# Question regarding Cytomel increase



## Reporter (Mar 17, 2011)

I had a TT August 28, 2015 due to having nodular Graves disease and Hashimotos. I had a hard time adjusting to levo but eventually got to 100 mcg without symptoms. This January my T3 and Free T3 were both on the low end of normal. My endo at Duke (per my request) switched me to 100 mcg Synthroid and added 5 mcg of Liothyronine (my request). He advised me to take it once a day WITH the Synthroid. I had terrible reactions to the T3 although it's a very small dose. My TSI around that time was 200 I believe. I now split the T3 into two doses about 6 hours apart. No problems.

Because my insurance was canceled in December, I have not gone to my regular doctor but did go to ER due to panic attacks that I truly thought were reactions to the T3. Because my pulse was a little low a few times, not consistently, still the ER doctor admitted me due to that and the chest pain which I now know was anxiety. I had an echo and stress test and was told my heart is quite strong and that my pulse was fine, that my exercise capacity exceeded my age-predicted exercise capacity. The only thyroid workup from that visit (02/14) are as follow:

TSH 0.21 (0.30 - 4.50) this was 21 in October/November

T3 0.79 (0.80 - 1.80).

I understand that I need my Free T3 and Free T4 and I've heard about a Reverse T3.... I hope to have those tests this month or early next.

My question: is the 5mcg of Liothyronine too negligible a dose to raise my T3/Free T3? I'm thinking about taking that twice a day so a total of 10 mcg. I'm concerned about being hypo for too long, the effect on my heart. I'm concerned about taking too much T3, the effect on my heart as well, considering I may still have TSI. My eyes have started aching and are dry. My thigh muscles are achy so my thoughts are that I'm hypo.

I hate that I am unable to get to the doctor this week. All I can do is lie around and worry, guessing about increasing the T3. Also wondering if my TSH is too low?

Thanks.


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## GandKsmommy (Feb 15, 2016)

I could not tolerate t3, but I think it was because my dr added 15 mcg slow release to my 125 mcg levo. I think she shoukd have started out lower given that my cortisol levels were a bit high and my ferritin was on the low end. That is the key to adding t3 to your t4. Your cortisol needs to be at a good level and ferritin should be optimal. Another thing is, t3 suppresses your tsh, so your body will not convert t4 to t3 as well because tsh helps to stimulate t4 to t3 conversion. What happens is, but supplementing t3, you take over some of your body's ability to do it on its one. So the key is, to figure out what your body needs to make up for your body not doing it on its own. I recommend you look up tired thyroid.com. It is written by a women who has graves and did a lot of experiments with medications on herself and she talks about this subject on her blog and in her book. Right now, I am trying to get my tsh to around 1. The more I read, it seems like it's the golden number, but who knows. I just lowered my levo to 112 mcg a few weeks ago because my tsh was .05 and my free t4 was .1 over the range. I'm hoping if I can get my tsh up, it will stimulate conversion. My aunt does not have a thyroid and she does fine. She's only on 88 mcg t4.


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## jenny v (May 6, 2012)

Definitely get a Reverse T3 test done and maybe even a more recent TSI test. Also, if you've got iron or adrenal issues, you'll have trouble tolerating T3 at all even if your body needs it.


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## Reporter (Mar 17, 2011)

Thank you all for responding.

What I believe I understand is this: T3 suppresses TSH so the T4 that I am taking (100 mcg Synthroid) is not being converted to T3 and the T3 that I am taking is so negligible an amount that it is unlikely to be helping at all.

*Is that correct?*

I will get the Frees and Ferritin for sure. Ferritin, Iron have always been on the low end of normal for me. Vit D. is usually optimal.

I'm thinking about taking 5mcg of the Cytomel twice daily. Currently I take my levo at midnight with 1/2 of the 5 mcg tab and the other half of T3 around 6 a.m.

I will contact my endo about this of course.

*Last question: what is considered dangerously hypo? *


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## GandKsmommy (Feb 15, 2016)

The following was taken from the American Thyroid Association: "Another concern with using T3 treatment is that the body is deprived of the ability to adjust the conversion of T4 to T3 to regulate the supply of T3 according to the body's own needs". Basically when a person uses t3, it will automatically suppress the tsh. Tsh helps the body regulate conversation. If a person takes t3, then the tsh goes down, slowing conversion, make sense? Therefore, a person needs to find a sweet spot of how much they have to take to make up for the slowed conversion rate from supplementing t3, and a person's possible slower inability to convert on his/her own. I read about this first in tiredthyroid.com and the author's book, from my functional medicine dr, and then from above. The functional medicine dr put me on a total of 20 mcg t3, and I just did not do well on it. I took myself off it after a year, and tried a new endo. I am seeing the head of the endocrinology dept at our local hospital with the hopes that he can help me. I want to be like my aunt and take t4 only. My new dr said his wife is hypo and he keeps her tsh around 1. He said he likes to keep it lower in the range, but not too low where conversion gets slowed. He said t4 and t3 drive the tsh down, but t3 more so than t4. The only thing is, he won't do free t3 testing, just free t4.

Definitely get ferritin checked. Mine was 39, last time it was checked 8 months ago. I do not recall if you are male or female. Anyways, I have slacked on iron the past couple months because I was moving, renovating, moving again, etc. My last cycle was horrible. I had such achy legs and they felt so weak. I called my functional medicine dr and she told me to double up and iron, and sent me for a ferritin test 4 weeks after. I will find out my results next Friday. She said that even though I was in range when tested, heavy cycles, can lower the ferritin. Additionally, my ferritin was not optimal. I felt a little better right away after taking two iron doses before bed that night I spoke with her. It should be around 70-90. People with autoimmune disease tend to have lower ferritin, which can also mimic hypo symptoms.

I am not really sure what a dangerously Hypo is. I was running on adrenaline and crashed and burned with a tsh of 21, while my cousin was just a little tired and moody with a tsh or 50 something.


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