Thyroid UK
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Fluid retention Cytomel

Hi Everyone!

My doctor put me on Cytomel liothyronine after my fasting blood test showed low ft3. All my numbers were in the lower range and she said I probably have a problem converting t4 to t3. I have some mild hypo symptoms since April, such as, kind of more tired than usual (feeling bushed by the end of the work week - but my job is physical and I put it down to the hardish work), my eyebrows were increasingly sparse, I seemed to be unable to lose weight despite my diet and exercise routine.

Since starting t3 I feel great overall. I don’t feel hyper symptoms, my hypo symptoms are gone, I’m less depressed, I think my eyebrows are growing back. When I first started Cytomel I finally felt hungry at normal intervals throughout the day, but that has worn off and I’m back to being able to go without hunger for many hours...

The issue is that I have this strange water retention in my stomach and arms only since starting Cytomel. My clothes fit the same, I haven’t lost weight as I’d hoped but everything else has improved. Would increasing my dose decrease this strange water retention? I’m getting very frustrated by it.

I take 25 mcg Cytomel per day split into a morning dose and an afternoon dose.

TSH 0.53 (0.35-4.0)

FT4 14 (9-19)

FT3 2.3 (3.0-5.90)

My vitamin D is insufficient it’s very vey low but I can’t remember the exact number. My ferritin is on the low end of being within range.

I also might add that I’m a chronic dieter. I have always been the type to forget to eat and my calories are usually 1200-1500 per day. I’m a 39 yo female. So I sometimes wonder if I was ever truly hypo but my past blood tests always have my FT4 and ft3 in the low but in “range” with a TSH of 1.5.

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I have to add that this is my fourth week on t3 and the first three weeks I worked up to the 25mcg per day. Initially I took a quarter of the 25mcg twice per day, so 12.5mcg per day. I’m also wondering if the dosage I’m at has likely only raised my t3 slightly hence the water retention and lack of weight change? I’ve anecdotally heard that 25mcg is the same as what your body produces so more than 25mcg could be needed to bump the low t3 to top of range

Any help is appreciated

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Were those labs done whilst taking 25 mcg? If so, it looks like you're not absorbing it. Your FT3 is under-range.

How do you take your T3? Do you take it on an empty stomach, leaving at least one hour before eating or drinking anything other than water? And at least two hours before taking any other supplements or medication?

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The labs were taken before I ever took Cytomel and it was the blood labs that initiated my doc prescribing the Cytomel.

I take the first dose in the morning and then I wait half and hour before I have my morning coffee with cream. I take the second dose a couple hours after lunch or half an hour before food.

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Half an hour before coffee with cream is probably not long enough. Try waiting an hour. We always recommend an hour between thyroid hormone of any kind and food/drink - especially caffeine.

You did increase rather quickly, I don't know if that has anything to do with your problems, but we normally recommend increasing by 6.25 every two weeks.

When are you planning to get retested?

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I was going to give it two more weeks (6 weeks since starting) until I get retested. I’m also going to test my rt3 and thyroid antibodies, both of which were not previously tested.

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There's no point in testing rT3 if you aren't taking any T4. It's T4 that converts to rT3.

Six weeks is good. :)

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Good point! I’m going to try wait the full hour before eating or drinking anything. I guess once the blood tests come back I can see how much my ft3 has bumped up since starting Cytomel and go from there.

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:)

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But this person is still making her own T4 and that is where her reverse T3 comes from so she is very correct to get at least two antibodies tests TPO and TGAb and the reverse T3 at the same time as the usual TSH and FT4 and FT3.

I know as I am in the same situation and reverse T3 is my only issue and it also comes from lots of dieting and intermittent fasting and my level wasn't really bad, but I found her choice of dose is actually just the dose I found was the best to use.

I also take the needed supplements and my levels are fine. In fact now my temperature is 98.9 maybe it went up as soon as I saw you were going to mislead her and tell her rT3 is of no use. I totally disagree.

She should be glad she has an enlightened doctor as she is on what I would do as soon as I can get some more T3 just to take in an on and off manner in one month periods so I never lose my own ability to make the hormones. Naturally I do take the needed nutritional inputs.

It has been about a year since I did my successful reducing of rT3 and without the T3 it has been climbing up again, but I do tests only twice a year. I expect it will take me 6 months to get to the lower end of the range as I did in 2017 and then I would widen the periods of taking T3 to just the same two doses for one month and then be off for two months and just keep track every 6 months with tests.

The last rt3 I took was 13.x ng/dl as it needs to be sent to the USA as Cdn authorities do not think rT3 is a problem, but they are WRONG as too many people get put on thyroid hormones with more T4 in it and wonder why they don't feel better and that would be because of the rT3 created from the added T4.

So I am all in favour of the T3 only approach, but in a way so as to not eventually lose one's own ability. I had been up to 18 ng/dl at the worst time and had been as low as 8 ng/dl after my three trials of different levels of T3. So i would say this lucky woman is on the right track and my vote is she definitely needs to those extra tests done all on the same day.

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FT4 14 (9-19)

That FT4 is not high enough to be the cause of high rT3. Therefore, if she has high rT3 its due to something else. Doing an rT3 test is not going to tell her what's causing it.

You say your high rT3 is caused by "lots of dieting and intermittent fasting". In which case, the cure would be to eat more calories, not go onto T3 only. If you permanently have high rT3 then the cause is not lots of dieting and intermittent fasting, because as soon as you ate more calories, the rT3 would decrease, because it's only in the blood for about 2 hours before it is converted to T2.

You also say "my level wasn't really bad, but I found her choice of dose is actually just the dose I found was the best to use." So, if that dose of T3 made you feel better, then it wasn't rT3 making you feel bad, it was low T3.

In fact now my temperature is 98.9 maybe it went up as soon as I saw you were going to mislead her and tell her rT3 is of no use. I totally disagree.

The fact that you disagree with me, doesn't mean I'm wrong. And your temperature has nothing to do with your rT3, it's to do with your FT3.

An rT3 test is of no use because it will only tell you if there is a problem, but won't tell you were the problem lies. You have to do that for yourself, and you could do that without taking an rT3 test.

She should be glad she has an enlightened doctor as she is on what I would do as soon as I can get some more T3 just to take in an on and off manner in one month periods so I never lose my own ability to make the hormones. Naturally I do take the needed nutritional inputs.

She should be glad she has an enlightened doctor that prescribes T3, that I agree with, but that has nothing to do with rT3. Taking T3 does not get rid of high rT3. Fixing the problem that caused the high rT3 gets rid of high rT3.

However, you should not take T3 'in an on and off manner'. That is going to totally screw up your metabolism. If you're going to take T3, it needs to be taken in a steady, regular 'manner' to heal the body. And taking it one month on and one month off is not going to preserve your own ability to make hormones. Being hypo is going to cause you to lose your own ability to make hormones. Taking thyroid hormone replacement, be it T3 or whatever, does not shut the thyroid down completely. If you stop taking it for any reason, the thyroid will just carry on where it left off, making what it can. It's a myth that once you start taking it - because you start taking it - you're on it for life. You're on it for life because you are hypo and your thyroid is no longer capable of making enough hormone to keep you well. Your on/off method is going to completely stress your body and make you sick.

too many people get put on thyroid hormones with more T4 in it and wonder why they don't feel better and that would be because of the rT3 created from the added T4.

They will only make rT3 if they are taking a lot of T4 and not converting well. When the FT4 reaches a certain point, it starts converting to more rT3 than T3. It's not just because you are taking T4 that you have high rT3.

But, what exactly do you think is so terrible about having high rT3? What do you think it does? As far as anyone knows, it doesn't do anything much. It is inert, stays in the body for about 2 hours, as I said, and then it's gone. But, where you are building up future problems for yourself is your way of taking T3 on and off, because you don't understand how the thyroid works. And the OP is on the right track because she's taking T3, not because the T3 is going to get rid of high rT3, because it isn't. If she has low ferritin or cortisol problems, or something, the high rT3 will remain despite the T3.

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I disagree with you on that one point of the reverse T3 in more than one way you look at it. So, she being a smart person can find out herself just like I did as taking T3 did get my rT3 down as I mentioned and it does so by reducing the T4 the body already makes on its own.

I did not have high FT4 either, but I did have mid-range rT3 as mentioned, the first was 17.1 ng/dl in June 2014 and it climbed to 18.0 before I started the T3 late in 2016. During that first 2 years I was educating myself about all the needed nutrients and anyone can do that, even without being here on this site. But taking all the needed nutrients was not enough to reduce reverse T3. Instead it just climbed slightly.

I joined here when I was in the later stages of my 3 experiments with T3.

I added my comments because I saw my case in what she mentioned. I had in the past done a month each spring to get my winter weight off. I did drop from 134 to 126 in the month of May 2014 by including 6 full days of complete fasting done here and there in that month. But intermittent fasting has been my way of life for so long, I would say the past 18 years. My height is 5’6” so I really wasn’t that overweight as 130 lbs is supposed to be normal for my height. I have eaten a low carb diet for years as I have been so called T1 since I was 24 but my weight stayed in the range of 135 lbs for all that time, until the last 6 months when I decided to add back milk to see if that which has some iodine in it could make me also feel better, but I did gain weight as I had to increase my insulin. So it will take time to lose it, but it was done as an experiment.

So I do not need to contribute any more to this site as it is obviously not allowing any other comments than those by the leaders. So I wish the woman all the best, but do not need to say more as I have zero interest in arguing with someone I just disagree with on the one topic of reverse T3 testing as to whether it is needed or not. I say it is a very useful measure.

I just sincerely HATE to see people who are not really a fully thyroid deficient person being turned into one by the medical establishment wherever it is and it is a dismal mess in Canada. I say she is on the right track with her doctor and the adding in of those tests as she was planning to do is the best thing to do. She needs to find out if those two antibodies tests are negative, as mine were, as that points out that a person still has a healthy thyroid and the details of conversion need working on. Just having a little bit of iodine makes a big difference. The selenium helps in the conversion of T4 to T3. But I had that selenium all along before anyway, but was too low on the iodine.

I can imagine her elation would be the same as mine was when she discovers there is a way to get the reverse T3 down and she is actually doing it already, but without the reverse T3 tests for the before and after measures, she can’t see the progress, what a shame. I say yeah for the reverse T3 test and yeah that she has a cooperative doctor who understands.

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Low calories can cause low T3

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Hi Twinsugar, because we had not marked as "following" each other I just noticed in my Messages box which you can access by clicking on CHAT above to the left of the screen. You you asked if I was Cdn 3 days ago, but we don't get notified of these messages unless we are already "following" the person, then I think we get an email notification.

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