Zeroing in on optimal dose of Synthroid/Cytomel combination.

[susanmhall62]

I've been tinkering with different thyroid drugs & doses since the NP Thyroid went sideways in March 2020. I think I'm close to my optimal dose and the good news is that the RT3 decreased from 32.5 to 23.8 mg/dL.

Current dose: 112 mcg Synthroid & 20 mcg Cytomel. Background is that I had a full thyroidectomy due to papillary thyroid cancer in 2004.

T3, Free 4.3 (range 2.0-4.4 pg/mL)

T4, Free 1.43 (range of .82-1.77 ng/Dl)

Reverse T3, Serum 23.8 (range of 9.2-24.1 ng/dL)

TSH 0.007 uIU/mL (range of 0.450 uIU/mL-)4.500 uIU/mL

Vitamin D was tested and it's at 61.6 ng/mL (range 30.0 ng/mL-100 ng/mL)

The doctor wants to reduce my dose to 100 mcg Synthroid & 10 mcg Cytomel. She's still talking about low TSH, bone loss & atrial fibrillation. I might be ok with a small drop in Synthroid but I feel like I need to continue with the higher dose of Cytomel to drop the RT3 lower in the range.

Re symptoms I feel better but not as well as I did on NDT. I'm walking 4 miles five days a week but running has been problematic. I'm taking Thorne Lysine L for hair loss and it's slowed down quite a bit.

Any insights are appreciated. Thank you in advance!

[jrbarnes]

Same here with the NP Thyroid and I've been having a difficult time with sorting out the Levo/cytomel combo. My lab uses the same reference range for T4 and I'm currently at 1.6 on 88mcg of Levoxyl. I tried to decrease to 75mcg plus 12.5mcg of T3 but it probably wasn't enough T3 to compensate. Currently I'm trying to add T3 onto the 88. So far, I haven't felt any of the benefits that I got from NDT. I suspect that once you go back to synthetics it takes several months to get normal again. I don't agree with reducing the Synthroid and cytomel. I'd try to add an extra 12.5 mcg of Synthroid one or two days a week for 6 weeks. Even though the T3 is the most important I find that I need my T4 to be higher, in fact unless my T4 is over the range at 1.9 I'm barely able to function. I had a partial in 2007 and the other side doesn't work well so it's like not having one at all.

When you add over a certain amount of T3 to Levo it will dramatically reduce the TSH but you don't have a thyroid anymore to stimulate so ask your Dr why it matters? It would only matter if you still had a thyroid and you had hyperthyroidism because then it would actually be secreting too much hormone. Not having enough T3 is responsible for heart disease, stroke, kidney problems and the list goes on. It boggles my mind why Drs are still trying to dose by the tsh when a patient doesn't have a thyroid any longer!

[susanmhall62 in reply to jrbarnes]

I feel like they think they aren't doing their job it they don't tinker with your dose usually by lowering it.

[jrbarnes in reply to susanmhall62]

Tinkering is exactly how I would describe what they do

[Batty1]

I think you should lower you T3 because your FT3 is almost at the top of the range and instead of doing the 20mcg drop to 15mcg.... a lot of people here don’t give too much thought about reverse t3. Just a thought .