Low TSH, High T3, Feel great?!

[Nynaeve506]

I have lived with depression since I was young (I was described as a "serious" child).  Finally after years of depression (and many, many major depressive episodes), I went to get help (two years ago).  I'm a 28 yr old female.  I've been on so many antidepressants it's insane (about ten? in combo and alone).

Two months ago my psychiatrist prescribed Cytomel 50 mcg (starting with 25 mcg for a week and then up to 50).  After three or four weeks, I felt great.  The exhaustion, the pain, the depression, completely and utterly gone.  I was calling friends, laughing, crying (normally instead of the numb inability I had before).  My thyroid in March 2010 was 1.08  

I went to an endo to have my blood work done to check things and I got a call last Thursday saying my numbers were all wrong.  TSH 0.00 and T3 10.42 and the doc wanted me to cut my dosage to 25 (because I was, number-wise, hyperthyroid).

But I had no symptoms of hyperthyroidism.  And in fact, three days later I feel like I did before I took the med.  I couldn't even take my son trick or treating because I feel THAT bad.  I've laid in bed.  I've moped.  I don't want to do anything because my entire body hurts.

I'm going to call tomorrow, but I feel completely unable to navigate this (and can't find very much information on what could possibly be wrong with me).  My numbers say one thing.  My body feels something completely different.  Has this been true for anyone else???

I don't want to feel like this anymore :(

[Nynaeve506]

My B12 and Vitamin D are great (I'm a very healthy person, according to the numbers).  

My endo is talking to my psychiatrist but in the mean time said I should go back to my higher dose...

Interestingly enough after three days of feeling horrible...and now three days back on the high dose, I'm feeling excellent.

So we'll see :)

[Super_sally888]

Hi,

I am very interested to see how you go and I have heard of cytomel  used to treat depression.

Looks like you are getting a team of doctors together.

I would like to see the results of the other tests.  I think they should also consider thyroid hormone resistance.  In such a case high doses may be needed.  But this should be properly investigated.

Please make sure they test B12 and Vitamin D.  I believe these 2 to be critical to wellbeing.

[Nynaeve506]

I agree with you which is what sent me to the endo to begin with.  The endo is going to call my psychiatrist and hopefully they can have a chat (and maybe brainstorm...).  

I've also set up an appointment with an internist (she's fairly difficult to get into so I figured I'd make the appointment and cancel if the endo and psych docs came up with something).

The only frustration I've had is the lack of clear direction.  I don't know what my doctors are thinking - but it seems like a good sign that they're talking to each other.

[Barb135]

While I can commend a doctor for recognizing that low thyroid hormones can certainly cause depression, I can't imagine a doctor of any kind giving a script for a T3 med without testing first to insure that it's needed.  

I'm sorry, but to me, that's just irresponsible. Too much T3 in the body can be very dangerous, causing issues from "thyroid storm" to osteoporosis.......

I know we all say in a lot of instances, TSH isn't so important, but there are times that it needs to be considered. I think, in your case, it should have been.  AND since T3 is a thyroid hormone and not an antidepressant, your psych should have made sure of your thyroid hormones before prescribing it........

All of that said - I tend to believe that fibro and CFS are "symptoms" of something else.  Have you been tested for autoimmune thyroid disease?  Both Hashimoto's Thyroiditis and Graves Disease can cause depression, body aches/pains, etc and many doctors prefer to pass out the antidepressants rather than do the lab tests.......

Insist on the proper labs before you go further with thyroid hormones........... you need to get tested for TSH, FT3, FT4 and antibodies.......

I'm not saying you don't need the cytomel; I'm simply saying that it's important to make sure that you DO need it........

[Nynaeve506]

Update: Spoke with my endo today.  He told me to increase my dosage from 25 (one pill) to 1.5 pills.  He's also going to talk to my psychiatrist to try to get more information about what his plan is long term.  

Thanks for everyone's input.  Of course I'm always glad to hear more :)

[Nynaeve506]

I was given the Cytomel purely off of the depression.  With my body aches, fatigue, etc, the psychiatrist was looking at possible fibromyalgia or chronic fatigue (my paternal grandmother had fibro among other issues).  We'd gone through a lot of antidepressants: Zoloft, Lexapro, Effexsor, Wellbutrin, Celexa, Lithium, Pristiq, EmSam (MAOI) and mixed several with Abilify, Geodon.  I'd had Clonopin and Xanax for anxiety (still have the Xanax PRN, but when I was feeling good on the Cytomel, I went two weeks without taking any - still haven't, but my anxiety has shot up significantly again as has my depression, fatigue, body aches).

I literally felt nothing with any of the antidepressants.  Then a month-month and a half on Cytomel 50 mcg I felt fantastic.  I'd never felt that good - I had energy, my anxiety disappeared, I was laughing, when I cried it was cathartic - everyone noticed a significant improvement in my mood.  I was playing with my son...

Now I'm back to dragging myself out of bed :S

Prior to this experience, I never thought about in depth testing for my thyroid - my TSH was always normal (1.08 in March).  

[Barb135]

Had you been diagnosed with a thyroid issue prior to being placed on the cytomel; or did your psych give it to you simply because of the depression issue?  

[stella5349]

the base question to ask a new doctor on thyroid would be this.

Do you treat according to the Free T3 and Free T4 labs and not based off the TSH?

If you find on off those referrals that do - half the battle of getting well will be over.

Docs found in majority that do treat by the frees are DO's - Intergrative med - some MD's/

[Nynaeve506]

I'm definitely calling my endo tomorrow (maybe get more info with my lab tests?  I don't know what more they could tell me.).  I like my psychiatrist a lot, but his external resources have felt a little thin (he was only going to have my TSH, T4 tested at whatever lab I chose, it was the endo who added the T3 - and I went to him independently).  I got the name of another doctor from a friend of mine who has Hashimoto.  Actually I got the name of three doctors :)  I'm a former Air Force brat, so I'm used to not seeing the same doctor twice and having to take charge of my own medical treatment.  I definitely don't want to self-diagnose (huge no-no IMO), but I would like a satisfactory response from the docs I see.

I agree with the idea of a team approach.  I just need a team :S

Thanks.

[stella5349]

another thing I just thought of....

IF this doctor that prescibed the Cytomel - DOES know the ins and outs of T3 drugs and how they manage mental condition balancing thyroid hormones....

I would bet s/he has a network of GP's and DO's that know about the labs regarding RIGHT thyroid care and it wouldn't hurt to ask that at your next appointment so you could have  a TEAM approach more than just one... and another ( endo) doing opposite things

[stella5349]

I commend this psych doctor for knowing about the T3 medication and utilizing that instead of psycho drugs so commonly -widely prescribed...

However.. He/she may not know how to manage a thyroid condition entirely.

I feel YOU - as the patient will really have to utilize this properly so you can maintain yourself as you are feeling better on the .25 Cytomel right now.

This isn't a real hefty dose of the T3 medication but - knowing the T3 issues as a whole - if this is not properly being monitored with your whole system you can have issues... Cardiac is #1 on that list.


I certainly don't want to say stop taking it. I do feel your on the right track in this but.. please make sure you read about thyroid and know hypothyroidism - then work with this doctor to really med-treat you correctly with decent labs and monitoring.

[Nynaeve506]

I should add that I am currently not on an antidepressant.  I have a Xanax (PRN - which I actually went two weeks without a panic attack...) and Requip for restless leg (I've been on that for over six months - the Cytomel only two months).

[Nynaeve506]

I don't know what my T3 was prior to the Cytomel, but my TSH was 1.08.  My endo did mention that it wasn't entirely unusual for psychiatrists to pair Cytomel with an antidepressant though he did seem a little surprised at the dosage (even still, the endo didn't want to contradict my psychiatrist right away).  

The only question I would have would be, how long is lag time?  I know in anti-depressants it can be up to six weeks and I thought it was fairly similar with this (I know the endo wants me to do blood tests again in a month).

I think what confuses me is that in two years I haven't had a single antidepressant work and then when I'm put on this I feel significantly better.  Does this mean that the relapse of what I feeling the result of my body trying to readjust?  I just find all of this to be very new territory for me.

Thanks :)

[gimel]

A couple of things to be considered.  Your psych probably doesn't know too much about T3 or else you would not have been started on T3 only and probably not such a high dosage all at once and then increased by 100% in only one week.  What were your thyroid test results before starting on the T3, and why did the doctor decide on T3 only rather than T4 , or a combination of T4 and T3?

Symptom relief is all important, but symptom relief often lags behind changes in blood levels of the thyroid hormones.    FT3 is so active that gradual increases over a period of time, while monitoring your symptoms carefully and also your FT3 and FT4 levels would have been far better, in my opinion.   We often hear from members that have started with too much or increased too quickly and they encounter hyper symptoms, and have to back way down and basically start over.  

I can understand why the Endo wanted to cut the dosage.  The main concern would be the  very high level of FT3, more than double the recommended range.  I don't pay a lot of attention to TSH when a thyroid patient is taking significant amounts of thyroid meds.  We frequently hear that from members.  Suppressed TSH  alone does not make you hyper,  except in the eyes of many doctors.  You are really hyper only if you are having hyper symptoms caused by excessive levels of FT3.  Your FT3 level was excessive and most likely effects of that just hadn't caught up with you, perhaps due to the symptom lag I mentioned.  The only other reason I can think of would be very unusual.  In three years on the Forum I think I have only heard from one member with what is called thyroid hormone resistance, requiring higher than normal levels of FT3 and FT4 to relieve symptoms

Since you were already at a very high level of FT3, cutting your meds in half would be expected to have a drastic effect, as you've noticed.  Since you were not yet experiencing any hyper symptoms, it would have probably been much better to reduce you gradually while monitoring symptoms and FT3 levels.  

At this point I think I would like to hear the answers to my questions above  and then maybe other members will also offer their opinions as well.

[Nynaeve506]

Oh!  I forgot to post the lab ranges:

TSH - 0.3-3.0
T3 - 2.3-4.20