How much Cytomel is enough?

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    I had a total thyroidectomy back in 1999 for a large precancerous Hurthle Cell Adenoma. Since then I had been seeing Guttler and mailing him my blood work from Colorado. In the last year I let my family practice physician take over watching my thyroid tests. I just couldn’t afford or tolerate Dr. Guttler not listening to how I felt anymore. I have been taking Synthroid brand 150mcg since 1999 and my primary physician wanted to add Cytomel to this. She said that I should be brought up to 25mcg a day of cytomel according to resent studies. I started taking 5mcg once a day first and waited 6 weeks and had blood work. My free t3 and free t4 were both in the high end when they did the blood work and my tsh was suppressed. She then moved me up to 7mcg for 6wks and I still felt good so we then went up to 12.5mcg. I tried to take that for a week and had heart palpitations. Should I have given it more of a chance and worked through the heart palpitations and chest tightness? I dropped back down to the 7mcg and also had the chest tightness and heart palpitations again so then I went back to the 5mcg once a day and I’ve been taking that for the last 6 months. So my question is what dose should I be on of Cytomel if you do the combination. Do they need to drop my Synthroid dose down to raise my Cytomel dose? I do definately feel better adding the Cytomel in after 12years of being tired and sluggish from just being on Synthroid. What would anybody recommend to do? We have no endocrinologists in my small town and I’ve cut ties with Dr. Guttler since he won’t listen to how I feel. I’m open to any new ideas. Thank you.



    My thyroid was blown out as well, but in my case with radio iodine.
    I had palps, as well, for years being on Synthroid and Cytomel.
    This all but disappeared when I started with natural thyroid, which contains other things whose function “science” yet have to discover, like calictonin.
    I ate Atenolol for 15 years because of the T4+T3 which was less than sufficient.
    How are your parathyroids, gone too?



    Thank you for the response. My parathyroids have been fine I’ve had my calcium checked and I take calcium routinely. I had radioactive iodine in 2003. Which I think that my thyroid levels were actually more stable after that. It took awhile to get me regulated correctly because what is normal is not the same for everybody it comes down to how you feel and if you are still suppressed. I’ve been suppressed since 1999 when I had my total thyroidectomy. I’ve battled the weightloss and weight gain like everybody else. The 20-30lbs have become like an old friend. I’m hesitant to start messing with my Synthroid dose when it took so long to find the right dose for me. My family practice doctor is willing to do whatever I want but I’m in the medical proffession and I’ve heard of course all of the horror stories of natural thyroid and how it’s not as consistent and all that jazz so I’m still kind of skeptical. I definately feel better with the addition of the cytomel but I got the heart palpatations and chest tightness when we went a little bit higher. So do I give it the six weeks and see if it goes away or just stick to the 5mcg? Its so hard to know what’s right anymore. I just want to be normal like everybody else does. I’m tired of the weight gain and having to lose it all over again. I haven’t noticed as much fluctuations with my weight with the addition of Cytomel. Before it was like you would just gain five pounds out of the blue without even eating anything different and then it would just go spiraling up from there. I’ve been able to keep it more under control lately with the addition of Cytomel. So any suggestions would be great. Is it worth going thru the nightmare again of regulating me with the natural?



    >> I’m in the medical proffession and I’ve heard of course all of the horror stories of natural thyroid and how it’s not as consistent and all that jazz so I’m still kind of skeptical<<<

    I was skeptical too, for 14 years, foolish me. I never felt better.

    What data do you have to support that USP Thyroid is inconsistent? Absorption of T4 is highly variable, check your Abbot Labs spec sheet. 5mcg/day of T3 is not that much, a healthy thyroid produces 20 – 30 mcg/day, Although I'm only taking 125mg ERFA per day, ( 72 mcg T4 + 18 mcg T3 plus other stuff from the thyroid).
    Synthroid does dot have a snow white history, run ins with FDA etc. Problems with natural thyroid meds are overblown. Dosage according to labs tests are not the way to go, as these pages point out, the pituitary response is isolated and does not paint a systemic picture.
    Most GP's have little experience with USP thyroid, and big pharma has been financing research to suit their needs forever.
    Read the paper it has 280 some references, how many can your GP give you to support his position?
    I don't know what you do in the "medical proffesion" but I've met a few professors of medicine and of endocrinology who don't get this. New medical research takes an average of 17 years of getting into general practice, not very impressive.
    Try the natural stuff, (ERFA, NatureThroid, Acella, or other USP meds) it will not kill you, and you can always revert. Swallowing these pills is a different story and I take these sublingually or under the lip.


    Dr. Evans

    Any dose of thyroid medication that is too high can cause heart palpitations, whether it is T4, T3, or T4/T3 combination. The fact that you feel well on 5 mcg Cytomel is good. You did the right thing by backing down to the dose where you feel better, the palpitations don’t usually resolve if the dose is too high. If you feel well and your weight is stabilizing, then maybe you’ve found the right medication combination. That being said, Cytomel is instant-release T3, so often causes the kind of side effects that you experienced. Often a sustained-release T3 eliminates those problems. Many patients do better on Armour or other combinations of T4/T3 or even sustained-release T3 only, but you are correct– if your prescription is working for you, it isn’t wise or necessary to make a big change.



    Thanks for the replies. I’ve been a Radiation Therapist for 12years treating cancer patients. I’ve treated patients with thyroid cancer and have tried to educate myself about the thyroid. I also worked in a pharmacy when I was in Xray school and the pharmacists always laughed when a patient wanted natural thyroid. Which of course I always found a little disturbing. Shouldn’t they know best? So would anybody think that it would be ok to take a chance and change me to natural thyroid? What dose would my family physician start me out at I take 150mcg Synthroid and 5mcg of Cytomel once a day. I know if it ain’t broke don’t fix it but here is my feeling: It will be 13years since my total thyroidectomy. I just added Cytomel to my Synthroid last August and feel so much better. I do have my weight pretty stable right now. Stable to me means that the swings in my weight are not as great but I’m still having issues losing weight. I am to a tee the thyroid patient that has struggled with their weight ever since my thyroidectomy. Just like I said the 20-30 lbs I gain and re lose has become my friend. It’s gotten harder and almost impossible to lose it this time and I don’t want it to be my friend anymore. I’m tired of working my but off working out and dieting and not losing anything! I’m 37 yrs old and I just want to lose it and be done with it. I’m very active and eat well and bottom line I shouldn’t be over weight I dont’ eat enough to be over weight. So what can I do? I’m at the point in my life where I think I want to try something different. Thank you for any comments and suggestions.



    @ Dr. Evans,
    My dose of 50 mcg T4 plus 5 mcg T3 gave me palps, (the T3 did not affect it as much as the T4). When I switched to ERFA, 120mg (or 2 grains Armour) which would correspond to 72 mcg T4 and 18 mcg T3 the palpitations disappeared.
    That synthetic combo gave me a pituitary response of 3.0 (TSH) and the natural desiccated thyroid 0.03, which is not as important that I feel better, cholesterol in normal range finally after 15 years, and my weight is down 25 lbs.
    It would seem reasonable to think that something other than the T3 and T4 in those NDT pills are responsible for this.
    5mcg T3 is a baby dose, I now realize, and should reasonably be given to everyone taking T4 just to find our if they belong to the “20%+” group identified by Damiano Gullo in the population study on 1,800+ athyreotic patients that did not respond to T4-monotherapy, as also evidenced by their fT3/T3 _ratio_ (not their absolute numbers).
    While a 100% of healthy thyroids produce T3 it would not hurt to give a little T3 to everyone on T4, as the 20%+ number may still hide some deficiencies.
    According to a couple of text books the thyroid normally produces 20 or 30 mcg T3 per day, and likely for a good reason, so the reluctance to prescribe this is a mystery.
    Its not expensive, addictive, dangerous, nor artificial like most products produced by big pharma, and not likely to be recalled like the crap they usually hawk.

    The delivery method for these hormones are quite different than the natural one, and may explain the variability in results, which has led myself and many others to take these pills sublingually, in an effort to increase transdermal absorption, giving more consistent results. I understand this would not work well with the marketing people at those companies and would never be suggested.
    The stomach is a pretty tough environment for a lot of different things, last time I checked most diabetics get their insulin in pill form.



    .. I meant: don’t get their insulin in pill form.
    Can an edit function be added by your webmaster?

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