# Cytomel Side Effects?



## jenny v (May 6, 2012)

I'm trying to figure out if the Cytomel is causing this or if it's something else, since I've only been on the Cytomel for 5 days, but I've been having:

1. A racing heart (not horrible but enough that I've been doubling up on my beta blocker)
2. Trouble sleeping
3. Going from feeling super hot to super cold in a matter of minutes (mostly at night when I'm trying to sleep)
4. An overall achy feeling through my body 
5. Heartburn

I'm only taking a quarter of the 5mg Cytomel--the first day I took a half and fully intended to take the second half later but it gave me such a rush of jittery energy I backed off. Is it possible for such a teeny dose of Cytomel for only 5 days to cause these symptoms?


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## emmacat13 (Jan 22, 2013)

Hi There,
I am newly diagnosed and I just started 5mcg cytomel between 2-5pm last week. I also started Nature-throid (in the mornings) at the same time and I felt a racing heart and wired feeling within the first week. I also had severe insomnia. My doctor told me to stop the cytomel for now and today I lowered my Nature-throid as well (from 1 grain to a 1/2 grain). Today was the first day on 1/2 grain and no cytomel and I felt calmer. Hoping I can sleep tonight!


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## joplin1975 (Jul 21, 2011)

Popping into say you should be very, very cautious about taking a t3/t4 (Nature-throid) med AND t3 (Cytomel)...

The two usually don't mix well at all. Good luck!


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## emmacat13 (Jan 22, 2013)

I'm curious why...is it too much T3? Do you have any resources or other threads you could point me to?


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## joplin1975 (Jul 21, 2011)

Exactly -- too much t3. T3 is the active hormone so a little bit goes a long way (but it also "burns out" faster).

The dessicated thyroid hormones are produced to have the optimum (or near-optimum) t4/t3 ratio. Once you start adding t3 on top of that, it would only seem logical that you would experience those kinds of symptoms.

I do well on T4 only, but I'll look around for citations. I'm sure those who are more well-versed on the ins and outs of the combination medications will pop and likely beat me to the punch.


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## Andros (Aug 26, 2009)

emmacat13 said:


> Hi There,
> I am newly diagnosed and I just started 5mcg cytomel between 2-5pm last week. I also started Nature-throid (in the mornings) at the same time and I felt a racing heart and wired feeling within the first week. I also had severe insomnia. My doctor told me to stop the cytomel for now and today I lowered my Nature-throid as well (from 1 grain to a 1/2 grain). Today was the first day on 1/2 grain and no cytomel and I felt calmer. Hoping I can sleep tonight!


Nature-throid has about 9 mcgs. of T3 per grain. Add to that 5 mcg. of Cytomel and you are on too high of a starting dose of T3 not to mention as pointed out by Joplin, Nature-throid and cytomel do not mix well. At all.

Your doc would do well to slowly titrate you upwards about every 6 to 8 weeks based on current labs and clinical presentation until you are euthyroid. This usually takes several months. There is not easy fix but there is a fix and that is "slow" titration.

Most patients start on only 1/2 grain, get labs at 6 to 8 weeks and are titrated upwards by only 1/4 grain. No cytomel added.


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## emmacat13 (Jan 22, 2013)

Thanks a lot for that information. I appreciate it!


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## Lovlkn (Dec 20, 2009)

jenny v said:


> I'm trying to figure out if the Cytomel is causing this or if it's something else, since I've only been on the Cytomel for 5 days, but I've been having:
> 
> 1. A racing heart (not horrible but enough that I've been doubling up on my beta blocker)
> 2. Trouble sleeping
> ...


Yes, Cytomel is very powerful. Did your doctor lower your T-4 medication when he prescribed the Cytomel?

Can you post your labs (and ranges) that were run before the Cytomel was started?

I had a horrible time the 1st try on Cytomel and gave up after 6 weeks. I was easing into it and it gave me all sorts of anxiety. You need to be patient and possibly back down on your T-4 med's if you are having issues. You may eventually get to go back to your original T-4 dose after you get used to the Cytomel in your system. I now take my old T-4 dose of 125mcg and 12.5mcg of Cytomel daily. I dropped to 112mcg while I was adjusting to the Cytomel.


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## jenny v (May 6, 2012)

Thanks for the response, Lovlkn! I have not had a single good night of sleep since starting the Cytomel last Friday (last night I woke up around 1:30am with heartburn so awful I was actually hoping to throw up so I would feel better, ugh) and while the jittery-ness is gone, my heart rate is still elevated. I'm just exhausted. I've decided to stop the Cytomel for a few days to see if that is really what's causing all of my problems.

My endo decreased my Synthroid from 75mcg to 50mcg when she prescribed the Cytomel but she didn't run new labs (my last labs were in November). I'm going in tomorrow for a new set of labs, just to see where things are.


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## Lovlkn (Dec 20, 2009)

Please post your labs from November.

Why did your doctor prescribe the Cytomel? What symptoms were you having, or was it conversion issues?

I think discontinuing for a few days to determine if it's the Cytomel is a good idea. When you begin taking again you may want to take one day and skip the next on an alternating plan until you can tolerate the medication. I suggest to everyone beginning Cytomel to begin slow and not increase until the hyper symptoms subside. I personally think it takes a body longer to adjust to adding Cytomel than a T-4 only medication.


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## jenny v (May 6, 2012)

My November labs were:

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

I was still having a few mild hypo symptoms (coldness, weight gain, fatigue) and we can never get my FT3 over a 3.1 no matter how much my Synthroid increases, so we decided to try a very small dose of Cytomel to see if it helps. I have only been taking 1.25mg of the prescribed 5mg dose of Cytomel so far and it's still giving me hyper symptoms.

How long does T3 work in the body? I know it's faster acting than T4 but will it be out of my system in a few days if I stop taking it? I'm going to stop it for a few days to see if that is what's causing my issues or if it's something else; I'm also scheduled to do labs tomorrow.


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## Andros (Aug 26, 2009)

jenny v said:


> My November labs were:
> 
> TSH: 1.91 (range .4-4.5)
> FT4: 1.45 (range .8-1.8)
> ...


If your Ferritin is in the basement, it is unlikely that you will be able to tolerate much Cytomel if at all.

Have you had a ferritin test?

Ferritin (should be 50 to 100; the closer to 100,the better) 
http://www.thewayup.com/newsletters/081504.htm


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## emmacat13 (Jan 22, 2013)

For me, since stopping cytomel 3 days ago, I've been sleeping great again and the wired feeling I had completely went away already. I also lowered my Nature-throid from 1 grain to a 1/2.


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## jenny v (May 6, 2012)

Andros, my ferritin is actually great, it's 100.1 (range 13.0-150.0). It's one of the few things that's working right!


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## Lovlkn (Dec 20, 2009)

jenny,

I think your FT-4 is a bit high which may be causing your issues. Did you take the reduced Synthroid dose for a few days when you began the Cytomel or did you switch the same day you began the Cytomel?

When you take Cytomel - theory is that you will not convert as much T-4, therefore, if your FT-4 was in high range to begin with you may be tipping the scale on your FT-4 level to top or over top range, or simply have symptoms of hyper due to your levels being high range.

I find if my FT-4 gets too high I have a horrible time with my Cytomel.


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## jenny v (May 6, 2012)

Thanks for the info, Lovlkn. I switched over from the 75mcg of Synthroid on Thursday last week to the 50mcg of Synthroid and Cytomel on Friday. I think I'm just going to take the 50mcg of Synthroid only for a few days and see if my symptoms abate. I just wonder about the horrible heartburn; I've been hyper before but that was never a symptom for me.


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## Lovlkn (Dec 20, 2009)

That sounds like a good plan.

Because you only had 1 day between reducing your Synthroid and adding the Cytomel I think that might have been the issue. Your FT-4 levels should drop in a few days - then try the Cytomel again, adding 1/4 a pill until you do not have symptoms.

You also mentioned your iron being 100. Do you supplement? When I get to 100 I feel hyper, 70 is a better range for me.

I notice the same with my D levels, if they get too close to top range it makes me feel hyper.

Hope this info helps.


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## jenny v (May 6, 2012)

I've been off the Cytomel since Wednesday and I've skipped my Synthroid for two days and I'm getting back to normal. The racing heart and the jittery anxiousness are subsiding and the heartburn is slowly going away (I had no idea heartburn could be a hyper side effect, I never had it when I was hyper for over a year).

I did labs yesterday and I'm going to start taking the lower Synthroid dose again tomorrow; I'll do Synthroid only for a few days and then start the Cytomel again, 1.25 mg every other day and build up from there.

What an adventure!


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## Andros (Aug 26, 2009)

jenny v said:


> Andros, my ferritin is actually great, it's 100.1 (range 13.0-150.0). It's one of the few things that's working right!


Absolutely excellent!!! I am very relieved to know that and I am glad you went down to what should have been the starting dose of Naturethroid which is 1/2 grain. Get labs in 8 weeks. FREE T3 ideally should be at about 75% of the range given by your lab.


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## jenny v (May 6, 2012)

So the labs I did yesterday just came in (in record time!) and I've somehow swung seriously hyper!

My November 2012 labs were:
TSH: 1.91 (range .4-4.5)
FT4: 1.45 (range .8-1.8)
FT3: 3.1 (range 2-4.4)

My January 24, 2013 labs are:
TSH: .008 (range .4-4.5)
FT4: 2.06 (range .82-1.77)
FT3: 4.7 (range 2-4.4)

Son of a @$%&! I can't believe I've swung that hyper in 2 months and I didn't have any kind of dosage change until 6 days ago. I hate these crazy swings. :-(


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## Octavia (Aug 1, 2011)

Whoa. Hyper indeed.


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## Lovlkn (Dec 20, 2009)

Your doctor added Cytomel without a lab first?

That's insanity at it's best.


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## jenny v (May 6, 2012)

I thought it was a little odd, too, but I guess she thought things wouldn't have changed that drastically since my last labs 8 weeks ago? I never would have guessed I became that hyper that fast, I didn't really have any bad hyper symptoms until the last week or so. I'm waiting to hear back from her to see what she wants to do about my medication but I'm not taking anything (Synthroid or Cytomel) until I hear from her.

Hyper stinks but I will admit it's nice to finally be warm again! I'm always so cold when I'm hypo.


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