Hi everyone! I need your opinion please. I’m on T3 only (brand name Cytomel) and have been slowly titrating up. Got up to 30mcg daily and developed pain around the liver, stomach pain, elevated liver enzymes, and slightly enlarged liver as shown on ultrasound last week. Doubted it was Cytomel and assumed maybe it was the corticosteroid I’m on for secondary adrenal insufficiency and/or not enough steroid. Increased Cytomel dosage by another 5mcg and the pain worsened. Lowered dosage by 5mcg and then another 5mcg and pain continually starts within 30 minutes of ingesting. Skipped Cytomel today and no stomach pain. On the Pfizer website, it says elevated liver enzymes can occur but mostly likely due to overdose. My labs show my T3 only 50% thru range so I can’t believe I overshot my sweet spot. Do you think it’s a filler issue? I cannot tolerate synthetic T4, so the only other thing I have in the house is 1 grain Armour. If I switch to that, should I start at 1 grain? I can’t live with this pain around the liver. Thank you.
Cytomel and Liver Pain/Elevated Liver Enzymes - Thyroid UK
Cytomel and Liver Pain/Elevated Liver Enzymes
I may be wrong here, but I've always been told that the liver has no nerve endings, so can't hurt. Are you sure it's not your gallbladder? Gallbladder stones are a frequent symptom of hypothyroidism.
Gallbladder was removed years ago and ultrasound just showed no problems. Liver is swelling and that’s probably the pain I feel as it presses. Worsens significantly after ingesting the T3. Trying to increase to get past 50% in range but pain becomes unbearable. Wears away once the T3 wears away.
Well, the T3 doesn't wear away. It has a half-life of about 24 hours in the blood, and what gets into the cells stays there for about three days.
Do you take your T3 with or without food? Do you take anything else at the same time?
What does your doctor say about your swelling liver?
I take it without food, about one hour after my hydrocortisone. Then I wait about an hour and eat. Nothing else medicine wise until my next hydrocortisone dose 4 hours later.
The doctor didn’t seem concerned about the liver only because the same thing happened last year when I trialed T3 and Cortef. A lot of tests and scans were done at that time and everything was negative. Took me off of the medication and everything went back to normal except of course adrenal insufficiency and hypothyroidism worsened and sent me back to being bedridden .
I don't know if this has anything to do with your pain, but you're taking your HC too close to your T3 - or the other way around. They should be at least two hours apart. But maybe it's not the T3 causing the pain, maybe it's the HC. And, of course, HC does cause water retention, so maybe that has something to do with it.
Do you have Addison's? How many doses of HC do you take in the day?
Come to that, how many doses of T3? How much T3 are you taking?
Oh wow really? My doctor always said to give the HC an hour to get into my system and then take the T3. I take 30mcg of T3 daily. I’ve tried splitting it but never felt good, so I take it all in one go in the morning. Occasionally I will add 5mcg at bedtime, especially if I had an active day and it helps me sleep great. On that dose I’m about 50% thru the range. Lately with the pain I tried splitting it again, but it makes me feel worse.
As for the HC, I take 10mg upon waking and then 5mg 4 to 5 hours later. My doctor wanted to leave me on a lower dose than that, but I couldn’t function. I don’t have Addison’s but I do have secondary adrenal insufficiency. Pituitary stopped sending out the signals for an unknown reason. I thought it could be the HC raising the enzymes as well as I know corticosteroids can affect the liver, but I don’t have any pain when I take it and leave off the Cytomel for a day. Still could be the HC. In which case, not sure what to do since I need it. Last year when I was trialed on steroid, I had methylprednisolone and thyroid hormone.
Well, I'm afraid doctors don't always really know these things. We always say that other medications/supplements/etc. should be at least two hours away from thyroid hormones. I don't know how long it takes HC to get into the blood, but to be on the safe-side, always leave two hours.
Taking an extra 5 mcg T3 from time to time is not a good idea. For T3 to do what it's supposed to do, you should take exactly the same dose every day. So, why not take 35 mcg every day? 50% through the range is a bit low. Most hypos need it higher than that. Have you tried taking all your T3 at night, so that it's well away from the HC?
I don’t have Addison’s but I do have secondary adrenal insufficiency. Pituitary stopped sending out the signals for an unknown reason.
OK, so you have a pituitary problem and your ATCH is low? Is your TSH also affected? Have you had a 24 hour saliva cortisol test? If so, what were the results? Are your adrenals making any cortisol?
Thanks for your thorough reply. I have not tried taking the full T3 dose at bedtime only because I feel that my cortisol isn’t high enough to support it then. I certainly could give it a try when there is a morning I don’t need to be somewhere in case I wake up dreadfully ill from the low cortisol. I’m sure I need an increase in my hydrocortisone as well. I don’t feel like it’s strong enough to get through the day.
My ACTH is always at 6 (lowest number in the range) and my saliva test was low all day, but under range in the morning and the lowest part of the range at the three other times in the day it was measured. The low ACTH and low cortisol finally pushed the doctor to diagnose secondary adrenal insufficiency. I have had hypothyroidism for about 10 years now, so my TSH was low (highest was 7.0) before treatment. My growth hormone was also low when I had my cortisol test. All pituitary hormones I’m told. My adrenals can make cortisol as evidenced by the ACTH stim test, so not Addison’s, but they don’t make enough on a daily basis in order for me to tolerate my thyroid medicine without adrenal crashes. Those were happening the last 4 years, but have stopped now that I’m taking hydrocortisone with the thyroid medicine.
So, does your doctor not think you ought to be taking more HC throughout the day, to mimic the natural secretion of your adrenals? Not necessarily a high dose in the morning, but further small doses are regular intervals. That is normally what is done for secondary adrenal insufficiency. He's treating you as if you had adrenal fatigue and were going to get better. But, if the problem lies with the pituitary, then you aren't.
Silymarum (common name Milk Thistle) is a liver detox and may help you. You can get it from Holland & Barratt. It cleanses the liver and makes it work more efficiently. Even if it does not help, it will not do any harm and is very good for the metabolism and helping to lose weight. However, do not take it for more than three months in any 12 month period.
A word of caution also - do not eat peanuts and only eat rice if it is very freshly cooked. Both tend to grow a mould which causes liver cancer and they have to be very very fresh but quite usually are not. Never ever re-heat rice.
Thank you! I did buy some but I haven’t tried it yet. The bottle says take one capsule with a meal. Is that how you take it? I was contemplating taking it with dinner.
I usually take it after breakfast plus at any other time I can remember. On the Solgar tablets from Holland & Barratt, you can take 1 to 3 capsules per day. I am not sure there is any added benefit in taking 3, so I usually take 1 capsule once or twice per day. You can tell if it is working because you start to feel a bit slimmer.
If you are having noticeable liver problems, I would suggest you ask the GP for some liver blood tests. Liver cancer is very easy to detect by a blood test and very curable at most stages as the liver regenerates. However, this may not be the case if left too long.
Thank you! The belief is my liver enzymes are elevated due to my medication. Ultrasound last week was normal and I had many, many liver tests last year and they were all normal. If we stop the meds, everything resolves.
I think you need to be careful regarding milk thistle and thyroid issues.
Silychristin, a Flavonolignan Derived From the Milk Thistle, Is a Potent Inhibitor of the Thyroid Hormone Transporter MCT8
healthunlocked.com/thyroidu...
There have been other posts as well.
Hi.I wonder would it be worth having a liver profile bloods done. I have hashimoto since I was 14yrs. 2 yrs ago I developed severe fatigue and raised LFTs. I'm positive for auto mitochondrial antibody (AMA) and M2 positive, diagnosed now with PBC, primary billary cholangitis. It often goes with hypothyroidism.
Maybe ask gp for these blood tests 🤔.
Take care.
Good day, in your comment you mentioned some blood tests that can be asked from GP.
I have Hashimoto for more than 11 years and my GP only checks my TSH and T4 (thyroid wise). I was never referred to the endocrinologist though I was asking for it.
Just wonder if you are talking about private GP with whom you can get more blood tests done and get a better picture of what is happening in the body or there are ways to somehow get them from the NHS?
Hi, I'm in ireland and our gp does private and public. I'm private.So the bloods are lfts, AMA that's (anti mitochondrial antibodies)and m2 , that's specific to PBC.
I'm not sure about your Doctors and NHS. But if there is a risk of an underlying condition surely your gp should do those bloods. PBC is rare and AMA bloods are not in the usual autoimmune bloods panal, but with raised LFTs and history of thyroid disease AMA should be checked.
I hope this is helpful.
Take care
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