In December 2018, I sent a message to my PCP: "I continue to be plagued by worsening hair loss, nails splitting, dry skin, fatigue, under eye swelling, neuropathy, foot cramps, cold intolerance, heat intolerance, weight gain and difficulty losing weight, constipation, brain fog, loss of outer eyebrows, tingling in hands and feet, as well as Reynaud's phenomenon." I have been taking 175 mcg Levothyroxine for several years.
Testing revealed my Free T3 was under range at 1.9 pg/ml. TSH and FT4 were both in range at 1.79 uIU/mL and 1.5 ng/mL, respectively. My PCP agreed to start a trial of Cytomel (T3). To my surprise, I received a supply of 25 mcg tablets. I had been expecting 5 mcg tablets.
On December 31, I sent a message to her: "I decided to titrate my dose of T3, and have been taking 1/4 of the 25 mcg tablet per day. What I have noticed so far is that my bowel movements have become regular. I plan to increase to 1/2 tablet next week."
On February 12. while I was still taking less than a full tablet, my FT3 had increased to 3 pg/mL, while TSH went down to 0.108 uIU/mL. In March, TSH had gone down to 0.01 mIU/mL, FT4 was down a little to 1.5 ng/ML, and FT3 was at a very nice 4.2 pg/mL, in the top quadrant of the range. Not much later, she phoned to say that she was concerned about how low my TSH had gone. I had noticed a few palpitations, so I agreed to cut the dose of Cytomel in half.
After I saw the lab results from April, I wrote to her: "Back at the beginning of April, I may have spoken too quickly when I suggested lowering the dosage of Cytomel to half of a 25 mcg. tablet. My blood tests of 3/19/19 were actually ideal, with free T3 and free T4 both near the top of their ranges. I had already noticed improvements in many of the hypothyroid symptoms I reported when we began this journey.
After I began taking the lower dose in response to your concern about the low TSH result, only one symptom continued improving -- I no longer suffer from frequent constipation.
But my hair has gone back to being dry and breaking off, and both thumbnails and the middle nail on my left had are still splitting vertically, with no evidence they are growing back as normal nails. Also note that the lab result of 4/19/19 while on the half-dose shows that FT3 has dropped from 4.2 pg/ml to 2.9 pg/ml (only 37% through the range). So apparently a drop of 12.5 mcg per day (50%) was too much for my body to handle well."
She agreed to provide me with a prescription of 5 mcg tablets of Cytomel. I discussed taking 3 per day to raise my daily intake to 15 mcg. As it happens, the pharmacy sent me 90 tablets, with a direction to take 1 per day. At the rate of 3 per day, those would be gone before it was time to retest blood levels. My solution was to take half of one of my remaining 25 mcg tablets, adding one of the 5 mcg tablets in the afternoon. Thus my new dosage worked out to 17.5 mcg per day.
When she had me retested in May, she forgot to specify FT3 in the lab order. All I could tell from those results is that things appeared to not have changed from April. I saw her for a bronchitis attack at the beginning of July, for which she prescribed doxycycline, 5 days of Prednisone, and benzonatate. She renewed my Ventolin inhaler prescription. I decided to wait until all these drugs cleared my system before retesting, because being ill can affect thyroid lab results, as can some medications.
Now that she has seen my results from July 29, she wants to call me to discuss a change in medication. How much do you want to bet that even those the TSH has (nominally, I'll admit) improved, she wants to reduce meds to bring my TSH up to a "healthy level." No, those aren't her words, but that's the way the endocrinologists have the medical world oriented: TSH, and only TSH results show how healthy your thyroid is. Both FT3 and FT4 are lower than they were in April.
How do I feel? Well the improvements in my digestive system and weight have managed to stay will me and I have managed to lose a little more weight. The hair, nails, fatigue, etc., etc. are still problematic. I still need a nap every day, despite getting at least 7 hours sleep at night.
My goal (since FT4 is doing fine) is to bring my FT3 level up to at least 3.8 pg/mL. I want to go back to taking a full 25 mcg tablet of T3. I hope meeting this goal will bring along my other hypo symptoms.
Comments? Convincing arguments?
Labs opinion
Different lab results on Same dose. Conflicting free assays. 
2 Months since partial thyroid lobectomy.
