# How much Cytomel do you take?



## Octavia (Aug 1, 2011)

I've been more than a bit tired lately, so I asked my doctor's office if I could get some labwork done. I was thinking maybe I was slightly hypo.

The nurse called with my results, and she was happy with them and did not want to change my Levoxyl dosage. On the phone, she and I only discussed my FT4 and TSH, and based on those, I had to agree with her that an increase in Levoxyl was not called for. However, when I went online to see my results, my FT3 indicates that perhaps some Cytomel would help.

Those of you who take Cytomel, I'd love to hear your thoughts. And I'd love to know how much you take, so when I call the nurse back next week I can be better informed about a potential starting dose.

Here are my lab results from a week ago:

TSH: 0.03 - very suppressed (I'm post-cancer, so that's good)
T4, Free: 1.8 (0.8 - 1.8) - I'm at the very top of the range
T3, Free: 3.0 (2.3 - 4.2) - low-ish in the range

My doctor's goal is to keep the TSH as suppressed as possible while keeping Free T4 within range. That's being done.

Thoughts?


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## Andros (Aug 26, 2009)

Octavia said:


> I've been more than a bit tired lately, so I asked my doctor's office if I could get some labwork done. I was thinking maybe I was slightly hypo.
> 
> The nurse called with my results, and she was happy with them and did not want to change my Levoxyl dosage. On the phone, she and I only discussed my FT4 and TSH, and based on those, I had to agree with her that an increase in Levoxyl was not called for. However, when I went online to see my results, my FT3 indicates that perhaps some Cytomel would help.
> 
> ...


Correct; you are not converting the T4 to FREE T3 very well, that is why the FT4 is high.

Hope you can talk her into lowering your T4 dose and starting you on about 5 mcg. of Cytomel. If necessary, you can split the pill and start on 2.5 mcg. to make sure you can tolerate it.

Slow is good. Gives your body time to adjust.

How much Levoxyl are you on? The ratio should be 4 to 1, the latter being the T3.


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## Octavia (Aug 1, 2011)

I'm on 137 mcg of Levoxyl. I was on 150 at first, but that proved to be slightly high...the heart palpitations started to scare me, especially when I was exercising. Also, my heart rate would skyrocket when exercising when I was on 150.

Perhaps 137 is too high for me too...


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## teri2280 (Feb 7, 2012)

Hee hee. I'm out of this world on this one. 175 synthroid (gen) every other day (I couldn't cut them in half without losing some, so my endo said just to do one every other day), 25 mcg Cytomel (gen) at "breakfast" (I don't eat breakfast, so use this term loosely), another 25 at bedtime. Last labs were perfect, according to my endo's secy, waiting on snailmail to get the copies.

And, Andros, and Octavia - I know both of you were concerned about this dosage when I first started it, but I feel GREAT!!! (AND I'm starting to lose weight!!!!!!  My work pants are baggy after about 2.5 mos. of this "concoction"!!!! Not a drastic amount that I'm worried about by any means, just a normal amount consideing my activity.)


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## Octavia (Aug 1, 2011)

teri, thanks for the info! Do you happen to have your lab results from just before starting Cytomel? I'm just curious to see how mine compare to someone who has already been prescribed Cytomel. I look at my labs and I think "they're not THAT bad..." but seriously, I'm getting to the point of feeling like I want to either hibernate or fall into a coma every day, early afternoon. Some days, I do. It's a struggle to keep my energy level up enough to be productive. I'm relying a little too heavily on caffeine pills, and I know that's not good.


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## webster2 (May 19, 2011)

Octavia, I hope you get sorted out soon. Sounds like it is tough for you right now.


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## jenny v (May 6, 2012)

This thread has been a very interesting read for me as I have had problems getting my T3 up in the past, too, and have wondered if a small bit of Cytomel might help (I'm currently on Synthroid only).


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## teri2280 (Feb 7, 2012)

Octavia said:


> teri, thanks for the info! Do you happen to have your lab results from just before starting Cytomel? I'm just curious to see how mine compare to someone who has already been prescribed Cytomel. I look at my labs and I think "they're not THAT bad..." but seriously, I'm getting to the point of feeling like I want to either hibernate or fall into a coma every day, early afternoon. Some days, I do. It's a struggle to keep my energy level up enough to be productive. I'm relying a little too heavily on caffeine pills, and I know that's not good.


That 2.11 in my signature (along the other #s) were the numbers before starting cyto. He was originally going to just up my synthroid, but I ran the whole "felt better on cyto" by him yet AGAIN, and he actually listened to me this time.  It was WAY high on just the 175 Levo. I honestly didn't feel HORRIBLE at that number, but definitely wasn't feeling as good as I had while on just Cyto prior to my RAI, and finally was able to convince my endo on it. I'm still really new to all of this, though, so "not horrible" to me might be horrible to you. LOL. Not having been in the "game" that long, prior to feeling how I do now, I was content to just not feel as crappy as I did during hypohell.

*ADD* And before you ask about the antithyroglobulin ab level in my signature, it's not right. I have the antibodies naturally, and that result is the result the local lab got. They have to send mine to USC to get an accurate read because of the natural occuring ones. I don't know off hand (read: don't feel like digging for the paperwork right now lol), but if I remember correctly it was somewhere between 3 & 6.


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## teri2280 (Feb 7, 2012)

I just had a thought. I wonder if it's possible that your TSH isn't entirely accurate? Hear me out, as this is JUST a theory.

If you take your synthroid first thing in the morning when you wake up at, say 6 am, but your blood wasn't drawn until, say, 4 pm, wouldn't that have an effect on your actual TSH? Or if you take your synthroid at bedtime (I know of a couple of people who go to the same endo I do that were told to take theirs at bedtime, while I was told to take it first thing in the morning), and your blood draw is at 10 am the next day? I know synthroid stays in your system for a while, but it only makes sense (to me at least, even if not to others lol) that waiting 10 hours before having blood drawn would cause your tsh to be higher. I know I might be reaching here, but it kinda sorta (in my head at least lol) makes some sense....

What I'm getting at, is, even though your TSH doesn't seem "that bad", number wise, if you had your blood drawn a few hours after you took your pill, your TSH is possibly going to look ok, even though you're still feeling like poo.


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## Lovlkn (Dec 20, 2009)

Octavia said:


> I'm on 137 mcg of Levoxyl. I was on 150 at first, but that proved to be slightly high...the heart palpitations started to scare me, especially when I was exercising. Also, my heart rate would skyrocket when exercising when I was on 150.
> 
> Perhaps 137 is too high for me too...


Octavia,

I was on Unithroid only post op for almost 2.5 years and struggled with constipation mostly and fatigue.

When I began Cytomel I had to back off my Unithroid a bit - eventually having to go back to the original dosage. Ease into Cytomel 1/2 a pill each dose until you can tolerate it without heart palps or hyper feelings.

I sometimes have to reduce my Cytomel by 1/4 pill a week to help keep the edge of hyper from happening. It's such a small adjustment , however it makes a huge difference.


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## Octavia (Aug 1, 2011)

Thanks for the info...I appreciate it!

teri, I see where you're going with the pill time vs. lab time. I generally take my pill first thing in the morning. On lab days, I wait to take my pill until after my labs, which I get done first thing in the morning. I've been very consistent with that.

Sounds like it might be worth a try for me to start on a little Cytomel, with or without a small decrease in Levoxyl. Wednesdays (today) are the nurse's day off, so I am going to call and talk with her about it tomorrow and share an update.


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## jenny v (May 6, 2012)

Not to hijack Octavia's thread, but I'm wondering if I might be a good candidate for Cytomel, too. My current labs are:
FT3 3.1 (range 2.0-4.4)
FT4 1.45 (range .80-1.8)

I've never been able to get my FT3 over 3.1-3.2 no matter what my dose of Synthroid is (current dose is 75 mcg). And I continue to have hypo symptoms, although they are not as bad now as they have been in the past.


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## jenny v (May 6, 2012)

Bumping this up to see if Octavia had been able to talk with her doc about Cytomel.


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## Octavia (Aug 1, 2011)

We've been playing phone tag...so no update yet.


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## jenny v (May 6, 2012)

Ugh, I know how that goes. Good luck! I'm interested to hear if she'll put you on it given your numbers. They are very similar to mine.


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## Octavia (Aug 1, 2011)

I will definitely report back via this thread...so stay tuned!


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## jenny v (May 6, 2012)

Bumping this thread up again! It has been dead at work so I have been putting together a case for my endo to see if Cytomel would potentially help me and wanted to see what those of you who take it think.

Even though my TSH and FT4 respond to changes in my Synthroid dose, my FT3 seems to be stuck and I still have lingering hypo symptoms I can't seem to shake (coldness, constipation, fatigue). Unfortunately, my previous endo didn't test FT3, so I don't have any numbers for all of 2011 and the early part of 2012, but below are my 2012 labs since switching to my new endo. Looking back at my records from before 2011, my FT3's were all hovering between 2.8-3.2 (range 2-4.4).

7/13/12 (Synthroid dose of 60 mcgs)
TSH--1.58 (range .4-4.5)
FT4--1.53 (range .8-1.8)
FT3--3.1 (range 2-4.4)

9/18/12 (Synthroid dose of 65 mcgs)
TSH--2.58
FT4--1.17
FT3--3.0

11/12/12 (Synthroid dose of 75 mcgs)
TSH--1.91
FT4--1.45
FT3--3.1

My antibodies are at the lowest levels I've ever had and for the most part the Synthroid works pretty well for me (I tried Armor a few years ago but something in it made me break out in hives within days of starting it). Does anyone think a small dose of Cytomel might work well for me or am I barking up the wrong tree?


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## Lovlkn (Dec 20, 2009)

jenny v said:


> Bumping this thread up again! It has been dead at work so I have been putting together a case for my endo to see if Cytomel would potentially help me and wanted to see what those of you who take it think.
> 
> Even though my TSH and FT4 respond to changes in my Synthroid dose, my FT3 seems to be stuck and I still have lingering hypo symptoms I can't seem to shake (coldness, constipation, fatigue). Unfortunately, my previous endo didn't test FT3, so I don't have any numbers for all of 2011 and the early part of 2012, but below are my 2012 labs since switching to my new endo. Looking back at my records from before 2011, my FT3's were all hovering between 2.8-3.2 (range 2-4.4).
> 
> ...


I think a 5mcg might work for you - be sure and split in 1/2 taking it in the morning then 6 hours later. You may need to tweak down your Synthroid dose for awhile or possibly forever.

I am struggling with lower than 1/2 range labs for the last year , likely due to an increase in calcium consumption but still feel pretty well.

It is SO important to dose on how you feel and not toally on thyroid lab numbers.


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## I DClaire (Jul 31, 2011)

jenny v said:


> Not to hijack Octavia's thread, but I'm wondering if I might be a good candidate for Cytomel, too. My current labs are:
> FT3 3.1 (range 2.0-4.4)
> FT4 1.45 (range .80-1.8)
> 
> I've never been able to get my FT3 over 3.1-3.2 no matter what my dose of Synthroid is (current dose is 75 mcg). And I continue to have hypo symptoms, although they are not as bad now as they have been in the past.


Not to hijack Octavia's OR jenny v's thread but here are my last labs (on 105 mcg Armour) and I honestly don't know what I'm going to do about the almost debilitating fatigue I feel from the time I wake-up every morning until almost straight up and down 6:00 P.M. every afternoon...then I feel virtually normal until I go to bed around 11:00.

My labs, on December 6, were:

FT3 - 2.7 (range 2.0-3.6)
FT4 - .9 (range 0.8-1.5)
TSH - 0.010 (range 0.37-4.55 BUT Endocrinologist says TSH doesn't mean anything for Armour patients)

The Endocrinologist told me to try bumping back up to 120 mcg but I can't do it - I feel hyper, shaky, AND have panic/anxiety attacks. The strangest thing to me is that I have the anxiety attacks with virtually the same regularity as the time of night I begin to feel well. On 120 mcg, I'll have what feels like an anxiety attack between 10:00-11:00 A.M. and again around 4:00 P.M.

Can a person take Cytomel with Armour? My Endocrinologist has never mentioned Cytomel and after my latest tests dismissed me for 4 months.

I called her office last week to ask about the 24-hour saliva test for adrenal dysfunction and nobody returned my call.

For several weeks I actually felt better - the weeks immediately following the mega-antibiotic regimen for H. Pylori. I felt better than I'd felt in a year or more, now I'm right back with the lethargic fatigue that I fight but I think it's getting worse.


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## jenny v (May 6, 2012)

> I think a 5mcg might work for you - be sure and split in 1/2 taking it in the morning then 6 hours later. You may need to tweak down your Synthroid dose for awhile or possibly forever.
> 
> I am struggling with lower than 1/2 range labs for the last year , likely due to an increase in calcium consumption but still feel pretty well.
> 
> It is SO important to dose on how you feel and not toally on thyroid lab numbers.


 Thanks for the advice, Lovlkn! I feel better than I have in a long time but I've still got lingering hypo symptoms I'd like to get rid of. They aren't totally debilitating as my previous symptoms were but they still do drag me down a little and I know I could feel better than I do.

I DClaire, I'm no expert, but your FT3 level is still way low, not even at the midpoint of your range. Is there an Armour dose between 105 and 120 mcgs that you could try?


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## I DClaire (Jul 31, 2011)

jenny v said:


> I DClaire, I'm no expert, but your FT3 level is still way low, not even at the midpoint of your range. Is there an Armour dose between 105 and 120 mcgs that you could try?


I don't think so, Jenny. I take a 90 mcg and a 15 mcg combination to get the 105 mcg. I am so frustrated - I feel hypo but sometimes I wonder if I'll ever get all this stabilized. Even when I do begin to feel better, I cannot hold onto it.

I see you're in Dallas - I'm in Shreveport!! hugs1


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## jenny v (May 6, 2012)

Could you take a 90, a 15 and split another 15 in half to get to around 112 mcgs? I don't know how Armour works but I've been splitting doses of Synthroid for years to ease into increases (my body has freaked out when I try to go up in normal doses of Synthroid like 75 mcg to 88 mcg, so my endo has had me split pills to go from 60 to 65 to 70, etc.).

I've been to Shreveport many times! I grew up in East Texas just a 2 hour drive away.


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## I DClaire (Jul 31, 2011)

jenny v said:


> Could you take a 90, a 15 and split another 15 in half to get to around 112 mcgs? I don't know how Armour works but I've been splitting doses of Synthroid for years to ease into increases (my body has freaked out when I try to go up in normal doses of Synthroid like 75 mcg to 88 mcg, so my endo has had me split pills to go from 60 to 65 to 70, etc.).
> 
> I've been to Shreveport many times! I grew up in East Texas just a 2 hour drive away.


I began my thyroid journey with Synthroid in September, 2011. I took it for approximately three months but had a lot of problems. I was started on 125 mg the day after my thyroidectomy and, in retrospect, I can't help thinking that was too much.

My endocrinologist tried several different approaches - she'd have me skip days, etc., but she never mentioned lowering the dosage. I've been on Armour since last December and was looking at a chart I keep today - my test results on December 6 (taking 105 mcg Armour) were virtually identical to my test results on April 4 (taking 60 mcg Armour).


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## Octavia (Aug 1, 2011)

IDC...is it possible that your activity level increased significantly enough after your h. Pylori treatment that you "threw your numbers off" so to speak? It is certainly odd that your labs are the same-ish on such vastly different dosages of Armour.

Here's my update: I finally connected with the nurse, and she called in a prescription for 5 mcg of Cytomel while I was on my way out of town a few days ago. I went to pick it up today, and the pharmacy didn't have it. They said they'd have it tomorrow. The nurse said we could do labs again in 8 weeks or so, but they'll pay more attention to how I feel on it and go from there.


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## jenny v (May 6, 2012)

That's exciting, Octavia, I hope it helps you to feel better. Will you be splitting the dose and taking it twice a day? Did you have to adjust your dose of Levoxyl?


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## Octavia (Aug 1, 2011)

The nurse did not mention splitting, and did not decrease my Levoxyl dose. I was just reading on here about splitting, and am open to doing that on my own. We'll see how it goes!


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## Lovlkn (Dec 20, 2009)

Octavia - YEA!!! Ease yourself into the Cytomel. I started at 1/2 pill 2x a day and quit my first time due to heart palp's. The 2nd try I took 1/4 5 mcg pill every 5 hours until I got the prescribed does in me. I even took 2 weeks to get the whole dose. I now adjust by 1/4 pill weekly - during the Winter my body needs less from Oct to April. Keep good logs of how you feel and your dosing.

Addressing the previous 2 posts -

The first thing I would look at is Ferritin levels, B-12, Vit D.

The next thing to look at is allergies - food or environmental.

I was fatigued post op and once I added Cytomel, addressed my anemia and low vit D levels things got much better. I also have allergies - those are currently being addressed with a new antihistamine nose spray as they are environmental.

IDC - do you sleep well - have sleep apnea? Your labs still show you to be a bit under-medicated - can you split up the additional doses your doctor suggests?


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## Octavia (Aug 1, 2011)

Okay, lovlkn...thanks for the advice! I was wondering how to start on the Cytomel. Do you take your Cytomel WITH your Synthroid, or 30-60 minutes AFTER your Synthroid? Do you still split the Cytomel dose and take it 2x a day, or do you take it all at once?


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## Andros (Aug 26, 2009)

Octavia said:


> The nurse did not mention splitting, and did not decrease my Levoxyl dose. I was just reading on here about splitting, and am open to doing that on my own. We'll see how it goes!


Yes; 2.5 mcgs. would be a good idea to start on for about a week or 10 days to give your body a chance to acclimate.

The Levoxyl really should be lowered but I don't know how much. I hope you can get with your doctor about this.


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## I DClaire (Jul 31, 2011)

Lovlkn said:


> IDC - do you sleep well - have sleep apnea? Your labs still show you to be a bit under-medicated - can you split up the additional doses your doctor suggests?


I have the most sporatic sleep pattern. For the past several weeks, I've been sleeping extraordinarily well...but I may slip into a routine of not sleeping normally for awhile. I slip back and forth.

I have had an exceptionally bad day today. The endocrinologist's new nurse called early to say my doctor does not believe in the 24-hour saliva test for adrenal issues. She said she'd order the blood test but I don't think it is worth the effort, based on what I've read.

Then, by mid-morning I was terribly ill with what seems like a stomach virus...on my husband's birthday, no less. I've been battling a respiratory bug and I'm hoping this is the last of it!!

I am giving very serious thought to trying to see a new doctor app. 60 miles from here - her website is something like "AgeLess Clinic in Minden, LA.". The manager of The Vitamin Shoppe told me a lot of people are going to see her and she also deals with thyroid and adrenal problems.


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## jenny v (May 6, 2012)

Octavia, totally being nosy here, but how is the Cytomel working for you?


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## Octavia (Aug 1, 2011)

Jenny, honestly, I'm not sure yet. I'm on day 4. I do feel a bit more energized sometimes, but I wonder if that's just a placebo effect, since I'm only on day 4. Right at this moment, it's almost 2:00 in the afternoon, and I could easily fall asleep at my desk.


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## jenny v (May 6, 2012)

Maybe it takes a while to see a big improvement? Did you end up splitting the dose and taking it twice a day?


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## Octavia (Aug 1, 2011)

Don't tell anyone else here, but I'm taking it all at once in the morning. 

I tried the splitting thing on the first day, but my eating schedule is too unpredictable to have a reliable twice-a-day schedule where I can take it on an empty stomach.


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## Andros (Aug 26, 2009)

Octavia said:


> Don't tell anyone else here, but I'm taking it all at once in the morning.
> 
> I tried the splitting thing on the first day, but my eating schedule is too unpredictable to have a reliable twice-a-day schedule where I can take it on an empty stomach.


That's fine and clearly your body needs the T3, that is why you really don't "feel it" so much yet.

When do you see the doctor next for further titration of the Cytomel?

The good news is that you seem to tolerate the Cytomel and for that, we can be very very grateful. Be mindful of the titration process. Go by small increments each time.

I figure you will end up on about 25 to 30 mcgs. of Cytomel. And has the T4 been cut down?


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## Octavia (Aug 1, 2011)

I get labs in 8 weeks. No decrease in the Levoxyl (yet). We'll see how that goes.


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## jenny v (May 6, 2012)

I am joining the ranks of Cytomel users!

I saw my endo today and brought it up and she was open to letting me try a small starting dose, 5 mg. However, she wants me to cut my Synthroid back from 75mcg to 50mcg if I'm going to take the Cytomel. That freaks me out a little since it's such a big drop. Does that seem off to anyone else? She tends to be very, very cautious of me going back towards hyper symptoms.

My current labs are:
TSH: 1.91 (range .4-4.5)
FT4: 1.45 (range .8-1.8)
FT3: 3.1 (range 2-4.4)

I'm supposed to split the Cytomel dose in half and take half in the morning and half in the evening. She didn't say I couldn't take it at the same time I take my Synthroid, so I'm going to do that. I go back in for labs in 8 weeks to see how things are going.


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## Octavia (Aug 1, 2011)

Jenny, I'm taking my Cytomel at the same time as my Synthroid, too. I started out taking the Cytomel 30 minutes after the Synthroid, but then I also have Nexium to take in the morning, and I felt like waiting 2 hours for breakfast was a bit obnoxious. The pharmacist said I could take the Cytomel and Synthroid at the same time...hopefully that works out well for both of us!


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## Heidi68 (Jan 2, 2013)

Hi! I have both Graves' and Hashi's antibodies. RAI in July 2009 and have been a mess ever since.

I started Cytomel 11/29/12. My labs then were:
tsh 4.59; ft3 2.7 (1.8-4.6); and ft4 1.3 (0.7-1.8)
I was told to take 2.5mcg Cytomel in addition to my 88 levoxyl.

It made me feel pretty good! I was having a lot of hypo symptoms- muscle stiffness and aches (I'm a runner), dryness, fatigue, etc. Within a few days I noticed a change but also thought maybe it was in my head.

New labs on 1/9/13:
tsh 1.58; ft3 2.34 (1.8-4.2); and ft4 1.17 (.8-1.83)
My Doc didn't want me to increase my Cytomel after these labs because he said my tsh was good where it is. Thanks to you all and the info I have found on this board I convinced him to give it a try and at least let me take 2.5mcg in the morning and 2.5mcg in the evening.

I thought it was weird that even after adding the Cytomel, my ft3 actually dropped. I wonder if that is because I'm using it up?

I started the new dose on Monday and am feeling pretty good. Maybe a little bit too energized, but that could just be that I'm so used to feeling hypo that this is normal but feels different. I haven't felt normal in so long I'm not sure how normal is


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## Andros (Aug 26, 2009)

jenny v said:


> I am joining the ranks of Cytomel users!
> 
> I saw my endo today and brought it up and she was open to letting me try a small starting dose, 5 mg. However, she wants me to cut my Synthroid back from 75mcg to 50mcg if I'm going to take the Cytomel. That freaks me out a little since it's such a big drop. Does that seem off to anyone else? She tends to be very, very cautious of me going back towards hyper symptoms.
> 
> ...


Your doctor clearly understands this stuff. T3 is your active hormone. You don't want the T4 to build up as it will convert to rT3 in your body. You only need a little T4 for peripheral deoiodination.

You most certain should take them both at the same time.


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## jenny v (May 6, 2012)

Thanks for the reassurance, Andros! My endo is super smart (and adorable--she's this tiny little thing who sits crossed legged in her chair because her feet don't reach the ground!) and interested in making sure I feel good instead of just going by my labs, so I'm lucky.

For you Cytomel users, a few questions:

1. For those of you who split your dose, how far apart do you take it? I took my first dose this morning (I'm on 5 mcg, split in half) with my Synthroid, when should I take the second dose?

2. Is it like Synthroid where I have to wait a while to feel any results?

3. How long did it take for you to start noticing results? I'm taking it for residual hypo symptoms (fatigue, coldness and weight gain, primarily) so I'm interested to see if it will make a difference and how long it will take.

4. Anybody have any side effects? I'll be honest here, I got the prescription on Monday but I've waited until today to take it because my body randomly freaks out on new medications sometimes and I'm a wimp. I actually only took a quarter of the pill (instead of the full half) so far, just to be on the safe side.


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## jenny v (May 6, 2012)

And an update, I took only a quarter of a pill today, but that was enough to make me feel totally jittery to the point that I took an extra beta blocker. Whew! Apparently I am super sensitive to T3 and will have to slowly increase my dose like I do with my Synthroid. I'm planning on only taking a quarter dose for a week, then trying half a dose for a while, then 3/4's, etc.


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