# Help/advice needed somewhat urgently?



## starfire (Jun 10, 2014)

Hi, all...

So I am currently hypothyroid, and on 100mcg of Synthroid and I was on 15mcg of Cytomel. Lately, my heart has been very fast, and I have been very heat intolerant. This has been going on for about 2 weeks. I have dropped my Cytomel down to 5 mcg, but my heart still races after I eat. Average pulse lately has been about 100.

I am currently on vacation, so I can't go see my doctor. But my ankles and feet are all swollen today... Granted I am on vacation, and I have been on my feet everyday for about 6 hours. Also my stomach is quite puffy, but again, I have been eating vacation foods.

But is there any chance the cytomel or synthroid is causing heart failure with my pulse being up that high? I'm scared and unable to enjoy myself worrying so much. I am new to thyroid problems, if it was not obvious.


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## Lovlkn (Dec 20, 2009)

> So I am currently hypothyroid, and on 100mcg of Synthroid and I was on 15mcg of Cytomel. Lately, my heart has been very fast, and I have been very heat intolerant. This has been going on for about 2 weeks. I have dropped my Cytomel down to 5 mcg, but my heart still races after I eat. Average pulse lately has been about 100.


You should call your doctor immediately.

You are clearly over medicated with a pulse of 100. Ask if you can stop your Cytomel completely and come in for lab's when you return. Cytomel will leave your system quickly and your heart rate should drop once the Cytomel clears your system.

Do you have an idea of where your last labs were?


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## starfire (Jun 10, 2014)

I stopped it as of this morning. Should I stop the Synthroid too? I am going to go in for labs when I return, as I have a standing order.

Labs last were done about 4 weeks ago. TSH was severely suppressed at 0.020, FT3 was mid-range normal, FT4 was 0.91.. Just over the bottom range.


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## Lovlkn (Dec 20, 2009)

How long have you been on the Cytomel?

Based on the lab's you posted you should not be having a heartrate of 100.

Also, based on your labs - a higher dose of your T-4 medication would be a better plan than taking 15mcg of Cytomel daily. Cytomel is very powerful and can cause hyper symptoms when adjusting to it. I had a horrible time and it took awhile for me to be able to tolerate the 12.5mcg I take.

How long have you been taking replacement medications?


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## starfire (Jun 10, 2014)

Cytomel since late April. Synthroid since about May. My heart rate is down now, to about 76. But goes ways up still to 100-120 if I eat.


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## starfire (Jun 10, 2014)

Went to the ER. got too afraid with the swelling in my legs that was pitting. The doctors ran an ECG, which showed something abnormal at first.. But then the doctor cleared me as OK after labs came in.

Better to be safe than sorry I suppose.

My thyroid labs also were done. They came back as:

FT4: 1.09
FT3: 2.8
T3: 134
T4: 7.4
No reference range listed, but nothing reads high or low. No TSH either. I think it was still pending or maybe just not done at all. My glucose did come back high though. They didn't say anything, but likely because they figured I had eaten. I hadn't. That was fasting.

Also... Can thyroid cause leg swelling?


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## Andros (Aug 26, 2009)

Are you eating a lot of seafood whilst on vacation? Usually those of us w/thyroid problems find they have severe allergy to "too much" seafood. Especially shrimps, lobster and crab. Also msg might be in a lot of the vacation foods you are eating. Hence the edema.

Too much seafood does not go well w/exogenous T3.

Other than that thought pattern, Lovlkn has given excellent advice.

Hugs


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## starfire (Jun 10, 2014)

Funny...I am eating a lot of seafood and high sodium/probably msg.

Also, doc told me stop taking meds for a day. Call doc and resume tomorrow. Thoughts? I think I might just stop Cytomel completely.


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## starfire (Jun 10, 2014)

The EKG was abnormal, but doctor ruled it OK in the end... Should I just trust that? Ahhh so much nervousness.


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## joplin1975 (Jul 21, 2011)

Depends on who the doctor was....the hospitalist? Or did a cardiologist review it?


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## Andros (Aug 26, 2009)

Well; you may benefit from cleaning up your vacation diet and if you resume meds and I think you should, perhaps just cut that Cytomel in 1/2 for the time being and get back with the doc when vacation is over. And I am good at the advice but bear in mind, I am not a doctor.

Anyway......................I hope you are having fun. Vacations just go way too fast.

Water is a natural diuretic; drink plenty to flush the chemicals out of your system.

Hugs,


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## starfire (Jun 10, 2014)

Just the doctor on staff/call who read it. I don't believe any cardiologist read it. But they didnt even suggest I follow up with a cardiologist at home (I will be).

Is it possible my thyroid medication is too high even tho thyroid labs are normal?


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## Lovlkn (Dec 20, 2009)

While I am sharing my opinion - I am no doctor and since your primary doctor has not weighed in - and stupidly prescribed 15mcg of Cytomel then added 100mcg of Synthroid - I'm not sure you should take his advice either.

If it were me - and I base my opinion on these labs...



> Labs last were done about 4 weeks ago. TSH was severely suppressed at 0.020, FT3 was mid-range normal, FT4 was 0.91.. Just over the bottom range.


Stay on your Synthroid - skip the Cytomel until you can lab in approx 4-6 weeks. Six weeks will give you the best idea but if you are having symptoms or issues then go in 4. If you go any earlier the labs will be absolutely useless. Be sure and phone your doctors office and tell them what happened and what you are doing as far as medications.

Cytomel is like TNT - very explosive - causes severe symptoms if too high and thus your heartrate of 100.

I still feel strongly that an increase in Synthroid first and labs both FT-4 and FT-3 will give you the best picture to determine what medications and doses you should be on.


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## starfire (Jun 10, 2014)

Is the Cytomel very dangerous at that dose? It scares me that I've been on it for so long now. Even higher too, as they started me at 25mcg and then I dropped it further and further. I was only on 5mcg as of yesterday.

I'm so unsure if I should take my synthroid til I see the doctor. That's happening on Wednesday.


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## Lovlkn (Dec 20, 2009)

OK - you are going to see your original doctor on Wednesday - tomorrow?

He is the one who put you in your current situation -

Prescribing 15mcg of Cytomel then adding 100mcg of Synthroid a week later is a bit much to say the least. Most doctors would start with a dose of Synthroid or other levothyroxine drug and test in 6 weeks, then add Cytomel if you were not properly converting.

Can you please post your 1st labs done with ranges to give us a clearer picture of where you started. Also , post as many other labs and dosages beside that you have and hopefully we can give some guidance as what you should be asking for.

Right now your system is in complete imbalance due to medication changes - any labs he runs now are useless and it would probably be best to try and calibrate a dose off your original labs since you've quit all but the 5mcg of Cytomel which can clear your system quickly if your original labs point to being on just Synthroid to begin with.


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## starfire (Jun 10, 2014)

Hi -- sorry I am being unclear. I am actually going to my 2nd endo. First one started me on 25 mcg Cytomel and then 100 mcg Synthroid. I felt she was too off the wall, just in everything she did (not just medication) and went to new endo. New endo suggested staying on 100 mcg Synthroid (as average dose is 112 mcg or so?), and said to discontinue Cytomel. However, after discontinuing Cytomel for a week, I feel awful... So I called back and was advised to take 15 mcg of Cytomel instead. But as I started to feel more and more jumpy, I reduced dose of Cytomel on my own... Til I got down to 5 mcg. Which maybe was still too much?

Anyhow, first labs run were without any medication. They were:
T3 Free: 1.7 [range 2.2-4.0] 
FT4: 0.77 [range 0.93-1.70] 
TSH: 1.15 [range 0.27-4.20]

Labs after 6 weeks 100 mcg Synthroid, and 8 weeks (almost) 25 mcg Cytomel:
TSH: 0.020 [range 0.35-4.50] 
T4, FREE: 0.91 [range 0.89-1.76] 
T3, FREE: 3.1 [range 2.1-4.2] 
Anti-Thyroid Peroxidase: <28 (reference range <60) 
Anti-Thyroglobulin: 20 (reference range <60) 
TSI: <89 (baseline <140%) 
TBII: 20 (reference range <17)

Latest labs run two days ago at ER: 
No TSH run
FT3: 2.8 (no range listed)
FT4: 1.09 (no range listed)
Total T4: 7.4 (no range listed)
Total T3: 134 (no range listed)


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## starfire (Jun 10, 2014)

So, doctor says ECG looked normal (even though it read prior heart attack). He said they hooked up leads wrong... That's what the ER doc said, too. He is attributing the arrthymia and the chest pains to stress/anxiety and too much Cytomel. I'm staying on 100mcg Synthroid and then 5mcg Cytomel for now. He also prescribed Atenolol for the palps.

Any thoughts?


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## bigfoot (May 13, 2011)

starfire said:


> He said they hooked up leads wrong... That's what the ER doc said, too.


Well, that's not exactly comforting. I know mistakes happen, but gee whiz, putting leads on properly is pretty important. 

It sounds like the 100 mcg of Synthroid is sitting okay with you. That's good, so at least you have a starting point to work from. As you found out, Cytomel (or T3 in general) is like jet fuel. The beauty of T3 however, is its very short half-life. So if you feel as though you are on too much, you can throttle back a bit and notice improvements almost immediately. Not so with T4, as its half life is measured in weeks and months.

When I tried Cytomel a couple of times, I had difficulty even taking 5 mcg. There were quite a few days when I even halved those pills into 2.5 mcg, or even quartered them at 1.25 mcg. (Eventually I switched over to Nature-Throid, which is T4+T3 in one pill). IMHO, I think it's better to start low with T3 and work your way up, rather than start high and try to taper down. Another trick is to split up your dose throughout the day, since a majority of it is absorbed within 3-4 hours. If it's still giving your trouble you can try taking it with a little bit of food.

It sounds like you really do benefit from taking some T3, so I wouldn't pull the plug on it unless you are having difficulty. I think you made the right decision to cut back to 5 mcg of Cytomel and go from there. Maybe you can eventually try adding in another 2.5 mcg some other time during the day (for a total of 7.5 mcg) and see where that gets you. Slow 'n' steady wins the race. Heck, this stuff is more of a journey than a race!


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## starfire (Jun 10, 2014)

Thanks, Bigfoot! So far, I've experimented with one day on Cytomel, one day off&#8230; that seems to work alright for me. When I take 5mcg every day, I seem to get a bit too jumpy. Heart rate is all over the map, anxiety is up (even more than normal)&#8230; So I think maybe day on, day off is what works? But is that even a dosage that makes sense? I feel like my doctor is a smidge dismissive, so I can't really ask him. I feel a bit on my own.

Anyhow, does hooking up the leads wrong really make an EKG read something so scary? Just hearing those results made me feel like I had a heart attack, haha. I can't stop stressing now!!


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## bigfoot (May 13, 2011)

I'm no doc or pharmacist -- but my very rough estimation is that by taking Cytomel/T3 every other day you are basically pumping it up to the 5 mcg dose, then letting it go down to nothing after 48 hours. It might be worth your while to try 2.5 mcg every day and see if that helps. Maybe it would level out the peaks and valleys. Whatever you do, the trick is to be consistent with thyroid meds. And if it works for you, it works for you.

If you notice a heart rate over 100 bpm just sitting around, it is something to pay attention to. Could be from a few different causes... In the short term, it could just be your body temporarily adjusting to the sudden increase in thyroid hormone. But if it continues it possibly means you are over-medicated. Another thing to consider is signs/symptoms of the autoimmune attack. For example, when I was new to Hashi's and it wasn't being controlled, my antibodies were high, my thyroid hormones were all over the place, and I would get a racing pulse and bad anxiety just totally out of the blue. That was probably from my thyroid being attacked and randomly dumping hormone into my system. Eventually, as more external thyroid hormone was added, things calmed down. Still, there was a transition period that made me feel like I was on a roller coaster. I'm still on the recovery journey, but things are better than they were originally.


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## starfire (Jun 10, 2014)

Bigfoot --

That advice just made me feel like 1000x better! Thank you!

I keep having random panic attacks and my heart rate just rockets up for seemingly no reason&#8230; which I know is in part to my own anxious personality, but I also know the limits of my anxiety, and I have far exceeded them. I knew something extra had to be going on with my body, physically speaking. I do have antibodies for both Graves and Hashi's, my doctor told me. He is calling me Hashimoto's officially now, though.

The other day, I did notice my heart rate staying around 90 just sitting. When I stood up, I would get all dizzy and lightheaded and my pulse would go to about 120. Needless to say, I spent a lot of time sitting down haha. I think maybe the 5 mcg is too much still. I tried it again today, and same issue happened. But when I went off it for those two days, per ER doctor's orders, my heart rate was stable at 65. It's so strange, because before DX, my resting heart rate was 40 if I was lucky. It's pretty surreal to be sitting around with a heart rate of 90 now. It feels insanely fast, as I had gotten so used to my hypo rate. Did you ever notice your heart rate increasing after eating, especially?

I was thinking along the same lines regarding the Cytomel, too (after I actually spent some time considering it). I think it's better to keep a stasis, so I will try 2.5 everyday. I have read that some people take upwards of 75 mcg a day of Cytomel. I do not know how that is humanly possible. 

Anyhow, I hope that I start to stabilize more as my body adjusts to the T4 more and more, too. I have noticed some things changing for the better!


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## bigfoot (May 13, 2011)

starfire said:


> I have read that some people take upwards of 75 mcg a day of Cytomel. I do not know how that is humanly possible.


Hmm, that sure doesn't sound right. That is a *ton* of T3!

You mentioned your doc said you had both antibodies for Graves' as well as Hashi's. If that's the case, I'd press him/her for more answers if you can. While Hashi's is no picnic in its own right, truly having both Hashi's *and* Graves' can be one big, hot, stinking mess. It would be nearly impossible to predict where you would fall on the spectrum from month-to-month. Treatment could wind up like a yo-yo, with thyroid hormones one week and beta blockers another. The problem is that much of the business of antibodies seems poorly misunderstood or misinterpreted. Getting properly diagnosed is, IMHO, the hardest part of all of this.

Good to hear you are seeing some improvements!


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