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Dr. Bob is Robert Hsiung, MD,
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Posted by tealady on July 31, 2004, at 17:52:59
In reply to Cytomel short half life?, posted by gardenergirl on July 31, 2004, at 15:47:22
> I started Cytomel (25 ug) about two weeks ago. This is intended as an adjunct to Nardil for atypical depression. I also take Synthroid (50ug) for hypothyroidism. My TSH in April was 2.25.
Hi, I'm not thinking very well today, but I'll attempt to give a rough answer..hope it helps a bit.
I'm assuming a TSH of 2.25 was when you were on synthroid 50ug? for at least 12 weeks...OK?If so adding in 25ug of Cyotomel may have been OK..but usually not in one go...like in 5ug steps may have been the way to go.
The reason (as you kinda guessed) is Cytomel has a short half life..so its max. level in your blood is reached in about 2 to 3 weeks (may not be quite accurate as my brain isn't working, sorry).
So assuming you have now reached around the plateau for T3 and t4 meds...you are probably, as you guessed, a tad hyper. The reason is your ownhypothalmus and pituitary haven't as yet had a good chance to adjust to the increased level of thyroid meds in your body..it usually takes up to 3 months, but somepeople are a lot faster...which is why it's usually advisable to go onto thyroid meds gradually with a TSH in the 2's.The T3 of 25ug is arguably "equivalent" to T4 of 100...so your "total equivalent" may be approx 150ug..like its the same as adding in an extra 100ug of T4 in one go..except that the T3 (having a shorter half life) reaches its plateau faster in your body.
Guess what I'm trying to say is you still have your own thrypoid hormone in your body PLUS what you've taken...so that is why you feel (are probably) a tad hyper. If it was me, I'd go and ask for a test of FT3, Ft4 to check this out like on Monday. Then I'd probably stop the t3 for one or two days (to let the levels drop, length depending on my symptoms) and restart on only 5ug a day and build up every couple of weeks..depending on how I felt..but discuss this with your doc. This allows more time for the feedback to reset your own thyroid output.
>
> Since I started Cytomel, I have noticed the following symptoms, and I wonder which, if any, are side effects:
>
> 1)I've had a headache for a few days that is not quite a migraine, not quite a sinus headache. It's definitely not a tension headache, eihter. More like one sided pain in the frontal area. It feels like my head is like a bowl of jello, and the lining of my skull is a raw nerve...so when I move my head too much, the jello goes splat against the nerve and ouch! Tylenol doesn't help. My BP is still within normal limits (125/75 at its highest).
I get a something like a mild "tense" headache..it's not like anything else..not like a migraine..and its right at the very front of my forehead when I'm too high on T3..only had twice ..and last time was about 9 months ago..so I've forgotten exactly what it was like, sorry..but I know the frontal headache is a common sign that you are a bit hyper on the T3
>
> 2) I am much more sensitive to the effects of caffeine, especially in the a.m. I read somewhere that cytomel can actualy push someone into hyperthyroidism for a few hours after taking it. Also, the epinephrine in the novacaine I got at the dentist yesterday morning caused tachycardia and tremors for about 15-20 minutes. Ugh! Especially cause I have to go back in two weeks.
That's normal..everyone usually has to cut down caffeine..actually you usually don't crave it as much anyway. I suspect caffeine substitutes for thyroid hormones in a way.
Chemist has already mentioned the epi-free dental anesthetics..actually you have to tell the anesthetists for all ops...
>
> 3) I've got some odd hip pain that started last weekend. It's not in a joint, but rather at the top of the hip, where you would put your hands on your hips. It's definitely in the bone, though, and not muscle or tissue.Sorry..no help here...
>
> Any thoughts? Any of this related? I think the sensitivity to caffeine and epinephrine are related, and possibly the headache, but what's up with the hip? Osteoporosis wouldn't affect me that quickly would it? Plus, I take 1200 mg of calcium each day.
Lucky about that calcium..is it calcium carbonate?.that should help by "blocking" the T3 to an extent (and I think from memory) its what you should take to help with the fast heart beats etc..together with magnesium..so get some magnesium too(like very soon) and take it twice a day..also some potassium, OK?..and phone your doc on Monday and let him know how you feel?Hope this makes some sense
>
> Thanks in advance,
> gg
Posted by Pfinstegg on August 1, 2004, at 0:15:51
In reply to Re: Cytomel short half life?, posted by tealady on July 31, 2004, at 17:52:59
Cytomel does have a short half-life of 3-4 hours. This is why it is given in divided doses- morning and evening. For a TSH around 2, I think you are taking a LOT of Cytomel.
I am taking 5 mcg. of Cytomel twice daily, plus 50 mcg. of Synthroid once daily. This has resulted in a TSH of .38. I haven't had any side effects from this dosage, but I believe it's one of the things which has helped me get into remission, depression-wise. I don't see why you would ever have to take more than 10 mcg. of Cytomel a day. I started with a TSH of 5, and the small dosages I am taking have gotten me down to my present low TSH level. You might be able to accomplish the same thing with 2.5 mcg. twice daily.
Osteoporosis takes at least a year to develop, if it's going to. I think it would be good to have a baseline bone scan, even though you are young, and then one every two years or so. Taking the extra Calcium is very important. You could also consider taking about 300 mg. of Magnesium and 400 IU Vitamin D- that way, you'd be maximally protected against osteoporosis- assuming you do weight-bearing exercise a bit also!
BTW, epinephrine is a vasoconstrictor, and so can raise BP in combination with Nardil.
Posted by Pfinstegg on August 1, 2004, at 0:18:45
In reply to Re: Cytomel short half life?, posted by tealady on July 31, 2004, at 17:52:59
Posted by gardenergirl on August 1, 2004, at 12:42:57
In reply to Re: Cytomel short half life?, posted by tealady on July 31, 2004, at 17:52:59
Thanks for all the great info. Actually, I have a scrip for labs to be done one month post starting the Cytomel. I can use that and get them drawn tomorrow. Your post sounds like perhaps you don't want to alarm me, but that there is some urgency here. I will call my doc. tomorrow, but I am wondering what your concerns are. Is there anything specific I should be worried about?
Thanks,
gg
Posted by gardenergirl on August 1, 2004, at 12:44:37
In reply to Re: Cytomel short half life? » tealady, posted by Pfinstegg on August 1, 2004, at 0:15:51
Well heck, Doc didn't tell me to take it in divided doses. But that makes a lot of sense. And I forgot to mention, I do take magnesium, too. I think 250 mg, but I may double that per chemist's recommendations from a past conversation.
Thanks for you help. Also, good to know that osteoporosis doesn't happen that quickly. I didn't think so, but this pain is weird.
Thanks again,
gg
Posted by gardenergirl on August 1, 2004, at 12:45:07
In reply to Re: Cytomel short half life? » gardenergirl, posted by chemist on July 31, 2004, at 17:09:50
Thanks again, sweetie. Always can count on you!
gg
Posted by chemist on August 1, 2004, at 13:03:23
In reply to Re: Cytomel short half life? » chemist, posted by gardenergirl on August 1, 2004, at 12:45:07
> Thanks again, sweetie. Always can count on you!
>
> ggwell, you can count on me to occasionally get something right, perhaps....i think the others did the legwork on this one, and i certainly learned quite a bit!!!!! be well, chemist
Posted by tealady on August 2, 2004, at 4:18:45
In reply to Re: Cytomel short half life? » tealady, posted by gardenergirl on August 1, 2004, at 12:42:57
> Thanks for all the great info. Actually, I have a scrip for labs to be done one month post starting the Cytomel. I can use that and get them drawn tomorrow. Your post sounds like perhaps you don't want to alarm me, but that there is some urgency here. I will call my doc. tomorrow, but I am wondering what your concerns are. Is there anything specific I should be worried about?
>
> Thanks,
> ggYou guessed correctly. I don't really think you will have any more problems on that dose than you already are on.... I also guess you are reasonably young and fit with healthy adrenals and great ferritin levels too<grin>.
On the other hand, if you did start getting racing heart beats and came down with an infection and got really stressed about about something...it could be dangerous..so I just thought you should talk to your doc and let him know how you are going. Keep a check on your resting pulse too I guess. But you didn't mention anything that would really lead me to panic..I'm just a born worry guts , I guess.
The Magnesium helps with the heart especially..acts as a relaxant I think.
A great idea would be taking calcium and magnesium twice a day while you are a tad hyper...say (600mg calc + 300mg magnesium), two times a day. The reason I suggest two times a day at present is because in hyperT your metabolism is a LOT faster.The consensus amongst "experts" I know seems to be that "we" can't absorb more than 600mgs to 1000gs calcium at a time anyway!
The increased metabolism in hyperT uses way more nutrients, and with a faster digestive process you simply don't absorb all the nutrients from food. And various nutrient deficiencies cause different symptoms.eg. lack of magnesium and B vitamins, particularly B1 and B5 can cause palpitations...which usually are harmless but they sure are scary.
Here's a link to the "worst" that can happen from too high thyroid hormone levels (promise not to panic OK?).. you don't sound anywhere near this ..still it's good to know I guess
http://www.suite101.com/article.cfm/graves_disease/54728BTW I've heard of a no.of folk on more thyroid hormone than you..most just went on it more gradually..but we are all individuals in the amounts of T4, T3 we need..and it can work to lift depression, "cycling" etc..at least for some.
I think your T3 is probably highest around 2 hrs after you take the T3 meds..Taking them twice a day is a great suggestion..taking the T3 with food will also help cut that peak...but ask your doc.
Posted by gardenergirl on August 2, 2004, at 6:18:53
In reply to Re: Cytomel short half life?, posted by tealady on August 2, 2004, at 4:18:45
Thanks so much. You've been very helpful. Come to think of it, the other day my resting heart rate was higher than normal. Definitely calling my doc today.
Thanks again.gg
Posted by gardenergirl on August 4, 2004, at 17:41:33
In reply to Thanks, tealady, posted by gardenergirl on August 2, 2004, at 6:18:53
Well, y'all were right...I had labs drawn yesterday, and the doc's office called me today to tell me not to take my thyroid meds tomorrow and to come in ASAP. My T3 is "very high" and my TSH is "very low". They didn't give me numbers, but I'm not surprised.
I suppose I could say "I told you so" to my doc, because I asked if I should go halvsies on the Synthroid and Cytomel, but no...he just added 25 mics. Yikes! (hey, I've been rhyming a lot lately.)
But saying I told you so is not so satisfactory when I am the one suffering.
Thanks again for all your advice. 'T will be interesting to hear what he recommends.
gg
Posted by tealady on August 4, 2004, at 20:06:26
In reply to Well whadya know? I'm hyperthyroid now, posted by gardenergirl on August 4, 2004, at 17:41:33
Hi,
I was just going to ask how you were going.
You got the expected results..just ask about adding it gradually ..like 5mcg every week until 15mcg t3 ..then 2.5mcg every 2 or 3 weeks until you feel right. It's good to monitor your blood pressure and temperature too..gives you an indication of just how much you need and when you are OK to increase your T3 amount.(how fast or slow to increase and whether you need to increase)
Actually that 25mcg seems maybe like a reasonable amount (if that is what you need) ..in the long run. I know girls on almost twice that (not many admittedly). I'm on a perhaps a tad more myself..if you do the conversions.
Some people go better on more T3 and some on more T4.I assume your headaches stopped within a couple of days of stopping the T3? (that's what good about the short half life)
BTW How long after your T3 meds did you have your blood test?
Good luck...thyroid meds ain't easy to take..which when you consider thyroid hormones affect most almost everything in our body..
Posted by tealady on August 4, 2004, at 20:19:47
In reply to Well whadya know? I'm hyperthyroid now, posted by gardenergirl on August 4, 2004, at 17:41:33
OOps forgot..monitor your pulse too..
resting pulse, resting temperature and resting blodd pressure ...at least two times a dayhere's where I discussed it before
http://www.dr-bob.org/babble/20031004/msgs/267612.htmlhttp://www.dr-bob.org/babble/20031010/msgs/268077.html
http://www.dr-bob.org/babble/20031010/msgs/268617.html
and rest of thread
Posted by gardenergirl on August 4, 2004, at 20:49:11
In reply to Re: Well whadya know? I'm hyperthyroid now » gardenergirl, posted by tealady on August 4, 2004, at 20:06:26
>
> I assume your headaches stopped within a couple of days of stopping the T3? (that's what good about the short half life)Actually, they stopped a couple of days ago, so I thought maybe I was adjusting.
>
> BTW How long after your T3 meds did you have your blood test?Not sure what you are asking here. It was about two weeks after starting the Cytomel. If you mean what time of day, it was about four or five hours after taking it. I did wonder how it would be if I had it later in the afternoon. Plus I was fasting because they also did lipids and liver.
And thanks for the links in your next post. I'll bring this to doc tomorrow.
Take care,
gg
Posted by Pfinstegg on August 4, 2004, at 21:14:03
In reply to Have of read of these links » gardenergirl, posted by tealady on August 4, 2004, at 20:19:47
I think you are taking FAR too much Cytomel for someone who is basically euthyroid (i.e. normal), and already on a moderate dose of synthroid. You only need a little bit- somewhere between 2,5 and 5.0 mcg twice a day- NOT MORE! If you are so close , or at normal, to begin with, you may even need to lower your synthroid to something below 50 mcg. To help with depression, the goal is to get to a TSH of 0.5 or a bit lower, using a combination of Synthroid and Cytomel, but in very low amounts. I think I mentioned above that I take VERY low doses of both- see above- and have gotten to a TSH of 0.38 This has helped with the depression, I think, although it's hard to be sure because of the other things I've done also, but it's very good with weight loss- I've lost 45 lbs. since starting the thyroid meds, having gotten quite overweight with various AD's. Just don't forget that with a thyroid as normal as yours, the very lowest doses of synthroid and Cytomel should do everything that's needed.
Posted by tealady on August 5, 2004, at 2:11:06
In reply to gg- your T3 dosage, posted by Pfinstegg on August 4, 2004, at 21:14:03
> I think you are taking FAR too much Cytomel for someone who is basically euthyroid (i.e. normal), and already on a moderate dose of synthroid. You only need a little bit- somewhere between 2,5 and 5.0 mcg twice a day- NOT MORE! If you are so close , or at normal, to begin with, you may even need to lower your synthroid to something below 50 mcg. To help with depression, the goal is to get to a TSH of 0.5 or a bit lower, using a combination of Synthroid and Cytomel, but in very low amounts. I think I mentioned above that I take VERY low doses of both- see above- and have gotten to a TSH of 0.38 This has helped with the depression, I think, although it's hard to be sure because of the other things I've done also, but it's very good with weight loss- I've lost 45 lbs. since starting the thyroid meds, having gotten quite overweight with various AD's. Just don't forget that with a thyroid as normal as yours, the very lowest doses of synthroid and Cytomel should do everything that's needed.
Agree, if you CAN do it with small doses it's definitely the best way. Unfortunately it doesn't work for all, but it's really worth considering trying first.
(The other way you end up partly suppressing your own thyroid production and replacing it with the thyroid meds basically.)
Pretty confusing I guess...and even then , especially if you have antibodies(TPO, TG, TSI, TBII), it is still not the best..as they flare up and wane and change your thyroid production...(which is where selenium helps a little in helping to suppress the antibodies a little as well as helping with T4 to T3 conversion. )
Posted by tealady on August 5, 2004, at 2:59:55
In reply to Re: Well whadya know? I'm hyperthyroid now » tealady, posted by gardenergirl on August 4, 2004, at 20:49:11
> >
> > I assume your headaches stopped within a couple of days of stopping the T3? (that's what good about the short half life)
>
> Actually, they stopped a couple of days ago, so I thought maybe I was adjusting.
> >
> > BTW How long after your T3 meds did you have your blood test?
>
> Not sure what you are asking here. It was about two weeks after starting the Cytomel. If you mean what time of day, it was about four or five hours after taking it. I did wonder how it would be if I had it later in the afternoon. Plus I was fasting because they also did lipids and liver.
>
> And thanks for the links in your next post. I'll bring this to doc tomorrow.I wouldn't bother ..I was just trying to explain to you what was happening and why. Your doc sounds like he has a reasonable idea. I was only trying to get ya to let your doc know what was happening. (if your hypothalmus and pituitary feedback etc. had adjusted faster, you would have got away with it, not typical though)
Good luck..at least you can now recognise a too high T3 headache
>
> Take care,
> gg
>
Posted by gardenergirl on August 5, 2004, at 8:48:18
In reply to Re: Well whadya know? I'm hyperthyroid now » gardenergirl, posted by tealady on August 5, 2004, at 2:59:55
>
> Good luck..at least you can now recognise a too high T3 headache
>Hmmm, learn something new everyday! I suppose I could have done without, though.
:)
Thanks.
gg
Posted by gardenergirl on August 5, 2004, at 8:49:34
In reply to gg- your T3 dosage, posted by Pfinstegg on August 4, 2004, at 21:14:03
Yeah, I tried to get him to go halvsies on the two meds, but he said it was okay. Silly man. But we'll figure it out today. Thanks for your suggestions!
Take care,
gg
Posted by gardenergirl on August 5, 2004, at 8:50:59
In reply to Re: gg- your T3 dosage, posted by tealady on August 5, 2004, at 2:11:06
Question: If I wind up back on just Synthroid, would it make sense to take selenium, then, to help with the conversion?
Thanks,
gg
Posted by tealady on August 6, 2004, at 2:56:02
In reply to Re: gg- your T3 dosage » tealady, posted by gardenergirl on August 5, 2004, at 8:50:59
> Question: If I wind up back on just Synthroid, would it make sense to take selenium, then, to help with the conversion?
>
> Thanks,
>
> ggHi, I answered this one on alter..have a look
Jan
Posted by Dr. Bob on August 6, 2004, at 22:57:25
In reply to Re: gg- your T3 dosage » gardenergirl, posted by tealady on August 6, 2004, at 2:56:02
> > If I wind up back on just Synthroid, would it make sense to take selenium, then, to help with the conversion?
>
> I answered this one on alter..Here's a link:
http://www.dr-bob.org/babble/alter/20040718/msgs/374594.html
Thanks,
Bob
Posted by gardenergirl on August 7, 2004, at 0:19:24
In reply to Redirect: selenium, posted by Dr. Bob on August 6, 2004, at 22:57:25
Posted by Pfinstegg on August 7, 2004, at 0:22:09
In reply to Re: gg- your T3 dosage » Pfinstegg, posted by gardenergirl on August 5, 2004, at 8:49:34
gg - to get the most antidepressant effect, you don't want to take just synthroid- the T3 is very important. Is there an endocrinologist you can see at your university? In my opinion (I'm a doctor), you are being BOMBED with these drugs. All you need is a low amount of each one. Sorry to keep harping on this topic!
Posted by gardenergirl on August 7, 2004, at 11:06:56
In reply to Re: gg- your T3 dosage » gardenergirl, posted by Pfinstegg on August 7, 2004, at 0:22:09
That's okay, I welcome your input. My school is not a research school and not a medical school. I suppose I could see an endo., in fact my hubby does for his diabetes, so I have a ready made referral. I agree the T3 is important, and my doc was starting to decide how to get me a lower dose when he suddenly said to just go off the Cytomel. Since I do have quite a few left, I am thinking of cutting them and taking a tiny dose anyway...yikes! I'm such a rebel. My other thought is to try selenium, but I realize that is not the same.
My free T3 level was 374.6,on 25 mics, so I was estimating that a quarter dose, 7.25 mics might be appropriate. I wish he had started me at 5...
Thanks,
gg
Posted by tealady on August 9, 2004, at 6:43:15
In reply to Re: gg- your T3 dosage » Pfinstegg, posted by gardenergirl on August 7, 2004, at 11:06:56
> That's okay, I welcome your input. My school is not a research school and not a medical school. I suppose I could see an endo., in fact my hubby does for his diabetes, so I have a ready made referral. I agree the T3 is important, and my doc was starting to decide how to get me a lower dose when he suddenly said to just go off the Cytomel. Since I do have quite a few left, I am thinking of cutting them and taking a tiny dose anyway...yikes! I'm such a rebel. My other thought is to try selenium, but I realize that is not the same.
>
> My free T3 level was 374.6,on 25 mics, so I was estimating that a quarter dose, 7.25 mics might be appropriate. I wish he had started me at 5...
>
Hi again,
Your blood test levels were as expected by me a least. It means either (expected) your hypothalmus-pit had not ye adjusted so you were getting T3 from your own thyroid PLUS what you were takingOR ...that you maybe had adjusted a little (which may be expcted if the rapid cycling has anything to do with your thyroid-hypothalmus-pit axis)..but for some reason you had gone from hypo to hyper..expected with some antibodies..can your doc test you for those?
So I assume your doc just wants to check what your normal levels are before started any thyroid meds..just in case. (probably easiest..and if "normal" he'll have learn a lesson about length of time for your body to adjust to thyroid hormone level changes)..which hopefully he might apply to othersAnother girl on this forum went on 25mcg T3 ..I gathered straight on to it and successfully..or so I thought..perhaps you could ask her?
Have a read of my posts to her anyway..bit more info
Re: whats the typical cytomel dosage for depressio
http://www.dr-bob.org/babble/20031004/msgs/266528.html
http://www.dr-bob.org/babble/20031010/msgs/268077.html
http://www.dr-bob.org/babble/20031010/msgs/268617.html
..whole thread if you likeOh..and my learning experience is here
http://forums.about.com/ab-thyroid/messages?msg=42948.54 (to follow the thread, just click on the "in reply to" to go back)..and set view to "advanced"Jan
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