# Just changed meds... Don't feel right- Help?



## GeekGirlNB (Nov 7, 2010)

Hi all, I'm a newbie, but not to hypo.

I was diagnosed when I was 12 or 13, I am 29 now, and have just recently begun taking an active role in my thyroid health after years of just accepting hypo symptoms.

So, I finally found a Dr. That listens and treats my symptoms, not my lab numbers!

My new dr saw that my free t3 was just under the low lab range (2.1, I believe) and my TSH was 1.91, but my hypo symptoms were very much present. So he started me on Cytomel.

Here's where confusion comes in. He kept my levothyroxine level at .175. He added Cytomel at 25 mcg once daily (and I am actually taking a generic called liothyronine). In addition, I take Zoloft. I was taking 100 mg daily, but last week I got it down to 50 (with the intent to get off Zoloft soonish).

So, I took my first dose of cytomel Friday mid morning with my synthroid. I did feel immediate clear headedness for about an hour.

I took my 50 mg zoloft mid day, as usual.

Today is Sunday, and each day after taking the synthroid and cytomel together in the am, empty stomach, I feel like a zombie after! None of the usual symptoms, no heart racing or jitters. I feel zoned out, unable to care about anything, sad, can't feel. I have a headache today, too. None of the great cytomel benefits, though I know it's only been a few days.

I don't know if this is because of my lowered zoloft amount? If it's because I am taking too much cytomel and/or synthroid at the same time? I am under huge amounts of marital stress right now, so I know that contributes to my mood, but it seems too coincidental that I zone out right after taking my cytomel and synthroid in the a.m., right?

Anyone have ideas? I think I need a better dosing schedule, though my dr. And pharmacist both said it would be ok to take both together in the a.m.

Help! I can't stand feeling so emotionless!

Nicole


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## lainey (Aug 26, 2010)

Lets start with 25 mcg cytomel = 100mcg of synthroid! That's a big dose change!

He should have started you at 5 mcg of Cytomel per day, no more, and considered lowering the levothyroxine to 150mcg.

T3, the medication in Cytomel, is the active thyroid hormone, and very powerful. Many people have difficulty adjusting to it, and it should be titrated up SLOWLY.

Are you taking a brand such as Synthroid or Levoxyl? It's generally not recommended that thyroid patients take a generic, just because the dosing range is so narrow for thyroid medication. This could make a difference to you also.

Why did you decide to start tapering the Zoloft now? It will be hard to tell where your symptoms are coming from if you are changing 2 things at once.
Did you discuss tapering the Zoloft with your doctor? This is not a medication that you want to stop taking on your own--you need guidance for tapering. Some people find this process difficult--perhaps some people who have experience with these medications can add to this.


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## GeekGirlNB (Nov 7, 2010)

Hi, thanks for responding.

Even though the cytomel dosage info and medication facts say to begin at 25 mcg, I knew it was too much, mostly according to every other online patient story I've read the last few days! Thanks for confirming 

I had decided to taper off the zoloft 2 weeks ago. I was on 100 and took a week of tapering to go to 50, which is fast I know. Current Dr said I should stick with the 50 for the time being, and that we would look into getting off completely after I adjusted to the cytomel.

Ok, so step 1 should be talking to dr about adjusting the 25 mcg down, right? I didn't get the jitters or anything, so I wonder if just halving the medication and taking 2x per day would be ok?

Secondly, getting off the generic? I am on generic cytomel, and my "synthroid" bottle says levothyroxine (mfr Mylan). Is that generic?

I've only been on the 50 mg of zoloft for about 5 days... Should I talk to my dr about going back to my usual 100 until the thyroid meeds are figured out? I wanted to get off zoloft for many reasons, weight gain being one. Also I'm just tired of being dependent on anti depressants.

What about dosing schedule? Is it ok to take zoloft around noon and the others together in the am?

Thanks so much for responding!


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## lainey (Aug 26, 2010)

I personally wouldn't add the Cytomel and delete the Zoloft at the same time.
I would pick one or the other to do first.

HALF of a 25 mcg cytomel twice a day is still 25mcg total, still WAY too much to start without significantly reducing the levothyroxine (by about 75mcg). Your doctor should know that, and you should question it with his/her office.

Cytomel is available in 5mcg dose, no splitting, no mess. Once per day. Lab in 4 weeks to see where you are. That's my advice regarding that--more Cytomel and you are likely to quickly become hyper, even if you don't think you're feeling it now.

If the bottle says "levothyroxine", it is likely the generic. A generic drug is only the same in dosage strength, route (ie by mouth), and active ingredient as the brand. Bioavailability, shelf life and fillers can all be different by manufacturer. Each time you fill the generic prescription, you may get medication from a different generic manufacturer. For thyroid patients these can all make a difference, and such variability can affect symptoms and lab results. You should, in my opinion, should be taking a branded medication such as Levoxyl or Synthroid--there are several.


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## Lovlkn (Dec 20, 2009)

GeekGirlNB,

You most likely have the generic which a friend of mine used without any different effects than the brand. The 25mcg dose is a huge dose to take with 175mcg of levothyroxine. My opinion differs with lainey and as long as you remain on the same brand of levothyroxine with every refill it should not make any difference. I have been on generic Unithroid since my surgery 6 years ago.

As far as Cytomel -the insert itself says that starting dose is 5mcg and with you being on 25mcg that is a huge replacement dose.

I had heart palps from day 2 and the 2nd time I went onto it I began with 1/2 pill split down to 1/4 pill and took it 2x a day for a few days then added another 1/4 then a few days later the whole 5mcg but split. Today I take 10mcg + 1/2 and I divide it in 3 doses as I can feel the 2nd and usually 3rd dose. You FT-3 is so low it's most likely building in your system but eventually you will begin to feel it. I split my dose because I definitely feel a drop off about 6 hours after the first morning dose. As far as my 1/2 pill, pill splitters work wonderfully.

You can do a web search an find the insert and definitely call your doctor.

What was your FT-4 level? Was it low range as well?


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## GeekGirlNB (Nov 7, 2010)

Yikes, thanks for responding.

Ok, found my lab results from before adding cytomel:

Tsh 1.92 (.40-4.50)
T4 total 6.0 (4.5-12.5) looks like ft 4 was not run... Which is why this dr was fired and I found the new one 
T3 free 2.1 (2.3-4.2)

See, i never had heart palps, and today was day 3. I just kinda shut down almost directly after taking the 25 cytomel and .175 t4 med... Scary.

Tomorrow I will take 1/4 of the cytomel with my usual t4 med. Then I'll take my zoloft mid morning as usual. I'll put a call in to my dr to discuss.

I'll update after I speak to the dr.

Thanks so much!


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Hi all, I'm a newbie, but not to hypo.
> 
> I was diagnosed when I was 12 or 13, I am 29 now, and have just recently begun taking an active role in my thyroid health after years of just accepting hypo symptoms.
> 
> ...


Nicole, welcome. I will get straight to the point. THAT is a very very high dose of cytomel. Most patients are started out on 5 mcg. and even at that, a lot of folks have to split that pill and take only 2.5 mcgs..

I am not a doctor but I do strongly urge you to quit taking the 25 mcg. as it could land you in the ER. This is a very very potent med.

Please let me know how you decide to handle this. I am worried.


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## GeekGirlNB (Nov 7, 2010)

Put a call in to the dr.

This morning I took 1/4 of the 25 with my .175 synthroid and 1/4 at lunch time with my zoloft. No problems, no "zombie feeling" or shakiness.

However, I had the worst insomnia last night! Didn't fall asleep until 5 am, and I had to drug myself to do that. So, of course I was in bed this a.m until 11. So, not quite a normal day with which to guage my symptoms.

We'll see what the dr says and I'll keep everyone updated here.

Thanks again.


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## lainey (Aug 26, 2010)

GeekGirlNB said:


> Put a call in to the dr.
> 
> This morning I took 1/4 of the 25 with my .175 synthroid and 1/4 at lunch time with my zoloft. No problems, no "zombie feeling" or shakiness.
> 
> ...


Insomnia = probably too much cytomel. 1/4 = the 5 mcg we were talking about, and today you took about 12mcg.

Speak to the doctor.


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## GeekGirlNB (Nov 7, 2010)

Spoke with dr.s office. He approved me taking 1/4 of the 25 mcg, leaving my synthroid at .175, cause we want my TSH to go a little lower (I have felt best around a .8-1.0 and I am at 1.92 prior to med changes).

I feel really good today. Energetic and clear headed. No crying spells and my mood seems level, for a change. Bought a pill splitter for the duration of this bottle, cause I really can't afford to re-fill it at a lower dose. I'll use what I have and split it all up nicely until my next labs.

Dr. Did say that 25 mcg is what he has started other patients at (my sister included)... Oh well, he's willing to do what I need to feel my best, so that's good.
Thanks for your help, everyone.


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## CA-Lynn (Apr 29, 2010)

I'm glad you spoke with your doctor.

I'd like to clear something up on the board about starting doses for Cytomel. There are different recommended starting doses depending on the condition being treated.

*Mild Hypothyroidism*Recommended starting dosage is *25 mcg daily*. Daily dosage then may be increased by up to 25 mcg every 1 or 2 weeks. Usual maintenance dose is 25 to75 mcg daily.

The rapid onset and dissipation of action of liothyronine sodium (T3), as compared with levothyroxine sodium (T4), has led some clinicians to prefer its use in patients who might be more susceptible to the untoward effects of thyroid medication. However, the wide swings in serum T3 levels that follow its administration and the possibility of more pronounced cardiovascular side effects tend to counterbalance the stated advantages.

Cytomel (liothyronine sodium) Tablets may be used in preference to levothyroxine (T4) during radioisotope scanning procedures, since induction of hypothyroidism in those cases is more abrupt and can be of shorter duration. It may also be preferred when impairment of peripheral conversion of T4 to T3 is suspected.

*Myxedema*Recommended starting dosage is *5 mcg daily*. This may be increased by 5 to 10 mcg daily every 1 or 2 weeks. When 25 mcg daily is reached, dosage may be increased by 5 to 25 mcg every 1 or 2 weeks until a satisfactory therapeutic response is attained. Usual maintenance dose is 50 to 100 mcg daily.

*Congenital Hypothyroidism*Recommended starting dosage is *5 mcg daily*, with a 5 mcg increment every 3 to 4 days until the desired response is achieved. Infants a few months old may require only 20 mcg daily for maintenance. At 1 year, 50 mcg daily may be required. Above 3 years, full adult dosage may be necessary (see PRECAUTIONS, Pediatric Use).

*Simple (non-toxic) Goiter*Recommended starting dosage is *5 mcg daily*. This dosage may be increased by 5 to 10 mcg daily every 1 or 2 weeks. When 25 mcg daily is reached, dosage may be increased every week or two by 12.5 or 25 mcg. Usual maintenance dosage is 75 mcg daily. In the elderly or in pediatric patients, therapy should be started with 5 mcg daily and increased only by 5 mcg increments at the recommended intervals.

When switching a patient to Cytomel (liothyronine sodium) Tablets from thyroid, L-thyroxine or thyroglobulin, discontinue the other medication, initiate Cytomel at a low dosage, and increase gradually according to the patient's response. When selecting a starting dosage, bear in mind that this drug has a rapid onset of action, and that residual effects of the other thyroid preparation may persist for the first several weeks of therapy.

For what it's worth, I have several autoimmune diseases and react to changes in medications. Therefore I confer with my doctor and "break in" all meds very slowly, gradually working up to the Rx'ed dose. Again - with my doctor.

Now: regarding anti-depressants. Never, never, never adjust these meds on your own. You should only allow the prescribing doctor do the adjustments [and hopefully that prescribing doctor is a psychiatrist or neurologist]. I would never have a doctor other than the Zoloft prescribing doctor adjust the anti-depressant. Only psychiatrists, neurologists and those endocrinologists who specialize in neuro-endocrinology are trained to know the full blown spectrum of effects of anti-depressants.

My personal belief is that ANY doctor who prescribes ANY kind of drug to a patient who is already on anti-depressants needs to introduce the new drugs at the lowest possible dose to see how it interacts with the antidepressant.


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## Andros (Aug 26, 2009)

CA-Lynn said:


> I'm glad you spoke with your doctor.
> 
> I'd like to clear something up on the board about starting doses for Cytomel. There are different recommended starting doses depending on the condition being treated.
> 
> ...


I like your personal opinion re this and thank you for copying and pasting the prescribing information.

And no where does it say it should be used in conjunction with T4. It says to discontinue the other medication.

This did need clarifying.


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## GeekGirlNB (Nov 7, 2010)

Yes, thanks for the clarifications. What you copied and pasted is where I had read that the intro dose is 25 for hypothyroidism. I knew I had read that somewhere.

Fwiw, my original prescribing dr for the zoloft is not available to me anymore, and wasn't a psychiatrist or endo... Just a family practitioner, and a horrible one at that.

To update, the last 2 days on the smaller dose have been great! Going to the gym, out of bed early, getting things done around the house, and a general feeling of wellbeing. It's been wonderful!!

Thanks so much for everyones help. I am looking forward to continuing with my dosage and finally living my life


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Yes, thanks for the clarifications. What you copied and pasted is where I had read that the intro dose is 25 for hypothyroidism. I knew I had read that somewhere.
> 
> Fwiw, my original prescribing dr for the zoloft is not available to me anymore, and wasn't a psychiatrist or endo... Just a family practitioner, and a horrible one at that.
> 
> ...


Yeeeeeeeeeeeeeeeeees!!! I am so glad to hear this!! Whoohoo!! Stay the course and get labs in a timely manner.


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## CA-Lynn (Apr 29, 2010)

That's always good news.

Now about the Zoloft......who's monitoring you for that?


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## GeekGirlNB (Nov 7, 2010)

At this point, I've turned it over to the same dr that is monitoring my thyroid. I don't have insurance at the moment, so not too many options.

This dr. Says he wants me to stay at the 50, and then, after thyroid meeds are stabilized we can see about weaning off if we think it'll be ok to do so. I weaned myself down from 100 to 50 before I saw this new dr, which I know is a no-no. However, my previous dr wanted to increase my zoloft each time he saw me, instead of listening to me about my t3. So that's why I did it on my own, fired that dr, and found the new one. 

When it's time to get off the zoloft, I'll let my new dr. Dictate it!


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## GeekGirlNB (Nov 7, 2010)

An update:
Shocker, tsh level came back too low (.016), so I swung to the hyper side. Was having side effects to that effect- sweating, itchy skin, muscle fatigue, etc.

Dr. Changed Synthroid to .125, cytomel remains the same (which now I am taking 12.5 2x per day).

Zoloft has been slowly lowered. Was at 100 mg, then 50, and then a week at 25mg. I will be cutting the 25 in half and then stopping altogether!

Just wanted to give an update!


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> An update:
> Shocker, tsh level came back too low (.016), so I swung to the hyper side. Was having side effects to that effect- sweating, itchy skin, muscle fatigue, etc.
> 
> Dr. Changed Synthroid to .125, cytomel remains the same (which now I am taking 12.5 2x per day).
> ...


Wonder why the doc did not lower the Cytomel as well?


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## GeekGirlNB (Nov 7, 2010)

Andros, Dr said the T3 levels looked fine and he wanted to move one med at a time until we get to an optimum level.


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## Andros (Aug 26, 2009)

GeekGirlNB said:


> Andros, Dr said the T3 levels looked fine and he wanted to move one med at a time until we get to an optimum level.


That's cool; doc is on top of it big-time. You are lucky to have such a good doc!


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## daisydaisy (May 12, 2010)

wow..u have to taper slowly..you really don't have a choice unless you want to be non fuctional and go on a rollercoaster ride. Zoloft will give you a doozie in itself! VERY VERY slow wean. It takes the body/brain takes 4-6 weeks to get used to a new lower dose...so yes it may take a year or two but you'll get off the stuff. You want minimal side effects and maintain your job.


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