# Confusion Over New Lab Results For Hashimoto's Thyroiditis



## Alohagirl (Apr 13, 2015)

Hello,

I last posted 2 years ago and thought I had learned enough about Hashimoto's and lab results and how to decipher them until now. I've been working with a new doctor for the last year and he totally understands the need for Cytomel, etc. But my labs came back 2 days ago with results that now have me concerned because "I think" I'm experiencing "hyper" symptoms. The doc is not worried about these values because they are close to my results 9 months ago when I was doing good. I've asked my doc to cut me back on my 25 mcg's of Cytomel by half, making it approximately 12 mcg's daily. I started that today. I am also taking 75 mcg Synthroid.

Question 1: Is it possible to be doing OK on a higher dose of Cytomel and then need less at some point when you have had Hashimoto's for 20 years?

Question 2: Can a person be on the wrong dosage of Cytomel and it takes awhile to manifest hyper symptoms when it's too much? The only thing I have changed is my activity level. I walk 30 - 40 minutes a day. Started a month ago.

Question 3: I cannot find anyone that has close to my lab results. Could someone in this forum tell me what they think might be going on. Maybe I need more Cytomel????? Maybe it's not Thyroid related.......

Symptoms started 4 weeks ago:

Sweating during the day

Heat intolerance for the first time

Dizziness

Foot & leg muscle cramps (been for about 3 months)

Exhausted by 4:00pm

No motivation

Poor memory

Free T4. 0.9. ref range 0.9 - 2.1

Free T3 6.7. ref range. 2.0 - 4.4

Total T3. 246. ref range 80 - 200

TSH <0.07. I know this doesn't matter.

Any input would be appreciated.

Aloha Girl


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## Pamzilla13 (Sep 9, 2013)

Did you take your thyroid meds before your lab draw?


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## Lovlkn (Dec 20, 2009)

1/2-3/4 of range is goal for both FT-4 and FT-3.

Your FT- 3 is above and too high.

Most people report symptoms when FT-3 is too high for them.

If it were me, I would reduce FT- 3 and increase levothyroxine to try and get to above stated ranges.


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## jenny v (May 6, 2012)

I would be interested to know if you took your Cytomel before doing labs. Even if you did, your Ft3 is still way too high.


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## Alohagirl (Apr 13, 2015)

Yes, I took both Cytomel and Synthroid about 3 hours before labs were taken. I always take my Synthroid at about 5 AM and Cytomel around 8am. I cut my 25 mcg Cytomel in half yesterday. Would anyone suggest I keep doing that?

I have been on 75mcg Synthroid for a year and just found a full bottle of 88mcg left from 2015. I don't know how long Synthroid stay therapeutic and 100mcg from 2013.

I really appreciate all of your input.


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## Alohagirl (Apr 13, 2015)

Pamzilla13 said:


> Did you take your thyroid meds before your lab draw?





Lovlkn said:


> 1/2-3/4 of range is goal for both FT-4 and FT-3.
> 
> Your FT- 3 is above and too high.
> 
> ...





jenny v said:


> I would be interested to know if you took your Cytomel before doing labs. Even if you did, your Ft3 is still way too high.


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## fttfbass (Jan 8, 2014)

You should be spreading your T3 in smaller doses throughout the day. The reason your Free T3 is so high is because you took the entire dose of T3 before your labs (if I'm understanding you correctly). T3 medication has a short half life and doesn't stay in the body for long.

If I was you, I'd use a pill splitter and divide the 25mcgs into two or maybe even three smaller doses spread out during the day. Do half in the AM and the other half in the afternoon. Or do half in the AM, a quarter early afternoon and the last quarter early evening. See how you feel doing it like that and retest labs in 4-6 weeks, without taking any thyroid meds the morning of your lab draw.

Judging by your Free T4 and the fact that you took T3 meds before the lab draw, I personally doubt you're overmedicated. Technically, you're overmedicated for the first half of your day and then most likely hypo for the remainder of the day and night until you take your next morning dose when your thyroid levels spike again. If you spread those T3 meds out, your thyroid levels will be a little more consistent throughout the day.

There's also a good chance that taking 25mcg's of T3 at one shot daily may have stressed your adrenals and now that you've increased your activity level symptoms have manifested.

If I misunderstood and you already do take it spread throughout the day, then ignore everything I wrote.


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## Alohagirl (Apr 13, 2015)

fttfbass said:


> You should be spreading your T3 in smaller doses throughout the day. The reason your Free T3 is so high is because you took the entire dose of T3 before your labs (if I'm understanding you correctly). T3 medication has a short half life and doesn't stay in the body for long.
> 
> If I was you, I'd use a pill splitter and divide the 25mcgs into two or maybe even three smaller doses spread out during the day. Do half in the AM and the other half in the afternoon. Or do half in the AM, a quarter early afternoon and the last quarter early evening. See how you feel doing it like that and retest labs in 4-6 weeks, without taking any thyroid meds the morning of your lab draw.
> 
> ...


Thank you, you are understanding perfectly. I usually take my full 25mcg after I walk each morning since I always feel great in the morning. My blood draw was taken around 11:30 that morning, after I had walked and then took my Cytomel. It's 11:10 am here now and I just took my first 1/2. Any idea why I feel so good in the mornings after no Cytomel in my system for hours.

I will absolutely try what you are saying. It makes sense. I will try my first 1/2 each morning after I walk and the second half around 4. My pills are so small cutting in thirds would be hard. I did find some 5mcg tablets that says to discard after 1/24/17. Could use those ???? (1) 1/2 25mcg then (1) 10 and (1) 10 later. That's close 25mcg

What do you suggest for stressed adrenals or do they bound back on their own?

Lennie


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## Lovlkn (Dec 20, 2009)

Your FT-4 is too low regardless. I bet your FT-3 will still be at high range with a morning draw without taking your Cytomel

I suggest you private pay for a lab in the morning prior to taking either of your medication's.

Great advice to spread out your Cytomel dose, however I am thinking you will need a dose reduction as well and an increase in your levothyroxine dose.

Why do you think your adrenals are having issues?


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## Alohagirl (Apr 13, 2015)

The adrenal issue was addressed in one of the reply posts. I have no knowledge about adrenals. I split today's dose in half and did better. Going to a lab and paying myself is possible but would need a prescription if anything needs to change with Synthroid. I have a few higher than what I'm currently taking (75mcg) but not many.


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## Lovlkn (Dec 20, 2009)

> Free T4. 0.9. ref range 0.9 - 2.1
> 
> Free T3 6.7. ref range. 2.0 - 4.4


I'm curious - your doctor is completely fine with these lab results?


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## fttfbass (Jan 8, 2014)

I wouldn't worry too much about adrenals yet. It's a possibility, but it's more likely that your thyroid meds are causing all of your issues. Especially, since you say you feel good in the morning before taking your cytomel.

Lovlkn is correct that you need to raise your synthroid, since your Free T4 is at the very bottom of the range. It's hard to tell if you need a reduction in cytomel or not because of the 25mcg dose taken prior to the lab draw. Splitting the dose should definitely help and may bring your Free T3 within the range if you don't take it prior to testing. But, raising your synthroid should also bring your Free T3 up a bit, so a decrease in cytomel would probably be a good idea.

As previously stated by Lovlkn, a rough guideline for where you want your Free's to be at is the 1/2-3/4 part of the range. Which would be 1.5-1.8 for Free T4 and 3.2-3.8 for Free T3. But, the one thing that's more important than labs is how you actually feel.

Edited to add-If you do reduce your cytomel dose, you should still split it up into at least two doses.


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## Alohagirl (Apr 13, 2015)

Lovlkn said:


> I'm curious - your doctor is completely fine with these lab results?


Yes, he is fine with the lab results.


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## Alohagirl (Apr 13, 2015)

Yes, my doctor is fine with these lab results. I split my pill in half yesterday ( 1/2 at 11 AM and half at 3:30) and did good until around 8PM. I hit "a wall" as I call it, and had to go to bed. An immediate fatigue set in.


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## Alohagirl (Apr 13, 2015)

fttfbass said:


> I wouldn't worry too much about adrenals yet. It's a possibility, but it's more likely that your thyroid meds are causing all of your issues. Especially, since you say you feel good in the morning before taking your cytomel.
> 
> Lovlkn is correct that you need to raise your synthroid, since your Free T4 is at the very bottom of the range. It's hard to tell if you need a reduction in cytomel or not because of the 25mcg dose taken prior to the lab draw. Splitting the dose should definitely help and may bring your Free T3 within the range if you don't take it prior to testing. But, raising your synthroid should also bring your Free T3 up a bit, so a decrease in cytomel would probably be a good idea.
> 
> ...


Thank you for your input. Really did well by splitting the dosage yesterday but became extremely fatigue by 8 pm and had to go to bed.


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## Alohagirl (Apr 13, 2015)

Lovlkn said:


> Your FT-4 is too low regardless. I bet your FT-3 will still be at high range with a morning draw without taking your Cytomel
> 
> I suggest you private pay for a lab in the morning prior to taking either of your medication's.
> 
> ...


Just found out we do not have an independent medical lab on our island. I need a docs referral to go so that option is out. I am going to call my doctor tomorrow and ask him to send in a prescription for 5 mcgs tablets so I can take small doses throughout the day. I will be able to cut back on my own that way, too.

Today was interesting since I've been paying more attention to how I feel. I took 1/4 pill (1/4 of the 25mcg) in the a.m., went for my walk at 7, felt great. At 11:30 I took 1/2 of the pill and within an hour had some symptoms back. So I now know I need less than 12.5 mcg's at a time, correct?


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## Lovlkn (Dec 20, 2009)

Alohagirl said:


> Yes, my doctor is fine with these lab results. I split my pill in half yesterday ( 1/2 at 11 AM and half at 3:30) and did good until around 8PM. I hit "a wall" as I call it, and had to go to bed. An immediate fatigue set in.


You hit a wall from a different reason than thyroid replacement med's. They work longer than that.


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## Lovlkn (Dec 20, 2009)

Your FT-3 is awful high - I personally would be concerned of a cardiac event. What is your resting heart rate?


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## Alohagirl (Apr 13, 2015)

Lovlkn said:


> Your FT-3 is awful high - I personally would be concerned of a cardiac event. What is your resting heart rate?


98 when I time it for 10 seconds and multiply by 6


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## Lovlkn (Dec 20, 2009)

98 resting is what I consider high

You need to be careful - exercising or even walking.

Are you experiencing anxiety or heart palpitations ?


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## Alohagirl (Apr 13, 2015)

Lovlkn said:


> 98 resting is what I consider high
> 
> You need to be careful - exercising or even walking.
> 
> Are you experiencing anxiety or heart palpitations ?


Anxiety. My doctor wants me to take an anti-anxiety medication but I believe it is all thyroid related.

Add on: At 7:30 I walked this morning for 35

minutes, part is gradual uphill. My husband clocked my heart rate and I never went above 120.

At 10:00am I took 1/4 Cytomel which would be approximately 6 mcgs

At 12:30 tremors have set in and I'm anxious. I felt great this morning. Any idea what is happening?

Yesterday I took the full 25 mcg's but took it throughout the day. Not all at once and started later in the morning.

Thank you.


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## Alohagirl (Apr 13, 2015)

Alohagirl said:


> Anxiety. My doctor wants me to take an anti-anxiety medication but I believe it is all thyroid related.
> 
> Add on: At 7:30 I walked this morning for 35
> 
> ...


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## Lovlkn (Dec 20, 2009)

> Anxiety. My doctor wants me to take an anti-anxiety medication but I believe it is all thyroid related.


Yup! You are testing above range therefore you will likely have anxiety, probably racing mind as well?



> At 12:30 tremors have set in and I'm anxious. I felt great this morning. Any idea what is happening?


Your body is over medicated - I don't care if you break the pill and spread it out or take it all at once, you are way over FT-3 range, thus over medicated. No telling what symptoms you will have along the way. When you break a pill you are assuming the active drug of 25mcg is breaking out evenly with the fillers used. Maybe your break had more or less active hormone -

You need to get your FT-3 no higher than 3/4 of range and also your FT-4 at no more than 3/4 range. If your doctor is not concerned they I would consider him unwilling to work with you - go find a doctor who will.


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## Alohagirl (Apr 13, 2015)

Lovlkn said:


> Yup! You are testing above range therefore you will likely have anxiety, probably racing mind as well?
> 
> Your body is over medicated - I don't care if you break the pill and spread it out or take it all at once, you are way over FT-3 range, thus over medicated. No telling what symptoms you will have along the way. When you break a pill you are assuming the active drug of 25mcg is breaking out evenly with the fillers used. Maybe your break had more or less active hormone -
> 
> You need to get your FT-3 no higher than 3/4 of range and also your FT-4 at no more than 3/4 range. If your doctor is not concerned they I would consider him unwilling to work with you - go find a doctor who will.


Just curious about your opinion. Last night I did not have my normal diet root beer.

I always take my 75 mcg Synthroid around 5 AM. I took 1/2 of my cytomel at 6AM.

This morning I did not drink my usual 1/2 cup of coffee and did not take my liquid normal supplement with L-Arginine, L-Carnitine, Macs Root, L-Ornithine, Panax Ginseng, Garcenia Cambogia & Rhodiola. Can supplements affect the thyroid meds? Can caffeine?

I seem to be doing better. Will know more by the end of the day. And, thank you for being here for me, everyone. We have company here for 2 weeks and I haven't told anyone about what I am going through. This forum has been my support and I am so grateful.


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## fttfbass (Jan 8, 2014)

I'm not familiar with those supplements, but caffeine can most definitely give you anxiety symptoms.

Also, with your continuing symptoms it would be best to lower your dose of cytomel. I know it's a pain to split the pills into anything smaller than 1/2's, but I'd drop down to something like 1/2-3/4's of a pill a day. If you take 3/4 daily, take half in the AM and a quarter in the afternoon. If you drop to 1/2 daily, take the larger quarter in the AM and the smaller quarter in the PM, since they probably won't split very evenly. Hopefully, the next time you see your doctor you can get an increase with your synthoid because currently your Free T4 has plenty of room to increase.

Once you get your Free T4 to a good spot, then consider the possibility of increasing cytomel if needed. There's also a chance that you're a good converter of T4 to T3 and don't need cytomel at all. Is there a reason that you're already taking cytomel while your Free T4 is so low?

*Edited to prevent confusion


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## Alohagirl (Apr 13, 2015)

Thank you. Yes, before Cytomel I was shivering cold in 80 degree weather. Wouldn't go down the freezer isle of a grocery store. What appeared to be carpal tunnel was so painful I could hardly stand it plus weight gain no matter what I did to eat healthy etc etc

I joined this forum and didn't send a message but read everything I possibly could. It's where I learned about Cytomel for the first time. I literally went through 3 doctors before I found one to prescribe Cytomel. Three days after starting 5mcgs I was 80% better with all pain gone. Then one year later I underwent emergency surgery and as I recovered from that my thyroid levels changed and I needed more. I went from 5mcgs 2x a day to 25mcg daily.

Today,after my request, my doctor called in 5mcg pills with the idea I would take them throughout the day and still get 25mcgs a day. However, I am actually going to cut back. Earlier today, I still had to cut my 25's and taking equivalent of 3/4 pill. I just picked up the 5mcgs and my pharmacist told me my symptoms were classic of too much Cytomel.

Starting tomorrow with the 5mcg tablets...how would you take them if you were me?

Lennie


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## Lovlkn (Dec 20, 2009)

> I just picked up the 5mcgs and my pharmacist told me my symptoms were classic of too much Cytomel.


Yup!

I would suggest you take 1 upon waking or earlier if you wake early like I do at 5-5:30 am. Then take 1 6 hours later and another 6 hours later. Some people say taking Cytomel after 5PM disturbs their sleep.

I take 5mcg at 5:30 am, 1 at 11:30-12:30 and my 1/2 tablet around 2. I don't sleep well, ever - since child birth is my trigger - this is also when my thyroid disease was triggered. I take Calcium 3x a day so I do have some interaction from that as I take it with lunch. By breakfast I have the 4 hours from first dose to first calcium intake, my noonish pill gets some interaction from my mid day calcium ( if I remember to take it- which I often forget) and my dinner my 3rd dose has no interaction.

Key is to develop consistency on taking it, and any supplements you also take - do not take replacement med's prior to your lab - if you are above 3/4 range and have not yet taken your Cytomel, then you likely need a reduction.


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## Alohagirl (Apr 13, 2015)

Thank you, all good info. My doctors nurse called me this evening per the doctor and told me not to cut back more than 5mcgs and to keep it there for 4 weeks and he'd run another thyroid panel.

What has been your experience going straight from 25 to 12.5? I have an important job starting Saturday and I've got to be at my best.

Also, what brand of calcium do you take?

Thanks again. This has been so helpful.


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## Lovlkn (Dec 20, 2009)

You are over range - you need to reduce - no telling how much as it takes time to dial in the optimal dose. If your doctor suggests 5mcg cut back and you now have 10mcg pills - your doctor suggested dose is 20mcg. I would suggest you take 10mcg early morning, 4 hours away from any other supplements other than your levothyroxine. Take the next dose 6 hours later and the 4th dose to complete 20mcg 6 hours later.

You can adjust times if you have issues. Goal is to remain consistent for at least 3 weeks prior to your lab.

Cutting your dose in 1/2 will likely reduce all hyper symptoms you are having - no telling if cutting in 1/2 is too much, I'm confused - why are you suddenly mentioning cutting your dose in 1/2? Are you saying this because of how I described my dosing? I take 12.5mcg Lilothyronine which is Cytomel generic.


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