I recently began adding cytomel to my levoxyl because I still had hypo symptoms (brain, fog, fatigue and muscle/joint pain with stiffness) for years in spite of my family doc increasing my levoxyl dose and having a very, very low TSH level. I went to an endo and she I asked her to put me on cytomel,too. I began a daily combo therapy of cytomel/levoxyl this past fall. Right now, I take 112 mcg. of levoxyl around 6:30am along with 5 mcg. cytomel, then I take another dose of 5 mcg. cytomel at 11:30 am and then about 2.5 mcg. cytomel at about 4:30 pm. Dr. Pepper what do you recommend to your patients would be the best time to get your TSH, Free T3 & Free T4 tested? My last labs I held off taking my morning dose of both meds and got my blood drawn at 7:oo am and then took my morning doses of cytomel and levoxyl. Is this how you recommend your patient's do their labs. I have read that this is the best way and my doc agreed but I read that one must take a lab several hours after taking the cytomel dose to make sure you are not taking too much and making yourself go hyperthyroid for a time. I have been taking my pulse several times a day prior to dosing and an hour or two after. The range at rest has been between 62 and 86 never above or below. I also have had no palpitations or other hyper symptoms. Dr. Pepper, I would appreciate your insight on this matter.
Thank you, PKM
What is the best time to take labs on combo. cytomel/levoxyl therapy ?
(3 posts) (2 voices)-
Posted 6 months ago #
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PKM
I am curious to know if the addition of Cytomel has helped you. That is probably the most important piece of information of all. I see you are putting a lot of effort into creating an ideal thyroid environment for yourself. Taking Cytomel three times daily as you are doing is likely to provide optimal results but few people want to put that much effort into it.
When assessing the effectiveness of t4 plus t3 therapy I primarily want to know if the patient's symptoms have resolved and if side-effects of the treatment have popped up. You seem to be doing a great job of tracking those items. I am less concerned about the value of individual t4 and t3 levels at specific times of the day since these values can be highly variable, particularly t3. The over-all long term effect of t4 and t3 on biologic function is determined by examining the TSH level. As you probably know, regulation of TSH is a complex event controlled by the hypothalmus portion of the brain in concert with the pituitary gland. This axis is the central processing area for almost all endocrine events in the body. TSH has a minor daily rhythm (circadian rhythm) and changes slowly from day to day in response to the combined effect of t4 and t3 levels in the blood. I don't want to set any values out here for the acceptable lower TSH level as individual factors play a key role in where I draw the line between healthy and unhealthy.
I hope this info helps.
G. Pepper, Editor-in-Chief, The disclaimer of metabolism.com applies to this and all my posts on this website
Posted 6 months ago # -
Dr. Pepper,
Thank you so much for your reply. Initially I was adding 5 mcg. cytomel three times a day at the times I stated above. I then had my labs done in the early morning prior to any meds as I stated above and my TSH was .05 (range .4-5.5), Free T3 was 3.5 (range 2.1-4.7) and Free T4 was 1.1 (range 1.0 - 2.0). I have to say I was having some improvement with fatigue about 25% - 30% if I had to estimate. I use to have to take a mandatory 1-2 hour nap at least in order to function. Now I am still greatly fatigued but at least now I can leave the house for greater stretches of time and can push on through.However, if I need to go out after dinner I must take a nap.
My doctor didn't seem too concerned with my low TSH because I was having no hyper symptoms and also my Free T3 & Free T4 were not in the high range. I told her that I read that having too much medication and a low TSH can also cause fatigue and she agreed. So I suggested cutting the last cytomel dose in half to bring the TSH back up a bit. I wanted to try being around 1.0 -1.5 because I have been at the very low end for the last several years and it has not worked. If anything my all around symptoms have gotten worse. However I have only been just on a T4 med. We did discuss perhaps we could also increase the T4 and cut back on the T3 if need be.
Decreasing the third T3 dose has definitely notched up my fatigue a bit more especially by dinner. On occasion I have missed the last dose altogether and am flat out exhausted only to realize the reason why,it was I missed the dose. Taking meds 3 times a day is no fun but I liken it to a Type 1 diabetic and their need for insulin, which I think must be even more of a challenge than popping a pill. So I can't complain.
Do you ever let your patients TSH remain down around .05 if they are not having hyper symptoms? I know they keep thyroid cancer patients TSH suppressed and I read that the research shows them having no osteoporosis risk as a result.
Thank you so much for your response?
Sincerely, PKMPosted 6 months ago #
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