Update on Current Cytomel Titration

[Andyb1205]

The goal is, as prescribed by the Endo, 75 T4/25 T3 (12.5 x 2). History can be found in my previous post titled Cytomel Titration. So far been on...

Five days on 100 T4/5 T3

Four days on 100 T4/10 T3

Five days on 75 T4/15 T3

Feeling a bit hyper, for past two days I decreased to 75 T4/12.5 T3, taken as 7.5 T3 in morning and 5 T3 at night.

I’ve still noticed, in morning and afternoon, minor sweating and hand tremors, irritability, and headache. Slight sharp pain in chest and muscle weakness. But by the evening I am constipated and a bit hypo.

Any advice on how to properly adjust? From bit hyper in morning and afternoon I become more hypo from the evening. Do I simply need to be patient to allow my body to adjust?

Update:

I took 75 T4/ 5 T3 this morning, was planning to take another 5 T3 at night. I was feeling better, avoided sweating and irritability.

Rather than the usual constipation in later evening it began today in late afternoon so I took 2.5mcg, felt better. Will take 5mcg T3 three times tomorrow, 8 hours apart.

Would appreciate any input or advice. I know I am being anxious and impatient but the titration for T3 can be confusing! Thanks.

[greygoose]

You're going too fast. T4 should be increased or decreased by 25 mcg every six weeks. T3 by 5 mcg every two weeks.

You start by decreasing T4 by 25 mcg and start 5 mcg T3.

Two weeks later, you can reduce the levo by another 25 mcg if you wish, but you would need to know your FT4 result. A second reduction might not be necessary. But, you do increase your T3 by 5 mcg - either taken at the same time as the first 5, or at another time.

Carry on increasing by 5 mcg T3 every 2 weeks.

How much T4 were you on to begin with? What was your FT4 result? It isn't absolutely obligatory to reduce levo every time you increase T3.

[Andyb1205 in reply to greygoose]

These were my results 3 weeks ago on August 21, on 125mcg for around 6 weeks.

TSH 0.20 (0.32-5.04)

FT4 14.0 (10.6-19.7)

FT3 3.99 (3.00-5.90)

I tested negative to both TPOab and TGab, and my ultrasound supposedly came back as normal. As I was self-dosing, he believed I was on 112mcg Synthroid and prescribed me 75mcg T4 and 25mcg T3 (12.5 twice daily). As that is equivalent to around 150mcg Synthroid I couldn’t complain.

He ignored my lab results believing they don’t suggest hypothyroidism though I disagree. Yet being old school said he will instead treat me based on my symptoms, suggesting my tissues aren’t getting enough thyroid hormones. I took what I got.

I’ve now been on 75mcg T4 for around 2 weeks and skipped it yesterday. Day two on 20mcg T3 today (10 x2). I don’t really feel hyper anymore. Rather over the past few days I’ve been feeling very cold, and it appears I’m most hypo both in the morning and in the evening. Hoping it all evens out soon enough.

I think I’m not absorbing the evening dose well enough. I’ve only been leaving 30-60mins without food both before and after. I had assumed Cytomel gets absorbed quickly.

I only have enough 5mcg tablets to dose 20mcg for another 5 days. I have my next meeting with him at the end of October and so need to be on the prescribed dose soon, giving me 6 weeks on 75 T4/25 T3 before doing my labs. Wish I was given a dosing and titration plan, an icky situation. Will try to quit cigarettes again soon, the drop in thyroid hormones should help adjust to such a large dose too.

[greygoose in reply to Andyb1205]

Cytomel may be absorbed quickly - although that's debatable - but not if your stomach is full of food. If you're taking it after a meal, you need to wait 2 to 3 hours depending on the size of the meal, for your stomach to empty. Cytomel still needs to be taken on an empty stomach or it will bind to certain elements in the food and you won't be able to absorb it. And it's wise to leave one whole hour before eating because you cannot guarantee how long it's going to take to leave your stomach. That probably depends on your level of stomach acid. You can't really afford to take chances on this. Your wellbeing depends on it.

I gave you a dosing and titration plan above. It's not complicated. Increase by 5 mcg every two weeks. Experiment with what is the best time for you to take it, and whether you feel better with one dose or two.

[Andyb1205 in reply to greygoose]

I only have x14 5mcg tablets left to play with, out of the x60 25mcgs I also have I can fiddle with around x10. As I’ve adjusted to 15mcg T3 quick and quite well I can try ~17.5-18.75 T3 for 1-2 weeks. To be honest the drop from 125mcg T4 to 75mcg T4 is hitting me hard recently. Can’t my body eventually get used to slightly high T3 doses which can then even out?

I’m assuming doing labs now to have a peace of mind would be inaccurate, I’d be on 3 weeks of 75mcg T4 with varied doses of T3.

What was that Endo thinking when he dropped my T4 by 50mcg and added a whopping 25mcg of T3. Lol!

[greygoose in reply to Andyb1205]

First thing you have to learn is that endos know nothing about dosing. They make a big thing about it, as if they know what they're doing, but the don't. Do you have enough levo to put it back up to 100?

You need to be on any dose of anything for six weeks to get an accurate test result. So, not much point in testing now.

Can’t my body eventually get used to slightly high T3 doses which can then even out?

What do you call a slightly high dose of T3? If it's too much, then no, your body won't get used to it. If you mean can it compensate for the lose of the T4, then only time and blood tests will tell. It's all so much easier if things are done slowly right from the start. In future, ignore anything your endo says and cheque here before changing. Changes in dose should only be 25 mcg every six weeks for T4 and 5/6.25 mcg T3 every two weeks. Anything more is too much.

[Andyb1205 in reply to greygoose]

I have some 125mcg tablets which with 75mcg can make 100mcg, but not enough for 4-6 weeks, more like barely 2 weeks.

What I meant by the T3 evening out is that I feel hypo in many ways, slowed metabolism, constipation, worse digestion, cold, fatigue and sleepy. I feel better with more T3 in morning so today I took 12.5mcg T3 and will take 7.5mcg at night. It’s my 4th day on 20mcg and have enough to continue for another 10 days.

When I increased T4 before I felt bit hyper, some parts of body had too much while others less, until the thyroid hormones were more evenly distributed through the body. I’m wondering if it’ll be the same with T3, because right now this is ridiculous. Hypo even though T3 is three times stronger than T4!

When I first began T3 I had the sweating, warm body, faster metabolism, anxiety, jittery, today the only possibly hyper symptoms even with 20mcg T3 are slight headache if at all! I’ll have to be patient I guess but this sucks. Maybe take 125mcg T4 for next couple days.

[greygoose in reply to Andyb1205]

If you have both hyper and hypo symptoms, you need a steady dose at the same level for at least six weeks. Taking a bit more here and a bit less there is not going to help anything.

There is a reason why you have hypo and hyper symptoms at the same time. It's because, when thyroid hormone first starts getting low, the body adjusts by closing the receptors in parts of the body considered 'non-essential', and that's what causes symptoms, the cells that aren't getting enough hormone, or no hormone at all - and that is different for every body which is why everybody has different symptoms. When you start thyroid hormone replacement, you have to convince your body that those days of privation are over, before it will open up those receptors again. And, you'll only do that by maintaining a steady optimal dose. And, if your dose can't be optimal, a steady lower dose is better than chopping and changing. That's not how you're going to get rid of hypo symptoms. So, there's no point in increasing your dose if you can't maintain it at that level. That's just asking for trouble, I'm afraid.

[Andyb1205 in reply to greygoose]

Thanks, that makes much more sense. I’ve just been so puzzled at what’s going on but patience is the key I guess. Slow and steady.

In regards to why I was thinking of taking 125mcg T4 for one or two days. A few days ago I felt I was becoming hyper while adjusting to T3 as lots of T4 remained in my body. I foolishly skipped the 75mcg that day.

[greygoose in reply to Andyb1205]

Well, you might have been over-medicated, but you weren't becoming hyper. You're hypo, so that just can't happen.

[Andyb1205 in reply to greygoose]

I will be sure to get advise on this forum when I do my labs in 6 weeks. Two years ago I made a post on this forum, I just reread it. You were the first one to reply, telling me that it’s not my fault and not blame myself.

I screwed up big time going off of NDT at that time, wish I was more educated and persistent with my health. Was gaslighted to be experimented on like a lab rat. Hopefully I can eventually find the right combination of T4/T3 and regain some normalcy for my health.

[greygoose in reply to Andyb1205]

Yes, endos do that sort of thing. They're very good at gas-lighting. Most doctors are. That's why we have to learn about our disease for ourselves and take control. If we know nothing, we're going to assume that they know what they're doing - which, of course, they should. But, they don't. If we have a good basic knowledge then we can call a halt to their weird little experiments and say no way, José, I'm not falling for that! And insist on proper treatment.

And, once we really know what we're doing, we can cut them out altogether and treat ourselves. So many of us do that, now, and we're so much better for it.

[RoadTrippin]

How does anyone adjust T3 by such tiny amounts as 5mcg ? My Cytomel tablets are 25mcg and even cutting into 1/4s is difficult with a pill cutter they never look even. I’m taking 1/2 tablet so 12.5mcg T3 and reduction of Levo from 100mg to 75mg once daily. I do feel I’d rather split the T3 dose but I’d have crumbs everywhere!

[Andyb1205 in reply to RoadTrippin]

I believe the tablets come in both 5mcg and 25mcg form.

[greygoose in reply to RoadTrippin]

Obviously you can't cut a 25 mcg tablet into 5s. So, you cut it in quarters and take 6.25 - the difference is so small it doesn't matter. I split my 25 mcg T3 tablet into quarters, with a pill cutter, and I don't have crumbs. But, even if they're not quite even, it's ok, because the difference will be even smaller. Don't worry about it.

[Andyb1205]

Update. Took my second evening dose of T3 a few hours ago. The only possible hyper symptom I’m noticing is muscle weakness. But as it’s the only one, no sweating and feeling rather cold, could also be a hypo symptom. So confusing differentiating the two.

[greygoose in reply to Andyb1205]

It is. That's why we do labs as a back-up.

[Andyb1205]

Definitely feels like my body is balancing itself out now. No more hyper symptoms, no sweating, feeling hot, or muscle weakness from over-medication. So today was day one of jumping from 20mcg T3 to 25mcg T3 alongside the 75mcg T4.

Will see how this goes. I’ve found myself needing to take the 2nd dose far sooner, around 7-8 hours after the first one. In a week may try taking it all together.

So I’ve been taking the 75 T4/12.5 T3 three hours before I wake up. Around 5-6 hours before, I take my iron supplement with Vitamin C. I hope there’s no interference, especially as metabolism slows down during sleep.

[Andyb1205]

As funny as this may sound I miss the hyper symptoms, because now my body temperature is quite low, I’m freezing! Feels like I’ve got a chronic cold! Yet the 75 T4/25 T3 is supposed to be equivalent to 150 T4. This will be an interesting experiment to observe as the T3 gets into my cells.

As I’m nearing a month on 75 T4, down from 125 T4, there must’ve been a massive drop of thyroid hormones in many parts of my body.

[Andyb1205]

After 8 days of splitting 25mcg into two daily doses, this is the 2nd day taking 25mcg T3 in one single dose in the morning with the 75mcg T4. I’ve learned the value of patience, I’m just happy I haven’t had sweating or a heart attack yet!

And so it begins, with labs end of next month followed by my second meeting with the Endo. *drum roll