Six Months later - upcoming meeting with my MD (input needed)

[Joyya]

[lab tests are from October 2022]

So, it is 6 months later and things were going well on 0.075mg Synthroid (75 mcg) and 15 mcg Cytomel divided over 3 daily doses.

I have been diligent with supplementing iron using a heme polypeptide every second day, alternating with zinc w/ copper and of course taking highly bioavailable B vitamins, vitamin C, selenium, Mg, ample Vitamin D along with K, etc. away from meds.. Human nutrition is my field, so this part I understand well.

The last 6 weeks I was feeling more tired, especially in the late afternoon, evening — despite taking 5mcg Cytomel at 4pm.

After some reading in the literature, I moved my Synthroid dose to before bed which helped my daytime energy significantly, but I am still getting the late afternoon evening slump. I take my Synthroid at 10 PM, Cytomel at 4 AM, 10 AM and 4 PM (with the larger dose at 4PM).

When I met with my doctor 4 months ago, he was willing to raise my thyroid meds based on how I felt, but I was continuing to improve and wanted to wait. I made an appointment to see him next week to discuss med adjustment.

Since I have to pay out of pocket for all tests he doesn't feel we should run TSH, fT4 and FT3 unless I have significant negative symptoms, like palpitations, etc. He is fine with "tweaking" my meds based on how I feel. (I know, amazing, right?).

While running a thyroid panel, hematology panel, ferritin and iron panel makes sense and adjust based on that, if he'd rather "tweak" my current dosage based on symptoms (knowing I got the nutrition end), here are my questions:

1. Would raising Cytomel by 2.5 mcg per day divided over the same 3 times of day help the late afternoon / evening exhaustion the most?

2. Would it make sense to increase Synthroid, since taking it at night seems to work much better? If so, by how much?

Thanks as always for your valuable input.

Joyya

[SlowDragon Administrator]

FT4: 14.4 pmol/l (Range 10.6 - 19.7)

Ft4 only 41.76% through range

Makes sense to increase Levothyroxine (Synthroid) as next step

Perhaps initially 25mcg and 50mcg alternate days

[Joyya in reply to SlowDragon]

I was thinking that and greatly appreciate the confirmation coming from someone with your knowledge, thank you!

Correction: current dosage is 0.075mg Synthroid (75 mcg) and 15 mcg Cytomel divided over 3 daily doses. I edited above.

So, 75 mcg (0.075 mg) Synthroid alternating with 100 mcg (0.1 mg), right?

[Imaaan in reply to Joyya]

I'd be more inclined to try 88mcg. If I recall it's a green Synthroid tablet.

If the dose increase is too much on your system, you might want to split it in half and take 44mcg in the morning and 44mcg at night

[Joyya in reply to Imaaan]

Yes, it does come in 88 mcg strength, thank you! And splitting into two makes sense except I read it is better absorbed over night, and I feel much better taking it at night.

SlowDragon Is there an advantage of alternating 75 mcg with 100 mcg over 88 mcg daily? I know with iron absorption, every second day is better absorbed than daily, so perhaps there is a reason for alternating. What would you recommend in terms of titrating up, given there is a 88 mcg dose?

SlowDragon could the Low T4 be the reason my muscles feel so sluggish again (hard to get up from a chair, exercise is very difficult)?

[SlowDragon Administrator in reply to Joyya]

Many of us prefer to take same dose everyday …so 88mcg daily rather than alternate 100mcg and 75mcg

And similarly splitting dose levothyroxine as half waking and half bedtime might suit you ….but might be better as single evening dose

Trial and Error what suits each person

Only change one thing at a time

[Joyya in reply to SlowDragon]

Thanks.

Yes, that's good scientific method. Since I already have the 0.075 Synthroid, I'll probably ask for the 0.100 so I can play around with dosages and timing.

Appreciate both yours and Imaaan's input.

[Imaaan in reply to Joyya]

Forgot to mention earlier that your ft3 hasnt budged since your last lab work. You might want to consider adding an extra 5 of your cytomel to your t3 regimen and take 88mcg of Synthroid

[Joyya in reply to Imaaan]

That is the old blood work from October. I will ask for new ones, although he is fine adjusting on symptoms.

[Gingernut44]

Personally, I would go for a 25 mcg increase in Levo but if you think 88 would suit best, get extra 25 mcg tabs and split into halves to make up to 88 then you have the option. Whichever you choose, retest in 6/8 weeks and go from there. Your current FT4 is less than halfway through the range so you have scope to increase.

[gabkad in reply to Gingernut44]

Synthroid is a biconvex tablet. These can't be split in even halves. At best, they break into 2/3 and 1/3 of a tablet. I think the tablet design is done on purpose and also why 'odd' strengths like 88, 112, 137 are available. (I'm not sure though if 137 is still being made.)

[Gingernut44 in reply to gabkad]

Point taken, we only have tabs in 25mcg + strengths, 25, 50, 75 and 100 here, in general, so my mistake. I still stand by my opinion that an increase of T4 to 100 mcg per day would be my choice.

[gabkad in reply to Gingernut44]

Yes, I am aware that in the UK levothyroxine tablets are flat and advice given to cut them in half is valid. Over here the manufacturer has decided that splitting tablets is too inaccurate, so they make sure to make them entirely impossible to split in half.

[Joyya in reply to Gingernut44]

Thanks for your input. Since Synthroid is so inexpensive (compared to the price of Cytomel) and cutting is not possible, I think I will probably go to 88 mcg and retest in 6-8 weeks.

[Imaaan in reply to gabkad]

I've taken Synthroid over 20 yrs and each tablet come with a scoreline that makes it ideal to be split in half. Also, the scoreline means the medical ingredients in the tablet are distributed evenly on both sides All you need is a pill cutter. I've taken split tablets on and off through out the yrs. This last yr I was on NDT and a quarter tablet of 25mcg Synthroid... meaning I was successfully cutting the tablet into 4 pieces.

[Joyya in reply to Imaaan]

That's good to know, thank you!

[Gingernut44]

I hope it works out for, good luck.