# Addition of Cytomel



## lbwell2 (May 7, 2013)

My doctor agreed to give me Cytomel 5mcg along with my current Synthroid 88mcg. I had hyper symptoms when I took the natural thyroid, so he told me to play with the dosage of Cytomel until I feel better. My question is, should my dose of Synthroid be lower if I am adding Cytomel? I have been splitting the T3 in half and taking it twice daily. By the evening, I start feeling irritable and like I am starving. I'm hoping to find a way to eliminate those symptoms, as my energy levels are much better with the added T3. He only checked T4 (1.2: .8-1.8) and TSH (1.02) this time.


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## Andros (Aug 26, 2009)

lbwell2 said:


> My doctor agreed to give me Cytomel 5mcg along with my current Synthroid 88mcg. I had hyper symptoms when I took the natural thyroid, so he told me to play with the dosage of Cytomel until I feel better. My question is, should my dose of Synthroid be lower if I am adding Cytomel? I have been splitting the T3 in half and taking it twice daily. By the evening, I start feeling irritable and like I am starving. I'm hoping to find a way to eliminate those symptoms, as my energy levels are much better with the added T3. He only checked T4 (1.2: .8-1.8) and TSH (1.02) this time.


What time is your second dose? How is your glucose? Also, check your ferritin level.

There is no doubt but what you will probably require more Cytomel at the 8 week mark and doc is going to have to run the FREE T3 to do this correctly.

For that reason, you may as well keep the Synthroid where it is at. 4 (T4) to 1(T3) ratio is the norm. See what happens. And bear in mind that T3 peaks in 4 hours.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Liothyronine (T3)
is almost totally absorbed, 95 percent in 4 hours.
http://www.frx.com/pi/armourthyroid_pi.pdf

If the T3 is peaking when you are trying to wind down for the evening; that may not work out so good depending on what time you take your second dose. It is also conceivable that you may be taking the second dose at the peak time as the first.

Will await your comments.


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## Octavia (Aug 1, 2011)

lbwell2 said:


> My question is, should my dose of Synthroid be lower if I am adding Cytomel?


We're all so different...maybe, maybe not. I did not lower my T4 drug when I started Cytomel, and I'm doing fine. But I don't have an autoimmune thyroid disease, so we're different in that regard.

Can you keep a log of times, dosages, and how you feel? Then you can begin to look for trends.


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## Lovlkn (Dec 20, 2009)

> he told me to play with the dosage of Cytomel until I feel better


You are lucky.

When I added Cytomel I split it into 1/4's and they were tiny.

I have also found that if I take with or near some food it helps ease into it.

You need to get your doctor into the habit of running FT-4 and FT-3, especially since you are now taking Cytomel.

Its the only way to properly dose your replacement. Be patient with the Cytomel - if you need it your body will eventually accept it.


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## lbwell2 (May 7, 2013)

I appreciate all of the information everyone shared. After reading the links provided by Andros, I'm left wondering if Armor would have worked better, had I been splitting the dose. My next prescription for blood work calls for Ferritin, and TSH/T4. I will ask to have the T3 included as well. Right now, I am taking one half in the morning, but not after breakfast, and one half in the afternoon. I will try taking half after breakfast and dinner, and see how that goes. My glucose is fine. Today, I only took one half in the morning, and I have the jittery feeling right now.


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## Lovlkn (Dec 20, 2009)

> I will ask to have the T3 included as well.


Be sure you ask for the "Free" tests.



> He only checked T4 (1.2: .8-1.8)


These ranges indicate your test is the Free.



> Today, I only took one half in the morning, and I have the jittery feeling right now.


You posted this in the evening - you would not be feeling your Cytomel this far away from a breakfast dose.

My suggestion would be to begin 1/4 pill and take away from your Synthroid dose. Stick with the 1/4 pill until you do not have any issues taking it - then add another 1/4 pill at least 6 hours away from the initial Cytomel pill. YOu may have to reduce your Synthroid dose for it to adjust in your system -

I tried and I quit the first time because I could not handle it - I struggled with fatigue - addressed low Ferritin and D levels then gave Cytomel another try - had to reduce my 125mcg of Unithroid down to 100mcg then eventually worked my way back up to the 125mcg. I have been on my current dose of 125mcg Unithroid and 12.5mcg Cytomel for almost 4 years but have been taking Cytomel for 6years.

For some ppl it can take some effort to get the dose right.


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## lbwell2 (May 7, 2013)

I will ask for the Free tests, and try the dosing you recommended, starting tomorrow. I'm glad you finally got your optimal dosage. I hope mine will be determined quickly!


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## Lovlkn (Dec 20, 2009)

> 5/3
> T4 Free 1.1(.8-1.8)
> T3 Free 3.1(2.3-4.2)


After second thought - you might want to try increasing your Synthroid first - your FT-4 is below 1/2 range - while your FT-3 is just above mid range.

Have you ever tried a higher dose of Synthroid? You seem to be converting OK, you are just a bit lower than you should be.


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## lbwell2 (May 7, 2013)

My doctor thinks my TSH is great, so he isn't willing to up my dose. I plan to seek some assistance from my primary doctor. He is usually open to letting me try things. What number should I be trying to get my TSH level to?


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## Lovlkn (Dec 20, 2009)

You need to be more concerned with mid to 3/4 level of FT-4 and FT-3. TSH is primarily a diagnostic test and can also lag 6 weeks behind your Free tests. TSH can also be affected by blocking and stimulating antibodies - it simply is not a good test to dose yourself by.

If your doctor is trying to dose you by TSH or control your dosing based on TSH then you need to keep looking for a doctor who will dose by your Free's. It took me 6 doctors before I found one - I am better medicated because of it.


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## Ana78 (Aug 8, 2013)

All i can tell you about thyroid pills, if something i have learned, is that some of them would make you VERY VERY hungry like starving. i dont find many people talking about this, they might assume they are going hyper. 
the pills would give you what you may interpret as "going hyper, so let me lower the dose a little before i kill someone" (even when you actually feel hypo,). This happened to me with natural pills but am still on them. syntetics are far worse for me, i get blown like a baloon, difficulty walking, thinking, brathing.
try eating something 20 min after taking the pill (i know its not recomended but it is the only thing that helps me). You might discover you were HUNGRY and not hyper, if you do what i suggest and the hyper symptoms dissapear. Good luck!


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## lbwell2 (May 7, 2013)

I got nervous about messing with my Synthroid dosage, so I decided to take 1/2 of the Cytomel at 2:00 in the afternoon, instead of in the morning. So far, I'm feeling pretty good tonight.  I eat frequently throughout the day, and have tried snacking at night, but it never gets rid of the starving feeling.


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## Lovlkn (Dec 20, 2009)

I have to ask because I changed my original opinion on your use of Cytomel because I saw labs in your signature - did you edit your signature after you started this thread?(maybe I just missed it and signatures do not appear when typing a reply)

I think your symptoms are because you don;t need a higher FT-3, instead, you need to get your FT-4 higher and naturally convert.

Your labs prior to adding Cytomel confirm you convert T-4 replacement quite well.


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## lbwell2 (May 7, 2013)

Hi,
The labs in my signature weren't changed. My endocrinologist felt my TSH was good at my previous visit, but he agreed to up my Synthroid then because I was feeling sick. He said he wouldn't go up to a higher dose now, because he didn't want me to end up in the hyper category. How low should my TSH be? I think my primary doctor will up my Synthrois if I ask him and have some good reason behind it.


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## lbwell2 (May 7, 2013)

Sounds logical to me. I have never been in a higher dose of Synthroid. I will request an increase and see how that goes. I can't believe how complicated it has been to get the correct dosage. It seems I'm in a bad area for doctors.


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## Lovlkn (Dec 20, 2009)

lbwell,

A cut and paste from another thread you started. Corrected to DX with hypo



> Hello,
> 
> I was diagnosed with Hyperthyroidism by my primary doctor in July of 2012. After three months of getting nowhere, I went to see an Endocrinologist. He said my thyroid had small nodules, and that I tested positive for Hashimoto's. I was switched from Thyroid 30 to Syntroid 75 last month because the Thyroid was causing me to be shaky and making my heart race. Now, I feel tired, depressed, and I'm suffering from muscle pain. The doctor said, "your numbers are good now, but since you are complaining, I'll increase your Synthroid to 88mcg. Do my numbers look good to all of you? I am so tired of feeling sick and tired. Has anyone really been cured completely of symptoms?


Do you by chance have those original labs run at your diagnosis? Can you share the treatment that you began with.

I still stick to my opinion that you are being treated with the incorrect medication - and that an increase in your Synthroid is what needs to occur. You are converting your current T-4 very well.

Your FT-4 remains low - this could be the cause of your fatigue - along with your 1/2 range FT-3, although I believe that should be higher as well and can be increased with a slightly higher FT-4 dose.

Ferritin, D and B-12 all cause fatigue and are frequently low range in Thyroid patients.


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## lbwell2 (May 7, 2013)

The original labs were run by my primary and he only ran the TSH test, which was around 9, I believe. I never actually saw those results. My B12 and D were checked and came back fine. I have Ferritin on my prescription for the next round of labs. I'm not supposed to have those done for three months though.


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