Cytomel

[Free Bird82]

Hi everyone. Does anyone know if an regular m.d. will ever prescribe Cytomel?  I went to my endo who monitored my nodules & he asked how I felt. I told him still pretty crappy.  My tsh was down to .45 with still a low T4 (5.9), but my FREE T4 was 1.08. He explained away the low T4 to being my Thyroid Binding Globulin low & said I should only concern myself with Free T4's.  Anyway, I am on two separate doses of Synthroid (162mcg. total) & at first felt good - bowel movements good, etc., now after 6 weeks I am back to very small bm's & still lightheaded & have (again no one but us hypos believe this) been exercising 5 miles + each day (which I've always been healthy) & REALLY REALLY CUT DOWN ON EXCESS EATING AND SMALL PORTIONS ETC., & in a weeks time did NOT lose even 1 lb. (since all this began I GAINED 16 lbs.). Anyway endo just said to diet more.....
I asked about lightheadness & he just shook his head ("I don't know). They never took blood pressure or anything.  He said since TSH is so low they were not going to increase to 175mcg for me.  I am switching my primary docs in a month & was wondering if they even know about cytomel etc. or if everyone that gets this T3 ever gets it from their pcp or from a specialist in thyroid disorders....  I am so frightened about putting on so much weight since I've tried so damn (sorry) hard to keep it off in the first place.  I've always had to watch & this just stinks.  Plus have palpitations & tiredness still!

[Barb135]

Hi Free Bird... What's the reference range for your Free T4?  Reference ranges vary lab to lab and have to come from your own report for best comparison.  It's pretty much true that we only go by Free T4, because most of T4 is bound by protein and isn't available for conversion to T3 anyway.  That's why we measure Free (unbound) T4 - so we know how much is available for use...

Has your Free T3 been tested, at all?  No doctor would or should, prescribe a T3 medication without testing Free T3 levels in order to make sure that's what you need.  

There are some primary doctors that will prescribe T3 meds, if they're good doctors and know exactly how the thyroid works and that TSH is not the best indicator of thyroid status.  Your current doctor is, obviously, not a good thyroid doctor if he's so worried about the TSH being too low.  This is a problem I have fought for the past 8 yrs, so I know how frustrating it can be.  I'm also quite familiar with the weight issue.  

I did discover, personally, that I have insulin resistance so, for me, it's not always, only, the number of calories I eat, it's the type of calories I eat.  I have to make sure I eat low glycemic in order to keep blood sugar levels from spiking, which in turn spikes insulin levels and causes any excess carbohydrates to turn to fat.  I found that adding more healthful fats and vegetables helped me lose the most weight.

[JonGrant]

OK, I understand that I am responding to a very old post, but here goes anyway. My doctor prescribed combination t3, t4 treatment after t4-only seemed not to work. The addition of cytomel helped a great deal, even with the small 5mcg I was taking, but one day I took the cytomel before breakfast, but forgot to take the levothyroxine. Surprisingly, I responded much better without the T4. The moral of the story is that if your doctor doesn't test reverse t3, you may never get to the bottom of your problem. And of course, the main problem is that many doctors (and even endo's), aren't very good at "fixing" thyroid problems. You might want to talk to your doc about using only small amounts of t4 in your regimen; you may be producing too much rT3 form the t4 you are taking.

[artfemme]

I'm telling you what my doctor said to me. She had no reason to lie and was appalled at the prior treatment I had received. She told me she had gotten a memo from ATA. stating such, after I asked her why she thought I had had such difficulty getting help. She said she was glad she was not practicing as an endocrinologist. You are lucky to have a good endo, Barb...I went through five, each worse than the next, at one of the best hospitals in my large metropolitan city. Thank god for my PCP and my gynecologist.

[Barb135]

Never heard of a threat from ATA for endos prescribing T3 med; no idea where that came from. My endo has no problem with it.... in fact, just recently increased my dosage.

[artfemme]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148220/

http://www.eje-online.org/content/161/6/895.full

http://www.eje-online.org/content/161/6/955.full

[artfemme]

Most endos will not prescribe Cytomel. My gynecologist, a specialist in women's endocrine systems, told me that the American Thyroid Association has threatened endos who prescribe it, following their acceptance of the limited UCLA study that claimed T4/T3 therapy was no more effective than T4 alone. Of course insurance companies love to only pay for one drug, and the manufacturer of Synthroid has long had a (paid) clamp on the market.

However, in February several LARGE and long-running meta-analytic studies, one from Denmark and one from Italy, were published in the Journal of European Medicine and accepted by the NIH. These in-depth studies refute the UCLA findings and make the case for combined T4-T3 therapy. I will find those studies for you and publish the links.

I have been sick and told I didn't have a thyroid problem (with ALL the symptoms except for constipation including hemorrhoragic periods) since 2005. I finally took over my own treatment with blood tests every 6 weeks and the help of my PCP in 2010 after endos nearly killed me. I have a tissue resistance or conversion problem (secondary hypothyroidism) that they refused to consider. I am finally recently stabilized on my medication :  150 mcg generic T4 and 30 mcg Cytomel. My TSH is non-existant but my FREE tests are perfect. 5 mcg of Cytomel up or down from the 30 mcg I now take made an enormous difference. At 25 mcg I was hypo and depressed, at 35 mcg I had trouble sleeping and a few heart palpitations. I feel well, even though I'm still not losing much of the 40 lbs. I gained while the endos told me I shouldn't be on medication AT ALL.

One of the ways I convinced my PCP to do as I asked was by telling her that if I was correct in my own diagnosis, my OTHER labs that had gone south from their former perfect levels....particularly my cholesterol....would restabilize to their former levels with the addition of T4-T3 and no other changes....and that a short trial dose wasn't going to kill me.

WALLA ! My blood pressure, which had shot up to 196/98 !!! went back down to its usual 124/70 or lower. My cholesterol dropped from 232 back down to 163. My bone density slightly increased and my thyroid nodules shrank. It took a little while, but it started right away and was significant enough to convince her. I also took her research and the book "The Thyroid Solution" by Dr. Ridya Arem, which I highly recommend...medical information, not "self help", excellent resource.

Best wishes. I'll go look for those links and post them.  

[eeemas58]

Hi, do you mind if I ask what dose of Synthroid you were on and what dose of Armour he put you on? Did he make this switch all at once? Thank you.

[JRinWI]

I understand your frustrations - my endo won't discuss anything besides his rigid Synthroid treatment plan.

So, I also did a lot of research and made an appointment with my PCP who LISTENED to me and agreed to add Cytomel to my meds.  He was actually very willing to prescribe whatever amount I thought would be correct so I did even more research and came up with a combination that seemed appropriate..

After two weeks, I'm still unsure if I'm on the correct revised dosage of Synthroid, but I'm trying to be patient like another member told me!

I never thought to approach my PCP with this issue until a NP told me to try.  I'm glad I did!  I hope yours will listen also.

[zachslp]

I was on synthetic meds (Synthroid and the like) for 25 years (I'm 37) and this past year began having more hypo symptoms, despite "normal" TSH.  My PCP kept lowering my dose, despite my complaints.  Finally I switched PCP's and while awaiting my first appt with my new PCP, did TONS of research on this forum as well as Mary Shomon's website and others, in addition to reading some books on thyroid maintenance.  I was prepared to go in to my new PCP and FIGHT for a change to either Armour (t3/T4) or adding Cytomel (T3), but after a discussion with my new doc, he seemed to think I had done my research and switched me to Armour right away.  Since then (over 2 months) I have finally regained my energy (which I am so thrilled about), my mood has stabilized (no more mild depression), and I've lost INCHES around my waist, legs, and arms.  I have not lost many pounds (maybe 3 or 4) but that might be because I have more energy, am exercising more (2 mile walk per day) and eating healthy (all of which I was trying to do before my switch to Armour, with no change in energy, weight loss or inches lost).  I am a new person!!!  Please don't give up your research - there are some wonderful websites out there, just google Hypo or something similar.  I don't know about your lightheadedness, but some hypo symptoms can include lowered blood pressure, so that may be it.  Anyway, don't give up...keep your head up and keep looking.  good luck!!!!

[Jenipeni]

Hi Free Bird82
Can't answer about Cytomel but about the weight loss, after 1 week of exercising and watching what you eat.  Many people won't lose the pounds straight away as the exercise is building muscle and muscle weighs more than fat (some people even put on weight to begin with!).  This is a good thing - don't stop what you're doing!  Muscle burns calories even after you've stopped exercising. Yay!

I am facing the same struggle.  People with thyroid problems often experience difficulty with weight - trying to maintain it or get it off.  It can take longer for people with thyroid problems over someone 'healthy' to lose weight.

Be careful to make sure that you have enough calories in the day so your body does not go into hoarding mode.  If you don't have enough calories the body tries to conserve the current level of stored energy (fat) because it thinks you are entering a time of famine etc.  Low GI foods and small meals spread out throughout the day helps with this phenomena.

The change in diet could also affect your bowel movements. Make sure you are getting enough fibre in your diet - fresh fruit and veges are your best source and great when trying to lose weight.  It's an old one but often forgotten - drinking lots of water helps dieting too and is especially important when exercising. (Steer clear of sports drinks, they have heaps of sugar!)

Unfortunately there is no magic formula, losing weight for most people is just hard work and commitment. Keep up the good work - don't focus so much on the scales but how your clothes are fitting and how toned you look - muscle might weigh more but it is more compact and looks heaps better!
To quote a corny ad - it won't happen overnight but it will happen!
Don't lose heart, keep at it - best wishes.
Jenipeni