# Lab results, please help!!



## jennab9105 (Jan 2, 2016)

Hi all,

I'm new here and I'm not sure if I'm posting in the correct forum so I apologize if I am not. I started on Cytomel about a year ago because of treatment resistant depression and subclinical hypothyroidism. I started at 25mcg and have been at 50mcg since April. I've never felt better--my depression is under control and almost all of my hypo symptoms went away including the extra 35 pounds I had put on. I had no idea that 50mcg is a lot of cytomel until a few months ago. My GP ran my blood work and my TSH is very low and she wants to reduce my dosage. My current labs are as follows:

TSH .016uU/M, range .340-5.6

Free T3 3.4PG/ML, range 2.3-4.2

Free T4 .35NG/DL, range .61-1.81

I should also mention that my doctor did a full physical and I have NO symptoms of being hyperthyroid--its just my TSH that is so low that is a problem. Because of T4 Free is also low, my doctor said we may want to consider adding Armour to my regimen as well as reducing my cytomel by increments of 5mcg until my TSH is closer to normal. My question is-has anyone every had this before? By reducing my cytomel, will my hypo symptoms return? Should I expect to gain all my weight back even if I reduce by 5mcg? Will adding armour help with any of the symptoms? Thanks in advance!!

Jennab9105


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## Lovlkn (Dec 20, 2009)

> TSH .016uU/M, range .340-5.6
> 
> Free T3 3.4PG/ML, range 2.3-4.2
> 
> Free T4 .35NG/DL, range .61-1.81


We try to get our Free's into 1/2 - 3/4 of range and your FT-3 is almost perfect. Because T3 hormone is the one we "feel" this is likely why you are feeling the best in years.

Your FT-4 is low because you are basically skipping the "conversion step", meaning, most people take a T4 hormone such as Synthroid and the body converts the T4 hormone to FT-3. Because you are taking a large dose of T3 ( Cytomel) your body does not have to go through the conversion so your FT-4 is low ( because you are also not taking T-4 hormone). TSH is low because your body has sufficient hormone and is not "calling for more to be released by the pituitary"



> Because of T4 Free is also low, my doctor said we may want to consider adding Armour to my regimen as well as reducing my cytomel by increments of 5mcg until my TSH is closer to normal


If you feel good - there is no reason to change anything. If your doctor is forcing you to make a change it's impossible to tell what will happen. Do you have labs prior to taking the 50mcg of Cytomel? Read the Cytomel insert - you are on a recommended dose and I believe it talks about TSH ( not positive)

Armour is heavy in T3 hormone with a small amount of T4 hormone.

I have antibodies that suppress TSH called TBII. It might be worth asking for that test to be run prior to making any changes.

Your labs are really in a decent place - I would fight to stay where you are. Another option would be to add a small dose of a T4 medicine such as Synthroid or Levothyroxine and reduce your Cytomel. I take 125ncg Unithroid with 12.5mcg of cytomel daily and have no thyroid. Both my FT-4 and FT-3 stay between 1/2 and 3/4 of range.


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## jennab9105 (Jan 2, 2016)

Thanks for your response---is there any danger to staying where I'm at even though my TSH is low? Will it effect anything? My doctor said it may make my bones weaker and/or heart problems but as of now I'm completely fine. Totally normal BP and I had a bone density scan which said I'm right where I should be for my age (22). Will this make it difficult to have children later on in life? Thanks!


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## Lovlkn (Dec 20, 2009)

jennab9105 said:


> Thanks for your response---is there any danger to staying where I'm at even though my TSH is low? Will it effect anything? My doctor said it may make my bones weaker and/or heart problems but as of now I'm completely fine. Totally normal BP and I had a bone density scan which said I'm right where I should be for my age (22). Will this make it difficult to have children later on in life? Thanks!


My TSH runs low to 0. There is some connection to low TSH and bones, however, if your Free T-4 and Free T-3 do not reflect you being in a hyper state, then it is my understanding that there is no issue. That is how my current doctor views it - I am thankful for that as most doctors have issues with low TSH. I happen to have osteopenia that is approaching osteoporosis and I am 52. I was un-diagnosed hyper for at least 7 years, in my 30's with low TSH and likely high Free's, although nobody would test them.

As far as pregnancy, you should not have any issues since your FT-3 is about perfect. If you have concerns about the low FT-4 then you could try and change up your med's at some later date.

Good for you - getting an accurate diagnosis and proper treatment!


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## Reporter (Mar 17, 2011)

Dec 2015 labs

TSH 4.010 (0.450 - 4.500)

Free T4 1.01 (0.82 - 1.77)

TSI 228 (0 - 139)

T3 Uptake 26 (24 - 39)

Free Thyroxine Index 1.8 (1.2 - 4.9) wrong test!! should have been Free T3, lab error, not endo as I heard him request it.

T3 63 (71-180)

Hi - Had a "Transaxillary" Thyroidectomy, it was a total removal, on Aug. 28. Started on 50 mcgs of Levo. Tried 100 made me hyper. Finally was able to tolerate the 100 mcgs. The above results are after having been on 100 mcgs of levo for at least 8wks.

Today my endo at Duke switched me to 100 mcg of Synthroid and added 5mcg of Cytomel to be taken at the same time, which I AM GOING TO TAKE AT NIGHT. I read that studies show patients get to feeling better when levo/Synthroid are taken at night. My weight 155 pounds.

I understand the switch from the generic but *adding the T3, why is that so important: will my menstrual cycle, which has been absent since surgery 4 mths ago, will that return*? (appointment scheduled with gyno)

Also having TSI--and I think this has been answered, but for clarification, *how will having TSI and taking T3 affect my heart or blood pressure or antibody level?*

Thanks for your help.


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## Lovlkn (Dec 20, 2009)

> TSH 4.010 (0.450 - 4.500)
> 
> Free T4 1.01 (0.82 - 1.77)
> 
> ...


The Free T-4 and Free T-3 labs will give you the most accurate idea of blood levels at time of draw. A total can give a "general indication" Your TSH because you have TSI and probably TPO antibodies would not be one I would rely on ever for dosing, although yours does clearly point to you being hypo.

I am in total agreement that taking Cytomel in addition to your T4 drug is a good idea - since you are only taking 1 pill and it has a 1/2 life of 6 hours, I would suggest splitting the pill and taking at least 6 hours apart.

Why in the world are they still testing your TSI?

For "Duke Doctors" the tests they are running are clearly outdated. I know several of people who go to "Duke" and feel they do no wrong - I can tell you - the labs run are not the best to monitor you. Keep pushing for the proper labs which at this time would be FT-4 and FT-3 every 6 weeks until you get to 1/2-3/4 of range and that really depends on when you took your last dose prior to the draw.


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## jenny v (May 6, 2012)

I will tell you, and this is just my experience, I can't take my Cytomel after 2:30pm or it keeps me up all night. I take half in the morning when I wake up and half around 1-1:30pm.


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## Lovlkn (Dec 20, 2009)

> *Questions:*
> 
> *Is it okay to take the meds at night instead?* There are a few studies that show patients had better results taking levo at night just before bed.
> 
> *How much time should pass before taking the last dose and having the draw?*


I take 500mg of calcium 3x a day due to osteopenia so I decided to avoid the 4 hour either side of my Unithroid (T4 ) medication, I take it when I wake up at night which usually happens sometime between 1:30-3. I take it with at least 6 ounces of water, I then wake up about 3 hours later and usually have to pee around 4-5:30 so I take my 1st Cytomel then. I recently read that the Adrenals need T3 hormone to make Cortisol and my morning Cortisol is on the low side so I was hoping it might help. My remaining sleep has not been affected by the first dose. I sleep like crap overall.

As far as when to take on lab day - there is some discussion on that. We preach 3/4 of range for labs and not to take your med's prior to the dose so for me, I go almost 27 hours without T4 hormone and 17 without T3 hormone and usually am around mid range which is probably a good place. I know people who take their med's the morning of the draw and do not have the draw until mid afternoon. I plan to switch to that on my next lab to see where I really am as my last 2 labs have been 3/4 of range and to be honest, I feel a bit keyed up - maybe? Kids? Life? Who knows.

Consistency is key.

Oh - Jenny V and I have about exact cortisol levels and I wonder if the late dose Cytomel might be impacted by the high range Night Cortisol. - just a thought. I need to read more on that.


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## Reporter (Mar 17, 2011)

So very helpful. The answers to my questions get answered in such detail.....

And, incidentally, I felt very keyed up myself this morning and was wondering if it's just the Cytomel, TSI...is it life? The kids? They go from Disney to The Shining over night. You somehow become the enemy.....I tell you.....these kids.....or maybe it's me....

Oh well.

Thanks I do appreciate you all. I can't say that enough.


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## Lovlkn (Dec 20, 2009)

> I tell you.....these kids.....or maybe it's me....


Kids are a challenge for sure!

You are hypo - I've been both hypo and hyper and can tell you kids will throw you off even when "normal".

It's probably the Cytomel. I am under the understanding that once one is hypo for a period of time, Cytomel is harder to add to the body. That was my personal experience. I was hypo longer post op than I probably needed to be, because my first experience with Cytomel was awful - filled with anxiety and like I was hyperthyroid again. I got to the point I was cutting my pill into 1/4's to ease into it. If FT-4 is high ( mine was) it's even worse adding Cytomel.

Half the problem is finding a doctor to prescribe - I was also juggling 2 doctors when I added Cytomel because my TSH immediately fell to below range and one freaked out, the other gave me a year before she freaked out so I found my current. Thankful my current doc ignores TSH and only doses by FT-4 and FT-3.


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## jenny v (May 6, 2012)

Cytomel keys me up for 7-10 days after every increase, no matter how hypo I am and how much I need it. My body calms down after that and I'm good to go.


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