How long is too long for adjustment period to Cytomel increase? - Thyroid Disease General Discussion Forum - Thyroid Boards

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How long is too long for adjustment period to Cytomel increase?


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#1 Rollingsound

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Posted 09 June 2018 - 04:28 PM

Hello,

 

I'm 164lbs 5'11", I've been on 112mcg on Synthroid and 10 mcg of Cytomel for about 8 weeks. About a week and a bit ago we went up to 15mcg of Cytomel. It's been a rough time adjusting to this particular dose increase. Problem is my personal situation has admitedly been a bit more stressful than baseline if you will this past week with travel and commitments, so it's hard to tell what's just normal anxiety and what's the pill. Question is, how long is too long to be feeling the "temporary" symptoms of a dosage increase? one week? 2? I've had a pretty stable and not too high heart rate, but i've been quite anxious and short of breath after doing any pushups or anything strenuous (more than normal). Sleep is fine, I'm actually more tired at the end of the day  than I was on the 10 mcg. Had Ferretin  and iron labs checked, came back normal. My AM cortisol has always been high and I take a B12 supplement and Vitamin D pills. Any ideas?

Thank you!



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#2 Lovlkn

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Posted 12 June 2018 - 10:53 AM

Welcome to the board!

 

Do you have lab's you could share prior to your Cytomel dose increase?

 

Goal is to be close to 3/4 range for both FT-4 and FT-3.  If you are over on either it could cause symptoms of being hyper.  For me - I have to actually reduce my T3 hormone in the winter months a whopping 2.5mcg a week which makes a huge difference in how I feel and also reflects in my labs.  Don't underestimate how small dose changes can affect how you feel


Free T-4 and Free T-3 are absolutely necessary to properly dose yourself.
My experience is that 1/2 - 3/4 of range is your goal for optimal treatment

My Journey... 7 years to receive a diagnosis. TT 2004 after 4.5 years on Tapazole that had to be adjusted monthly - endo ran labs every 4 weeks. Remission was never going to happen for me so I opted for surgery to remove. Final DX by surgeon was Hashitoxicosis, TPO antibodies over 2000 and TSI 316% within the year prior to surgery. I never had a ultrasound or any lab testing to rule out cancer - pathology was negative. Post surgery I was kept hypo for many years - until I figured out how to dose my self, relying on where I fell in the FT-4 and FT-3 labs. I run TSH below range due to positive TBII antibodies. Horrible time adjusting to addition of Cytomel = patience pays off when adding this drug to the mix.

The happy ending ---> Stable dose since 1/10 Unithroid 125mcg, Cytomel 12.5mcg - labs I can live with.

None of the information on ThyroidBoards.com is intended to diagnose, treat, cure or prevent any disease. Information shared is based on my personal experiences and should not be considered medical advice. Please consult a physician before adjusting any medication.

#3 Rollingsound

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Posted 12 June 2018 - 03:45 PM

Labs before using any cytomel, just on 155mcg Synthroid:

 

TSH: 0.17    Range: 0.35-5.00

T4 FREE: 24  Range 12-22

T3 FREE: 4.5 Range 3.4-5.9

 

Labs after being on 112mcg Synthroid and 10mcg Cytomel for 8 weeks:

 

TSH: 0.41    Range: 0.35-5.00

T4 FREE: 16.8  Range 12-22

T3 FREE: 4.5 Range 3.4-5.9

 

I've since gone up to 112mcg Synthroid and 15mcg Cytomel, it's been 2 weeks with that dose but I have no labs yet since it's too early. My Free T3 has pretty much always been around 4.5ish even going back a ways to when I was titrating up initially on Synthroid years ago. 



#4 Lovlkn

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Posted 13 June 2018 - 10:36 AM

Labs before using any cytomel, just on 155mcg Synthroid:

 

TSH: 0.17    Range: 0.35-5.00

T4 FREE: 24  Range 12-22

T3 FREE: 4.5 Range 3.4-5.9

 

Labs after being on 112mcg Synthroid and 10mcg Cytomel for 8 weeks:

 

TSH: 0.41    Range: 0.35-5.00

T4 FREE: 16.8  Range 12-22

T3 FREE: 4.5 Range 3.4-5.9

 

I've since gone up to 112mcg Synthroid and 15mcg Cytomel, it's been 2 weeks with that dose but I have no labs yet since it's too early. My Free T3 has pretty much always been around 4.5ish even going back a ways to when I was titrating up initially on Synthroid years ago. 

I see the issue immediately - ((4.65-5.27)) is 1/2-3/4 of your FT-3 range.  Before you added the extra 5mcg of Cytomel you were already at 1/2 of range.

 

As far as your FT-4 ((17-19.5)) is 1/2-3/4 of your range and you were at 1/2 range.

 

The first thing I personally would have done as far as dosing is raise your levothyroxine to 125mcg and retest in 6 weeks.  Raising Levothyroxine usually will raise FT-3 just a smidge and with you being already at 1/2 of range for FT-3 that's all you really needed - 

 

Taking a full 5mcg dose of cytomel with your current labs is likely pushing you over 3/4 range therefore you are symptomatic.

 

If you want to stay the course and only increase the T3 hormone then I suggest adding  only1/2 a pill daily and retest in 4-6 weeks.  


Free T-4 and Free T-3 are absolutely necessary to properly dose yourself.
My experience is that 1/2 - 3/4 of range is your goal for optimal treatment

My Journey... 7 years to receive a diagnosis. TT 2004 after 4.5 years on Tapazole that had to be adjusted monthly - endo ran labs every 4 weeks. Remission was never going to happen for me so I opted for surgery to remove. Final DX by surgeon was Hashitoxicosis, TPO antibodies over 2000 and TSI 316% within the year prior to surgery. I never had a ultrasound or any lab testing to rule out cancer - pathology was negative. Post surgery I was kept hypo for many years - until I figured out how to dose my self, relying on where I fell in the FT-4 and FT-3 labs. I run TSH below range due to positive TBII antibodies. Horrible time adjusting to addition of Cytomel = patience pays off when adding this drug to the mix.

The happy ending ---> Stable dose since 1/10 Unithroid 125mcg, Cytomel 12.5mcg - labs I can live with.

None of the information on ThyroidBoards.com is intended to diagnose, treat, cure or prevent any disease. Information shared is based on my personal experiences and should not be considered medical advice. Please consult a physician before adjusting any medication.

#5 Rollingsound

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Posted 13 June 2018 - 03:08 PM

I see the issue immediately - ((4.65-5.27)) is 1/2-3/4 of your FT-3 range.  Before you added the extra 5mcg of Cytomel you were already at 1/2 of range.

 

As far as your FT-4 ((17-19.5)) is 1/2-3/4 of your range and you were at 1/2 range.

 

The first thing I personally would have done as far as dosing is raise your levothyroxine to 125mcg and retest in 6 weeks.  Raising Levothyroxine usually will raise FT-3 just a smidge and with you being already at 1/2 of range for FT-3 that's all you really needed - 

 

Taking a full 5mcg dose of cytomel with your current labs is likely pushing you over 3/4 range therefore you are symptomatic.

 

If you want to stay the course and only increase the T3 hormone then I suggest adding  only1/2 a pill daily and retest in 4-6 weeks.  

 

 

 

 

 

Thanks for your reply, a side note is that I was having a very hard time with any kind of endurance exercise, strength training was going well and my recovery from that was "normal", but anything more than 30 minutes on the bike and I was wiped out completely. Perhaps that pushed my endo to go towards more of a T3 heavy treatment? I'll need to check.

 

My bioavailable testosterone was on the low end when I did the test while on 112mcg T4 and 10mcg T3 too, perhaps that may have played a role in going heavier on T3. Again, I'll need to check






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