Too much cytomel??

[KtotheA]

My labs are as follows:
Ft4: .73
TSH: 1.10
Rt3: 8.1
T3: 3.3

I take .025 synthroid and 10mcg of cytomel twice a day. Recently I’m gaining weight, extreme water retnejnv  and feeling anxiety. My dr told me to reduce the cytomel to 10mcg in morning  and 5 mcg at night. I’m just so confused by my numbers. Can someone please help? I took one full day off the meds and lost 5 lbs.

[KtotheA]

Will do!

[KtotheA]

I followed up my original endo and he said to get off Cytomel and go back .05 Sybthdoid. I emailed him my results and he said I don’t hbserstand why you are on cytomel??? So you were right the Other Dr that prescribed me the cytomel was pushing me further hypo. I have been on the .05 synthroid now for less than a week and my vertigo has disappeared, anxiety is completely gone and I lost 6 lbs of water weight. I feel so relieved.

[Barb135]

Do you know if you have Hashimoto's?

[KtotheA]

Yes that was my original diagnosis

[Barb135]

Hashimoto's is progressive, meaning that the antibodies continue to destroy the thyroid until it no longer produces hormones on its own.  You will need progressively higher doses until your thyroid eventually, "dies" out, but you may need to tweak your dosages every now and then, depending on numerous variables.  

I'd suggest that you find a different endo.  In the meantime, if I were you, I'd certainly not want to reduce my dosage... I would want to increase it and I'd be calling my doctor to try to get that done.  It takes 4-6 weeks for an increase in T4 dose to take effect so you might be able to get in to see another endo in that time.  I think I'd be asking for 50 mcg Synthroid to start with and leave the morning Cytomel like it is (10 mcg), and change the 6:00 pm Cytomel to early afternoon (say 1:00 pm).  I'd also ask for testing to be done in about 5 weeks to see what TSH, FT3 and FT4 are; you wouldn't need to do rT3 again.  Depending on levels and symptoms, you could then make adjustments as needed.

Of course, your doctor has to agree with whatever you ask for...

[KtotheA]

Thank you. I appreciate your help.

[Barb135]

No problem, please keep me posted on how you're doing and let me know how it turns out for you.

[Barb135]

You're saying that you're taking the cytomel "at night" - what time at night are you taking it?

[KtotheA]

I take it at 6 pm which I guess is too early?

[Barb135]

No - most of us that take T3 medication take one dose in the morning with our T4 medication (if you take that in the morning), then take the second dose about noon or early afternoon.  It's typically, not recommended to take T3 after about 3:00 pm because it can interfere with sleep.  Another thing is that you're taking a larger dose in the morning and it kicks in quickly, but since T3 is fast acting, it's worn off before you take that 6:00 dose.  If you'd take your second dose earlier you'd keep your Free T3 level more stable during the day instead of getting that big dose in the morning then having it wear off before you get the second dose.  

Of course, it doesn't help that you're only getting 25 mcg of T4, which isn't giving you anything to convert either.

What kind of doctor are you seeing?

[KtotheA]

I was seeing an eNDO and now more recently this is a GYN. I guess I’ll keep going as is on same meds but take both at same time in morning and second dose in early afternoon. I’ll make an appt with an endo asap. Thank you so much.. this is so frustrating.

[Barb135]

You don't necessarily need an endo; if you have a good primary care physician you trust that would work, too, but it's pretty obvious that your gyn doesn't know thyroid and she's not helping you.  

If you did okay on just the Synthroid, you may do so again, or you may need a little T3 with it.  Make sure the endo is willing to prescribe T3 if you need it or you'll end up having to find a different one yet.

[Barb135]

The biggest problem I see is that you're very hypo and you need more, not less medication...

As you can see, your Free T4 is below range, indicating that you need more T4 medication.  In addition, your Free T3 could stand to be higher, not lower.  

This makes me think your doctor might not be a good thyroid doctor...

Most of us feel best with Free T4 at about the mid-range point; you, obviously, have a long way to go to get there.  Free T3 should be in the upper half to upper third of its range; your Free T3 is at 54% of range, which isn't bad.  you might be running into trouble because your Free T4 is so low.  You need to have a balance between Free T4 and Free T3...

As for rT3 - Free T4 is converted to either Free T3 or rT3.  Free T3 is the hormone that's used by almost every cell in your body.  rT3 is a mirror image of Free T3 and is inert, so we want it to be relatively low.  In your case, you're only taking 25 mcg of Synthroid, which is hardly anything, so you have nothing to convert.  If you weren't taking the Cytomel, you'd really be in bad shape, but now your doctor is even reducing your Cytomel dosage causing you to be even more hypo.

You said: "She told me to reduce cytomel to two 10 mcg in morning and 5 mcg at night along with my .025 synthroid"  Does that mean you're taking 20 mcg (two 10 mcg) in the morning and only 5 mcg at night?  Why do take Cytomel at night?  Because T3 is fast acting, it's typically split between a morning and noon/early afternoon dose, but avoided at night so it doesn't disturb sleep.

Please clarify your med schedule and dosage, if you don't mind.  

Why were you dropped all the way from 75 mcg Synthroid to 25 mcg?

[Barb135]

I was typing at the same time you were... "She told me to reduce the cytomel because I felt anxiety and my heart was racing. She said sometimes when you take too much T3 you can retain water and it does kind of reverse."

Yes, but those symptoms can also apply to hypothyroidism (I had them horribly when I was at my most hypo).  She dropped your Cytomel and didn't replace it with anything (like more T4) so she's sending you further into hypo-land...

[KtotheA]

I knew something seemed odd with her dose. Let me clarify on some history. I had a baby two and a half  years ago and was kept on .75 mcg postpartum. I felt fantastic and fell pregnant again 7 months later.  I had another baby last June. After the baby he dropped me to .50 mcg but something seemed so wrong. He kept telling me it was normal postpartum stuff. I had a rash that looked liked poison ivy everywhere and was really depressed that nobody was listening. I switched Drs a year later this June and she prescribed the addition of cytomel to my .50 synthroid she prescribed 5 mcg in morning and 5 at night. Then we did blood work and she bumped me again to 10 in morning and 10 at night but also lowered my synthroid to .25 mcg. I feel so puffy and my brain is racing. My heart races when I eat. I’m so at a loss as to what to do I think I should go back to my original dr but what to do in meantime I don’t know what to take tomorrow morning

[KtotheA]

Should I just go back to 50 mcg of synthroid and no cytomel while I wait to see another ENDO?

[Barb135]

I'm not a doctor, so I can't tell you what dosage to take, but seriously, I doubt that 50 mcg and no Cytomel would be adequate.

[Barb135]

Hello... Can you please post the reference ranges for the Free T4 and Free T3?  Ranges vary from lab to lab and have to come from your own report for the best comparison.  

Your symptoms are those of being hypo, not hyper, and even without the reference ranges, your levels don't look hyper, so I'm not sure why your doctor told you to reduce the Cytomel.

If you've been retaining fluid, the 5 lbs weight loss could easily be fluid loss.

We'll be able to tell you more when we see the reference ranges for your labs.

[KtotheA]

Thank you so much! The ranges are:

T4: .73 ref range= .82-1.77 Ng/dL
TSH: 1.20 ref range + .450-4.500 uIU/ml
FT3: 2.0-4.4 pg/ml
RT3: 8.1 ref range: 9.2-24.2 no/dL

So my T4 and RT3 were flagged low. Forgot to mention I am a female. I’m also nursing a 13 month old boy. With my first son two year ago I was dropping pregnancy weight so nicely on .75 synthroid and no cytomel. Maybe that was a fluke but now I feel terribly bloated and I am gluten free dairy free and very conscious of all other triggers. She told me to reduce cytomel to two 10 mcg in morning and 5 mcg at night along with my .025 synthroid.

[KtotheA]

She told me to reduce the cytomel because I felt anxiety and my heart was racing. She said sometimes when you take too much T3 you can retain water and it does kind of reverse.