# Cytomel



## AandA'sMom (Jul 27, 2017)

I'm not sure where the best place to post this is. I was originally posting in the new to the boards section, but that doesn't really seem like the appropriate place for the questions I have as of right now.

These are my last labs drawn earlier this month:

FT4 1.04 Reference 0.40 - 1.40 ng/dL Normal

TSH 0.05 Reference 0.34 - 5.60 uIU/mL Low

FT3 3.5 Reference 2.9-3.9 pg/mL Normal

Total T3 81.00 Reference 26.0 - 178.0 Normal

My PCP said my TSH was low, my FT4 was in the high normal range and my FT3 was "normal". She wanted to lower my Synthroid from 175 mcgs to 150 mcgs and leave my Cytomel at 5 mcgs. After going to my appointment to discuss the results, we agreed we'd lower my Synthroid to 150 mcgs but increase my Cytomel to 10 mcgs, because I still had a lot of hypo symptoms that had improved when I initially started Cytomel in early July but had come back to about where they were before starting it.

I'm two weeks out from the change, and I've got a couple things going on that I'm not sure about. First is I've started having headaches. I have a history of headaches, that I attribute to sinus/allergy problems. Our weather had started to change here in WV (much cooler evening, nights and mornings), so that could be the cause of the headaches. I initially lost a few lbs after upping the dose of Cytomel, but now over the past couple of days I've put on a few. It could be for other reasons, but I have read some stuff where Cytomel can cause weight gain although that is rare. I'm very conscious about my weight, because I have been on a weight loss journey since April that has resulted in a pretty significant loss. I do NOT want to put the weight back on. My caloric intake is between 1,000 and 1,200 calories a day, and I walk two miles or 30 minutes (whichever is the longer) three to four times a week. I also do some toning and ab work three days a week. I just don't feel I should see any gain. Finally I'm having some dizzy spells too. I was having them before Cytomel if I stood up too quickly or would bend down and then come back up too quick. I'm having them more often now on the Cytomel and not necessarily with moving from down to up. It has crossed my mind that maybe I am not consuming enough calories, but my PCP does know what I am consuming and has approved 1,000 to 1,200 calories per day.

Anyone have any thoughts as to if the Cytomel at 10 mcgs might be causing the issues? If you read the side effects for Cytomel some (not all) state headaches and dizziness are a serious side effect and could indicate overdose. Is that even possible on 10 mcgs? I am not having any other symptoms of being hyper/overdose. My BP is not high (if anything it is low). My heart rate has remained the same (60 bpm resting and in low to mid 70s with normal activity). I'm not having a pounding heart or palpitations. I am not hot or sweating (quite the opposite as I am still cold all the time). I do not have diarrhea. I am sleeping fine (still very tired). If you were me, would you call the doctor? I hate to be a hypochondriac, but I also don't want to do anything to jeopardize my health. I am scheduled to have more labs around September 22nd and a follow up appointment the next week.

Thoughts?


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## jenny v (May 6, 2012)

When did you take your Cytomel in relation to your labs?


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## AandA'sMom (Jul 27, 2017)

I took my Cytomel and Synthroid 29 hours prior to having the labs drawn and not again until after.


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## AandA'sMom (Jul 27, 2017)

Seems there is many people here with a lot of good knowledge, so I was hoping to get some responses on what others think *might* be going on, and some advice on what my next step should be given I am new to the T3 journey.

I did end up calling my PCP yesterday. When the office called back they said she said to go back down to 5 mcg of Cytomel. I pushed for 7.5 mcg, since my Synthroid has been lowered from 175 mcg to 150. They said they'd have to check and call me back. They said it would probably be today.

I did only take 5 mcg yesterday. I woke this morning with an overall feeling of being unwell. Headache is still there. Dizziness is still there. Felt like I was going to throw up on my way to work (could have been because I was feeling super hungry). Feel like an overall slug. In addition when I got on the scales this morning, I have gained 3.2 lbs since Sunday. Maybe people here don't want to hear about weight gain or weight loss, because many of us (myself included) are so sensitive to the weight because of this disease. I have absolutely worked too hard to find some success in the loss department to let a medication that is supposed to help with it disrupt it. I've been trying to do some reading, and it does appear that for whatever reason, gain does sometimes happen to people on Cytomel.

Given the way I feel this morning, I did not take my Cytomel. At this point I'm a bit afraid of it. I guess now my question is can I stop it cold turkey, or do I need to ween off?

I think I'm going to go back to my 175 mcg of Synthroid only and then ask my PCP for a full thyroid panel with antibodies (are antibodies necessary if I already know I have Hashi's?). I probably should have asked for that BEFORE starting Cytomel... live and learn. What are the specific tests I need to ask for? Do you all think this is a good plan or not?

Thanks.


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## joplin1975 (Jul 21, 2011)

The labs from earlier this month -- those were from when you were on Cytomel? The 5 mcgs dose? What did your labs look like before Cytomel?

The highest you'd want you free t3 is 3.4 and you are a smidge over that. An increase in Cytomel was not the direction you needed to go, especially if your labs were done 29 hours after you took your last dose.

I would stop the Cytomel, too. You are likely hyper (yes, you can gain weight being hyper) and that can take some time to get back to normal.

Wait few weeks and then get TSH, free t4, free t3, TPO, Tg/TgAB, and TSI. Then decide from there.


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## jenny v (May 6, 2012)

Agreed, I would back off the Cytomel or stop taking it. You were already at the high end of the range 29 hours after you last took it, which means you're on too much. I would stick with the Synthroid dose and test again to see if your FT3 comes down a bit and your FT4 comes up a bit.


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## AandA'sMom (Jul 27, 2017)

Thank you for the replies!

I don't have labs results from before Cytomel. The Cytomel was added after a discussion with my PCP about how I feel so horrible. She agreed to add the low dose of Cytomel to my Synthroid to see if it helped. When I got the above results back, she said my FT4 was high (I don't really agree with that) and wanted to lower my Synthroid because of that and the low TSH. Since my FT3 level was at what I thought was the median level and I thought you could go up to 3/4 level (3.7) I asked if we were going to lower the Synthroid if we could up the Cytomel as the first few weeks on Cytomel had produced good results (felt better, increased energy, weight loss that had stopped had picked back up - I'd actually started to gain prior to starting Cytomel, constipation started to go away), but the good results had mostly worn off by six weeks. I was afraid if she lowered the Synthroid and did not up the Cytomel that I would become even worse off.

My symptoms are pretty much textbook hypo. Even now with the headache and dizziness everything on the hypo symptoms list is me. I actually thought dizziness was a hyper symptom as I've been asked that frequently related to my thyroid over the years, but after doing some more reading after posting here earlier, it isn't. Neither is headache. Both of those can be side effects of Cytomel though, so my guess is it is more likely the medicine and not being hyper. I could be completely wrong though.

I've never heard of anyone gaining weight when being hyper. Why would that be?

Can I stop the Cytomel cold turkey? I'm leaning towards that, going back to my 175 mcg of Synthroid and asking for new labs in six weeks (would I really need to wait six weeks?).


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## joplin1975 (Jul 21, 2011)

Symptoms cross over -- hyper symptoms can happen when your hypo and vice versa. People get irritated when we always insist on labs before a dose change, but that's why: we are trying to figure out the cause of symptoms.

Often times people have an increased appetite when they are hyper and sometimes consume more food than they realize. Other times, it's just your body's weird reaction to a metabolic imbalance -- it could even be simple water weight gain. Dizziness and headaches are classic hyper symptoms too, especially if your blood pressure is too high.

You can go off Cytomel cold turkey. Given all the med changes you've made and the inconsistent labs, I'd start with a clean slate and wait those full six weeks.


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## AandA'sMom (Jul 27, 2017)

Got it. I will mention my BP is not at all high. Quite the opposite. I just sat down for the evening. I took my BP. It is 100/69, and my heart rate is 65 bpm. If I sit here for a bit, it will be in the low 90s/low 60s or high 50s, and my heart rate will drop as low as in the 50s. That being the case, I don't think the headaches and dizziness are coming from BP unless normal low BP can cause that. Would you agrer?


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## AandA'sMom (Jul 27, 2017)

Agrer = agree


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## joplin1975 (Jul 21, 2011)

Agreed - but at the same time, antibodies can cause headaches too.

My point is that this whole thyroid thing is faaaaaar from an exact science. There's lots of trial and error and my experience won't mirror your experience, ya know?


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## jenny v (May 6, 2012)

Also, have you done iron, Vitamin D, Vitamin B12, etc. labs lately? Sometimes when there are issues with those, it can mimic thyroid symptoms.


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## AandA'sMom (Jul 27, 2017)

joplin1975 said:


> Agreed - but at the same time, antibodies can cause headaches too.
> 
> My point is that this whole thyroid thing is faaaaaar from an exact science. There's lots of trial and error and my experience won't mirror your experience, ya know?


Completely get what you're saying. At this point I am very confused about the whole thing, so I plan to go back to my long term dose of Synthroid and then asked for all the labs mentioned above in about six weeks. In the meantime I pray I don't go hypo. My PCP's office seemed a little frustrated over my calls and asking for different things (I told them I'd be happy to schedule an appointment to come in to discuss), so I hope she doesn't get ticked off at me for taking it into my own hands. I'm afraid she is going to take this as me telling her what to do. That is not my intent. My ultimate goal is to get this figured out and to feel better.

Again than you all for your help!


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## jenny v (May 6, 2012)

If they get ticked off at you, that's their problem not yours, lol. You are trying to educate yourself and feel better, so you'll stop having to bug them and they should support that.


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## AandA'sMom (Jul 27, 2017)

I have been off the Cytomel and back on my 175 mcg of Synthroid for almost two weeks, and I feel like death. If it wasn't for the fact that I work outside the home full-time and my kids, I'm pretty sure I would not get out of bed.

My PCP did give me a lab order for all the tests I requested, which were all the ones listed above and maybe a couple others I ready about.

I really think my issues were with the Cytomel itself and not with being hyper. Supposedly I have been hyper before, and I have never felt the way I did. If I was hyper, I don't think I could have been that hyper, so I'm really leaning towards it being a reaction to the Cytomel.

I'm not sure what to ask to try next. I originally felt better with T3 added to my Synthroid, so I think I need that. My PCP didn't seem thrilled about the suggestion of Armour and was the one that suggested Cytomel and Synthroid together. I think she will prescribe it if I ask, but I'm wondering if others have tried it with success.


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## blackngold (Oct 28, 2011)

I just start on 5mcg splitting it in half and have noticed headaches and some anxiety too so yeah id say it's definitely the t3


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## Lovlkn (Dec 20, 2009)

Did you draw labs prior to stopping the Cytomel?


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## AandA'sMom (Jul 27, 2017)

I decided to come back to this post instead of starting a new one, so I wouldn't have to go back and retype the information I previously provided above. Around the beginning of September I went off the Cytomel, because I'm pretty sure I was having a reaction to it (not necessarily my thyroid levels but an actual reaction to the medication). These are my results from today at 175 mcg of Synthroid alone (been on that dose since the beginning of September).

Nov 01, 2017 25-Hydroxy Vitamin D Total 33.5 ng/mL 30.0-100.0 ng/mL

Nov 01, 2017 Ferritin 28.3 ng/mL 11.0-306.8 ng/mL

Nov 01, 2017 Free Thyroxine (T4) 1.31 ng/dL 0.40-1.40 ng/dL

Nov 01, 2017 Free Triiodothyronine (T3) pg/mL 3.2 pg/mL 2.9-3.9 pg/mL

Nov 01, 2017 Iron Level 83 ug/dL 28-170 ug/dL

Nov 01, 2017 Thyroglobulin Antibody < 0.9 IU/mL 0.0-4.0 IU/mL

Nov 01, 2017 Thyroglobulin Level 3.53 ng/mL 1.3-31.8 ng/mL

Nov 01, 2017 Thyroid Antimicrosomal Antibody 0.30 IU/mL 0.0-9.0 IU/mL

Nov 01, 2017 Thyroid Stimulating Hormone (TSH) 0.05 uIU/mL 0.34-5.60 uIU/mL L

Nov 01, 2017 Total Triiodothyronine (T3) 116.00 ng/dL 26.0-178.0 ng/dL

Nov 01, 2017 Vitamin B12 Level 350 pg/mL 180-914 pg/mL

Reverse T3 was also ordered, but I don't see a result for that. Does it take longer to process or is it there and I don't know what it's called?

My guess is my PCP will want to lower my Synthroid because of my TSH. My FT3 and FT4 seem to be pretty good (and pretty close to what they were when I was taking 175 mcg of Synthroid and 5 mcg of Cytomel), so I don't want her to do that. What are your all's thoughts?

I still feel like crap even with these labs. I was hoping maybe the iron or one of the vitamins might be low, but those are normal. I am exhausted. I am cold (freezing really - I wear two or three layers and still run a space heater in my office and need to be under blankets at home - it isn't really cold out yet). Constipation is at an all time high. My hair is falling out (it does seem to be better since starting hair, nail, skin vitamins - I haven't been taking them long so probably too soon to tell). I got my hair cut a week and a half ago, and my hair dresser comment on how thin my hair was (gone to her for year but hadn't been in months and she still noticed - I've always had thin hair but have had a lot of it so it looked thick until now). My memory is non-existent. I have joint pain in knee, hip, shoulder and elbow. Periods are normal. BP is pretty normal during the day 100 to 105/70. In the evening it drops pretty low by the time I sit down for the evening 90s/mid to high 50s (is that a concern?). Maybe this is just my "normal", but it would be nice to feel good, especially since I've lost a good bit of weight with a very strict diet and exercise (I've worked hard to do it). People say you have to feel so much better since you lost the weight. My answer is no...

Anyway would love to know your all's thoughts on my labs and why I might still feel like crap.

Thanks!


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## Lovlkn (Dec 20, 2009)

"Nov 01, 2017 25-Hydroxy Vitamin D Total 33.5 ng/mL 30.0-100.0 ng/mL 
Nov 01, 2017 Ferritin 28.3 ng/mL 11.0-306.8 ng/mL "

Both of these results should be closer to 3/4 of range

Are you taking any Vit D or Iron supplements ?


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## AandA'sMom (Jul 27, 2017)

Thanks for the reply. I take a multi-vitamin daily that has 1000 IU (250%) vitamin D and 18 mg (100%) iron. The hair, nail, skin vitamin I take has an additional 1000 IU vitamin D, but like I said I haven't taken it long.

I can ask about taking extra, but doesn't iron cause constipation? I don't want that to get worse.

Thoughts on the thyroid levels? Should I push back if she tries to lower my Synthroid?


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## Lovlkn (Dec 20, 2009)

Yes. Push back if she tries to lower your levothyroxine. At least give it a few months. Your levels are not dangerously high and actually quite close to perfect.

1k of D daily will take forever to raise you levels if at all

18mcg of iron is also too low to raise your Ferritin levels. You can try adding a dose of Floridix which is a liquid iron supplement easier
On your system. If you have a monthly cycle your Ferritin levels will be lowest after your cycle so it's important to note when you have labs drawn


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## AandA'sMom (Jul 27, 2017)

My doctor's office called. As I feared she wants to lower my Synthroid, because I'm "over replaced". She wants to lower it to 150 mcg, which seems like a big drop to me given my labs. Would you all agree? They said iron was on the low end of normal and told me to take a multi-vitamin with iron, which I already do. They did not mention the vitamin D. I told the nurse I already had an appointment scheduled to come in on Monday (the reason I did the labs yesterday), so I didn't want to change my Synthroid until I came in to talk with the doctor. She said that was fine and would just note that in my chart.

I think I'll be able to "argue" my case with her, and she will be willing to leave things alone. I do want to talk with her about the vitamin D and iron too as well as my BP being low in the evenings, so I think going in is the best option.

In the meantime I'm going to look into the Floridix. Thanks for that suggestion.


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## joplin1975 (Jul 21, 2011)

If you are feeling well, I wouldn't change your thyroid meds. Remind him/her that t3 will artificially lower TSH so a low TSH isn't a concern.


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## jenny v (May 6, 2012)

Reverse T3 takes longer to process, so that will more than likely come in later.

You definitely need to address the low D and like mentioned above, 1,000-2,000 isn't going to cut it. I take 5,000 daily just to stay in the low 50's. Definitely push on that one because low D can mimic thyroid symptoms.

Floradix is great--it doesn't contribute to constipation. Have you ever tried magnesium citrate to help stay regular?


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## AandA'sMom (Jul 27, 2017)

Thank you all so much! I ordered some Floradix and will go ahead and get some vitamin D.

I've never tried magnesium citrate. Honestly I've never had real constipation issues until the past seven or eight months.

Oh and I forgot to say earlier the labs were drawn three weeks after I started my cycle, so I don't think that would have had much of an effect.

I think I have a plan now... push to stay on current dose of Synthroid, take Floradix and add around an additional 3000 IU of vitamin D. I'll also look into the magnesium citrate too.


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## AandA'sMom (Jul 27, 2017)

joplin1975 said:


> If you are feeling well, I wouldn't change your thyroid meds. Remind him/her that t3 will artificially lower TSH so a low TSH isn't a concern.


joplin1975 I'm not taking t3 right now. I've only been taking my Synthroid for the past two months. Can Synthroid artificially lower TSH?

Thanks.


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## AandA'sMom (Jul 27, 2017)

I got two additional lab results via the patient portal this morning. Reverse T3 is in the normal range, but I'm not sure if it is in the "right" normal range.

Nov 01, 2017 Reverse Triiodothyronine (T3) 24 ng/dL 8-25 ng/dL

Nov 01, 2017 Thyroid Stimulating Immunoglobulin <89 % baseline <140 % baseline

This is what it says about the TSI in comments:

Thyroid stimulating immunoglobulins (TSI) can engage
the TSH receptors resulting in hyperthyroidism in
Graves' disease patients. TSI levels can be useful in
monitoring the clinical outcome of Graves' disease as
well as assessing the potential for hyperthyroidism
from maternal-fetal transfer. TSI results greater than
or equal to (>=) 140% of the Reference Control are
considered positive.
NOTE:
A serum TSH level greater than 350 micro-International
Units/mL can interfere with the TSI bioassay and
potentially give false positive results.
Patients who are pregnant and are suspected of having
hyperthyroidism should have both TSI and human
Chorionic Gonadotropin(hCG) tests measured. A serum
hCG level greater than 40,625 mIU/mL can interfere
with the TSI bioassay and may give false negative
results. In these patients it is recommended that
a second TSI be obtained when the hCG concentration
falls below 40,625 mIU/mL (usually after approximately
20-weeks gestation).
The analytical performance characteristics of this
assay have been determined by Quest Diagnostics
Nichols Institute, Chantilly, VA. The modifications
have not been cleared or approved by the FDA. This
assay has been validated pursuant to the CLIA
regulations and is used for clinical purposes.

Can anyone help me understand these?

Thanks.


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## jenny v (May 6, 2012)

Nope, that Reverse T3 is too high. You want it closer to 11 or 12, not at the high end of the normal range. Essentially your body isn't utilizing T3 like it should and it's building up in your system, hence the high rT3. I had this same issue (it was caused by iron and adrenal issues) and my doctor added in Cytomel to help bring it down.


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## AandA'sMom (Jul 27, 2017)

Good morning. My appointment didn't go quite as well as I had hoped. My PCP seemed very uncomfortable with my TSH level. I tried to explain that since my FT3 and FT4 were at good levels I didn't think there was a real concern. I also tried to explain that my RT3 was too high, but she just doesn't know anything about RT3. She asked me what I was trying to achieve with the RT3. I tried to explain it to her based on my limited reading over the weekend, but overall I think I was just overwhelming her. LOL She ultimately said she'd like to get an opinion of an endo. Fortunately I know of one in my area who seems to be more open minded (I have a friend who goes to her). I've asked that they refer me to her. I think it will take several months to get in.

My PCP seemed willing to leave my Synthroid dose alone, but then she made ME nervous by saying she had to go over the risks of leaving my TSH at the level it is (apparently she thinks it is pretty bad - is it?). When she started talking about the risks, she made me nervous. Like I've said here and to her, I have no symptoms of being hyper and certainly no serious hyper symptoms. She said "some people don't have the symptoms". That being the case, we agreed to doing 175 mcg M-F and 150 mcg Sat-Sun. I'll retest in six weeks, but she only wrote my order for TSH and T4 (ugh) even after the discussions we've had. I'm hoping I can get in with the endo before then, but I highly doubt that.

She also didn't think I needed to be taking anymore iron than what is in my multi-vitamin. I disagree. She didn't say anything about taking vitamin D either, and by that point I was feeling afraid she might feel like I was telling her how to do her job (not my intent but no one is going to advocate for you except YOU!).

So do you all think my TSH is at a dangerous level at .05? As for my RT3, I'm a bit afraid of Cytomel at this point after my first go round with it. Do you think my taking additional iron alone might help my RT3 come down? I did read that dieting can cause your RT3 to elevate. I have dieted pretty hard for the past seven months. I'm very close to my final goal, so I will be easing up on it soon. I'm not going to go crazy, but I am not going to restrict my calories quite as much (unless I start gaining back). I'm going to try to find a maintenance mode opposed to a loss mode once I hit my goal.

I tell you this is all very frustrating to me, but I appreciate you all "listening" and taking the time to give me your input!


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## joplin1975 (Jul 21, 2011)

Nope, I don't think its dangerous at all. If you had heart palps or were up all night sweating or whatever, sure, there'd be concern. But you aren't so I wouldn't worry about it. TSH is not produced by the thyroid so it doesn't even factor into the thyroid equation.


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## jenny v (May 6, 2012)

Nope, not dangerous. Mine is 0.016 at last check and if you look at that number alone I look crazy hyper. However, my FT3 and FT4 are excellent and I have no hyper symptoms (even just had my annual cardiology appointment and things were totally normal). Some doctors are just not educated enough to understand that some thyroid meds suppress TSH entirely.


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## AandA'sMom (Jul 27, 2017)

On the Floridix... does it have to be the liquid? I bought some (wish I hadn't bought the big bottle until I tried it), and the taste is almost unbearable to me. I see it comes in tablet form. Are the tablets non-constipating too?


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## jenny v (May 6, 2012)

I've only ever used the liquid so I'm not sure about the capsules. I held my nose and did it like a shot, then drank a big gulp of water right after.


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## justmethatsall (Oct 1, 2015)

Wow........this topic was so very interesting. I had no idea that cytomel could suppress my tsh test and obviously neither does my endo!!


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## Reporter (Mar 17, 2011)

Hi Jenny v - is it okay to post here as I did post my labs on the lab forum page. Seeing this post, Jenny v, in which you mentioned having had a high Reverse T3. If you will, please, someone look at my most recent labs. My RT3 is on the high end of normal. FT3 and FT4 normal, in a decent range I believe. The TSH is way in the basement. Has always been low. I have both Graves and Hashimotos. TT a couple years back. Since having started the Cytomel and using that consistently, taken 5mcg once daily with 100mcg of Synthroid (I weigh 155 lbs if that matters), my TSH has hit the basement. Based on that dosage, having a high RT3 what might cause that, iron or chronic stress? You state that your doctor added Cytomel but I'm already taking it. Does that mean I need more in order to lower the RT3 or should I take it twice a day? The other thing I suppose I could increase my Ferritin?

I'm at a loss.


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