# Latest Labs: Adding Cytomel?



## kgriess (Jun 30, 2010)

Just looking for opinions...

I've been hypo for the last few years, treated for the last 2 with just levothyroxin (T4). From the start, my TSH was moving downward to the point where it got hyper on 50mcg, so I was cut back. Then it started going the other way and I eventually settled back on 50mcg with a TSH between 2.0 and 3.0 (for the last year). So, the same dose that pushed me hyper initially (after being on 25mcg for awhile prior) is now not enough.

I finally switched doctors because as long as I was in the normal range for my labs, he wouldn't do anything about it. All I know is...I wasn't feeling good. I get the late afternoon/early evening "slump" where I feel spacey, brain foggy and uncoordinated with speech/movements (like piano playing).

Found a new female doctor (yeah) and she tested me for all sorts of things. It all came back negative (including cortisol, Vit D, B12, pre-diabetes, iron). She did say that although my free T3 is in range, it's at the lower end so she wants to add Cytomel at 25mcg/day and keep my T4 dose the same at 50mcg.

Based on my labs, is this logical? I honestly think I felt better when my TSH was lower and didn't know if I should push for more levothyroxine, or try adding T3. I felt better when my TSH levels were under 1.0. But, my FT3 and FT4 have always hovered right around the same levels as my most recent labs.

Taken 1/26/12:

TSH: 2.57 (range: 0.4 - 4.5)
FT4: 1.2 (range: 0.8 - 1.8)
FT3: 2.5 (range: 2.3 - 4.2)

My biggest worries are having heart palpitations/rapid heart rate and increased anxiety. So, if anyone has experience with adding Cytomel or taking a combo of T3/T4, that would be appreciated.

Thanks for the help!


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## Octavia (Aug 1, 2011)

Since the Levo is working pretty well for you, and you know you feel better with a TSH around 1, it seems like it would be worth a try to add a little bit more Levo (T4) and see how that works for you, rather than rocking the boat so much more by adding the T3.

What are your thoughts on that?


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## miltomeal (May 17, 2011)

The T3 is a little more powerful on the body than T4, because it is the active hormone. not sure if i am saying this correctly, but if you do add some T3, i would start a little lower and titrate up slowly to where you feel the best.

best wishes!


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## northernlite (Oct 28, 2010)

My numbers are very similar to yours. My FT4 and FT3 don't seem to change much with different doses of T4 but my TSH does. My FT3 is also low in the range like yours. I also feel really good with my TSH down around 1 even though my FT4 and FT3 don't look great.

Personally, I would try a slight increase in T4. A 125 mcg cut in half is 62.5 mcg. Right now I am at about TSH=1.85 and have no other symptoms except crashing a little early in the evening. I go back in 2 weeks and am going to ask for a slight increase so I can get down around 1 or slightly under.


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## lainey (Aug 26, 2010)

> she did say that although my free T3 is in range, it's at the lower end so she wants to add Cytomel at 25mcg/day and keep my T4 dose the same at 50mcg.


25mcg of Cytomel is roughly equivalent to an additional 100mcg of T4 medication. This is way too much as a starting point, quite honestly.

I agree with bumping the T4 up a little first to see if that has the desired affect.

If you add Cytomel, the more common starting dose would be 5mcg, or even half of that. T3 is the active hormone, and most people react quite strongly to it. In this situation, it is much better to "ease into" it.



> I felt better when my TSH levels were under 1.0. But, my FT3 and FT4 have always hovered right around the same levels as my most recent labs.


The frees measure the active amount of thyroid hormone--the TSH measures the pituitary's response to it. Truth is, your symptoms should be more closely tied to your free T4/T3 than TSH...if making it lower does not have much impact on the frees, you may not be accomplishing much by increasing your dose. T3 only medications will tend to suppress the T4 and TSH numbers--you should be aware that by adding this, your lab numbers for both will naturally shift downward a bit.


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## Andros (Aug 26, 2009)

kgriess said:


> Just looking for opinions...
> 
> I've been hypo for the last few years, treated for the last 2 with just levothyroxin (T4). From the start, my TSH was moving downward to the point where it got hyper on 50mcg, so I was cut back. Then it started going the other way and I eventually settled back on 50mcg with a TSH between 2.0 and 3.0 (for the last year). So, the same dose that pushed me hyper initially (after being on 25mcg for awhile prior) is now not enough.
> 
> ...


So glad your doctor is anxious to help you but my very humble opinion is that 25 mcg. of Cytomel is waaaaaaaaaaaaaaaaaaaaaaaaay too much. Most of us start off on 5 mcg. and a majority of those find that is to much and start on 2.5 mcg. of Cytomel.

You should be concerned. You may end up on 25mcg. but truly, that really is a dangerous way to go about it.


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## kgriess (Jun 30, 2010)

Thank you so much for all of your insights and responses!

I think I would prefer increasing my T4 (levo) and seeing how that goes before messing with T3...and if I do end up trying it, it sounds like a much lower starting point is needed. Which makes me wonder if these doctors have any clue about this stuff. I'd rather be conservative than feel worse...or mess up other levels. We all know how hard it is to find any sense of feeling good and right now I don't feel too bad, just that late afternoon slump factor.

Now I guess I need to call her and discuss, or make another appointment. Hope she's open to my approach!


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## Andros (Aug 26, 2009)

kgriess said:


> Thank you so much for all of your insights and responses!
> 
> I think I would prefer increasing my T4 (levo) and seeing how that goes before messing with T3...and if I do end up trying it, it sounds like a much lower starting point is needed. Which makes me wonder if these doctors have any clue about this stuff. I'd rather be conservative than feel worse...or mess up other levels. We all know how hard it is to find any sense of feeling good and right now I don't feel too bad, just that late afternoon slump factor.
> 
> Now I guess I need to call her and discuss, or make another appointment. Hope she's open to my approach!


According to your labs, you would benefit from a "little" Cytomel. If you think we are giving credible advice and you decide to follow that advice, you should be good to go.

If you start on 5 mcg., my personal advice it to have a little bit of toast or an egg in the morning and then take it.


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## HeidiBR (Apr 4, 2010)

Hi kgriess -

I think Andros is correct; a little T3 might be good. Your labs were similar to mine. I tried the "let's increase the T4 a bit" and it sent me too high. And you want to avoid that like the plague.


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## miltomeal (May 17, 2011)

please remember that you are the only one who knows your body. trust this instinct/intuition with how you move through the titration process and what meds you want to take.

Also, please continue to be patient and let your body have the time it needs to adjust to a new level of meds. I see that you know what to look for if the meds are too much, so keep that in mind throughout the process and get labs done if you feel these symptoms coming back.

I agree with not wanting to go hyper, i am also avoiding that like the plague. LOL

good luck!:hugs:


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## kgriess (Jun 30, 2010)

I called my doctor back to find out about starting on a lower dose of Cytomel and the nurse said that the prescription is to take 1/2 of a 25mcg/day. So, 12.5/day. She also said this is the lowest dose available, although I read that there's 5mcg amounts for kids and Andos mentioned it.

I doubt I can cut a pill into fourths...so I assume I need to call back and educate her?


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## lainey (Aug 26, 2010)

Yes, educate the nurse that it is available in a 5mcg dosage. You shouldn't need to cut it into fourths. Call and ask for a prescription for the lower dosage.


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## Andros (Aug 26, 2009)

kgriess said:


> I called my doctor back to find out about starting on a lower dose of Cytomel and the nurse said that the prescription is to take 1/2 of a 25mcg/day. So, 12.5/day. She also said this is the lowest dose available, although I read that there's 5mcg amounts for kids and Andos mentioned it.
> 
> I doubt I can cut a pill into fourths...so I assume I need to call back and educate her?


If you are in the U.S. of A., you can get Cytomel in 5mcg.. Yes.

http://www.drugs.com/imprints.php?action=search&drugname=cytomel


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## bigfoot (May 13, 2011)

Yep, good idea to start at 2.5mcg (half pill) or 5mcg of Cytomel. I took it briefly last year and the 5mcg was MORE than enough. Everyone is right -- go low 'n' slow with any of these changes. If you aren't comfortable taking the big dose (and 25mcg of T3 is a lot) as the doctor or nurse is advising, just say so.


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## Lovlkn (Dec 20, 2009)

> My biggest worries are having heart palpitations/rapid heart rate and increased anxiety. So, if anyone has experience with adding Cytomel or taking a combo of T3/T4, that would be appreciated.


I have alot of experience withCytomelandmy advice toyou is take it slow.

Get a prescription for 5 mcg pills -they are available in brand and generic. The fact your doctor and nurse donot knowthis is alarming in itself. A 25mcg pill is WAY too much.

A pill splitter can split the pills into 1/4's. My suggestion is to begin with 1/4 a pill 2x a day for 3-4 days then add another 1/4 until you can tolerate them without any issues. A dose as small as 1/4 a 5mcg pill for me does make a huge difference in how I feel and it may for you too. Once you can tolerate the entire 5mcg pill I would sill suggest you take 1/2 a pill 2x a day due to the 1/2 life of around 6 hours. I take 3 doses per day that total 2 1/4 to 2 1/2 5mcg pills daily.

The first time I tried Cytomel I had severe anxiety and heart palps and gave up after 6 weeks and until I eased into it the 2nd time around I had no idea how powerful a little T-3 could be.

Good Luck and keep up updated.


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## kgriess (Jun 30, 2010)

Thanks, Lovlkn, for the advice. I got the prescription for 5mcg pills and attempted to cut one in half this morning without a pill splitter and that was a disaster. Shredded half of it...didn't take anything. Still worried about trying it. I will have to look into a pill splitter (can you get those anywhere?) and start really low. I have struggled with anxiety for years before my thyroid went bad, so I don't want to make it worse, I just want to get rid of the slump I feel in the late afternoon. The last couple of days I've just felt bad, in general. Sad, joint aches...I don't understand why it varies so much from day to day, although I do know the hormone balancing act is a tough one.

I don't know what to do about my endo situation. I didn't like the first guy because he kept telling me my labs were normal so it must be something else causing my problems...and I'm 43, so you start to wonder IF it could be something else, but I am tired, really tired of feeling bad. I can't trust how I'll feel from day to day!

The new, female endo, was willing to test me for other stuff and willing to put me on T3 (her idea), but her dosing has me worried she doesn't know what she's doing. There's just not a lot of doctor options in an HMO despite living in a big city.


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## miltomeal (May 17, 2011)

Yes, pill splitters are available at most stores where a pharmacy is inside. They are only a couple of bucks, but shouldn't be too difficult to find.

And yes, i understand your tenativeness with your endo. but, that is why you are here: to ask questions, participate in discussions, and learn what you need to know to advocate for yourself through this journey!!

Good luck!! 
there are a lot of people here who care and will help everyone anyway they can


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## Andros (Aug 26, 2009)

kgriess said:


> Thanks, Lovlkn, for the advice. I got the prescription for 5mcg pills and attempted to cut one in half this morning without a pill splitter and that was a disaster. Shredded half of it...didn't take anything. Still worried about trying it. I will have to look into a pill splitter (can you get those anywhere?) and start really low. I have struggled with anxiety for years before my thyroid went bad, so I don't want to make it worse, I just want to get rid of the slump I feel in the late afternoon. The last couple of days I've just felt bad, in general. Sad, joint aches...I don't understand why it varies so much from day to day, although I do know the hormone balancing act is a tough one.
> 
> I don't know what to do about my endo situation. I didn't like the first guy because he kept telling me my labs were normal so it must be something else causing my problems...and I'm 43, so you start to wonder IF it could be something else, but I am tired, really tired of feeling bad. I can't trust how I'll feel from day to day!
> 
> The new, female endo, was willing to test me for other stuff and willing to put me on T3 (her idea), but her dosing has me worried she doesn't know what she's doing. There's just not a lot of doctor options in an HMO despite living in a big city.


Any drugstore has them and they are under 2 bucks. If you are concerned, do what I do when taking a new med; make sure someone is around. If you are at work, just advise a co-worker w/whom you are friendly to keep an eye.

Once again, your labs suggest that a bit of T3 in the form of Cytomel would be highly beneficial to you.


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## kgriess (Jun 30, 2010)

I just wanted to check back in and thank all you lovely people. I started taking 1/4 of a 5mcg pill last Sunday and it has already helped me feel so much better. I initally had a dull headache for part of the day after taking it for the first few days, but that is already dissipating, I assume as my body adjusts if will disappear completely.

I'm starting to feel like my old self again - it's amazing! Really amazing! I haven't had my "slump" the last few afternoons and my brain feels sharper all day. I'm sure you guys know what I mean.

The added bonus is, I used to need to snack late in the afternoon because I would feel so bad that I'd eat to get energy or feel better - I'd eat healthy snacks like nuts, yogurt, Luna bars, fruit, but still...if I don't have to snack, hopefully I can get some weight off.

Anyway...I'm so glad you guys advised me about starting off with such a small amount (and told me about the pill cutter) because it's made a world of difference and I can't begin to think what would have happened if I had taken 1/2 of a 25mcg pill.

I hope my progress continues...I know I just started, but for what it's worth - THANK YOU!


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## Andros (Aug 26, 2009)

kgriess said:


> I just wanted to check back in and thank all you lovely people. I started taking 1/4 of a 5mcg pill last Sunday and it has already helped me feel so much better. I initally had a dull headache for part of the day after taking it for the first few days, but that is already dissipating, I assume as my body adjusts if will disappear completely.
> 
> I'm starting to feel like my old self again - it's amazing! Really amazing! I haven't had my "slump" the last few afternoons and my brain feels sharper all day. I'm sure you guys know what I mean.
> 
> ...


Thank God!!! I am so so glad that you found our advice to be helpful and maybe even life-saving.

When you are ready, add in another 1/4 of that which should be 2.5 mcgs.. You do not have to take it twice a day. One dose should do it as it builds up in the system and will remain steady on as long as you take it in a timely manner.

You must have gotten a good pill splitter to split that tiny pill into quarters! Good for you!

It is very concievable that you will end up on 25 mcg. but this truly is the very best way to do it. I "promise!"

Thank you for being here!!!


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## kgriess (Jun 30, 2010)

The pill cutter is far from perfect and I'm sure I'm not getting a consistent amount, but at least I can start slow and work up to 1/2 and then maybe the full 5mcg - depending on how I feel. It definitely works better than using a knife!

Slight dull headache today again for part of the day. But worth it if it eventually goes away and I feel better.

It shocks me to think of how many doctors are not willing to try all sorts of combinations to make people feel better. I just don't understand it. So many people on here seem to be suffering from one thing or another and half the time are begging doctors to give them something else. Thank goodness the Internet exists and this forum exists...so we know what's available, how to take it, etc. and can push for what we deserve.

OK, off my high horse! Preaching to the choir, I know!


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## kgriess (Jun 30, 2010)

I spoke too soon. The headaches continued and I started feeling worse and worse as the week went on. By Saturday, I was in an all-day tired slump which was awful and worse than I felt before starting it! So, I gave up. Didn't take it on Sunday (and felt much better) and called the Doctor on Monday to find out about just adding more T4 to get my TSH lower. She hasn't called me back yet...

I have to function and have a lot of deadlines at work where I could not tolerate feeling like I did last Saturday. I felt better with lower TSH, so I'm hoping she'll be willing to let me try that route next.


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## Andros (Aug 26, 2009)

kgriess said:


> I spoke too soon. The headaches continued and I started feeling worse and worse as the week went on. By Saturday, I was in an all-day tired slump which was awful and worse than I felt before starting it! So, I gave up. Didn't take it on Sunday (and felt much better) and called the Doctor on Monday to find out about just adding more T4 to get my TSH lower. She hasn't called me back yet...
> 
> I have to function and have a lot of deadlines at work where I could not tolerate feeling like I did last Saturday. I felt better with lower TSH, so I'm hoping she'll be willing to let me try that route next.


Why do you think you have headaches? Have you had your eyes checked? Do you have high blood pressure?

Let us know what you end up doing.


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## kgriess (Jun 30, 2010)

I had a headache from the medicine. It started the day I took it, went away at night, and started after I took it every day that week. I haven't head a headache since I stopped taking it. It's not uncommon...I looked it up and several others have had headaches on Cytomel. Even at my low, low level.

No high blood pressure and my eyes are fine...


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## kgriess (Jun 30, 2010)

I just called my doctor's office back because the doctor never called me like they said she would after I had called on Monday. The receptionist or nurse or whoever I got put me on hold and came back saying that because my numbers are in range, she wasn't willing to give me any more T4.

As you know, this is a very frustrating thing to hear. I told the person on the phone that I felt better when my TSH was lower. She said that the doctor won't give me more because it might push me out of range (including my FREEs). My FREEs have never been out of range even when my TSH was .1.

I asked what they suggest I do if I still feel bad and the doctor is only looking at labs and not listening to the fact that I still have symptoms. They then told me to take a multi-vitamin and vitamin D. Both of which I've been doing for years!

This is my second endo. I don't know what to do now. Go back to my primary doc and beg her to prescribe me more? Try to see if there's yet ANOTHER endo in my area?

I'm so tired of going to doctor's appointments and not getting the answers or resolution I need. I'm sorry to vent, but I'm really frustrated. Why are doctors so stupid?


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