First of all, let me say that I'm appalled that your doctor would prescribe a T3 med like cytomel without having done all the proper tests to begin with... That is enough to warrant a new doctor!! Now that I got that off my chest, I'll move on... :-)
The tests your doctor "should" have been ordering and using, along with your symptoms, to adjust your medication dosages are Free T3 and Free T4. Those are the actual thyroid hormones, while TSH is a pituitary hormone and neither correlates with symptoms nor FT3/FT4 levels. Free T3 and Free T4 should be tested every time you have a TSH test.
How are you getting 7 mcg/day of cytomel?
If you can get Free T3 and Free T4 tests done, you can post the results here, and we can help you interpret them. Be sure to post the reference ranges, as reference ranges vary lab to lab and have to come from your own report.
Because of your ongoing fatigue, you should also go ahead and get vitamin B12 tested. B12 deficiency can cause the most horrible fatigue imaginable. You can also ask for vitamin D and ferritin, since, both vitamin D is necessary for the proper metabolism of thyroid hormones and iron is needed for conversion of Free T4 to the usable Free T3.
Results "in range" are necessarily satisfactory...
Thank you Barb135 for sharing the knowledge I'm sure you've worked hard to gain. For my Cytomel dose, I actually take 1 1/4 of a 5mcg pill using a pill cutter to get the 1/4 (so I just rounded up calling it 7mcg). Based on what I'm learning from others, I'm going to try taking 5mcg in the morning, then another 1/4-1/2 pill around noon to see if that helps with my daily afternoon slump. I will also try a new doctor and request testing for everything you mentioned. Having some direction to try gives me hope for improvement! Thanks again!
I totally agree with increasing your T3 medication, however, I do not agree with increasing your Synthroid from 88 mcg to 100 mcg at the same time... First off, it's never wise to make more than one change at a time, because then you don't know which change made the difference... Secondly, your Free T4 is already at mid range, which is the target for Free T4 so increasing your Synthroid will only drive it higher, which you do not want to do...
Your body converts Free T4 into either Free T3 or Reverse T3, in your case, it appears that you're converting more to rT3 than to Free T3, which is another reason for not increasing your Synthroid dosage... The higher you get the Free T4, the more you're going to convert to rT3... Some say rT3 prevents Free T3 from entering individual cells. From the reading I've done, that seems to be controversial; however, everyone seems to agree that having too high rT3 levels is not good.
The elevated antibodies, merely, confirm that you have Hashimoto's; they do not change your treatment and your treatment does not change your antibody count.
It's true that when thyroid hormone levels are too low, the adrenals will kick in to try to take up the slack and when thyroid hormone levels are adequate adrenal hormones should go back to normal, however this doesn't always happen. You're correct that the medical community does not recognize adrenal fatigue as a medical condition, however, adrenal insufficiency is a medical condition. Primary adrenal insufficiency is called Addison's Disease. Secondary adrenal insufficiency is a pituitary issue. Both of these are relatively rare.
A single morning cortisol is pretty useless, because cortisol is highest in the morning as you're preparing for the day, then diminishes as the day goes on and you prepare for sleep... at least that's the way it's supposed to work. A 24 hr saliva test is the best way to test cortisol levels.
vitamin d deficiency, get corrected this fast. optimal range 50 - 70
There are a number of reasons that may contribute to excess levels of Reverse T3. So from my own experience it may be best to back off on the T4 med, to reduce the amount available to be converted. Along with that it appears that you need to increase your T3 dosage, since your Free T3 is only at the middle of the range. Doing that will help in two ways: it will increase your Free T3 level and also improve your FT3 to RT3 ratio.
One thing I see as a possible complication here is that your cortisol test results appear to show low cortisol. From a source on cortisol, note the following:
"We noted repeatedly that those with healthy adrenal function will have the following saliva results:
8 am: at the literal tip top of the range
11 am-noon: in the upper quarter
4-5 pm: mid-range
11 pm to midnight: at the very bottom (literally)."
Another way to assess cortisol sufficiency is the following questions.
1) Do you have a hard time falling asleep at night?
2) Do you wake up frequently during the night?
3) Do you have a hard time waking up in the morning early, or feeling refreshed?
4) Do bright lights bother you more than they should?
5) Do you startle easily due to noise?
6) When standing from sitting or from lying down, do you feel lightheaded or dizzy?
7) Do you take things too seriously, and are easily defensive?
8 ) Do you feel you don’t cope well with certain people or events in your life?
Of the 8 questions how many times would you answer yes?
Your symptoms and your saliva cortisol results point to cortisol insufficiency. Also note that it is recommended to resolve any cortisol deficiency even before starting on thyroid med.
Yes, there is a way to treat cortisol insufficiency: hydrocortisone. A trial dose of it taken 3 times a day would be used to determine the effect on your symptoms. If that proves beneficial then your dose would be adjusted to achieve optimal dosage. Along with that you would need to take adequate DHEA-S to achieve a good balance and offset any side effects from the cortisol.
So what do you expect your doctor would respond to a request for a therapeutic trial to check for cortisol insufficiency?