[Bobbi]

#1062469

The problem with cytomel (or any T3 product) is that it is instantly available to the cells, whether they "want" it or "need" it at that point in time. The half life of T3 is three-quarters of one day. So it is very short-lived. When you take the pill it gives you a rather instant boost, and then rapidly diminishes. In this respect it is a bit like diabetics who must take insulin. The insulin that they take is instantly available to the cells, whether they want or need it at that point in time, or not. And as a result, diabetics have a progressive erosion of their health over time. The insulin would be better if it were timed-release. Insulin pumps try to simulate the body’s production of insulin a bit better than taking it in shot form, but it still is instantly available, rather than available as the body needs it.

T4 products on the other hand, are in fact, timed-release. The body transforms them into T3 as needed, over time. This is the way the body worked prior to the removal of your thyroid. Only about 20% or so of the thyroid hormone created by thyroid cells was T3 — the rest was T4 which was transformed into T3 as needed.

You might argue — as many do — that therefore you should take cytomel-like products to better simulate the natural production of thyroid cells. But you are forgetting that not all of the hormone created by thyroid cells is released into the body all at once — much of it is stored for future use. So, even though 20% may have been T3, that 20% was likely to be released over time.

I have experience taking cytomel. Like you, there were reasons why I wanted –or thought I needed — the additional form of thyroid hormone. I was actually on half of the smallest dose of cytomel available. And, it adversely affected my heart over time. When I went off it, I was sure I would feel an instantaneous drop in energy: I did not. I continued to feel well.

[arandall20]

#1018061

Has anyone had any experience or knowledge of problems of adults over sixty years taking Cytomel? I am 63 years old and was diagnosed with Graves’ disease in 2003. I had radioactive iodine treatment. I eventually was placed on Synthroid when I became hypothyroid. Even though my TSH and T4 got to appropriate levels, I never felt well. My endocrinologist at that time placed me on Cytomel in addition to Synthroid. I had immediate positive results, feeling like my regular self. I continued on Cytomel until January 2011 when my current endocrinologist stopped it.

My endocrinologist (not the same person as the prescriber) says that because of my age, I need to be taken off Cytomel. He indicated that I could have cardiac problems such as abnormal heart rhythms. I do not have cardiac disease. I have done some Internet research but have not found much information about this issue. I currently am feeling worse with much fatigue and some weight gain although my Synthroid has been increased.

Thanks for any information that you can share.

Ann

[snelsen]

#1062470

Hi Ann, I don’t have a lot of time to post right now, but wanted to get a response going! Bobbi wrote one of the best explanations I have seen re Cytomel. My endo explained all of this to me (new endo) when I went to him, had been on Cytomel about three months (another endo, and primarily b/c I asked for it.) He said that having too much T3 or T4 does increased cardiac incidents, primarily atrial fibrillation. And that risk also increases with age. I can speak to this because I am older than you! Unlike you, though, who has no cardiac history, I do, for I have a bit of damage from all the chemo I had for an advanced breast cancer.
The first thing about Cytomel, which fits with what Bobbi says, is that we learned in the conference last fall (and I learned from my current endo) is that it should be a divided dose during the day. Not just once. The second thing I learned, was that there was a good rationale not to take it, but some endos will prescribe.

YOu did not mention your labs at all. ARe you getting them fairly regularly? I am not sure how long you have been off the Cytomel, but I suggest you give it at least a couple months, or 6 weeks, make an appointment now (cause it takes a while to get one,) to see your endo in 6-8 weeks and discuss the whole issue. My endo did say that a very few of his patients say it made a world of difference in a good way, and he is ok with it, but he wants a baseline EKG and cardiac echo.

In general, too much thyroid hormone is not a good thing for a heart, so important to keep track of labs. BUT also you want to have a life, and if you really feel like you are tanking in how you feel, get labs earlier than I suggested. However, weight gain (unless you are really going hyPO) is not a good reason increase thyroid doses, ever. But I am sure you know that.

Do write again, feel free to send a PM. So I don’t take Cytomel, right now I am at the right dose of Synthroid. But I am dealing with TED, which appeared decades after Graves’ first entered my world.
Shirley

[arandall20]

#1062471

3/15/2011
First thanks to Bobbi for her explanation and her experience with Cytomel.

To Shirley:

I have been completely off of Cytomel since 2/4/11. My last labs were on 12/30/10 and my next are due on 4/4/11. My TSH was 2.9 changing from 0.8 one year previous. My T4 was 0.6 on both tests. All of these numbers are within normal limits. T3 was not assessed.

My Cytomel dosage had been, for eight plus years, 5 mcg twice per day in addition to Synthroid. I did not ask to be placed on Cytomel. My prior endocrinologist prescribed it when Synthroid alone did not make me feel well. My current endo weaned me off Cytomel going from twice daily dosage to once daily dosage to every other day and then stopping. That process took about a month. By the fourth day of the process, I began feeling worse. By the time that I was off completely I really started feeling unhealthy. I feel as if I am in a state of malaise with little energy. My Synthroid has been increased twice, with current dosage at 88 mcg.

I think your endo’s suggestion of a baseline EKG and cardiac echo may be a good one. My cardiac labs in January (cholesterol, triglyceride, etc.) were normal. I do have a medical background as retired occupational therapist so can understand the risks. My endo is assuming that I will have cardiac disease. I may never. I want quality of life, and how I feel right now is far from quality.

Do you have a reference for the rationale not to prescribe Cytomel, or a brief summary of what you learned at the conference about it?

Thanks for your reply. I will keep you posted.

Ann

[snelsen]

#1062472

Hi Ann, I have not found one academic reference in 40 screens of Cytomel references on the internet.
All of it is pretty much anecdotal.

I think the two concerns I know, are that so frequently, it is prescribed only once a day. And the whole mater of the "dumping." And those are not huge concerns.

I totally understand how you feel, and I hope you talk with your endo and get back on it, based on your own experience. I am doing the same thing with Synthroid. I have subclinical hyperthyroidism, and know according to the labs and age, that my risk for cardiac stuff is slightly increased. But when I agreed to reduce Synthroid, and we did it right, around 12 weeks or so before a dose change, I became a zombie. Sounds like that is how you are feeling now. So I said, I will not live like this, let’s slowly increase the Synthroid, especially b/c TSH did not budge, regardless of the decrease in doses.
I chose the quality of life option, also! I still have more fatigue than I would like, and if Cytomel had helped with that issue, believe me, I’d still be taking it. The quality of life issue is critical. I hope you can have your discussion with your new endo very soon, and get where you want to be. It seems that you certainly have had enough experience with feeling good and feeling crappy to make an informed decision. And your labs are fine!
Maybe we both can work on finding a reasonable reference, if there is one.

OT a great profession! I am an RN, worked in neuro rehab, so you know how much I respect your profession!
Shirley

[arandall20]

#1062473

Shirley:

Thanks again. Regarding a reference, I also could not find one. I have done Internet searching for several days. I have been a member of the Graves’ Disease Foundation since 2002, so decided to ask here if anyone had any personal experience.

I will be seeing my family practitioner tomorrow for another issue, so will discuss the situation with her. I do not know if she will want to interact with the endo. As it stands now, I have an appointment with the endo’s nurse practitioner on 4/4/11 and with the endo on 5/11/11. I will update you if there are any changes in my medication.
I do appreciate your help. If others have any comments, please feel free to add them.

Ann

[arandall20]

#1062474

4/6/11

I just want to give an update of my saga regarding my endocrinologist’s decision to remove my Cytomel dosage and leave me only on Synthroid. The reasoning was due to my age (63) as a geriatric patient, I may develop cardiac problems, especially atrial fibrillation.

The trial lasted three months and now I am back on the Cytomel with Synthroid. Although my free T4 increased from 0.6 to 0.9, my TSH became more hypothyroid, with extreme fatigue and other symptoms. My TSH went from 2.9 to 3.8. I was placed back on the medication dosage that I was taking in January. Then in July there will be a decision what will be done next as my beginning TSH was not ideal then. (I will have labs again before the next visit.) However, I will not agree to remove the Cytomel unless I am having cardiac symptoms. I do not have any signs of cardiovascular disease currently or for the almost nine years that I have taken Cytomel.

I think the learning experience for me has been understanding thyroid hormones better. Unfortunately no one can predict how my physiology at the cellular level operates. No one can predict how well I convert T4 to T3. Then no one can predict how my cells’ receptors that are sensitive to T4 respond, and exactly what happens when the T3 enters my cells. The clinical study regarding the use of T3 and T4 published in the European Journal of Endocrinology in December 2009 infers that there may be a subgroup of patients who need T3 supplementation due to genetic makeup. Further research would be needed in this area.

Thanks again to Bobbi and Shirley for their information.

Ann

[snelsen]

#1062475

Hi Ann, I think your reasoning makes perfect sense!
Shirley

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