Why is my Doctor increasing my Cytomel?

[Laramie75]

In January 2019 I asked my Doctor if he would check my thyroid labs. I had the symptoms of hypothyroidism and have immediate family with thyroid issues. He did and my labs were within normal range (I believe my TSH was around 2.5 and Free T4 around 1). These were the only two he checked.

He told me that even though I was within range, since I was symptomatic he was giving me 25mcg of Cytomel to take daily.

I went back for my next appointment in yesterday (July 1, 2019). My new labs showed my TSH at 0.05 (0.36-3.74), and Free T4 was 0.62 (0.76-1.46). No labs on T3 were done which I thought was strange since I am prescribed a T3.

Doctor told me my TSH and T4 were plummeting, and I needed to INCREASE my Cytomel.  I am supposed to take 50mcg daily for 2 weeks, 75mcg for 2 weeks, then increase to 100mcg daily. Follow up labs in 3 months.

So  my issues are:

1. I was never truly diagnosed with hypothyroidism
2. My labs are way low, and I am being told to drastically increase my Cytomel
3. I have not seen any indications for 100mcg of Cytomel daily for more than 7 days

Anyone have any insight? I will definitely talk with my Dr. next week.

[Laramie75]

Here are my symptoms (although my Dr. did not ask if they were any better). However, they are not any better:

Severe Fatigue
-Weight gain (was between 125-135 my entire life) Last 2 years I have gained over 30 pounds even though I see a nutritionalist (1100 calorie diet), and exercise
- Increased blood cholesterol level (past year I have gone from 165 to 238)
- Constipation
- Puffy face
- Hoarseness
- Severe Muscle weakness, aches, tenderness, and stiffness
- Severe Joint pain, stiffness, or swelling
- Dry hair or hair loss

[Red_Star]

When I highly suspected I had Hashimoto's thyroiditis and went to my Dr for tests. The list I requested: TSH, free T4, free T3, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb).  My TSH which had been 1.4 to 1.6 for decades was now in the mid 2's. Both antibodies were high. Hashimoto's thyroiditis had arrived. Get those antibodies tested! Hashimoto's thyroiditis runs in families due to genetics. In my family HLADR4 is the meanie lol.

[gimel]

You have a number of symptoms that typically occur more frequently with hypothyroidism.    Symptoms are the most important indicator of thyroid status,  and thyroid related test results only help confirm a diagnosis.  Your doctor was correct to start you on thyroid med, but I have no idea why it would only be T3 med.  The T3 med caused your TSH to go down to .05 and and thus no longer  stimulate output of thyroid hormone from the gland.  Thus your Free T4 also went down, since there was no longer a source of T4.   When taking thyroid med, a suppressed TSH is common and does not mean that you are over treated, unless there are attendant hyper symptoms due to excessive levels of Free T4 and Free T3.  I also have no idea why the doctor would want to just increase your T3 med, without testing for Free T3.  I certainly would not do as the doctor directed and increase your T3 med so much.   It is almost like you were mistakenly put on T3 instead of the T4 they usually prescribe.  

So you need to have a discussion with the doctor and ask why not T4 med along with the T3 med.  Most people need both to get their Free T4 up to around mid-range and their Free T3 in the upper half of its range, and adjusted as needed to relieve symptoms.   If the doctor intended to prescribe T3 only, you need a good thyroid doctor.  Even if the T3 only was a mistake, I would be leery of the doctor.    

There is much more we can help with, but first please check with the doctor and find out why you were directed to T3 only and why the big increases without testing FT3.

[Laramie75]

Thank you. He did mention that after my next labs in 3 months, that I will probably need to start a T4. I will reach out to him next week when they re-open, but for now I'll stick with the 25mcg I've been taking.  Thanks so much

[gimel]

In preparation for your discussion with the doctor, I highly recommend that you click on my name and then scroll down to my Journal and read at least the one page Overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.   I think that info will clear up a lot of things for you.

[Laramie75]

Thanks! I will do that

[flyingfool]

Yeah, the Dr you have is showing their lack of knowledge to treat thyroid.  As Gimel said, your Dr by starting you out on a higher dose of T3  suppressed TSH and your natural production. Which is what crashed your Free T4 levels.

I recently heard and read that T4 only doesn't work as well for women as it does for men.  That Armour or natural desiccated thyroid meds work better.  But everyone is different.  Both my wife and daughter for example seem to do better on dual synthetic(taking both a T3 and a T4 med)  than either of them did with Armour thyroid.  And even better than my wife with Armour plus a T4 med.

The advantage of dual synthetic is that you can adjust both the T4 and T3 does independently.  Typically if using Natural desiccated thyroid med like Armour, it often results in the need to add a synthetic dose any way. Usually T4 as the person will feel well but they have very low Free T4 levels on Armour.

The most important thing is that you get the combination and dosage that makes YOU feel well. Whatever that is.  But it can sometimes take a long time to optimize and find that specific combination that works for you.  For some it is easy. Others it takes months and even years and several roller coaster rides to finally solve the puzzle.

Your Dr (IN MY OPINION) did it exactly the opposite way as I would generally recommend treatment.  Usually you start with T4 dose and work up until you get the Free T4 to the middle of the range (50% of the range), and monitor the Free T3 level and see how much changes in T4 dosage result in Free T3 rise.  After you get the Free T4 up to the middle of the range (or you feel well, whichever  happens first), ONLY then would adding in small dose of T3 and again work your way up in dosage until you feel well. Which is usually when the Free T3 level is about 50% to 67% of the range.

25 mcg of T3 that he had you start out with is also a fairly if not very large "starter" dose.  Most starter doses are more commonly in the 10 mcg range if not even 5 mcg.

Since you've s tarted "backwards". You may find that adding in the T4 dose, will result in the Free T3 level to go too  high, and you will have to decrease the T3 dosage.