# Meds



## PitbullMom (Feb 22, 2010)

Just wondering what meds everyone is on here? I just had a full thyroidectomy last week and my doc has started me on Cytomel 25mcg twice a day. How is this compared to Synthroid? Has anyone noticed more side effects with one or the other?


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## hillaryedrn (Dec 14, 2009)

Oh honey! You are in the SAME boat I am! I had my TT on 2/2 and they started me on Cytomel 50 mcg once daily. Here's what I've learned. Ok, there are two thyroid hormones, right? T3 and T4. T4 is the "initial" hormone and the body converts T4 to T3 and it's that one that gives you energy, increases your metabolism, etc. Cytomel is a T3 medication while Synthroid is a T4 medication. I just changed over from Cytomel to Synthroid a couple days ago. The Cytomel made it difficult for me to sleep at night. I'm still trying to get back to a full night's sleep. Is the Cytomel making you jittery or hyped up feeling? When do you go back to your Endo? Are you having RAI?


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## chopper (Mar 4, 2007)

Think of Cytomel like the drug crack - it gets you going hard and fast. You also "come down" hard and fast because its got a really short half life.

Think of Synthroid as a dilluted caffeine IV drip - you get a little "awakeness" over the course of the entire day - no fast ups and no fast downs but it's not as powerful as Cytomel so you may still feel sluggish until you find the right dose. Synthroid's got a really long half life so it stays in your system and builds up as you titrate your dose. Over the long haul and once you've found that perfect dose, Synthroid remains relatively stable because of its long half life.

Cytomel is usually either a very short term solution on it's own or used in very small quantities in addition to Synthroid. Cytomel is pure T3 and Synthroid is pure T4. T4 will convert into T3 so usually there is no need to add pure T3 but some people are not so good at converting T4 into T3 so those people may benefit from adding a little shot of Cytomel to their daily Synthroid.

Armour thyroid - the drug that's had some problems lately, has both T3 and T4 - mostly T4 and is made from pig thyroid.


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## PitbullMom (Feb 22, 2010)

Thank you for explaining the difference in the two meds. I have only seen my endocrinologist twice (once immediately after surgery so I was out of it and the day after surgery when I was in tons of pain) so I wasn't exactly in the mood to be asking questions. He mentioned something about RAI therapy but didn't really say much else. I have an appt. set up with the endo for March 22. I just went to my ENT Monday and got my stitches out. He said that the endo is most likely thinking of doing the RAI if he started me on Cytomel. I just started the drug a week ago and I have noticed some trouble sleeping along with a faster heartbeat and feeling hot/sweaty. Do these side effects go away eventually? I also feel nauseous in the morning but I think that is due to having too much calcium in my body now. I am taking 600mg calcium 3x a day for low calcium level after my surgery. My calcium and PTH levels will be checked again on the 8th. Hoping they will be normal again!


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## PitbullMom (Feb 22, 2010)

Another question: why do doctors only have people on Cytomel then if it is pure T3? Doesn't my body need T4 as well to balance out? Now I know why I hear so many people complaining about Armour being off the market!


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## chopper (Mar 4, 2007)

ok...here's the deal...I didn't catch if you had cancer or not.

When you get a thyroidectomy and there is cancer involved, the normal procedure is to do RAI AFTER thyroidectomy to get rid of any tiny thyroid cells that remain, just in case they are cancerous.

So...the thyroid sucks up iodine like a sponge. RAI is radioactive iodine. The thyroid is the only gland that uses iodine so it all concentrates in your thyroid and whatever is not needed gets peed out.

The idea is since Cytomel is so short lived - it can literally be out of your body within hours, so they can control how hypo you get and how fast you go hypo. If you had cancer they want to make sure you are hypo and any thyroid cells that are left are starved for some iodine. If cancer was present, shortly before RAI the docs will take you off Cytomel and tell you to avoid all foods with iodine, like fish, shrimp, etc. This will cause you to go hypo fast. What this does is raise your TSH and makes the RAI absorb better and faster.

The more hypo you are the more your thyroid will absorb the nuclear iodine = the more thyroid cancer cells die off, stopping the cancer in its tracks.

Sometimes they keep you on Cytomel if they don't have the pathology report back yet just in case even if you don't think you have cancer. Usually they get the path report back a few days after thyroid surgery and if it is all clear of cancer, they will probably start you on Synthroid and stop the Cytomel.

If they put you on Synthroid first right after surgery it would take 4 to 6 weeks to get the Synthroid out of your system before you turn hypo and if they did, your body would not absorb the iodine properly, hence the Cytomel. The Cytomel gives you enough "juice" to keep you alive just fine but at the same time it is so short lived they can have you stop it and turn hypo within a few days if they need to. That's not the case with Synthroid.

I hope I explained this well enough.


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## chopper (Mar 4, 2007)

Further, Cytomel is almost never a long term fix. I don't think I've ever heard of anyone who is on Cytomel alone over the long haul. It is common to start it for a few days or weeks following surgery however. Once cancer is ruled out, you will almost positively be put on a more permanent solution, like Synthroid or Armour which is much more stable and longer lasting so you don't experience short bursts of energy that only last a few hours at a time.


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## hillaryedrn (Dec 14, 2009)

Yep, what he said! LOL!!! I will say that I also had trouble sleeping after starting Cytomel. Crud, I'm STILL having trouble sleeping, but I know that will take a bit to get everything evened out. You aren't alone!


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## PitbullMom (Feb 22, 2010)

Phil, wow...very well explained! Thank you so much! To answer your question about cancer: the lab results from surgery came back mostly clear but there was a small cluster of papillary carcinoma (cancer) cells. My lymph nodes were clear of cancer but I think they want to do the RAI therapy just to be sure they got rid of it all. So Cytomel now makes sense to me. I am not having too much trouble with it yet but I can tell my energy level drops around lunch time. This could pose a problem when I go back to work next week since I am a vet tech and constantly on my feet! Hilary, how are you feeling after your surgery? It's been a week and a half and I am feeling pretty good. The low calcium level was pretty scary at first since it made me feel like I was walking around with my head in the clouds. How are you liking the Synthroid? Does it have any side effects?


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## chopper (Mar 4, 2007)

If you find you are falling asleep at work you can ask your doc about splitting your 2 doses into 4 and take a half a pill every 3 or 4 hours or whatever it is....this would give you a smaller shot more frequently and might help you get through your day better....it's a bit of a pain but might help....ask the doc about that.


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## Sandex10 (Feb 22, 2010)

Wow! Very informative thread. You couldn't have explained the differences in the 2 meds any better. I was going to go buy a book on thyroid diseases, but why bother. I can get all the info I need right here.


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## hillaryedrn (Dec 14, 2009)

I'm feeling awesome! I actually went back to work 10 days after surgery. I'm an ER nurse and work night weekends. I had tons of help, tho!

They accidentally took one of my parathyroids in surgery so I make sure to take extra calcium as well. I do notice, tho, that at times my face and hands will get numb and tingly. I mentioned this to my Endo at my follow up visit on Monday because I know that's a sign of low calcium and he's checking my levels. It only seems to happen at certain times so I'm not sure what that means. I've also noticed increased muscle twitching and jerking. Really not sure what that is all about as it is usually at night when I'm trying to go to sleep.

I am still having a hard time trying to sleep tho. I know that it's going to take a while to get my dose right, and if this is the worst I have to deal with then I'm ok! I feel great most of the time now. I start to run down just a bit late at night, but then I still can't sleep. It's really strange.

My incision is great! You can go to www.HillaryThyCa.blogspot.com and see pictures of my surgery if you want. I'm going to take some new ones here in a little to show how my scar is healing. This blog also has my story from start to current.


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## PitbullMom (Feb 22, 2010)

I went to the endo today and guess what? I don't need to do RAI! He said the cancerous part of the nodule was only 0.8mm so RAI is not necessary. If it was 2mm or larger, then they would have me do it. So my calcium and pth levels are back to normal which is good. I am going to start 136mcg Synthroid tomorrow. Hope my body adjusts well to it. It has been 1 month now since my TT and I must say I feel awesome...back to my old self! I am just wondering if 136mcg is too high of a dose to start out with. Hope I don't get any bad side effects. Hilary, how are you sleeping? It took a little bit for me to start sleeping good again but now I am pretty much back to normal with sleeping.


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## Andros (Aug 26, 2009)

PitbullMom said:


> Just wondering what meds everyone is on here? I just had a full thyroidectomy last week and my doc has started me on Cytomel 25mcg twice a day. How is this compared to Synthroid? Has anyone noticed more side effects with one or the other?


Hi and welcome. My first comment was Whoa! Holy Cats!!

Most of us are started on 5 mcg. of Cytomel per day and even that is too much sometimes. I started on 2.5 mcg.

I am really really worried about this because that is a lot of T3.

How long have you been taking 50 mcg. per day? How do you feel? How is your surgery healing up, good?

Here is info on Cytomel; just scroll down and click on Cytomel.
http://www.kingpharm.com/Products/Alphabetic_Listing_of_Pharmaceutical_Products.cfm


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## PitbullMom (Feb 22, 2010)

I was taking the cytomel for about a month. The docs put me on it because they were thinking I may need the RAI therapy. Now that I don't, they have switched me to 137mcg Synthroid once a day. I am feeling pretty good so far. Although I do get tired mid day at times. My scar is healing up nicely. People don't even notice it most of the time anymore. Thanks for the info you posted by the way.


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## hillaryedrn (Dec 14, 2009)

Yes, apparently this is the dose of Cytomel they put people on after TT when they suspect RAI might be necessary. It isn't intended to be a long term fix.

I'm doing really well now! It took about a week or two for me to get "regulated" on my synthroid and start sleeping like normal again. I will go back to my Endo for follow up in about a month. I feel better now than I have in quite a while. I'm just thrilled! My scar is still very noticeable, but I don't worry about it. Glad to hear you're doing well!


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## Andros (Aug 26, 2009)

PitbullMom said:


> I was taking the cytomel for about a month. The docs put me on it because they were thinking I may need the RAI therapy. Now that I don't, they have switched me to 137mcg Synthroid once a day. I am feeling pretty good so far. Although I do get tired mid day at times. My scar is healing up nicely. People don't even notice it most of the time anymore. Thanks for the info you posted by the way.


Remember, it will be important to keep your TSH suppressed. It's good to hear from you and you sound like you are doing well. You have been through a lot.

Hope it is smooth sailing from here on out!arty0045:


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## hillaryedrn (Dec 14, 2009)

I hope all is still well!!


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