What should I do with tirosint and cytomel? - Thyroid UK

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What should I do with tirosint and cytomel?

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I’m in a perilous situation, lab are in range reference, could use advice on tirosint and cytomel.

The question being that when I am cytomel 5mcg and tirosint 50mcg that I am able to function on a better level. I am prone to memory problems, tiredness and depression, mainly do to my tsh dropping a lot on both hormones, If I get off cytomel comes with fatigue, anxiety and paranoia.

I don’t understand, If I get off cytomel then why am I still miserable. It’s like my thyroid free t3 drops to t3, thereby I feel like dim witted and depersonalized. Of the things I notice is low TSH, don’t tell me low TSH, has no clinical value because every form of research study says otherwise. Do I need to bring my tsh at level like 1.0. Sorry, I know this post is terribly long, but I had to be specific on my case.

Previous Labs

TSH .33 range 0.40-4.00 (low)

Free T4 1.3 range 0.80-2.0

Free t3 4.1 range 1.0-4.0

Reverse t3 22 5-25

Present Labs

Last range TSH 0.49 range from 0.40 to 4.00

Free t4 1.3 range from 0.80-2.0

Free t3 3.2 range 1.0-4.0

Reverse t3 20 range 5-25

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30 Replies

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Angel_of_the_North6 years ago

The only way to increase TSH is to stop taking thyroid hormones, which is going to make you feel worse, and even then it might not rise. The reason older studies go on about TSH is because it used to thought that everyone's TSH was a perfect reflection of their thyroid hormones and it is a lot cheaper to test jut one thing. However, more modern studies have realized that TSH level is very individual thing and is not a reliable method of extrapolating free T4 and free T3. Studies that say low TSH causes heart disease and osteoporosis neglect to day that they didn't check whether the people with very low TSH also had very high thyroid hormones. And so on. i suspect that many people with thyroid disease have less than perfect pituitary glands which means that their TSH is not a reliable measure of anything. TSH does help to drive conversion from T4 to T3, but as you are taking T3, that shouldn't really affect you. Were both blood tests done at the same time of day, fasting? TSH has never been shown to affect memory unless thyroid hormones are also too high or too low. However, you need to have optimal levels of B12, folate. ferritin and vitamin D in order to feel well and utilize thyroid hormones. Are yours good? Are you dieting?

• in reply toAngel_of_the_North6 years ago

You made a good point on tsh, peer reviewed articles posit the same point, as I had tsh really low, it didn’t really affect me too bad.

I had fasted at my labs. Last time, I changed my vitamin b-12 was 800 range 400-1100, my folate was good and my vitamin d was low like 22 on a range of 40-100. I know these numbers, by the way are off hand. I think about the vitamins, because my labs were low on vitamin d.

danym6 years ago

maybe just reduce cytomel to half and take 2.5 and see how you feel. I feel better when my tsh is between 0.5-1 and my ft3 above 3. Your labs look good to me. Have you tested your vitamins,

• in reply todanym6 years ago

Danym, as you said on the vitamins, it’s probably time checking them, perhaps my symptoms are caused by low vitamins. It’s fascinating you mention vitamins, it’s basically I felt something wrong. It was my cells not taking up, all of the hormones, which I will get some labs done.

danym• in reply to6 years ago

let us know what you find out

• in reply todanym6 years ago

Thank you, Danym, I will let you.

SilverAvocado6 years ago

When dosing thyroid hormones symptoms are the most important thing. Blood tests are always an approximation, and the ranges are even more of an approximation.

If you felt better on the previous dose than the current dose there is really nothing wrong with those blood tests. Most people on thyroid hormone replacement will need a suppressed TSH. Your TSH in the previous set of tests is not very low at all. It's a teensy smidge under the range.

FreeT3 is a more useful blood test than TSH, because it measures the actual hormone in your blood, whereas TSH is a response by your pituitary, and no one is testing your pituitary to see how accurate and healthy it is. Your freeT3 is also a teensy bit over the range here, but it's so small it hardly matters.

It's up to you to decide whether you want to use a dosing strategy that tends to keep a lot of people ill (dosing by keeping the TSH inside the range), and if you do so you will probably also stay ill, or whether you want to evaluate using your own symptoms and feel better.

If you're not comfortable with the evidence of your own symptoms, there is still the possibility to juggle this dose a bit further. The two obvious options are to cut those tablets and have 2.5mcg of Cytomel per day in addition to the Tirosint. OR you could stick with 5mcg or Cytomel and try reducing the Tirosint by 25mcg (this is equivalent to about 5mcg of Cytomel).

• in reply toSilverAvocado6 years ago

Silver avocado, Yeah it’s a dosing balance, I feel somewhat than I have in many years, as far cytomel dosage, it’s differently time to talk more with my doctor on it. Do you know anything about reverse t3, like does it play a role in blocking t3 into the cells?

SilverAvocado• in reply to6 years ago

Previously it was thought that reverse T3 blocked T3 from getting into cells. But it seems to be completely up in the air at the moment, and nobody knows.

• in reply toSilverAvocado6 years ago

Yeah it seems theoretically!

guysgrams6 years ago

Looks like your FT3 from your current labs could actually be higher. Maybe need more of T3 than you are currently taking. Have you tried to increase the T3 at all?

• in reply toguysgrams6 years ago

Hi guysgrams, I haven’t got an t3 increase yet i will ask my doctor in 2 weeks, if she is willing to go up on my cytomel.

danym• in reply to6 years ago

how much t3 and t4 are you taking now?

• in reply todanym6 years ago

I was taking 50mcg of tirosint (levothyroxine) and 5mcg cytomel (liothytonine). I have to say that I feel my memory had diminished.

danym• in reply to6 years ago

are you still on that dose or did you increase it?

• in reply todanym6 years ago

Well I am on going to stick with the tirosint. I believe it could be my body, however, it’s adjusting to the hormone level changes. I had a high rt3 ratio and reverse t3, although my labs have improved with a reverse t3 of 20. I need to get my rt3 down a little more, I should be fine with a lower rt3.

danym• in reply to6 years ago

how do you lover your rt3, i had the same issue on levo meds

• in reply todanym6 years ago

Hey I just say your response, I think you asked on measuring your rt3?

danym• in reply to6 years ago

were you able to lower your rt3? I was asking if you know how to lower it.

• in reply todanym6 years ago

I will get my new labs back on Monday, I will let you know the results. Based on my old labs my rt3 went from 24 to 20. I am praying that my rt3 drops lowers, for my ft4 to convert to ft3.

• in reply todanym6 years ago

Tsh came back at (1.14) 0.4-4.5

Free T3 is (3.3) 2.3-4.2

Free T4 is (1.4) 0.8-1.8

Reverse (12) 8-25

danym• in reply to6 years ago

these are great numbers, how do you feel and what meds and doses were the tests on? did you take the meds in the morning before testing?

• in reply todanym6 years ago

I feel better than the last few months. I am hoping to keep up, with all the improvements.

danym• in reply to6 years ago

what dose are you taking now? what do you think decreased your rt3?

• in reply todanym6 years ago

I’m only taking tirosint 50mcg. I think decreasing my thyroid meds, the originally high dosage caused the rt3.

• in reply to6 years ago

I was on both tirosint and cytomel. I dropped the cytomel, starting to feel normal. I am still working back my way back, getting to my normal.

danym• in reply to6 years ago

when you did the labs were you still on cytomel? my ft3 is very low and ft4 is very high on t4 meds only, which increases my rt3, I'm trying to find something to help with conversion, as I don't tolerate cytomel

• in reply todanym6 years ago

The labs were done without cytomel. How long have you been on t4 hormone?

danym• in reply to6 years ago

5 years, trying ndts now, I'm on armour, but I don't feel well on it either