# My endo says these numbers are "good" but they seem off to me . . .



## ChristinaB (Jul 28, 2013)

Little background -- I've had Hashimoto's for 10 years, managed fairly well with just synthroid for most of those years, worked hard to lose weight and had a baby last February and ended up going hyper thyroid without realizing it until it got really, really bad. Dropped my dose down (I was at 200, then started back on 75) probably too far at first and was hypo through most of the fall and winter as we worked to get my levels back. I ended up leveling out at about 125 dose and have been taking that since about February.

I've had "normal" test results for TSH since around December but still don't feel wonderful. At the end of June, I requested the addition of the T3 to see if things would get better for me. Without changing my Synthroid dose, she added 12.5 daily of Cytomel. The first week I was obviously hyper, with diarhea and trouble sleeping, but I also felt energy for the first time in ages! I called my doctor about my symptoms and she had me drop down to 112 daily dose of Synthroid, keeping my T3 at 12.5. I did that combination for 3 weeks and then we got these test results:

TSH .19 .45-4.67
Free T4	.91	0.71-1.85
Free T3	1.0	2.4-4.2

The nurse called and told me to stay on the same dose that the numbers were "fine" but it seems like they are off to me.

I'm still having some hyper symptoms, though not diarhea very often anymore. I seem to be adjusting better to the medication. I had the dr. give me a change in the Cytomel to be 5 twice a day instead of the 12.5 (she was having me break a 25 pill in half for that). I'm feeling okay, but still tired more than I should be and sometimes have trouble sleeping.

So, are these test results just fine? Or do they show that the t3 dose is too high? Or is it too soon to tell with only changing the T4 for 3 weeks before the test?

Thanks for the help!


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## bigfoot (May 13, 2011)

Yup, too soon to see a significant change in either TSH and Free T4. Folks here theorize that the TSH runs about a month behind. And changing T4 medication means waiting at least a month before doing labs (preferably at 6-8 weeks).

Am I reading your Free T3 correctly, it is at 1.0, with a range of 2.4-4.2? That seems low. The low(er) FT4 is expected when taking a T3 medication. But I can't wrap my head around why your FT3 would be so low, especially on 12.5 mcg of Cytomel. Not only that, you're having hyper symptoms on it. It's possible your body is just getting used to it -- T3 is like jet fuel. I'll wait for the experts to chime in here...


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## Andros (Aug 26, 2009)

ChristinaB said:


> Little background -- I've had Hashimoto's for 10 years, managed fairly well with just synthroid for most of those years, worked hard to lose weight and had a baby last February and ended up going hyper thyroid without realizing it until it got really, really bad. Dropped my dose down (I was at 200, then started back on 75) probably too far at first and was hypo through most of the fall and winter as we worked to get my levels back. I ended up leveling out at about 125 dose and have been taking that since about February.
> 
> I've had "normal" test results for TSH since around December but still don't feel wonderful. At the end of June, I requested the addition of the T3 to see if things would get better for me. Without changing my Synthroid dose, she added 12.5 daily of Cytomel. The first week I was obviously hyper, with diarhea and trouble sleeping, but I also felt energy for the first time in ages! I called my doctor about my symptoms and she had me drop down to 112 daily dose of Synthroid, keeping my T3 at 12.5. I did that combination for 3 weeks and then we got these test results:
> 
> ...


Cytomel dose might have been too high to start out on. Clearly you need T3 for yours is in the basement. FT4 will be low when taking T3. That and TSH is really no longer of concern but the FREE T3 test will be used to monitor and titrate your dose of Cytomel.

"Most" patients start out on 5 mcg. of Cytomel and even that packs a punch. For that reason, many cut that in half and do 2.5 mcgs. for quite a few weeks and then start the titration upward about every f6 to 8 weeks by 2.5 mcg. at a time. It is a slow process but one designed for success.

Also, your doc will continue to cut back on your T4. It should be a 4 (T4) to 1(T3) ratio.

Let us know how you fare. It will take time to bring that FT3 up to about 75% of the range provided by your lab. Bear in mind that T3 is your active hormone so any activity by you is burning it up. But, do stay active.


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## ChristinaB (Jul 28, 2013)

Thanks again for the help. I went back in today for more labs and got another "good job, keep on the same dose" with these numbers:

TSH 1.59
Free T4 .81
Free T3 1.0

Since I posted, I had actually continued to have some hyper symptoms, so I'd dropped my cytomel down to 5 once a day instead of twice and I'd substituted 100 mg for the 112 every fourth or fifth day or so. I felt fairly good for several weeks in late July/early August. Not fabulous, but pretty good and with a nap most days, able to tackle my regular routine.

However, this past week, I've definitely felt hyper. I am tired and lay down for naps but can't sleep even after taking Benadryl. I'm feeling hot and when I go out in the sun, even though it's "only" 85 degrees or so, I feel like it's intolerably hot. I also have greasier hair and some diarhea.

I should add that it is my PMS week -- my period is due on Friday.

I do have an appointment at the end of September and I can get a check again then of the blood test numbers.

I'm a runner (ran a half marathon at the beginning of the summer and another one two weeks ago) and have felt muscle soreness after some of my runs where I shouldn't be feeling it.

I asked the nurse who called with the results to ask my doctor if we could adjust down a bit, but at the same time, it seems like my T3 is still low . . . Anyone with more experience want to make suggestions?


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## Lovlkn (Dec 20, 2009)

> T3 is like jet fuel


I refer to it as TN-3 aka TNT.

Christine - your labs are hypo - I am amazed you ran 1/2 marathon - with your labs I am amazed you can get out of bed.

Cytomel can cause some serious hyper symptoms - it must be 'eased into" much like Andros explained.


> "Most" patients start out on 5 mcg. of Cytomel and even that packs a punch. For that reason, many cut that in half and do 2.5 mcgs. for quite a few weeks and then start the titration upward about every f6 to 8 weeks by 2.5 mcg. at a time. It is a slow process but one designed for success.


I was cutting a 5mcg pill into 1/4 and taking 1/4 2 or 3 times a day until I could tolerate it then eventually eased into my current dose of 12.5mcg.

Perspective on just how potent Cytomel is. I had labs 2 days ago and never take my Unithroid or Cytomel before the lab - I take my Uni btw 2-4 a.m. and my Cytomel usually around 5:30. I never sleep. Anyhow - after my lab draw I took both my Uni and my Cytomel T 8:30 and 4 hours later my heartrate was 82 and I had some serious anxiety. I've been taking Cytomel for 7 years. You need to be patient and ease into it. Mid range to 3/4 range of Free T-4 and Free T-3 is what you are shooting for.


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## ChristinaB (Jul 28, 2013)

Believe me, it's taken all my strength to keep up with the running this year. I'm one determined woman. But really, I'm so tired of feeling "off" all the time and needing a nap no matter how much sleep I get at night (of course, it's been worse this week because I've needed a nap and haven't been able to get one). 

So, you would say both levels are too low? My feeling was I should drop back with the Synthroid (maybe to 100?) and then try to bring up the Cytomel a bit. I'm just so worried about going hyper.

I've also read different things about taking the Cytomel twice a day vs. once a day. What's the consensus here?

Thanks for the help, everyone!


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## ChristinaB (Jul 28, 2013)

Just got a message from my endo, saying that my labs look good, but that if I'm having hyper symptoms, maybe we should discontinue the Cytomel. I'd hate to do that, since I've felt more energy on the Cytomel (despite the waxing and waning of hyper symptoms here and there) than I had for years. But maybe I should drop back the dose and then take the full 112 of the synthroid? Guess that's what I'll ask for her to do.


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## Octavia (Aug 1, 2011)

I haven't kept up with this entire thread, but I just don't understand how your lab results (in your first post) could be interpreted as "good" or "normal." Are these the labs your doctor is looking at?

Given your very low Free T3, the last thing I would do is decrease Cytomel.


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## Andros (Aug 26, 2009)

ChristinaB said:


> Believe me, it's taken all my strength to keep up with the running this year. I'm one determined woman. But really, I'm so tired of feeling "off" all the time and needing a nap no matter how much sleep I get at night (of course, it's been worse this week because I've needed a nap and haven't been able to get one).
> 
> So, you would say both levels are too low? My feeling was I should drop back with the Synthroid (maybe to 100?) and then try to bring up the Cytomel a bit. I'm just so worried about going hyper.
> 
> ...


You are welcome and next time if you can, the results and the ranges please? Unfortunately different labs use different ranges.

You do appear hypo to me. I agree w/Lovlkn! But of course, that is w/o the ranges.


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## bigfoot (May 13, 2011)

ChristinaB said:


> Just got a message from my endo, saying that my labs look good, but that if I'm having hyper symptoms, maybe we should discontinue the Cytomel. I'd hate to do that, since I've felt more energy on the Cytomel (despite the waxing and waning of hyper symptoms here and there) than I had for years. But maybe I should drop back the dose and then take the full 112 of the synthroid? Guess that's what I'll ask for her to do.


"Good" to a doctor, and "good" to you can be two totally different things...

You: Geez, doc, I feel awful.
Doc: Hmm... your numbers fall in range as 'normal'. And you walked in here and are talking. You must be fine.

I wouldn't throw in the towel with the Cytomel just yet. But, if push comes to shove and the doctor practically insists, I'd go with what you are thinking, decrease it ever so slightly, and fill that small gap with your T4 drug of choice. (FYI: T3 is roughly four times as potent as T4. So 5 mcg of T3 = 20 mcg of T4.)

You can split up the dose of Cytomel and see how it makes you feel. Same goes for taking it with or without food.


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