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Does taking T3 Cytomel affect your TSH levels when added to L-throxine

does taking cytomel with L Thryoxine increase TSH levels? Or should the two together drop your TSH. My Dr increased my L Thyroxine to .35 mgs (350 mcgs) and added 15 mcgs of Cytomel and my TSH went from 4.5 to as high as 11 and 8 with the increase??? Also, I am putting weight on and feel tired...confused about how increasing doesages of both thryoid drugs can increase TSH levels when I was about .450 TSH for 21 yrs. Had a total thryoidectomy in 1992...thinking about stopping the cytomel???
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Avatar universal
Tmac,
sorry, I have to ask - do you always refrain from eating or drinking for 1/2 to 1 hour after taking your levo and cytomel to allow time for absorption?
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649848 tn?1534633700
COMMUNITY LEADER
I don't think the dosage is too high, you just need to keep the T3 more level in your system throughout the day.  It would be good if your doctor would prescribe another 5 mcg/day so you could split the dosage in half (10 mcg in am with the levo and 10 mcg around noon).  Ultimately, though I think you'll need even more than that.

What was the reason for the TT?
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Avatar universal
I had a total thyroidectomy in 1992. I will try splitting the t3 dosage (15 mcgs) over the day. Maybe one doseage is too much..thanks
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649848 tn?1534633700
COMMUNITY LEADER
Both your FT3 and FT4 are too low in the ranges, with TSH too high in its range, indicating a need for increases in medication.

I'd suggest that you ask for an RT3 test, with another FT3 and FT4.  It seems that you might be converting too much of the T4 med to RT3 and not enough to FT3.  You could try increasing your cytomel, in small increments, to see if that helps.

You should also be splitting the cytomel into multiple doses/day.  Most of us find that splitting T3 med keeps FT3 levels more stable over the course, of the day.  For instance, I take 10 mcgs T3/day... I take 5 mcg in the morning with my T4 med and the other 5 mcg around noon.  

You should also ask for a Thyrogobulin Antibodies (TgAb) test.  TgAb is another marker for Hashimoto's, along with the TPOab that you had and which was negative.  Both tests have to be done in order to rule out Hashimoto's, since some of us have one of the antibodies, while others have the other.  
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Avatar universal
T3 2.5 -  range is 2.0 -4.4 (a typo) I have doubled by Vit D and will do the same with the B12
Ft4is 1.04 (.82 - 1.77) seems good
T4 is 5.2 (4.5 - 12.0)  lower normal
Ftindex 1.5 (1.2 - 4.9)lower range
I am on 350 mcgs of l thyroixne and 15 mcgs of cytome
TPO 1.4  (0 - 34) not sure what this means??
TSH  is running 8 -11 range..
I take without food when waking. take the L thryxroxine and cytomel together.
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649848 tn?1534633700
COMMUNITY LEADER
Please check the reference range for the Free T3.  The range you have listed is very questionable...
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Avatar universal
Your Free T3 is OVER the top of the range.  While your Free T4 is nearly at the bottom of the range at only 23%.  So what makes your Dr think you need more T3 only?

Your B-12 is too low.  Many people don't feel well until that is over 800.

Your D3 is also BELOW range.

I would recommend supplementing with B-12 and increase the Vitamin D3 dosage as it is BELOW range still even with 5,000 Iu's.

Have you ever had your reverse T3 tested?  You are taking a large dose of T4 yet you arestill low in the range which seems odd.  an absorption issue perhaps?

How do you take your medication?  do you take them separate from eating?

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Avatar universal
Total Thryoidectom in 1992. Historically TSH has been 1.0 or lower for 21 yrs. taking 350 mcgs of L Thyroxine and 15 mcgs of  cytomel
TSH now 5.6 to 11.0 range
TPO 14  (0-34)
T4 5.2 (4.5 - 12.0)
Ft4 1.04(.82 - 1.77)
Ft3 2.5  (2.0 2.4)
FT Index 1.5  (!.2 -4.9)
B-12  569 (211-946)
Vit D 26 (30-100) inc dose to 5,000 iu
Irom 117 46- 155)
I have put 25 lbs in last 15 mos since ctyomel was added and TSH has gone up, feeling hypo but Dr thinks I need the cytomel??
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Avatar universal
Please post all the tests and the reference ranges.

"all OK" means ABSOLUTELY NOTHING.  because the Dr's will tell you that if it is "somewhere" within the range.  

Most people need to be in the upper half of hte range or more in order to feel well. So simply being at the bottom end but within the range does NOT mean thatl you are "OK".

B-12 for example has a HUGe wide range and most people need to have it above about 800 in order to feel well.  When in a lot of labs in the USA the bottom of the range starts at 200 while any other countries the bottom starts at 500. So again having B-12 in range may mean NOTHING as you can be in range and still be deficient.

Vit D3 as well needs to be I think about 70 for men and 80 for women while the range is usually well below that.  So again being within range could mean absolutely nothing!

T3 is used by the body's cells. When everything is working perfectly in the system the Free T4 that is in storage in the blood is available for "on demand" conversion to T3 as the body needs it as it uses it up.

For those who do not have sufficient T4 and for those who have problems converting the T4 into T3, they will need additional supplmentation of T3.

If the body is "happy" with the amount of Ft3 in the blood, the body will not have need to convert the T4 in the blood. So it just sits there and does nothing.  So the T3 medication won't really "suppress" the T4 medication.  It could allow for too much T4 to be in the blood and have to get rid of it either through filter out of the liver etc or the conversion of the T4 into Reverse T3 which is biologically inert.

T3 will at some point and it is frequent in occurance that the T3 will suppress the TSH.   This will shut the thyroid down and thus the natural production of thyroid hormone from your thyroid gland.  So it can I suppose cause the FT4 level to drop if your thyroid gland is still able to produce hormone.

I can tell you the typical treatment.  Usually the Dr's will begin treatment with a T4 only drug.  And usually they will continue to slowly increase the dosage every 6 weeks or so by evaluating the patients symptoms and blood lab results as it takes 6 weeks for the T4 to stabilize in the blood.  

When the FT4 level gets to the 50% of the range and the person is still symptomatic it is likely due to poor conversion issue.  It is at that point that a synthetic T3 drug is recommended to be taken.  Again this is usually in very small doses as it is active in HOURS.  T3 peaks in the blood about 4 HOURS after it is taken. Which is why it is recommended to taken at least twice a day (half in morning half in early afternoon) so that the level is sort of constant through the day rather than a huge slug in the morning and then fall off through the day.  Tyical starting doses are 5 mcg to no more than 10 mcg a day.  People may not tolerate more than 10 mcg a day to start.

Your s ymptoms suggest that you are still quite hypo.  Without having evidence that you have a conversion problem unless you can post your last couple lab results showing FT4 and FT3 levels and how they changed with the dosages, then I would recoommend that you need to be patient.  I would further recommend that you increase your T4 medication slowly up until you get 50% of the range. And if you reach that point and are still Hypo then add more cytomel.

because you are already on cytomel at 15 mcg, it may be that you will have to cut the cytomel as your FT4 levels rise.

Everyone is different and this is where the art of medicine comes into play.
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Avatar universal
thanks for feed back..Did the Free T4 and T3, all okay, B-12 and D levels fine as well as iron...
for 21 yrs at .3mgs without cytomel all okay .5 to 1.2 range of TSH...last yr my TSH was 11 so they added 15 mcgs of cytomel and I have felt tired, TSH is still high at 8 range and I have put on 20+ lbs in 8-9 mos.
Thinking that the cytomel might supress the L throxine since it is a more active drug??? Any thoughts or info about cytomel supressing L Thryroxine???
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Avatar universal
With such a massive dose of T4 medication yet still show hypo symptoms even with T3, I would also suggest as gimel did above that you have the Reverse T3 tested as well.

And as Gimel stated. TSH is completely worthless test outside of a screening test at best.  TSH is completely and totally inadequate to truly evaluate your thyroid balance.

TSH is also frequently suppressed when taking large T4 amounts and/or T3 medication.  You would qualify for both yet your levels with the outdated tests would not seem to indicate that your TSH is at all suppressed and in fact is going in the opposite direction AND your other tests would indicate possible lower levels of thyroid.

So you are either not absorbing the thyroid very well and/or you may have a conversion problem.

But it is all speculation until you get properly tested for Free T4, FreeT3 and I would suggest Reverse T3.
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Avatar universal
You might as well forget about TSH.  In your situation, it means nothing.  The thing to concentrate on would be your symptoms, and the levels of the biologically active thyroid hormones, Free T3 and Free T4.  Apparently you haven't even been tested for Free T3, which is the most important one to know.  The tests for Total T4 and T3 Uptake and Free Thyroxine Index are way outdated and not very useful.

With those tests, your blood levels cannot be rated as "great".  You don't even know results from the most important tests, Free T3 and Free T4.  Plus, trying to medicate a hypo patient based on TSH DOES Not Work.    A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So, you really need to go back and get tested for Free T3, Free T4, and I would also suggest Reverse T3.  Since hypo patients are also frequently too low in the range for Vitamin D, B12 and ferritin, those should be tested as well.  If your doctor resists doing those tests, then you should insist on them and not take no for an answer.  

While with the doctor you should also find out if he is going to be willing to treat clinically, as described, by adjusting Free T3 and Free T4 levels as necessary to relieve symptoms.  If not, then you will need to find a good thyroid doctor that will do so.  

When you have the additional test results, please post them here, along with reference ranges shown on the lab report and members will be glad to help interpret and advise further.  
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Avatar universal
Thanks for the response. All the other items you  mentioned are fine.
T4 came in at 5.2  (range is 4.5 - 12/0)
T3 Uptakeis 29 (range is 24 - 39)
FT4 is  1.5 (range is 1.2 4.9)
as you can seee I am at the low end of the above yet I am taking 350 mcgs of L Thyroxine and 15 mcgs of Cytomel
For 21 yrs 300 mcgs alone kept my TSH at about .450 to 1.0.
I have gain 25 lbs this last year. All other lab blood work is great. Very troubling. I went on the cytomel this last year because my TSH was 11 and 8. It hasn't helped..
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Avatar universal
First thing you should be aware of is that TSH causes no symptoms.  Doctors like to think that it accurately reflects levels of the actual thyroid hormones; however, it cannot be shown to correlate well with either of the biologically active thyroid hormones, Free T3 or Free T4, much less correlate well with symptoms, which should be the main concern, not just lab results, and especially not TSH results.  Don't be concerned about the TSH, and don't stop the Cytomel.

Next, you are taking a significant dosage of thyroid med, yet you still seem to have some hypo symptoms.  If tested for Free and Free T4, please post results and reference ranges shown on the lab report.  Since hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin, have you tested for those?  If not, you should do so.  If you have results, please post, along with ranges, as well.  One further thing I would suggest is to test for Reverse T3 also.  Sometimes the ratio of Free T3 to Reverse T3 is too low and causes hypo symptoms.  
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