave me some medication and we played around with doses. We found that I need a little push, but I don't dose every day; I still felt something was missing, tho.

With research I found that your thyroid cannot function properly without iodine; they found this out because there was a widespread problem back in the 40's and 50's with babies having birth defects and they concluded it was the lack of iodine in our diets. The only way they saw to fix it world wide was to supplement the salt. The problem is, in our time, most of us choose the healthy salt that doesn't include the iodine.

I called my pharmacist and asked him if it was ok to take iodine with the thyroid medication. He was emphatic; your medication won't do much good without iodine, a healthy thyroid requires iodine. Most supplements come in a mcg dose, but I found that for me, with the thyroid disease, I needed a higher mg dose, which I found in a Standard Process brand called Prolamine Iodine.

Do your own research on this and look at symptoms for overdose so you can monitor it; and by all means ask your doctor about it. I feel so much better physically and don't have the severe symptoms. I felt even better when I included the mineral, Magnesium malate. There was an article stating that the average adult is low in magnesium. The malate focuses on muscle and nerves. These two supplements (iodine and mag) have really helped cut down the fibromyalgia symptoms, too.

Good luck in finding your answers. Prayer is powerful!

lincolnsmom16

Thank you CD...i actually have the book thyroid solution and i love it. It is the reason i heard about t3/t4 treatment Keep us posted with your results you get back i think today right?

Thank you pugsley! I'm looking into that now!

cd37

While it is true that iodine deficiency can cause hypothyroidism, supplementing with iodine can wreak havoc for those of us with autoimmune thyroid disease.

I've read this in various books about thyroid disease and FinnMaid graciously pointed me to an endo journal about it.

I think that, before anyone decides to supplement, they should have their blood tested.

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Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10

cd37

Anytime, lincolnsmom

Glad you have "The Thyroid Solution" - I think it's one of the best books out there.....and, I suspect that's where you heard about dividing the T3 dose - right?

I'll be calling my doctor's office around 3PM (per their instructions) to get my results/discuss my dose with the doctor.

I think I'll start a thread about it 'cuz it seems to have piqued a few members' curiosity

Thanks for your interest! I have a few new ideas for myself moving forward and I'll share them on the thread as well.

Best to you!

__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10