T Nation

How to Convert Synthroid into CYTOMEL?

Hi,

this test result is when i was on 130mcg synthroid and 1 grain armour. My problem is i have been gaining weight, feel so tired. The doctor suggested finaly to stop synthroid an start CYTOMEL 10 mg/day + stay on 1 grain on armour

Did she make good suggestion and convertion. Any opinion?

thx
TSH 0.006 normal 0.450-4.500
T4 free 2.2 normal 0.82 - 1.77
T3 free 2.5 norma 2.0 - 4.4
Reverse T3 51.9 norma 13.5 - 34.2
florida2001

Posts: 7
Joined: Wed Feb 29, 2012 8:11 pm

[quote]florida2001 wrote:
Hi,

this test result is when i was on 130mcg synthroid and 1 grain armour. My problem is i have been gaining weight, feel so tired. The doctor suggested finaly to stop synthroid an start CYTOMEL 10 mg/day + stay on 1 grain on armour

Did she make good suggestion and convertion. Any opinion?

thx
TSH 0.006 normal 0.450-4.500
T4 free 2.2 normal 0.82 - 1.77
T3 free 2.5 norma 2.0 - 4.4
Reverse T3 51.9 norma 13.5 - 34.2
florida2001

Posts: 7
Joined: Wed Feb 29, 2012 8:11 pm
[/quote]

Interesting labs. You look to be over medicated TSH almost not detectable.

Your rt3 is very high, ft4 over range by a good margin. Ft3 is somewhat low compared to the others but this could be the result of your high rt3.

Not sure why the doctor still wants to be pumping you with t4 meds? I think it might be a good idea to just take t3 to clear your rt3 and see how you feel then.

I also hope the Cytomel dose of 10mg is a typo.

I myself would probably just go on Cytomel and drop the armour since that is a mix of t4 and t3. I am not sure what the dosage is of armour but being on 130mcg syntharoid plus 1 grain armour is a lot.

What did your previous labs look like?

If you can work out the ratio between ft3 and rt3 that will tell you where you are at.

You want the ratio to be 20+ in favor of ft3. From my understanding 20-23 is the mark.

What are the units of those results?

You certainly look to be in single digits as far as the ratio is concerned.

To answer your conversion question.
They say that t3 is roughly 4x more potent than t4. Your current protocol was 168mcg t4 and 9mcg t3.

Doctor wants to now put you on 19mcg t3 along with 38mcg t4.

If I was in your shoes I would probably go with 5mcg T3 3x daily if you can find the time to split the doses.

Clearing your high Rt3 will take some time will not be done in a couple of weeks more like months.

Hi thanks , the doctor didn’t want me to stop completely T4 that’s why she left me on Armour 60mg. I don’t know exactly why, but what im reading I should be only on T3 to clear RT3.

[quote]florida2001 wrote:
Hi thanks , the doctor didn’t want me to stop completely T4 that’s why she left me on Armour 60mg. I don’t know exactly why, but what im reading I should be only on T3 to clear RT3. [/quote]

You could just take only t3 and see if your symptoms improve.

Do you have any previous lab work you can post up? How your treatment progressed from the start?

Do you have any other sypmtoms?

Your tsh is low but your ft3 levels are on the low end which goes against the tsh reading.

In my opinion your are hypo even though tsh suggests hyper. The high dosages of t4 are not helping you and creating more rt3 which then is blocking a lot of the ft3 from getting to the receptors.

I would suggest t3 only meds as a trial and see how you do.

Do you have ferritin lab work along with cortisol vitamin b12?

Post everything that you have. Please also include the units on the thyroid tests. Would like to work out your ratio.

.

hi, thank you for your effort to help.

I haven’t done blood work for cortisol neither vit B12

here is what I have. The test was done on 18 day of my cycle.
vit D, 25-OH 47 reference range 30-100ng/ml
Thyroglobulin antibodies <20 refer range <20 IU/ml

Thyroid peroxidase <10 refer range <35 IU/ml
Progesterone 0.5 refer. range folicular phase <1.0, luthelal 2.6-21.5

Prolactin 7.0 refer range 3.0-30.0 ng/ml
Estradiol 148 pg/ml normal range folicular 19-144, mid cycle 64-357, luteal 56-214
HCG, total <2 referenc range <0.5mIU/ml
Testosterone, free 0.7 refer.range 0.1-6.4pg/ml
Testoster Total 24 refer range 2-45ng/dl

being on 150mcg synthroid and 60mg armour the results was
TSH 0.006 uIU/ml refer range 0.450-4.500
T3 free 4.0 pg/ml ref range 2.0-4.4
T4 free 2.32ng/dl ref range 0.82-1.77
Reverse T3 58.2 ng/dl 13.5-34.2

Gain weight, tired, constipated, not able to concentrate…like space head.

[quote]florida2001 wrote:
hi, thank you for your effort to help.

I haven’t done blood work for cortisol neither vit B12

here is what I have. The test was done on 18 day of my cycle.
vit D, 25-OH 47 reference range 30-100ng/ml
Thyroglobulin antibodies <20 refer range <20 IU/ml

Thyroid peroxidase <10 refer range <35 IU/ml
Progesterone 0.5 refer. range folicular phase <1.0, luthelal 2.6-21.5

Prolactin 7.0 refer range 3.0-30.0 ng/ml
Estradiol 148 pg/ml normal range folicular 19-144, mid cycle 64-357, luteal 56-214
HCG, total <2 referenc range <0.5mIU/ml
Testosterone, free 0.7 refer.range 0.1-6.4pg/ml
Testoster Total 24 refer range 2-45ng/dl

being on 150mcg synthroid and 60mg armour the results was
TSH 0.006 uIU/ml refer range 0.450-4.500
T3 free 4.0 pg/ml ref range 2.0-4.4
T4 free 2.32ng/dl ref range 0.82-1.77
Reverse T3 58.2 ng/dl 13.5-34.2

Gain weight, tired, constipated, not able to concentrate…like space head.[/quote]

Your vitamin d levels could be better maybe look at supplementing that.

I think you are overmedicated and the high rt3 is not helping your cause at all.

Are those blood tests different to your initial ones in you original post? As they look very similar but a few differences?
In one test free t3 levels are 2.5 and then in the other 4.0.

Before you started thyroid meds what were your blood levels like?

When you first started medication what were you taking and how much? Surely your doctor did not start you on 150mcg of t4 and 1 grain of armour right out of the blocks?

I think you need to consider t3 only for the time being to clear your sysyem. Then once things improve you may need to up/lower your dosage and treat by symptoms with blood work as a reference. You may then switch to armour once your rt3 is cleared and see how that goes. Just don’t be aggressive with the dosages and do gradual increments if needed.

You may also find that being on t3 only will make you feel better than you ever had.

hi,
one was done when I was on 200mcg of synthroid, the other one where T3 are lil higer I switched to 1 grain of armour+ 130mcg synthroid

Now after that finally doc put me on 10mg of cytomel and 1 grain Armour. I actually added 5mg in the evening bc I was literaly falling asleep.

[quote]florida2001 wrote:
hi,
one was done when I was on 200mcg of synthroid, the other one where T3 are lil higer I switched to 1 grain of armour+ 130mcg synthroid

Now after that finally doc put me on 10mg of cytomel and 1 grain Armour. I actually added 5mg in the evening bc I was literaly falling asleep.[/quote]

Now I am a little concerned. Are you really taking 10mg of Cytomel or is it supposed to be 10mcg? I ask because you keep writing everything in mcg but with cytomel you have written 10mg couple times now.

Do you have any idea of your values before starting any thyroid medication?

When you first started taking thyroid medication what was the dose the doctor started you on? Was it 50mcg syntharoid? or was it 150mcg? ???

I have asked these questions previously but never seem to get a response.

Have you stopped taking the armour and switched to t3 only?

How long have you been taking thyroid medication?

hi, sorry it’s littel confusing. Here is the explanation. I have been on thyroid medication abaut 8 years now. During this time I have been switching from synthroid to armour or I was on both. The higest dosage I was on, was 275mcg synthroid. But I’ve never been succesful in dropping my weight down. I exercise every day and eat very clean.

Here is the explanation to the blood test I have done

  1. I was on 200mcg of synthroid and following test are the result

TSH 0.006 normal 0.450-4.500
T4 free 2.2 normal 0.82 - 1.77
T3 free 2.5 norma 2.0 - 4.4
Reverse T3 51.9 norma 13.5 - 34.2

After this test doc has switched me to 130mcg of Synthroid and 1 Grain of ARMOUR . As you can see my free T3 were on low side. Anyway after 6 week being on this dosage my test came out following

TSH 0.006 uIU/ml refer range 0.450-4.500
T3 free 4.0 pg/ml ref range 2.0-4.4
T4 free 2.32ng/dl ref range 0.82-1.77
Reverse T3 58.2 ng/dl 13.5-34.2

So now the doctor see my REVERSE T3 are so high and she put me on 1 grain ARMOUR and 10mcg CYTOMEL. It’s been week since this change. I take now 1grain armour and 5mcg at 5 AM and another 5mcg 1PM. The whole issue is that I have gained 8 lb in the last 3 months and keep gaining despite my daily run, eating clean.

Today also I took my temperature at 3 AM it was 97.5…at 5 AM i always take 1 grain armour +5mg cytomel, at 7 AM my temperature was 98.1. at 12.30 Pm i took another 5 mc cytomel. 1 hour later my temperature DROPPED DOWN to 97.5…freezing, lil sleepy. WHY???

thank you

[quote]florida2001 wrote:
hi, sorry it’s littel confusing. Here is the explanation. I have been on thyroid medication abaut 8 years now. During this time I have been switching from synthroid to armour or I was on both. The higest dosage I was on, was 275mcg synthroid. But I’ve never been succesful in dropping my weight down. I exercise every day and eat very clean.

Here is the explanation to the blood test I have done

  1. I was on 200mcg of synthroid and following test are the result

TSH 0.006 normal 0.450-4.500
T4 free 2.2 normal 0.82 - 1.77
T3 free 2.5 norma 2.0 - 4.4
Reverse T3 51.9 norma 13.5 - 34.2

After this test doc has switched me to 130mcg of Synthroid and 1 Grain of ARMOUR . As you can see my free T3 were on low side. Anyway after 6 week being on this dosage my test came out following

TSH 0.006 uIU/ml refer range 0.450-4.500
T3 free 4.0 pg/ml ref range 2.0-4.4
T4 free 2.32ng/dl ref range 0.82-1.77
Reverse T3 58.2 ng/dl 13.5-34.2

So now the doctor see my REVERSE T3 are so high and she put me on 1 grain ARMOUR and 10mcg CYTOMEL. It’s been week since this change. I take now 1grain armour and 5mcg at 5 AM and another 5mcg 1PM. The whole issue is that I have gained 8 lb in the last 3 months and keep gaining despite my daily run, eating clean.

Today also I took my temperature at 3 AM it was 97.5…at 5 AM i always take 1 grain armour +5mg cytomel, at 7 AM my temperature was 98.1. at 12.30 Pm i took another 5 mc cytomel. 1 hour later my temperature DROPPED DOWN to 97.5…freezing, lil sleepy. WHY???

thank you

[/quote]

Okay. Looking at your values I don’t understand why the doctor wants to keep pumping T4 into your system when already you are quite a bit over range! It is worth a shot to clear your Rt3 and then be conservative with your dosages. It looks like you dosages were all over the place and if the doctor was trying to treat weight gain issues maybe that was a fault. From my understanding an under-active thyroid will really not play a major role in weight gain. I have read articles that state this and apparently it has been researched. Well not a major role as many people think it to be.

Have you ruled out other possible diseases that could be contributing to your weight gain? Heart, kidney, liver all check out okay? Have any labs? Could your weight gain be water retention? If yes then definitely get your heart and kidney’s checked out.

I think a lot of people are disappointed that they don’t start dropping the lbs off and then think maybe we should increase dosage. I think you might have another issue that is causing your weight gain and I think you might need to rule out other culprits and don’t just look at thyroid.

As mentioned, me in your shoes I would just take 15mcg T3 daily and retest your thyroid labs say in 6 weeks. See if you start feeling better if not you might need to give it longer and keep off the T4 meds until your rt3 is under control.

Once you have rt3 under control you can add in T4 if you need it but start small dosage and if need be work your way up slowly.

To me it looks like you are over medicated and the body is having a hard time getting rid of the excess.

Talk to your doctor about trying T3 only and monitor the effects. It would be best if you could work with your doctor.

I really don’t know how you will feel with rt3 under control. But you sure as hell have nothing to lose and everything to gain.

Do you take any other medication for example Anti-Depressants?

thank you for your help, That’s what I was thinking, I have also read about adrenal fatique that could be cause to. I just ordered cortisol test to see. I’ll try suggest to the doctor to put me only on T3, that’s what I wanted, but she was afraid to stop completely T4. So will see after I recheck my thyroid in a few weeks.

I don’t take any other medication.

iroc: 15 mcg may be too low. 25 mcg has been shown to be a replacement dose. I would take 25 instead of 15. Plus it is much easier to dose, unless you are using a liquid.

[quote]VTBalla34 wrote:
iroc: 15 mcg may be too low. 25 mcg has been shown to be a replacement dose. I would take 25 instead of 15. Plus it is much easier to dose, unless you are using a liquid.[/quote]

I agree 15 is conservative and will need to be upped most likely. I was just thinking maybe start small and work up. But she could get away with 25mcg from the start unless she gets sides in which case she would back it down a bit.

yes I agree too, I actually added another 5mcg cytomel, so now Im on 15 mcg cytomel and 1 grain Armour, so im getting aproxim. 25 mcg of T3 and no side effect at all.

Hi,
after 2 weeks I’ve changed the medication and being currently on 10mcg CYTOMEL and 1 grain Armour the results are
still tired, putting up weight slowly… free T4 low, BUN/creatinine ratio HIGH?

TSH 0.006 normal 0.450-4.500
free T3 3.0 normal range 2.0-4.4
free T4 0.74 normal 0.82-1.77 ng/dl
glucose serum 95 normal 65-99mg/dl
BUN/Creatinine ratio 31 normal 8-20
BUN 18 normal 6-20mg/dl
Creatinine serum 0.59 normal0.57-1.00
albumin 4.5 normal 3.5-5.5g/dl
Protein, total 6.6 normal 6.0-8.5g/dl
bilirubin 0.4 normal 0.0-1.2
AST 23 normal 0-40
ALT 32 normal 0-40IU/l
calcium 9.6 normal8.7-10.2
carbon dioxide 24 normal 20-32mmol/l
sodium 138 normal 134-144
potassium 4.0 - 3.5-5.2mmol/l
chloride 101 normal 97-108

any opinion? should I add cytomel?
thx

[quote]florida2001 wrote:
Hi,
after 2 weeks I’ve changed the medication and being currently on 10mcg CYTOMEL and 1 grain Armour the results are
still tired, putting up weight slowly… free T4 low, BUN/creatinine ratio HIGH?

TSH 0.006 normal 0.450-4.500
free T3 3.0 normal range 2.0-4.4
free T4 0.74 normal 0.82-1.77 ng/dl
glucose serum 95 normal 65-99mg/dl
BUN/Creatinine ratio 31 normal 8-20
BUN 18 normal 6-20mg/dl
Creatinine serum 0.59 normal0.57-1.00
albumin 4.5 normal 3.5-5.5g/dl
Protein, total 6.6 normal 6.0-8.5g/dl
bilirubin 0.4 normal 0.0-1.2
AST 23 normal 0-40
ALT 32 normal 0-40IU/l
calcium 9.6 normal8.7-10.2
carbon dioxide 24 normal 20-32mmol/l
sodium 138 normal 134-144
potassium 4.0 - 3.5-5.2mmol/l
chloride 101 normal 97-108

any opinion? should I add cytomel?
thx[/quote]

Has your tsh ever come back a different number than .006? You could look at increasing your t3 by a little. Now it looks like you are low on t4 big turn around in 2 weeks. Maybe might need to add another grain of armour? What does your doctor think? When is she planning on running rt3 again.

Have you ever had your iodine values te
sted?

Your high bun:creatine ratio could mean a number of things.

1.dehyrated at the time of blood draw
2. heart issues or liver
3. bleeding ulcer or any bleeding in the stomach or intestines
4. Also high protein diet can cause the ratio to be high

Any of these a possibility?

I think if your kidneys were giving you trouble you would probably have a high creatine value but I am not 100% sure. All I know is that my doctor saw high creatine levels and that prompted her to run lots of tests.

What kind of weight gain are we talking about in the 2 weeks?

Do you feel like you are holding onto a lot of water? If yes would ask to get your heart looked at to be safe.

Any family history with heart disease?

have done my saliva cortisol test can you help me to interpret it

im on 1 grain armour and 15 mcg cytomel

thank you

cortisol morning. 2.6 ng/ml. normal range. 3.7-9.5
cortisol noon 2. ng/ml. normal range. 1.2-3.0
cortisol evening. 1.1. normal range. 0.6-1.9
cortisol night. 0.2. normal range. 0.4-1

I have gained 12 lb already all together. in last month 8lb since i have changed medication.
i belive its both water and fat
my hearth is good no palpitation, but in family we have heart diseases

Im hypothyroid, last test has showed I have high RT3 so I switched from 130mcg synthroid and 1 grain armour TO 15 mcg Cytomel and 1 grain armour. I also did cortisol saliva test which shows im LOW in cortisol

cortisol morning. 2.6 ng/ml. normal range. 3.7-9.5

cortisol noon 2. ng/ml. normal range. 1.2-3.0
cortisol evening. 1.1. normal range. 0.6-1.9
cortisol night. 0.2. normal range. 0.4-1

the problem is I keep gaining weight, i have headaches, tired, feel like I have cold. What is the recomendation? How I shuld manage this. Please give me some advice. Anybody know or have an experience? Im sick of going from doctor to doctor

Additional information . All tests were done while Im on 15 mcg cytomel and 1 grain armour.
TSH 0.006 normal 0.450-4.500
free T3 3.0 normal range 2.0-4.4
free T4 0.74 normal 0.82-1.77 ng/dl - edit

After these test results, I’ve add cytomel so now im on 1 grain armour + 25mcg cytomel

Any opinion apreciated thank you