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Is my cytomel dose too low?

I’ve been hypothyroid for almost 10 years. It’s been relatively controlled on levothyroxine 37.5mcg up until last year. I severely over trained and underfed myself, damaging my metabolism. When I cut down on the training I gained 25 pounds in 3 months and my thyroid symptoms (cold, hair loss, fatigue, brain fog, irritability, constipation) were out of control. I finally got in to see a great ending who is committed to helping me feel better. My TSH and T4 were in the normal range, but I felt/feel horrible. We increased my levo to 50mcg with no relief.  We added 5 mcg of cytomel about 3 weeks ago. Based on everything I read about cytomel I was excited that this might finally be the thing to help, but I don’t feel much better. The only relief I’m seeing is more regularity in my bowel movements, haha. Is it too soon to ask my dr to increase cytomel? Is 5mcg cytomel + 50mcg levothyroxine even going to help? It seems so low.
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Avatar universal
Hi. How were you diagnosed as being hypothyroid? Did you have graves disease or hashimotos? Did you have your thyroid removed or have the radioactive drink to knock out your thyroid? If your natural thyroid does not function at all, then your current 50 T4 + 5 T3 would only be half of what is normally required.
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1756321 tn?1547095325
I overtrained too. I was going to the gym to do weight training every second day for 2 hours a day. I had no motivation to go to the gym, depression, irritability, flu like symptoms and my performance plateaued. I had to cut back to 1 hour sessions that include 10 minute warm up and cool down and 5 minutes stretching at the end. A max of 4 times a week. I wish I could go back to the gym but this toxic mould exposure is terrible..that's another story!  Anyway, this info below is from the article from Fitness Blender - How to Fix a Damaged Metabolism After Dieting...

"Fixing a damaged metabolism: Exercise

Lets start with exercise and how much time you should be designating to your work out regimen.  Take a look at the time you are spending working out and taper it to about 3-5 days a week, maximum, with an hour at a time - as a maximum. Really, 30-45 minute workouts are more than enough. Keep in mind that resistance and weight training is the best way to enhance metabolism, as muscle burns more than fat - building muscle this way may be a good way to help repair your metabolism, as muscle content requires more calories than fat.  Cardio workouts should be considered secondary and can be added in as part of the 3-4 day regimen, but a combination is best.  

Fixing a damaged metabolism: Eating habits

The next step is to look at your caloric intake, and be prepared to increase this slowly.  It is important to take this slow as to not gain weight back too rapidly, which will discourage you and may lead to another cycle of restricting your intake.  Try to calculate how many calories you are taking in and add about 50-100 calories a week.  The goal will be to have added about 500 calories after the course of a few weeks.  As your body starts to be fed correctly, your body will be able to slowly lose weight once again.  Keep it mind this takes some time and patience, but resist the temptation to over exercise and decrease your calories. The goal is to feed your body enough to allow your hormones to start to work efficiently once again.  The thyroid hormones will increase, leptin levels will no longer think you are in starvation mode and muscle tissue will increase.

It is also important to keep mixing things up.  For your body to continue to work efficiently it is important to “keep it guessing”.  This can be achieved by changing up your exercise routine every so often and varying the foods you are opting to eat.  These both will ensure that your body's metabolism is fed, working hard and restored.  Lastly, it is important to recognize that losing weight should not be a race, take your time and understand that weight that is lost more slowly is more likely to stay off for good."
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Avatar universal
Thanks for the responses. Most recent labs from prior to starting cytomel:

Free t4: 1.46 (range .82-1.77)
TSH: 2.61 (range .45-4.5)- interestingly, this went up after increasing the levo
T3: 138 (range 71-180)
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Your Free T4 is plenty high at 67% of range. As noted above, it's recommended that Free T4 be maintained at about mid range (50%), so you don't really need it as high as it is.

Unfortunately, your doctor ordered Total T3 instead of Free T3, so we can't really tell what's actually going on there.   Of the total T3, the majority is bound by protein and can't be used, which is why we ask for Free T3 levels.  Free T3 is the portion not bound by protein, therefore is available for use by individual cells.

Next time you get labs done, you should ask your doctor to order Free T3, not Total T3, that way we'll be able to better determine what's actually going on.  

Free T3 can lag behind and once you've been hypo for a while, it can take a while for the body to get well.  As I noted, 5 mcg T3 is a pretty small dose, but I don't think you should increase that anymore with your Free T4 as high as it is.  IMO, you could decrease your T4 dose to 37.5 and increase the cytomel to 10 mcg - 5 mcg in the morning and 5 around noon/early afternoon to see if that would help.  It's important to keep in mind that symptoms often get worse before getting better when changing doses/meds, as the body adjusts to the new dose(s).

You didn't mention how long you've been on the 50 mcg T4.
Avatar universal
I agree with Barb135. Need  to see most recent labs, and what dose you were on when the labs were taken. Also if you had taken your thyroid medication prior to the blood being drawn.

50 mcg or T4 is just barely a "starter dose".  So that is not much.  Also as Barb135 said, 5 mcg of T3 is also a low starter dose.

They COULD be sufficient as everyone is different and has different needs.

Since you are not seeing significant symptom relief, and that adding the T3 even the small 5 mcg DID offer some relief, even though it was seemingly minor.  It WAS and improvement. And anecdotally would SUGGEST that perhaps additional dosage increase of thyroid MAY be appropriate.

Whether T4 or T3 dose should be changed (if at all) will be better known after seeing the blood labs.

The rule of thumb however is to have BOTH of the following.

1) FT4 to be 50% of the range or slightly higher. This doesn't mean "somewhere within the range". It means to be at or above the dead center of the range.  SOOOO many people are told that they are "fine" or "normal" when their FT4 is sitting at or slightly above the bottom of the range. And that is simply not good enough for MOST people.

AND - That means in addition to #1 above.

2) FT3 to be 50% to 67% of the range.  Again notice ABOVE half way point. And it seems like many people need to be closer to the 67% of the range than 50%. In other words to be in the UPPER part of the range.  Again notice that simply being "somewhere in the range" is NOT good enough for most people!

Please note that these are a "rule of thumb" and everyone is different and feels well at a different level. But in general, the whole bottom half of the so called "normal" or "reference" range is NOT good enough for many if not most people.
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649848 tn?1534633700
What are your  actual thyroid hormone levels?  If you have results for Free T4 and Free T3, please post them along with the corresponding reference ranges so we can see where you are.  

5 mcg is a pretty small dose of T3 but once we see what your levels are, we can get a better idea of what's going on.  
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