Prescribed Cytomel, Fair Dose Adjustment?

[Andyb1205]

My context can be seen in my previous thread but I will share the most recent information. I have an interesting update as I’ve been prescribed Cytomel for the very first time.

So I was on 112mcg a month ago and in the past 4 weeks I self dosed, 137mcg for a week then 125mcg for 3 weeks. In the same month I began Zoloft 25mcg for OCD, it’s helped but also made me feel more hypothyroid. Recent labs.

TSH 0.18 (0.32-5.04) down from 0.22

FT4 14.2 (10.6-19.7) down from 14.5

FT3 3.86 (3.00-5.90) down from 4.01

My numbers would’ve been even lower if I stayed on the 112mcg.

Today I saw a new GP at a walk in who made a great impression.

To be on the safe side I did not disclose that I self dosed to 125mcg, so the doctor assumed I’m still on 112mcg.

I got a dose adjustment, Synthroid reduced to 100mcg with addition of 5mcg Cytomel to be taken once daily. Is this a fair adjustment? Thanks!

[Angel_of_the_North]

That would be about 115mcg levo-equivalent - you probably just need a dose increase. But you are converting fine, so may not make much difference; you are just undermedicated - free t4 isn't even 40% up the range and should be around 75% (about 17.5)

[Andyb1205 in reply to Angel_of_the_North]

Thanks for replying! I thought adding 5mcg Cytomel would require a 25mcg rather than 12.5mcg dose increase in Synthroid? Anywho, a couple things, please bare with me.

The self dosing of 125mcg was very unstable, I was cutting up 100mcg tablets into eighths which were constantly uneven, and adding it to 112mcg, equaling ~125mcg but regularly less or more than 125mcg.

Secondly, I have been so unmotivated and hopeless lately that simply to hang on by a thread until I see this thyroid patient recommended Endo in a few months, I need to make the best out of a difficult situation.

My family doctor had refused to raise the 112mcg to 125mcg twice now. Regarding the GP I saw yesterday at a further away walk in. On the one hand he mentioned that he could not increase my dose of 112mcg to 125mcg because of the risks of a low TSH, while also noting that he does have patients with a TSH nearly zero without hyperthyroidism, but he’d have to regularly monitor to dose by symptoms.

But he’s not accepting patients as he’s moving in a few months so can’t be my family doctor. Hence suggested the alternative of 100mcg Synthroid with 5mcg Cytomel, to prevent the TSH from going lower while noting that the Cytomel can help improve my energy levels. Perhaps I should’ve been honest about already self dosing on 125mcg but it was a risk.

On the one hand increasing Synthroid would be the conservative approach, on the other hand the evidence of patients preferring combination therapy to mono-therapy is interesting.

Options? Well I’d be open to suggestions, though I’d like to try something new and use combination therapy (I have previous two years experience being on NDT but long story why I was taken off it).

I was prescribed 3 months of 100mcg T4/5mcg T3, I already took out two months. I still have two weeks worth of 112mcg tablets and can probably get a a refill from the other doctor and a different pharmacy. So I can probably try 100mcg or 112mcg with the 5mcg Cytomel, with labs in 6 weeks. Sooner or later it will all catch up to me again as I move beyond self-dosing.

[Angel_of_the_North in reply to Andyb1205]

Adding T3 won't stop TSH from falling if it is going to - it might make it fall faster than extra levo. You need to find a doctor who understands the thyroid. You don't have to take the same amount of T4 every day, so no need to cut pills into stupid sizes (you can alternate dose), but you DO need to take the same amount of T3. T3 is roughly three times a potent as T4 so 5mcg T3 is about 15mcg levo but could feel like 20mcg. I'd say that you need at least 125mcg levo PLUS the T3. Zoloft probably isn't helping your thyroid, but T3 might help your OCD.

[Andyb1205 in reply to Angel_of_the_North]

The Endo that I’m in the waitlist for prescribes Cytomel and according to RateMD, puts a big emphasis on symptoms not merely labs. I just need to survive in the meantime!

Anywho I just took my first Cytomel with 112mcg Synthroid. If the GP knew that I was already taking 125mcg T4 he probably would’ve reduced it to 112mcg not 100mcg. I’m so stupid, he had taken my word on what dose I’m on so I could’ve lied that I’m prescribed 125mcg but I was both afraid and it would’ve felt wrong. ☹️

How long can I expect to wait until my body gets used to the Cytomel and I can feel the results?

[Angel_of_the_North in reply to Andyb1205]

It's very individual. I take T3 only and felt better from about 30 mins after the first dose. Other people don't get on with it at all.

[LAHs]

Hi Andy, it is widely reported that Zoloft will decrease the effect of thyroid meds. I do not know the mechanism, many other meds compete for the thyroid binding globulins (TBGs) but I have not yet researched if this is the case with Zoloft. But, yes, Zoloft will suppress your thyroid meds and therefore cause you to become more hypothyroid.

[Andyb1205]

I have no doubt Zoloft had affected my thyroid hormones!

I just received great news. I called the Endo’s office to ask if I’m still on the waiting list and supposedly I’m already booked for July 31! They had the wrong phone number on file. This was so unexpected, last week they just said they’re booking for December and to call back later. 😀