# New labs. One doc says quit medicine ASAP, other says stay where you are... UGH.



## starfire (Jun 10, 2014)

Thyroid labs from today:
TSH 0.033 (range 0.35-4.5)
FT3 2.4 (range 2.3-4.2)
FT4 1.18 (range 0.89-1.76)

Results were FWD'd to both my old (fired) endo and new one. Old endo called and said GET OFF meds right now. New endo says stay put.

Have antibodies for TBII.

Help. Am I in danger with this suppressed TSH?


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## jenny v (May 6, 2012)

Can you remind us which type of thyroid meds you're on?

First, ignore the old endo and stop taking his calls, lol! The new endo is right, you need meds because even though your TSH is suppressed, your Free T3 and Free T4 are on the low side and that can cause issues.


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## starfire (Jun 10, 2014)

Lol, I know, I should stop taking her calls. She's so reactionary and it stresses me out!!

I am on Synthroid 100 mcg, Cytomel 5 mcg at the moment.


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## starfire (Jun 10, 2014)

Oh also... I take my synthroid at night... Usually around midnight before bed. Last dose of Cytomel is usually around 3pm in the afternoon. Is it possible the midnight dose of Synthroid is lowering lab??


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## starfire (Jun 10, 2014)

I have labs done between 8-9 am, also.


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## jenny v (May 6, 2012)

I don't think the Synthroid dosing should throw off your labs, but are you taking your Cytomel before or after you do labs? It looks like after, but I wanted to be sure. It definitely looks like you could use a small increase of both the Synthroid and Cytomel.


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## starfire (Jun 10, 2014)

Thank you, Jenny! I am actually upping my 5 mcg Cytomel to 7.5. I figured id start slow (even though I was previously taking 3x this!). I am noticing palpitations after eating and late, late at night. I am also noticing a fine tremor in my hands. But everything else feels VERY hypo. I'm exhausted, falling asleep, constipation is back (sorry tmi), temp is 96, heart rate is usually around 55-60, and my blood pressure is 80/40!!!

So I'm NOT hyper, right?

Also, yes, Cytomel is far after labs!


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## starfire (Jun 10, 2014)

Okay, so, I took 10 mcg of Cytomel today, because my blood pressure dropped to 70/30 and my heart rate was 50 (I'm 95/50 now, with heart rate of 63). I feel SO much better!!!

Is it OK to be taking that much, with my labs?

Also&#8230; do I maybe have a conversion problem?


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## jenny v (May 6, 2012)

That's great, your body definitely needed the Cytomel! Keep in mind, that hyper and hypo symptoms do cross over. For me, tremors and heart palpitations come when I'm hypo, too. I would make sure you let your doctor know you've increased the Cytomel, but you definitely needed it. Your Free T3 was about to drop out of the range completely.


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## starfire (Jun 10, 2014)

Thanks, Jenny!! I think tremor/shakiness is a hypo symptom for me as well. Headaches too. I do have Hashis, my endo says, so maybe I swing back and forth.

Also... Can anyone explain also, how quickly DOES cytomel work? I've heard conflicting answers. But I swear it works within a few hours for me!! Also, does anyone happen to know the half-life? Like when is Cytomel truly out of one's system?


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## joplin1975 (Jul 21, 2011)

http://www.rxlist.com/cytomel-drug/clinical-pharmacology.htm

Since liothyronine sodium (T3) is not firmly bound to serum protein, it is readily available to body tissues. The onset of activity of liothyronine sodium is rapid, occurring within a few hours. Maximum pharmacologic response occurs within 2 or 3 days, providing early clinical response. The biological half-life is about 2-½ days.

T3 is almost totally absorbed, 95 percent in 4 hours.


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## Lovlkn (Dec 20, 2009)

starfire said:


> Thyroid labs from today:
> TSH 0.033 (range 0.35-4.5)
> FT3 2.4 (range 2.3-4.2)
> FT4 1.18 (range 0.89-1.76)
> ...


You have TBII which is absolutely suppressing your TSH.

Because of that you will need to find a doctor who will dose you on Free T-4 and Free T-3.

It took me 7 doctors post TT until I found one willing to dose me by my Free's. I had 2 prior to this one who worked with me for 1 year before freaking out about my low to non existent TSH.

Endo's are the worst and seem to live and die by TSH for dosing which amazes me considering they are considered the "specialist"


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## starfire (Jun 10, 2014)

joplin1975 said:


> http://www.rxlist.com/cytomel-drug/clinical-pharmacology.htm
> 
> Since liothyronine sodium (T3) is not firmly bound to serum protein, it is readily available to body tissues. The onset of activity of liothyronine sodium is rapid, occurring within a few hours. Maximum pharmacologic response occurs within 2 or 3 days, providing early clinical response. The biological half-life is about 2-½ days.
> 
> T3 is almost totally absorbed, 95 percent in 4 hours.


Thank you, Joplin! So does this mean that any palpitations I feel after the 4 hour mark are not due to Cytomel, but rather something else (anxiety perhaps)?


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## starfire (Jun 10, 2014)

Lovlkn said:


> You have TBII which is absolutely suppressing your TSH.
> 
> Because of that you will need to find a doctor who will dose you on Free T-4 and Free T-3.
> 
> ...


Many thanks to you again, Lovlkn! By this understanding of TBII blocking TSH, does this mean my pituitary is fine? I had another physician tell me my antibodies were fine, and that I probably have a pituitary issue.

Too much, I swear. I wish they'd all just get their heads on straight. Hopefully I can convince my new endo to base dosage on frees only. He seems somewhat open to my suggestions, as I was the one who said I needed/wanted to stay on Cytomel. He doesn't usually prescribe, but allowed it.


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## starfire (Jun 10, 2014)

Okay, soooo&#8230; new opinion from NEW endo. She says stay on Cytomel, but to bump it up just a bit (where I was on 2.5 to 5 mcg, she said try 7.5 to 10). She also suggested that she would like to see my TSH come up just a tiny bit, since I am having palpitations and my hair is falling out in rapid handfuls (but she did advise the Cytomel will lower the TSH). She suggested I try 88mcg of Synthroid, or stay on 100mcg of Synthroid, but take one day off a week like Saturday or Sunday. I don't feel good when I miss a day of my Synthroid, so I feel that I can try the 88 for a few weeks and see how I do? I am supposed to be retested in 4 weeks.

Any thoughts?

Again, labs were:

TSH 0.033 (range 0.35-4.5)

FT3 2.4 (range 2.3-4.2)
FT4 1.18 (range 0.89-1.76)

Oh btw, she said I have a "weird version" of Hashi's. It's auto-immune in nature and that my labs are all wonky, but that we should press on with the Synthroid/Cyto combo. I haven't asked about Armor yet or anything.


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## starfire (Jun 10, 2014)

So.. I had a pretty good day today, on 10mcg of cytomel. Last dose was at 1pm.

Took my synthroid this evening, like always, at 11pm. And here I am with palps, anxiety, insomnia at 4am almost...

Could my T4 be too high for my body?? This whole time I've been blaming the cytomel.


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## webster2 (May 19, 2011)

My FT4 was at the top of the range but the FT3 was at the bottom of the range. I take a lower dose of Levothyroxine on each of the weekend days and during the week, I take a higher dose every day. It feels a little like juggling but it works for me. Some people skip a day completely one day a week. It is a balancing act and takes time to figure out what works for you. It is often not so great during that figuring out phase.


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