# Adding Cytomel, but reducing T4? Do you Agree??



## Love2RunLong (Oct 21, 2014)

Recently, I went up to 50mcg of synthroid and I actually felt worse than I had on 38mcg. I asked my doctor to test my FT3 and see if I was a poor converter. Here were my results:

TSH = 1.5 (0.4-5.5)

FT3= 2.4 (2.3-4.2)

FT4= 1.2 (0.7-1.8)

I am on another board that says my FT4 looks pretty good but that my FT3 is very low. I emailed my DO and asked if we could add a bit of Cytomel because while I was in range, I was no where near optimal.

She sent me this:

"I sent the RX to CVS for Cytomel 5mcg twice daily. This is equivalent for about 40mcg of Synthroid/Tirosint, so I would take it with only one pill of Tirosint (25mcg) and check thyroid levels prior to appointment"

I know that when you are on and NDT T4 will be suppressed, but not sure why she's lowering my FT4 since I'm not on desiccated. Is this correct? Do I go down to 25mcg and risk messing up my FT4 for the sake of my FT3? or should I stay on 50mcg and just add in the Cytomel?

So confused.


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## Lovlkn (Dec 20, 2009)

Yes, a reduction in T4 medication is customary when adding Cytomel.

You are on such a low dose of T4 medication - cutting it in 1/2 sounds like a good start.

Many people feel hyper symptoms, especially anxiety when adding Cytomel. Start slow and ease yourself into the Cytomel - meaning, start with 1/2 a pill every 6 hours, say for the 1st few days only add 2 , 1/2's until you do not have any ill effects from it, then increase by adding 1/2 pill and if you have no ill effects you should be good to go with taking 1 full pill 2x a day approx 6 hours apart.

You are on a try and see what works to make you feel better journey - hang in there!

I for one had a very hard time adjusting to Cytomel, even 1/4 of a pill 6 hours apart. This went on for 6 weeks before I gave up. The second time I tried it a few years later, It worked and I now take 2 1/2 pills daily in addition to my 125mcg of Unthroid.

Many if not all of my lingering hypo issues resolved by getting my FT-3 up.


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## Love2RunLong (Oct 21, 2014)

Thank you!!!

So if she told me to take 2x daily.. you're saying I should split it up even more? Could you give me an example? Or should I start with one 1 5mcg pill a day for awhile?

And is Cytomel like T4 in that you can't eat around it? How will I take it a second time in the day without food being an issue? How many hours should they be spaced? She told me nearly nothing about cytomel.


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## Andros (Aug 26, 2009)

It is correct! Good for you for having such a good doctor.

And I agree w/Lovlkn..........................it would be best if you eased into it. It packs a wollop. Maybe 2.5 mcg. in the morning and 2.5 mcg. in the afternoon for a few days and see how you feel because it does take 8 weeks for the excess T4 to get out of your system. That must be considered also.

Then if all is going well, take 5 mcg. in the morning and 2.5 mcg. in the afternoon for a few days and then go for it!!!!


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## Love2RunLong (Oct 21, 2014)

WOW. I am stunned by this. On the other board they thought that was completely wrong. Hm. I will listen to the doctor and do as she instructed!

That sounds good with the Cytomel. I'll take 2.5 and 2.5 a day for now. Does it have to be 6 hours apart? or can it be Morning, and evening?


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## Lovlkn (Dec 20, 2009)

> That sounds good with the Cytomel. I'll take 2.5 and 2.5 a day for now. Does it have to be 6 hours apart? or can it be Morning, and evening?


I take mine at least 6 hours apart. My second dose is usually around lunch and my 3rd 1/2 is taken no later than 4 which makes it within 6 hours of the 2nd dose. I personally think if taken with food it slows down the punch of the 2nd dose. I don't feel my 1st dose of the day but I often feel my 2nd which comes around 2 hours after taking it.

Most important is to take your Cytomel with a full 8oz of water. That goes for the T4 medication too.


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## Love2RunLong (Oct 21, 2014)

Thanks!!

Might be a silly question but what does the full glass of water do? I often do not drink a full 8oz of water, but I certainly will start.

So how long AFTER my T4 should I take the Cytomel in the morning? I guess you don't take them at the exact same time? I usually take my T4 at 7am on an empty stomach.


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## Love2RunLong (Oct 21, 2014)

I still don't understand when i'm supposed to take the Cytomel! Do i take it with the Tirosint? or do i take it after? One thing I ready said take it after breakfast and dinner... but then i hear that it can mess with absorption!


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## fttfbass (Jan 8, 2014)

Take your first dose of cytomel on an empty stomach with the tirosint in the morning. Do you normally wait an hour after taking your tirosint before eating breakfast? It's recommended that you shouldn't take your thyroid meds within an hour of eating because it will mess with absorption. Although, consistency is more important than anything. So, if you need to eat within the first hour of waking due to time constraints, keep it consistent so you absorb the same amount of meds each day.

You should try to take your other dose of cytomel in the early afternoon, once again one hour away from eating if possible.


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## Andros (Aug 26, 2009)

Afternoon is best if you plan on sleeping at night but................if you work at night???

LOL!!


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## webster2 (May 19, 2011)

Hi, I take Cytomel twice a day too because of poor conversion. Initially, the T4 was reduced to 112 mcg daily. After some time, the dosage was increased to 125/ 5 days a week and 2 days a week 112 mcg of T4. I feel great. My FT3 is still on the lower end of the range but my doctor and I have agreed to use how I feel as well as test results.

Your doctor sounds like a good one.


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## Love2RunLong (Oct 21, 2014)

Thanks everyone! I do really like my DO. She's been really amazing so far.

I took my meds together this morning on an empty stomach with 8 full oz of water. I waited a full hour and ate breakfast.

I finished my lunch around 12:45 and will take my second dose of Cytomel around 1:50.

This biggest thing will be not forgetting to bring it to work every day. I might leave 5 pills a week here at work so that if I forget the bottle, I have it here.

She told me to take 5mcg twice a day but I took your advice and split the 5mcg pill today. So far the 2.5 hasn't given me any side effects, so that's good!

Thanks for all the help!


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## webster2 (May 19, 2011)

My endo is a DO. I really like him. I was so afraid of hyper symptoms that I started with 2.5 mcg of cytomel a day then went to 2.5mcg twice a day working up to 5 mcg twice daily. I never had an issue. I carry a bottle with 5 pills in my work bag and have my cellphone timer set for 2 pm for my afternoon dose. It works well. Good luck and you'll find a routine that works for you.


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## Andros (Aug 26, 2009)

It takes 3 days for the Cytomel to build up in your system. Glad it is going good for you; very glad.


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## Lovlkn (Dec 20, 2009)

> This biggest thing will be not forgetting to bring it to work every day. I might leave 5 pills a week here at work so that if I forget the bottle, I have it here.
> 
> She told me to take 5mcg twice a day but I took your advice and split the 5mcg pill today. So far the 2.5 hasn't given me any side effects, so that's good!


Give the 2.5 mcg 2x a day a week to settle in before you increase. Better to ease into it.

I think re-loading a small container with a week of afternoon doses is a good idea. It also makes it easier to know if you took your 2nd dose or not.

I put my Unithroid and my Cytomel on my bed-stand every evening and I know for sure I took both because they are gone by the time I wake up.


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## Pharm.D (Jul 10, 2015)

To answer your original question when converting a portion of your T4 dose to T3 the literature considers T3 three times stronger than T4. In other words, since you are now taking 10 mcg of T3, that would be equivalent to 10 x 3 = 30 mcg of T4. If you were taking 50 mcg of T4 you would lower your dose to;

T4 - 20 mcg

T3 - 5 mcg twice daily

This an approximation and your doses will need to be adjusted but it's how doses are typically converted


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