Hey there. Thought I’d ask what is probably a dumb question!
I’ve been on 75mcg Synthroid for over a month and successfully titrated to and been on 25mcg Cytomel for now 12 days. Both taken together in the morning as single dose.
In some ways I feel more hypo despite it being the equivalent of 150mcg T4, having previously taken 125mcg T4.
The pharmacist had done a poor job of splitting the tablets into two and so many of them are uneven. I do my best to mix two halves to form the original 25mcg Cytomel tablets. My question... is the bioavailability possibly spread unevenly? As life has made me very anxious these days maybe I need to just wait it out.
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Andyb1205
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I've always been told start low and slow with T3. Titrating up to 25mcg over 12 days is very quick and could be the cause of your current anxiety. As it is at least 3 x stronger than t4 your body needs time to get used to it. I increased a 1/4 tablet every two weeks and retested once I got to 25mcg. Also as Levo can take weeks to leave your system, you could be over medicated.
It may be worth stopping the t3 for a few days and starting again at a lower & slower pace.
Sorry I should’ve been more clear, my bad! I had titrated from 5mcg T3 to current 25mcg over the past month and half. In regards to my anxiety, ADHD, a neurobiological disorder runs in my family and that’s the cause of a lot of my anxiety. When I feel more hypo and constipated, bloated, my meds don’t work as well on top of hypo cognitive slowing.
You should take notice if symptoms are being relieved. It is ok to take both at the same time. 25mcg of T3 is around, in its effect, to 100mcg of levo. Are you taking them on an empty stomach with one full glass of water and wait an hour before eating? Are you taking a little too much? I use a pill-cutter and found this one the best for me and have tried several in the past.
Usually, we start on a dose and every two weeks add 1/4 tablet, always taking note of pulse/temp and if either goes too high drop to previous dose. Research has found combination of 3:1 or 4:1 on T4/T3 to be beneficial. Do you wait one hour before eating when you've taken your dose with one full glass of water.
I’ve been wary of what were hyper symptoms when I titrated over month and half from 5mcg to now 25mcg. I don’t believe the T3 is making me hypo but rather it not filling the gap with reduced T4.
I take my T4/T3 with a glass of water, and 30 minutes later take my Adderall with 25mg Zoloft (half of starting dose!). Eat 30 minutes later so an hour after thyroid meds. It worked well until I felt the drop in T4 more and more.
Will ask the pharmacy first to give me the full tablets for a month to cover me until I see the Endo on October 29th. Otherwise will try to fiddle with the timing of my meds.
Why is the pharmacist cutting the Cytomel tablets?
If you are taking 25mcg in one dose, and they are 25mcg tablets, what's the point?
If the tablets need cutting, why not buy a pill cutter yourself and cut the tablet on the day, that way you will be having just one tablet and not mixing and matching from previously cut tablets mixed together.
SeasideSusie, totally agreed. Bulk splitting is all very well for medicines like paracetamol - does it matter if you get a 200/300 split sometimes? probably not.
Bulk splitting should never be done to medicines which are at the extremes of dose sensitivity - that is, even small changes of dose can and do have a significant effect. You don't even know how careful they were at ensuring that nothing was lost.
There is no guarantee that what is visually an even split actually is an even split of the active ingredient. The best we can manage is what you have said - split as needed and be careful not to lose any bits.
I'll be posting something about tablet splitting soon!
My Endo had prescribed me to take it split so twice daily. Said it doesn’t matter but I figured I should try that route. I wasn’t thinking when I asked the pharmacist to split the tablets, as I don’t have a pill cutter. Wish I didn’t make that mistake and split as needed, lol! Will contact the pharmacy and see if they can help me out here.
So I called the pharmacy. As I’m going to be seeing my doctor later today I will get the month supply and take the 25mcg tablets whole! If need be will be sure to get my own pill splitter. I wish the Endo could’ve given me better instructions.
This all makes sense now, with my titration from 5, 10, 15, and 20, I was taking the 5mcg tablets that I had from an older script. When I then moved onto taking the two split 25mcg tablets things have been going downhill.
With plan to draw labs in 4 weeks, will they be accurate given:
- I’d be on 75mcg T4 for total 8 weeks
- unpredictable 25mcg split 2 weeks
- whole 25mcg T3 tablet 4 weeks
The good news is that I’ve now learned from this mistake. Quite comical actually. 😂 Don’t bulk split thyroid hormones, especially T3!
When you take T3, it affects your blood tests as it makes Free T4 appear to be lower than what it may actually be. But it's really not all that important as to your test results. Those results merely reflect what is in your blood, and not what is most important: the thyroid hormone that has made it to your tissues and cells.
With that said, whether T3 is 3 or 4 times stronger than T4 is far more relative to the individual. What is powerful to some isn't to another, not necessarily. It also depends on how far behind you are with losing T3 from your cells.
When I first found out I couldn't convert T4, I took 25 mcg. 4 times a day. Any less and it was horrible. But I was nearly depleted of thyroid hormone. When people today compare T3 to T4, they do so from researchers who used that "3.3 x" comparison when initially measuring the speed at which T3 could lower the signals of TRH and TSH compared to T4.
Hard to compare T4, as it takes time to work and must be converted before useable in that regard.
Even so, it still does give you an idea of comparable strength. Sort of.
You'll have to find out what combination works best for you. If you are not aware, part of your problem with feeling good when adding T3 might be that the T4 you have already taken has built up in your body as unused and thus turned into Reverse T3 (RT3). RT3 can negatively effect how much T3 can make it into the cells.
This can happen if you don't have adequate nutrient levels for converting T4 into T3, the active thyroid hormone needed to be in your cells for regulating all systems of your body.
"Reverse T3 - Optimal levels are as LOW as possible. If >15 I will start thinking about thyroid resistance at the cellular level or that leptin and/or inflammation are blocking thyroid hormone from getting into the cells. In the presence of High levels of reverse T3, your free T3 levels may look falsely "normal"."
Once you begin to realize that you may have interference in getting T3 to your cells, you'll see it's not as simple as routine blood tests to tell your doctor what to do. If he isn't aware of what is going on in your body, then he won't know how to correct it. But you can certainly read about what might need to be done and then suggest the tests to him. Sometimes it's all a doctor needs -- a good push!
I'd suggest you get two tests and tell him that since you take T3 it can affect the validity of routine blood tests. Jut so he knows.
An RT3 test will indicate whether or not you're taking more T4 than your body can handle at this time and whether or not the excess is becoming Reverse T3 which is detrimental to getting thyroid hormone to the cellular level. If you are having issues in that regard, no doubt they are due to low nutrient levels otherwise needed to facilitate thyroid hormone conversion from T4 to T3. When conversion slows down, the excess T4 is turned into Reverse T3. RT3 is normal in the body, but at levels lower than 15. Sometimes much lower than 15 -- much depends on the person.
You can always go back to T4 after getting your nutrient levels closer to optimal. In the interim, you may be able to take NDT, a combination T4/T3 natural product, or T3 by itself until you are able to properly convert T4. For some people, just staying away from synthetic T4 can help for a while. If you later want to go back to it, that should be just fine.
In the long run, you'll find it's far better to go by how you feel, rather than what the routine blood tests state. The RT3 and SHBG tests are not routine. Many doctors don't even know about them or how to read them!
But they are needed when routine blood tests don't tell the whole story -- or an accurate story. This is especially true when taking T3. Routine blood tests were not meant for patients taking T3. Many doctors don't realize that and then react to numbers that are not accurate due to the taking of T3. When they do this, it can be that they chase their tails while you suffer because of it.
Knowledge is power!!
Otherwise, for so many patients, as soon as they begin to feel much better, the doctor wants to lower the very dose of thyroid hormone that is making that happen. Doctors tend to panic as they read TSH results. If they see them as too low (not knowing that most these days actually need their TSH full suppressed in order to feel well). In reality, TSH lower than 1.5 should be completely ignored. There is no proof that low TSH causes harm to the body. Big Pharma pays big money to get doctors to write whatever they wish for them to write. The proof is in the success stories of those who have reversed their hypothyroid conditions or who have become euthyroid and still take thyroid hormone replacement to facilitate it.
Bottom line: I'd suggest you read up on getting an SHBG test as well, so that your doctor can hone in on exactly how much thyroid hormone and what type may work best for you. As hypothyroidism is successfully corrected, everything can change for the better. However, it is rarely thyroid hormone alone that can do this -- unless it is in the early stages of manifestation. Nutrients play a vital role in facilitating thyroid hormone conversion of T4 into T3 (the active thyroid hormone needed in all the cells for our best health). For most, hypothyroidism worsens as their inability to absorb nutrients continues. An SHBG test can help your doctor to stop looking at numbers and instead focus in on other tests that can be a shortcut to healing:
"If your "thyroid" labs look normal, but you still aren't feeling great make sure to check out these common nutrient deficiencies which may also play a role. The truth is your thyroid needs several different nutrients (that are commonly depleted in most people) to function at 100%. Some of the most common include:
Iron - To check iron status you'll need to obtain ferritin (15), serum iron, and TIBC. Iron deficiency results in decreased thyroid function.
Zinc - This nutrient helps T4 to T3 conversion (16) and acts as an anti-inflammatory agent, and may help improve your immune system. A deficiency in zinc leads to a hypothyroid-like syndrome which is ameliorated with zinc supplementation. The best way to determine if you are zinc deficient is with a trial of zinc supplementation.
Selenium - This nutrient also helps with T4 to T3 conversion, may help decrease autoimmunity (17) and antibody levels in Hashimoto's, and is required for thyroid hormone production.
B Vitamins including B2 and B6 - Activated B vitamins are required for thyroid hormone production and the production of adrenal hormones. Stress and other lifestyle factors can increase the demand of B Vitamins and may lead to a deficiency.
Vitamin D - Low levels are associated with an increased risk (18) of autoimmune disease and may also contribute to fatigue (19). " (There are more at the website)
Meaning you really should have your nutrient levels done (at least the ones most important to thyroid function) and tell your doctor what you've read here. He or she should then order them for you. Anyone with thyroid issues no doubt has some level of nutrient deficiency as hypothyroidism reduces stomach acid and thus inhibits proper absorption of nutrients! Hyperthyroidism has a way of burning through nutrients quickly with a sped up metabolism and also can cause low nutrient levels.
Knowing about optimal nutrient levels and optimal SHBG levels is key to ensuring you are taking the right amount -- and the right type -- of thyroid hormone for your needs. It does make a huge difference:
"If you are a woman, you want your SHBG to be in the 60-80 nmol/L range.
Anything higher is considered 'too much' and anything lower is considered 'insufficient.'
How to Treat Low SHBG (how to increase it when it's low)
#1. Get a complete thyroid lab panel
#2. Assess your estrogen/progesterone ratio (especially if menopausal)
Thanks I will check that out. I am supplementing with iron and Vitamin D currently, B12 was above 600 so is good. Will be getting the SHBG test along with total/free testosterone end of the month.
Though B12 may need to be more than 600 for you. B12 has no toxicity level, so no harm done if you go beyond 600.
"Sadly the current lab values of serum B12 grossly underestimate the incidence by using a cut-off range far too low. The current ranges for a common commercial laboratory, which I use are 211-946 pg/ml. Many researchers propose that we raise the lower limit of normal to 550pg/ml, above which is optimal. In my clinical practice, I have seen many patients who have significant symptoms of low intracellular B12 and they still show “within normal range” on serum lab values. Serum homocysteine and methylmalonic acid are much more sensitive markers as they may show a deficiency earlier than serum B12."
Take note of the last sentence above. Some are not aware of those much more sensitive tests. Your B12 of 600 may still be lower than what your body needs. I didn't notice feeling better with B12 (which was almost rock bottom before I started replenishing it), until it was well over 1200. But that's just me. We're all different and must listen closely to what our body tries to tell us.
If you're supplementing with iron, I'm hoping you have done so due to proven low iron serum and ferritin. It's good to get an idea where you are and to keep checking your progress to ensure you are able to absorb it and make use of the iron you take. Iron is somewhat fickle when we have inflammation -- and hypothyroidism can cause massive inflammation via autoimmune dysfunction which can compound.
As I've stated before, inflammation can cause iron to store only and not mete out to replenish lowering levels of iron serum. This can cause a big problem in prohibiting conversion of T4 to T3. Without adequate iron for our individual body, conversion of thyroid hormone can be greatly diminished. I've still got that problem, though I'm making making great strides in reducing inflammation by eliminating foods that feed inflammation, as well as steering clear of household products and cosmetics that increase histamine levels. Foods also can do that, some foods far more than others. But it works! Deep breathing also can help with lowering inflammation by lowering cortisol levels, if that's also an issue. Sometimes it seems daunting, but it isn't. Once you understand what is happening to your body, you can then do what is necessary to control it in as natural a manner as possible. No side-effects with natural remedies.
Also, please be sure to look to Functional Medicine for "optimal" levels of Vitamin D and iron, as well as other nutrients. I'm hoping you take vitamin K2 along with the Vitamin D supplement? It is very important that you do so, if you're unaware:
"If you're taking Vitamin D, it is critical that you consider Vitamin K2 supplementation.
(They) work together to maintain tight control over calcium levels in the body. Vitamin D controls the absorption of calcium into the blood. Vitamin K2 controls where that calcium ends up.
Over-supplementation of vitamin D3 without ample vitamin K2, leads to problems of excess calcium.
If calcium isn't laid into bone, it will find itself in other tissues, like your arteries. Calcium in the arteries is BAD. It contributes to atherosclerosis and vessel stiffness."
It's unfortunate that we have to know exactly what we're taking, as all nutrients are not created equal. But it's fortunate that we learn we must know these things and we build on our knowledge. We're proactive in our health and it pays off in restoring our health without causing a host of other problems during the process. Until we get it right, we will keep searching for the right scheduling of all we need to restore well-being and a euthyroid existence.
I try to find natural rather than synthetic nutrients whenever possible. It's terrible to find out we've taken something that isn't doing what we thought it would do as it was not the right type of nutrient for our needs. I've been there, done that a few times! I finally learned to look to Functional medicine's protocols for help.
So I got the month supply of 25mcg Cytomel from the pharmacy. Cost me zero dollars, got to love Canada!
Whoa, that first whole tablet this morning gave me such a rush. Will see how I feel throughout the day. Will be sure to only split one pill at a time if need be!
Andyb, it's important to start as low as possible with T3. That way you can recognize when you've hit your "sweet spot" with T3. So yes! Very wise of you to think to split the pill into two pieces and take one; then the other half about 3 hours later and see what happens. You should have done that first before taking the whole 25 mcg. I know... hindsight is 20/20, right?
Your body will get used to the T3 and react less as time goes on. The key is to take what is needed at the times that are best to get the most lasting feelings of health from it. So you have to pay close attention to how you feel. If you wait too long, the T3 leave with a feeling that you've "crashed" downward from where you were feeling just fine.
After taking 12.5 mcg. (1/2 the 25 mcg. pill), take notes on how you feel each hour that passes. Trust me, you'll be glad you did. Those notes will become valuable in getting you to where you need to be. Then do the same for the other half, and so on, noting what you took and how you felt with each passing hour. This will get you to hone in on that "sweet spot" so that the T3 can do as much for you as possible.
If you ever feel like you've taken too much (feeling overheated, too warm when you shouldn't otherwise, or hands trembling, or headache), just skip the next dose and your body will soon return to normal. The dose you do take next, make it a smaller dose or increase the hours between doses. You'll find there are many ways to hone in on exactly what your body needs.
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