[MiTh]

#1060266

Hi All: I am currently on T4/112mcg
Recent blood work has shown that my free T3 is lower than I would like it to be
I am assuming this is why I am having trouble losing the 10 lbs I have gained once going hypo post RAI.
My doctor and I decided to try Cytomel 2.5mcg (I believe I will be cutting a 5mcg pill in half) in addition to reducing my current Synthroid dosage to 100 mcg.

My question for those who tried combination therapy:

1. Should I take the Synthroid and Cytomel at the same time?
I read somewhere that it is best to take it twice a day. Should I therefore be cutting the half pills into halves?

2. If so, what is the best time in the pm to take it?

Also, if anyone can share their personal experience regarding Cytomel, I would really appreciate it.
If anything, this disease has taught me to take lead in my own treatment by advocating for myself through education. This forum is extremely helpful in accomplishing that.

MiTh

[ChristinaDe]

#1181640

I don’t have any experience with combination therapy yet, but I am curious about it so looking forward to seeing what kinds of responses you get. Just out of curiosity…what is your current T4 & T3 on labs?

Christina

[MiTh]

#1181641

Hi Christina: I got the lab results over the phone (while on the street) so I did not get a chance to write them down!
My doc is mailing it to me so I will get them over the weekend and post.
I am well within range; at this point, it is fine tuning…

MiTh

[barbra]

#1181642

Hi MiTh,

This is my second go-round with Cytomel. The last one was about 2 months ago, but only for two weeks, when my levels were all over the place and my TSH at 26.8
I had about the same symptoms as I have now: muscle aches, chest pain, cold, tired, no energy, weight gain – just plain miserable. The Cytomel seemed to help within a few days. I felt fine, I even lost 4 pounds. Then, about two weeks ago, the symptoms started again. I went and had early labs done and my levels came back in the normal range, all of them, except I felt terrible. My endo added the Cytomel again, 5mcg twice a day. He said I can take the first dose at the same time as the 88mcg of Levothyroxine, which for me is first thing in the morning. I take the second dose around dinner time.
Unfortunately, my symptoms haven’t changed, in fact I can now add hair loss to the list. I guess the NORMAL I experienced is not MY normal. I am just hoping that with time this crappy period will end. My next appointment with the endo is the middle of December.
Aside from the two meds mentioned above I take Cozaar 50mg for hypertension and 5mg of Ambien so I can sleep.
I bought a blood pressure cuff with memory so I can show my PCP that my blood pressure is consistently low and maybe I can get off the Cozaar, although we have a disagreement about that. He’ll probably say it’s low because of the Cozaar.
I have no idea why I feel so lousy, guess I just have to wait it out.

Sorry, this turned into a novel. I hope you find something useful in my post and I hope the Cytomel helps.

Hugs.
Barbra.

[barbra]

#1181643

I just want to add a couple of things:

I had RAI on July 1. of this year.

Labs 9/05/2013: FT4 = 0.4, ref. 07 – 1.8
TSH = 34.1, ref. 0.4 – 5.5

9/30/2013: FT4 = 0.7
TSH = 26.8

10/31/2013: FT4 = 1.4
TSH = 3.5
FT3 = 2.8, ref. 2.3 – 4.2

Hugs.
Barbra.

[MiTh]

#1181644

TSH 1.53 (0.4-4.5)
FT4 3 (1.4-3.
FT3 2.7(2.3-4.2)

As you can see, my FT4 is well within the 60%- 80% ;whereas my FT3 is low.

[ChristinaDe]

#1181645

MiTh, your labs look nearly identical to mine! While I feel better than I have in a very long time, in fact nearly perfect…I think that something is still just a tad bit off, nothing major (like you said) but just needing a slight tweak. Since I am feeling so good I’ve been afraid to mess with it further. On the other hand, I have to work super hard to maintain my weight & losing even a pound is pretty tough (I gained about 5 lbs while hypo after the TT) – plus I get the occasional muscle twitch & heart palpitation. I called my dr on this & she said that she wants to test my electrolytes and some other things first. At the end of the day I honestly think those last couple of lingering symptoms are going to come down to that “low-normal” T3. Will see.

Anyway, I really hope you’ll keep posting after you get going on the Cytomel! And I hope it resolves whatever your lingering symptoms may be.

[Ski]

#1181646

Hi MiTh,

I don’t have personal experience with adding T3 to T4 therapy, but I’ve heard a lot about it. As for when to take it, whether to take it with T4, and when to take it in the second half of your day, those questions are best asked of your prescribing physician or your pharmacist, both should be able to answer your questions the best way possible (they should know about the experiences of other patients, and should be able to share the pros and cons of your options).

As far as using combination therapy at all, that can be very individual. Some people have a real deficiency in converting T4 to T3, and those people need to have some supplementation. Others can experience a period of improvement, followed by a new period of hyperthyroid symptoms. Only time will tell where you fall in that spectrum.

Keep in mind that T3 levels are volatile, changing rapidly and depending upon what our needs are, so discuss that with your doctor. The two of you can figure out some way to get the right kind of lab results (enough samples, for instance, to determine a chronic pattern) so you’ll feel confident you’re doing what you need to do.

I hope this goes well for you, please do check in as you go through the process!

[MiTh]

#1181647

Thanks all for replying. After giving much thought to the subject of T3, I decided not to take Cytomel, but rather look into why my body is a little slow in the conversion department.
I have only been on my current dosage of Synthroid for about a month or two; and I feel that this is not enough time for my body to fully adjust. I also feel as if wanting to be 100% back to what I was prior to Graves is like flying too close to the sun.

[adenure]

#1181648

Hi!

You sound a lot like me. I too am on 112 mcg of Synthroid and my free T3 levels were at the lower end of normal. I wanted to add Cytomel so I was prescribed 5 mcg. I decided to just take 1/4 of a pill bc I know how I am with medicine (a little goes a long way!). After a week, hyperthyroid symptoms returned (diarrhea, anxiety, feeling shaky, everything seeming extra bright visually) so… I stopped. Kind of a bummer, but it’s okay. I’ve gotten more accustomed to life after TT as time has gone on. I’m one and 1/2 years post surgery and am on 112 mcg five days a week and 100 mcg two days a week as my recent labs showed me being slightly hyperthyroid (TSH of 0.29) Now I’m back up to 0.6. I don’t think we’re ever pre- Graves selves again, but I’m happy and I’m well. So, I can’t complain too much.

[SallyB62]

#1181649

The other posts pretty much sum up what I would say. One extra thing. . . My endo said that anytime there is a change in thyroid meds (up or down), I could experience hair loss for a few months. I am like you in that my body wants to ‘drama’ react to meds, so my hair loss lasted about 6 – 12 months.

Hope this helps.

[donnabgraves]

#1181650

MiTh wrote:

Hi All: I am currently on T4/112mcg
Recent blood work has shown that my free T3 is lower than I would like it to be
I am assuming this is why I am having trouble losing the 10 lbs I have gained once going hypo post RAI.
My doctor and I decided to try Cytomel 2.5mcg (I believe I will be cutting a 5mcg pill in half) in addition to reducing my current Synthroid dosage to 100 mcg.

My question for those who tried combination therapy:

1. Should I take the Synthroid and Cytomel at the same time?
I read somewhere that it is best to take it twice a day. Should I therefore be cutting the half pills into halves?

2. If so, what is the best time in the pm to take it?

Also, if anyone can share their personal experience regarding Cytomel, I would really appreciate it.
If anything, this disease has taught me to take lead in my own treatment by advocating for myself through education. This forum is extremely helpful in accomplishing that.

MiTh

I had an RAI in late May 2013 and went to my endo and was put on Synthroid, which I didn’t do well with. I went to another doctor and they put me on Armour, which I love. I was started of on a low dose and then worked up to 90 mg daily, this was over about a month time frame. A couple weeks later, I started having severe joint pain, my hips, elbow area, and even down in my feet upon standing hurt. I couldn’t take it, so back to the doctor I go….now Cytomel 5 mcg half a pill a day. It was like magic! I feel fabulous, the pain went way by the next day. No brain fog, no more being tired. Thanks Cytomel for getting me out of bed.

Since late August after finishing a remodel on my son’s home to put it up for sale, which I felt terrible and I do mean terrible while perfuming this hug overtaking. I was still on Synthroid 100 mcg. I laid in bed everyday all day long and felt terrible. Went to endo late October and was put on 112 mcg. 2 days on this and I couldn’t even stand to hear any noise and pretty much felt like ending it all. Stop taking all Synthroid the next day. Call my other doctor who believes in natural med’s no synthetic and was put on Armour.

I know this is several months after your post, but hopefully, others will read this and it will provide them some insight on getting some relief. I’ve only been on Cytomel for a few weeks now and I haven’t lost any weight, which I wish I would, but Wow do I feel like me again finally! I go today to talk to doc about my weight. 2 years prior to being diagnosed with Graves Disease in 2013 to present I have put on 30 pounds and that part really sucks.

Hopes this helps someone, because Armour and Cytomel are AWESOME!!

Also, while on Synthroid I experienced slight hair loss and it is pretty cool to watch all the baby hair come in. I watch it come in around the hair line area. My dry skin is also getting better and my nails are turning chalky white not translucent like they had been for several years.

[beach45]

#1181651

MiTh and others,
Great sharing; know this is a few months out since this post yet I’ve been going through the index/posts and finding different ones I can maybe respond to halfway intelligently from my own experiences; I used to be on here more yet I never forget this site and all the great sharing as one of the very first places I learned a lot about Graves disease! Lots of information out there yet I always say take what you need and leave the rest as I found for myself you can get into trouble if you don’t follow things how you and your doctor partner to help you achieve balance.

As far as when to take your doses as far as Synthroid and Cytomel, I take at the same time. I’m on a T4/T3 compound; I take it twice a day; then I take a supplementary Sustained Release T3 compound once or twice a day; total about 20 mcg T3 and 88 mcg T4; I think sometimes I do better with the less T3 yet then my energy tanks; I have no problems with palps or anxiety as we got other issues under control; yet with raises in T3 for me I gain weight as well with in past T4 only; so I am seeing this is really a balancing game which takes a while and it is easier for some than others;

I took my T4 in past before I went to bed and I slept the entire night; sometimes if you add in Cytomel better to take earlier in the day; the special doctor I see says take all the SR T3 in the AM only; in fact she believe in all SR and taken all at once in the AM; thus far that did not work for me; split dosages in the day helped me; early AM and then again early PM; I sleep well.

Yet the weight and energy thing are symptoms I struggle with; I’m not there yet; it is doable though as I see others; there are those who do well on T4 only; what I understand the conversion to T3 happens in the liver. With my talking live and listening to those post RAI or TT for Graves, I hear a lot of their FT4 is higher than the FT3; balance needs to be achieved for myself to feel more energy and weight loss as I’ve charted blood work, levels and symptoms about 3-1/2 years and I know exactly where I feel best; yet it is getting me there that is the challenge; too much T3 or T4 I gain; then I get set back; it is like my metabolism resets itself again; then the hormone doesn’t seem to work again for me; plus I hear many who have success on T3 only of late yet what are the long term effects on the heart and bones; yet I hear there are effects similar on long term T4 only; most doctors know how to dose properly on T4 only medication; I think in time that is going to change; yet with any thyroid hormone I say take caution as even too high amounts of T4 can make a person experience hyper symptoms. It is all what works for you and your doctor; yet I cannot go by levels alone yet I do see with my FT3 higher I function much better; and I am not a good converter from T4 to T3 which I see a lot of fellow post RAI patients have the same dilemma; too much or too little of the hormone yes is going to cause problems from my experience.

I hope things are going well MiTh and others as I see you were sticking with the T4 only; I only go by my experiences and hearing successes of others online and here in my town; or non-successes; sometimes I am finding in my four year journey thus far with Graves the more I know the less I really know. All our bodies and circumstances are different too so it definitely is not a once size fits all; yet I always suggest work with a good doctor who listens and partners with you to help you achieve balance as it can happen; however that is as we are all very different. Yes I agree this forum is very helpful because we have all somewhat traveled similar journeys having to deal with Graves whether on ATDs or post RAI or TT which I find is good because it is not just like having hypothyroid with a thyroid gland plus based on good research and studies. Hope you all have a great day!

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