I have finally been prescribed Euthyral by my French GP. He didn't know what Cynomel or Cytomel was so I couldn't convince him to go down that road (yet).
My question is dosing ... I have been taking 100mcg L Thyrox for the last couple of years and still getting crippling tiredness, sporadic blurred vision, low mood, brain fog.
I suggested to my doctor that I start slowly Euthyral and maybe alternate and he was ok with this even if he thought it unorthodox. We finalised on me taking Euthyral on the weekend and L Thyrox 100 mcg on week days.
I am wondering if this is too much L Thyroxin given my labs and weight 61 kg. I could maybe split my 100 mcg??
My latest labs were as follow. To be noted you have said in the past that my FT3 is low despite high FT4 and I probably would benefit from adding T3. My FT3 has increased a bit since I have been prescribed folic acid due to low folate.
May 2023:
TSH 0.35 (0.27-4.20)
FT3 4.90 (3.10 -6.80)
FT4 24.4 (12-22)
Folate 29 (4.4 -19.8) ... previous result in Feb 2023 : 3.4 (I have stopped the folic acid now as high)
Can you advise. Your help and guidance is very much appreciated.
Thanks
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lovelab
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If you're going to take a T3 containing medication it should be taken every day not just a copuple of days a week. T3 has a half life of 24 hours so it's essential to take the same amount every day.
hi SeasideSusie. Have a question about half life. Does it mean that after 24 hours it reduces to half its original value. Would this mean therefore if you take same dose every day it builds up over time? Thanks for feed back.
I'd like to answer that from the other end of the telescope!
If you do not take the same/very similar amounts every day, the level will drop very substantially.
That is far more the issue than building up.
And, as soon as you speak of building up, it forms the impression that the level could rise and rise and rise. In reality, if only half the dose is left after 24 hours, then you take your next dose, you will at that moment have 1.5 doses in you. But when you have had that for 24 hours, it will have dropped to 0.75 doses. So, with the next dose, you'd rise to 1.75. So the rise each day gets smaller. After only a few days, it is a steady state.
And that is all based on a very simplistic interpretation with mathematical precision unaffected by the variations of biology!
oh right. This is what I was worried about. The Euthyral is 100 T4 and 20 T3. Would it be better then that I take half a tablet each day to start and add in a quarter of 100 L thyroxin?
I didnt have other vits tested. But am always low in vit D too. Have changed to drops under tongue in last 6 months to help improve. My ferritine is always top of range with no supplementation and B12 was not brilliant before mid to low in range last time tested. Will change to B complex as you suggest.
edit :my vit b12 back october 2020 was359 (149-569)
initially I would start with 1/4 tablet Euthyral (25mcg and 5mcg T3 )
To start Reduce levothyroxine to 50mcg …..after 3-4 days add 1/4 tablet Euthyral
Assuming all ok
After week reduce levothyroxine to 25mcg ….2-3 days later increase Euthyral to 1/2 tablet….. perhaps as 2 separate doses - 1/4 tablet waking and 1/4 tablet late afternoon
Retest in 6-8 weeks
Or as Lalatoot Suggests…..drop last dose levothyroxine and add 3rd 1/4 of Euthyral
lovelab as your ft4 is over range you need to reduce your T4 dose by I would say 25mcg so you are aiming for a daily dose of 75mcg T4 plus T3.
It is advised to start T3 slowly at 5mcg daily so a quarter tablet.
A quarter tablet will give you 25mcg T4 and 5mcg T3.
I would Reduce levo by 25mcg and wait a week for levels to drop.
Week 2 Reduce levo by another 25mcg and introduce quarter of tablet of Euthyral.
Wait 1 or 2 weeks to see how things are going.
Then again drop levo by 25mcg and add in another quarter of tab Euthyrol either to first dose or as separate dose.
Wait another 2 weeks and reduce levo by another 25mcg and add in another quarter Euthyrol. By this time you will be on no levo but you will be taking 75mcg T4 and 15mcg T3
Wait 6 to 8 weeks and do bloods. What you do next will depend on your blood results,
thank you. I'll try this. I'll talk to my pharmacist to see if they can help me get my L Thyroxin in smaller doses to do what you say. I so want to try to introduce T3 to see if it helps but am nervous.
All we do with thyroid oral hormones is trial and error so don't be nervous. Be methodical though and note doses and symptoms.It took me 2vyears of methodical changes till I found my doses.
I live in France and I am prescribed Cynomel T3 made here in France by Sanofi. Taking the two i.e. Levo and cynomel it's much easier to sort out the dose. You could go back and ask for Levo and add T3. You can break up the cynomel into smaller pieces and take throughout the day. Most of the pharmacies stock it.
I agree with you but I've already tried and he didn't know the drug. And when I asked my pharmacie they didnt stock it or know what it was either. Given that this is the first time the doctor has even acknowledged my FT3 over here, I was rather taken aback when he said he would prescribe Euthyral. Think he was fed up with me whinging of being constantly tired. The last endocrinlogist I saw who has retired since, got really shirty with me because I paid to have my FT3 tested along with the rest, saying it was totally not representative and refused to even look at it... So as you can see, I'm not being helped much by the medical profession in my area.
I have been prescribed T3 in both parts of France, the first near Poitier and now in Brittany. When I took my first prescription for T3 into the Pharmacy they had never heard of it and had to order it in for the same afternoon, they then keep it in stock for me that was over 7 years ago now. I rarely visit the GP now and never visit an Endo either if I can help it. Lets hope that you do well with the new one.
Yes I agree it's not always easy with GP's or Endos. Give it your best shot and hope that it works. It will be interesting to see please keep us in the loop,
I did forget to say that these tablets were scored so slightly easier to make smaller to start with. To find your correct dose with these tablets is not easy they are Merck and if you look them up you can read how many people take them. There was always 100 in a pack are they still the same. You already take 100 Levo and probably only need a little T3 to make all the difference. I would go back to the GP and ask for the Cynomel.
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