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Avatar universal

Would you recommend I stop supplementing with Cytomel while on Nature Throid?

Good morning, I am hoping I could get some advice...First, I will post my labs:
Most recent:
TSH: .005 (.450-4.5)
Rt3: 11.9 (9.2-24.1)
Free T3: 5.2 (2.0-4.5)
Free T4: .78 (.82-1.77)

Results from 3 months prior:
TSH: .005 (.450-4.5)
RT3: 14.7 (9.2-24.1)
Free T3: 6.6 (2.0-4.5)
Free T4: .99 (.82-1.77)

My T3 is high, definitely, but both Free T3 and FreeT4 dropped over the 3 month period, without any changes in medication. As of the past month, I have been having extreme hypo symptoms, the first time I've had them in 2 years.

My symptoms are: weight gain, fatigue, low temps, low pulse, headache, often feel I have a fever but my temp is 97 degrees. Feeling foggy minded. Just overall HORRIBLE.

I am currently on Nature Throid, 4 grains, and 75 mcg of Cytomel.

I previously had an issue with RT3, so after going on T3 only to remove all RT3, I never fully removed all of the T3 once I added Nature Throid back to my dosing.

I feel that my high FT3 level and low FT4 level is causing my hypo symptoms. What would you recommend I change in my medication to reduce the FT3, and raise my FT4 back to normal range.

On a side note, why would I feel SO horrible with high FT3 levels? I would think that would balance out the lower FT4 effect.

In any case, I'm grateful for any advice that anyone can give.


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Avatar universal
There are really no "side effects" from lowering it, but if you do it gradually, and you find that you really do need it, then it will be easier to recover if you've only made the decrease in small increments.  T3 is so fast acting that you can recover from too much or not enough in a relatively short time, but I always find it's better to do it slowly and avoid going hypo or hyper in the process.  I find that it's easier to try to stay in the middle of the road than to have to recover from going into the ditch on one side or the other.  
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Avatar universal
Thank you so much, That makes sense to me. What are the side effects from lowering Cytomel either too much or too quickly?
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Avatar universal
Since you haven't changed how you take your meds, we can probably rule that out as causing your current symptoms.

Well, in my opinion, you could definitely lower your Cytomel dose a bit.  You don't have to do it all at once, but you really should just make one change at a time so you can isolate what did what.  

Raising your NT a half grain should raise your FT4 a little; the question is whether or not it would do enough.  I don't think you should raise your NT dosage without lowering your Cytomel dosage first, or at the same time.  I know I'm contradicting what I said above about only making one change at a time, but I'd be really reluctant to add any more T3 in from the additional NT without cutting back some on the Cytomel.  Half a grain of NT has about 4.5 mcg of T3 in it, so I'd think you'd have to lower it at least that much.  If you have felt well in the past with FT3 high in the range, you could probably try lowering it even more than that.

That's a hefty dose of Cytomel you're taking, so I'd definitely cut back in stages.  
  
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Avatar universal
I haven't made any changes in the way I take my meds between the labs, I've been dosing the same way for the past year. I was on T3 to clear Rt3 2 years ago, December 2013. I added my NT back to my dosing, reduced the T3 down to 75mcg, and have been that way since. Yes, my FT3 normally has always been in range, until the past year, likely from the additional T3.  I feel optimal when my T4 is low to mid range, and my Ft3 is high range. This is where I want to be, I'm just not sure how to tweak the meds to get there.
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Goolarra, in reviewing your answers, I'm getting that the Cytomel is likely not affecting the FT4 level. With this said, what is your opinion about me increasing my NT dose by 1/2 grain to raise my FT4. I do recall a few years ago feeling bad when my FT4 fell below range; so, it could be that I go hypo at the slightest below range FT4. It seems I've felt ok with over the range FT3, but not low/out of range FT4. If I do raise my NT dosage, what role would the Cytomel play, if any? I wonder if it's doing any good, or if I need it at all.
Avatar universal
I didn't see any interactions for either of those, but it's still probably worth it to take them away well from your thyroid meds.

Your TSH is suppressed, which is fine, but it means that all the T4 you are getting is from your meds.  So, no, I don't think your FT3 is in any way suppressing your T4.  Have you also been taking 75 mcg of Cytomel with your NT for the past year?

Have you CHANGED the way you take your meds in the three months between the labs, or have you always taken them the same way?

The problems with taking T3 are usually caused by not splitting the dose into two or more partial doses.  If you take T3 all at once, it is so quickly neutralized by your body if not used promptly that you are in effect "wasting" it.  Your FT3 will spike in a few hours, then it will go back down shortly after that usually causing an energy crash.  However, that is definitely not the case with you since you take it every 4 hours.

You were on T3 only for a while to clear RT3.  When was that?  Have you been on NT and Cytomel ever since?  Was your FT3 ever in range, and if so, do you remember how you felt then?  
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Avatar universal
It's normal to have some RT3.  Your FT3:RT3 ratio in both sets of labs is excellent.  In fact, there's RT3 in your NT.

I agree that your high FT3 level and low FT4 level is contributing to your symptoms.  FT3 is the biologically most active, but FT4 can't be ignored, either.  They have to be somewhat in balance.  

So, the first question:  Why did both FT3 and FT4 drop with no change in meds?  Any changes in other meds, supplements, diet, exercise, stress, trauma, anything at all that might affect how your meds are absorbed?

You are taking a lot of T3.  There's approximately 36 mcg of T3 in your 4 grains of NT, and you're taking 75 mcg of Cytomel on top of that.  Was the change to NT recent?    
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2 Comments
Answer to first question: The only changes were supplements.  I increased my dosage of NAC to twice/day, formerly was once/day. I began taking Bamboo extract also.
Answer to second question: No recent change to NT, I've been on 4 grains for at least a year, if not longer.
Do you think that the additional Cytomel is suppressing my T4? As I ask this question, though, the FT4 level dropped in past 3 months, prior to that it was in the normal range, although low.
I'm so confused...one minute I think that I should stop Cytomel completely, and then I think I should just reduce the dosage...? I really appreciate your input.
Goolarra, One thing I wanted to mention...I was taking all of my NT dose at once, in the morning, then 3 separate doses of 25 mcg every 4 hours. I wondered if the way I was dosing may have an affect on my meds being absorbed or the way I feel.
Avatar universal
The first thing I have to ask before responding further is if you took your meds before these blood draws.
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1 Comments
No, I had blood drawn first thing in the morning,  before any meds.
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