Need advice on titrating Cytomel!

[Andyb1205]

Was previously self-medicating already on 125mcg Synthroid so my labs are after 6-7 weeks on the dose.

TSH 0.20 (0.32-5.04)

FT4 14.0 (10.6-19.7)

FT3 3.99 (3.00-5.90)

My question is simply how I can best make this drastic adjustment prescribed by my Endo, from 125mcg T4 to 75mcg T4/25mcg T3. That is quite a lot of Cytomel to jump onto right away!

Luckily I have almost 2 months worth of 100mcg Synthroid and 5mcg Cytomel each to play around with and help with making this a smooth transition. So far I think I will begin with 100mcg T4 and 5mcg T3 (2.5mcg twice daily) tomorrow and stay on it for around a week. Any suggestions on a proper transitional plan moving forward, with the end goal being the 75mcg Synthroid with 25mcg Cytomel?

For some context. My previous labs can be found in my post history. Long story short, after my first Endo had written off my symptoms and positive response to thyroid hormone replacement as patient denial, my new Endo will be treating me as having idiopathic hypothyroidism. He explained that I may not be getting enough T3 in my cells and that thyroxine monotherapy is giving me both hyper and hypo symptoms.

While hesitantly accepting my request to increase my dose from 112mcg to 125mcg Synthroid for one month, to see how I feel, he prescribed me two months of combination therapy. 75mcg Synthroid and 25mcg Cytomel, to be split into 12.5mcg twice a day. Simply increasing Synthroid is not an option and finding this Endo was hard enough. Despite being uncertain if I even have a conversion problem I must make the best of it, the alternative is far worse.

Thanks!

[Angel_of_the_North]

Generally, people are advised to increase T3 very slowly: 1/4 tablet for 3 days to a week , then 2 x 1/4 and so on. You do know that "idiopathic" is from the Greek for " We haven't a clue why" (unknown cause) and probably just means that you haven't got Hashis. You'd also generally drop T4 by no more than 25mcg at a time. If you were already undermedicated, you wouldn't drop T4 at all but just add t3. One month is usually too short a time to retest after a dose change 6-8 weeks is better.

[shaws]

25mcg of T3 is approx 100mcg levo (in its effect). Therefore it is suggested that a 3 to 1 or 4 to 1 T4/T3 combination works well. It can also vary between patients.

You don't have to split doses of T3. You can take T4/T3 together as one daily dose - begin with 75mcg of levo and 1/4 tablet of 25mcg of T3 and every two weeks increase T3 by 1/4 tablet until you are symptom-free.T3 has to saturate the T3 receptor cells and then its work begins by sending out 'waves'.

Dr Lowe would never prescribe levo - only NDT and T3 for his thyroid hormone resistant patients. He was an expert in the use of T3.

I think you are aware that levothyroxine is the inactive hormone and has to convert to T3. T3 is the only Active thyroid hormone (unless you take NDT).

I shall give you some chapters from Dr Lowe which might be helpful.

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[Andyb1205]

Thanks for the kind replies.

As I was previously self-medicating already on 125mcg Synthroid, my recent labs reflect 6-7 weeks on the dose.

TSH 0.20 (0.32-5.04)

FT4 14.0 (10.6-19.7)

FT3 3.99 (3.00-5.90)

I was surprised that my doctor prescribed such a large amount of Cytomel and I’d like to avoid a heart attack and let my body properly adjust. To be clear, I’m to change from 125mcg Synthroid to 75mcg Synthroid with 25mcg Cytomel!

I won’t go into how I have these but as I mentioned I have around 7 weeks of Synthroid 100mcg and Cytomel 5mcg on hand.

Today was my second day on 100mcg T4/5mcg T3. I took them together in the morning. I will see if my body feels better with a daily or twice daily dose of T3, I’m prescribed the latter. From what I’ve seen on this forum it’s very individual.

So far I’ve thought about this plan in order, titrating roughly every week. I’d be on the prescribed dose (75 T4/ 25 T3) for 5.5 weeks to run the labs (though on 75 T4 itself for 8 weeks).

100 T4/ 5 T3

100 T4/ 7.5 T3

75 T4/ 10 T3

75 T4/ 15 T3

75 T4/ 20 T3

75 T4/ 25 T3

Does that seem too conservative? I wish the doctor had laid out a plan for me, but going from taking none to 25mcg T3 in one big leap seems dangerous.

[Andyb1205]

Another thing, when splitting Cytomel into two daily doses, how can I best absorb the 2nd dose which I’d take around 12 hours later? I’ve read it absorbs faster than Synthroid. Would an hour away from food before and after be sufficient?

Thanks again! I’m pretty excited to see how this whole trial goes. Before Synthroid I was on NDT and was doing much better though not yet optimal. Long story short I was manipulated to go off of it and now I’m trying to catch up 2 years later.

[Andyb1205]

An update. On 4th day of 100mcg T4/5mcg T3 taken together in the morning.

I can definitely feel the Cytomel working around 2.5 hrs after taking it. I assume it’ll take time to get into the cells and work more consistently from when I wake up? Also, around the same time I had a bit of sweating and itchiness which went away after a few minutes. Should I be concerned?

The good thing is I didn’t get a headache today like the previous three days from the Cytomel.