# New doc & new meds



## mememe (Mar 18, 2010)

I went to my new doctor monday, got labs drawn, and yesterday I got my ultrasound so I'm not sure the results of that yet, but I assume there isn't much change (multinodular goiter). I also do not know the results of my blood draw yet either, and the doctor is also testing me for celiac. Anyway, I've been on Synthroid 88mcg for maybe a year now, and while symptoms are "better", I think there is much room for improvement. My new doctor is trying me on liothyrine sodium 5mcg and levothyroxine 50mcg. I go back in three months for follow up. Is it common when adding a t3 medication to also change the t4 medication? (Synthroid 88mcg->levothyroxine 50mcg?)

For some background info., I've suffered a long time with fatigue/weight gain/brain fog, etc before getting diagnosed with hashi's in 2010. Since being medicated, symptoms have improved, yet symptoms still exist to the point that I am not "myself". I have tested posted for TSI, TRAB, TPO AB, I am B12 and vitamin D deficient also.


----------



## joplin1975 (Jul 21, 2011)

Did you have any more recent labs drawn? It's interesting that your doctor would add t3 when *all* your free t3 labs are high.

It is common to lower levo when t3 is added, yes....but I suspect any symptoms you have had *might* be due to that high free t3 number.


----------



## mememe (Mar 18, 2010)

Thanks for your reply. Sorry, I haven't updated my lab chart yet. The latest labs that I have the results for are below. I'm not sure when I'll get the results from monday.

10/27/14

TSH 1.0 (0.3-3.0)

Free T4 1.0  (0.8-1.9)

Total T3 183 (81-178)

thyroglobulin 10.6 (0.0-55.0)


----------



## joplin1975 (Jul 21, 2011)

Yeah, even your total t3 is high. Depending on what your results are from your latest labs, I'd be really hesitant to take the Cytomel.


----------



## jenny v (May 6, 2012)

I agree, I'm surprised the doc prescribed Cytomel when your FT3s have been so high. Too much more T3 could make you feel awful. You look like a really good converter of T4 to T3, so I don't think a T3 med is the answer. If anything, you need a slight bump up in T4.


----------



## webster2 (May 19, 2011)

I also would be hesitant to add the T3. My endo only added T3 because my FT3 was in the basement. Too much T3 will not make you feel well. Good luck.


----------



## mememe (Mar 18, 2010)

Thanks for all the feedback. What should I do? I already bought the two new medications...would it hurt for me to try it and see? Or should I try to talk to the doctor before taking it and see what her thought process is? I was planning on starting this new regimine Monday. EDIT: I was able to acces my note from my online account, and this is what is says under "plan", in regards to what we are discussing on this thread: "1. TSH, FT4 today - adjust LT4 as needed. Discussed that if studies are normal, we can trial T3 in addition to her T4 to see if her symptoms improve."


----------



## joplin1975 (Jul 21, 2011)

It's up to you, really. You have TSI and TRAB, which also makes me concerned about t3. If you decide to take it and have any symptoms of hyperthyroid, I'd really advise you to consult your doctor (and probably stop the medication immediately).


----------



## Andros (Aug 26, 2009)

You have had an ultra-sound; correct?

I don't see any harm in giving that dose a try. 50 mcg. of Levothyroxine and 5 mcg. of Cytomel; correct?

You may be suffering from ADD and the doctor knows that the brain needs T3 so I do think it is worth a try.

Seriously.....................

Let us know. And your doc is only a phone call away; right?


----------



## Lovlkn (Dec 20, 2009)

WHen did you begin taking a replacement medication?

Do youby chance have the labs prior to taking any replacement?

Your FT-3 is too high to be adding Cytomel to your mix.

I would love to see the labs you have had prior to beginning any replacement med's

Since you have TPO and TSI antibodies - you could be actually in a hyper stage based on your high FT-3.


----------



## mememe (Mar 18, 2010)

I believe I started taking meds in 2012. I do have labs from before I started medication To be best of my knowledge, these were all without having started T4 meds. See below:

4/24/12 12/5/11 4/18/11 11/22/10 7/27/10 4/27/10 4/13/10 3/9/10 
TSH 2.270 1.59 2.19 2.22 1.85 1.76 1.09 1.73 .450-4.5  
FT4 1.23 1.29 1.29 1.29 1.08 1.26 1.38 .82-1.77 
FT3 3.4 3.3 3.6 3.1 3.2 2.8 2.0-4.4  
TPO 421 340 393 355 374 304 0-34 
TgAB <20 <20 <20 28 0-40 
TRAB 0.57 <0.51 <0.51 <0.51 0.00-1.75 
TSI 39 39 56 92 0-139

edit: attached tables of labs. After reviewing, it does appear my FT3 has steadily increased...

edit: adding ultrasound info.

oldest->newest

4/2010

Right lobe 5.2x1.8x1.8cm left lobe 5.5x1.4x1.8cm lobes are diffusely heterogeneous. isthmus 0.3cm. diffusely heterogeneous echogenicity, multinodular goiter.

12/2010

slightly enlarged. right lobe 4.6x1.7x1.7cm left lobe 5.1x1.2x1.8cm. diffuse heterogeneity of thyroid parenchyma. some lobulation of the right lobe. slightly enlarged with heterogeneous parenchyma.

12/2011

Right lobe 4.1x1.4x1.4cm. Right love is inhomogenous in attenuation with a 2.0 solid nodule identified in inferior pole. left lobe 4.2x1.5x1.5cm heterogeneous in attenuation. isthmus 3mm. both lobes slightly enlarged and inhomogeneous in attenuation. a solitary, 2.0 solid nodule identified in inferior pole of right lobe.

(I went for an FNA and they could not locate any such nodule)

5/2012

right lobe 5.2x2.0x1.6cm, nonhomogenous, and nodular in character. left lobe 5.5x1.8x1.4cm, nonhomogenous, but nodular. isthmus is thickened. Thyroiditis.

3/2013

right lobe 5.2x2.0x1.6cm, nonhomogenous. left lower lobe enlarged 5.5x1.8x1.4cm, nonhomogenous. isthmus is thickened. There is extrathyroidal nodule in the left neck inferior and posterior to the left lobe of the thyroid gland measuring 1.1x0.9x0.7cm, new finding.

12/2013

right lobe is enlarged 4.7x1.7x1.4cm, nonhomogenous. left lobe is enlarged 4.9x1.6x1.3cm, nonhomogenous. Extrathyroidal nodule in left neck measuring 0.9x1.0x0.5cm.


----------



## mememe (Mar 18, 2010)

I want to update since starting the new regime on Monday. I have not had any negative side effects I've read about such as jitters, shakes, palpitations. The only thing I've really "felt" over the past few days would be "spaced out" /very focused feeling, but that's virtually subsided now. Every day except Tuesday, I've split my dose in half, once when I wake up with my synthroid, and then the other half in the afternoon, between 1-2 pm. I do believe splitting it helps. I do not get a "burst" of energy then crash as others have said. I just kind of feel like the brain fog is better and I'm able to focus on a task better, no real energy increase but I've found it easier to make myself go out for walks.

Also, and this may be totally unrelated, although nothing else has changed, my forehead has broken out. I've struggled with acne since probably middle school and have been on oral medication ever since, I normally break out on my chin and sometimes my cheeks, but never (since middle school) on my forehead. So, not sure if that's related to the Cytomel or not, but coincidentally, I have a dermatology appointment on Monday, so I'll see what she says.


----------

