Re: Med Change--Cytomel--Opinion Please

February 27, 2005

Carol... expense is relative. If you have insurance that covers your labs, yes, to have them done outside is expensive. But if you have no insurance and pay out of pocket Health Check is much much cheaper than having to go through a doc and clinic.

You can get just the thyroid levels checked, TSH, Free T4 and Free T3 for less than the full deal that I had.. I believe that is $75, plus the shipping charges, $12.

Checking the T3 would give you piece of mind, and a starting point before adding the Cytomel.... but I haven't been doing too bad with all of this self-monitoring. If I'd not have put my increases on hold so that I'd be ready to go when a ride to the lab was available (and I thank you again HUGELY for making that happen!!!!)... my dose most likely would have already been a bit higher...

Thyroid care was some 70 years old before blood tests came to be. And they came to be cause the makers of the synthetics came up with them. Before that folks used the naturals and observations of their symptoms to determine their dosage.

Since the labs have come to be we now have two diseases that are really long term under treated/untreated low thyroid.. Fibromyalgia and Chronic Fatigue Syndrome. Caught soon enough they can be reversed... left too long and the conditions become permanent.

As long as you are aware of your body and how it is reacting. We can take care of ourselves just as easily as all the folks that did it for the 75 some odd years that it was done before labs.....

Just my thought... My opinion.....

Topper ()

On Sun, 27 Feb 2005 07:11:29 -0000 "Carol" writes:

Hi,I'm in MN. It was so easy for Topper to get the lab work, I thought I would if I had to. So expensive though! Should I get the Free T3 checked before I start the Cytomel?Thanks,Carol

February 27, 2005

Oh, Carol.. what you're on isn't doing it for you....

Your TSH is too high.... and your Free T4 is at the top end... what that suggests is that your body knows that you need more hormone, high TSH, but you're on a T4 only med and your body isn't converting properly.

That's my guess.. even without seeing the Free T3, and shame on the doc for not testing that.... Once you are on replacement hormone it's the MOST important of the tests... to make sure that your body is converting enough of the T4, storage hormone, to T3, the active hormone...

.... and it's not just T3 conversion either... .your body converts some of that T3 to T2, which is linked to metabolism... and some of that T2 is converted to T1, which is linked to mental function.

For those that don't quite understand conversion... it's a chemical process that occurs mostly at the cellular level in our bodies.. T4 is distributed throughout our bodies and as the body needs hormone for normal function the T4 goes through a conversion process where Selenium is combined with the thyroid hormone and with sufficient energy is able to pull away an iodine molecule, leaving the active hormone.

T4 has four iodine molecules, T3 had three, T2 has 2 and T1 has one.

If your body doesn't have enough selenium, conversion will be low, if you skip meals and leave your body in a state where there is not enough energy to allow the conversion to happen, conversion will be low.

There are other variables as well... a small percentage of folks produce reverse T3, that doesn't work as it should. Some folks have damaged or improperly working T3 receptors... there are so many marvelous things in our body that can work right or wrong...

I'm starting to ramble... time to stop....

T3 is very fast acting and can be a shock to the system when it's not used to it. Starting out with 25 mcg, in my opinion, is WAY too much to hit your body with all at once... it's setting the perfect stage for your body to have too strong a reaction to it and then your doc starting the 'see? I told you so dance'...

My suggestion? Quarter the Cytomel tabs... take only one quarter of it to start. You can take it in the morning, or in the afternoon, if you slump in the afternoons.... whatever works best for you... But remember, you have to take it on an empty stomach...

Cytomel works quickly, it's in a form that can be used by your body right away. It's 95% used up in about 4 hours after taking it. That's why many folks taking Cytomel and Natural (that contains T3) take it more than once a day. To give their body extra direct T3 more than just once a day.

.... you'd have to play around with it a bit to find out what your body is most comfortable with... You've got some time to figure it out... T4 needs 4 to 6 weeks to cause it's full effect on your body and labs to show the true value.... T3 requires much less time... So give yourself 2 or 3 weeks to play around with timing and adjust to the T3...

Remember. T3 is much more potent that T4. When figuring equivalencies... you multiply the T3 by 4 to find out the amount of T4 you'd take to equal it....

You're currently on 88 mcg of T4 and are adding to that the equivalent of another 100 mcg (25 mcg of T3 times 4 equals 100 mcg of T4) that is more than doubling your dose!!!

NOT good.

Back to T3 testing. In my opinion... for anyone that is on a T4 synthetic, the most important test to have done is T3. T4 is the storage hormone. T3 is the active hormone. T4 is a TSH suppressant. So, if only one test is to be taken.. do you want to know the level of pituitary hormone (TSH), available storage hormone (Free T4), or available active hormone (T3)?

Pretty much the same thing if you are on Natural hormone. 80% of the T3 that our bodies use to function, to live, is made at the cellular level, during the conversion process. So even though you are getting more T3 in natural thyroid hormone replacement than would be made by your thyroid gland, if your conversion rate is inadequate you will have insufficient T3 (active thyroid hormone) in your system to function in a healthy manner and you're gonna feel hypo.

Topper ()

On Sun, 27 Feb 2005 02:02:00 -0000 "Carol" writes:

Hello All,These are my latest labs:T3 Uptake 36.3% Range 25.0-35.0T4 Free 1.3 .7-1.5TSH 4.26 .30-5.00AntibodiesThyroperoxidase 56.3 0-2.0Thyroglobin AB .3 0-2.0I had my gp run these labs, but as you can see there is still no Free T3. The endo who was content to leave my meds until my appt in late March, but I wasn't okay with that, so I went in on Friday (A phone call wasn't okay with him...I had to go in...that bugs me). Anyway I told him that I am still feeling these symptoms: having a hard time falling asleepwaking up in the nightleg cramps at nightachy musclestiredness cold intolorance, sometimes not alwaysI think I feel about 75% back to myself, before I was running at maybe 15%, so this is an improvement to be sure, but I'm not satisfied. I think I can expect to be at 100%. If I'm wrong about that I won't accept it until I've exhausted all options.Endo says that any symptoms I'm feeling aren't thyroid related because my numbers are fine. He decides to test some other things. Okay...I'm actually fine with that, why not...but Hello?!?! These are thyroid symptoms! The levels are not fine!!! When I mention the levels being not fine, he says, "Well the lab values ARE out of date, we go by the new lab values" Like I only know about lab values based on the piece of paper in my hands! And the numbers aren't in line with new guidelines!!!!!! So I bring up that the AACE supports what I'm saying. Then he agrees to talk about meds.Have been on Synthroid for about a year at varying doses. Currently I'm at 88. Endo's choice was to up that to 100. My thought is that I've tried for a year and I'm ready to try something new. I asked about other options like T3 or natural. He did the song and dance about natural being unreliable. The T3 argument was new to me. He said that there was a small study that showed T3 T4 combo was good but that taking a closer look at the study showed it to be a poor study and futher studies didn't prove the combo any good at all. But he gave it to me anyway, against his better judgement.So now he wants me to take 88 mcg Synthroid, which I take in the generic form...levothyroxine...is that right? And add 25 mcg of Cytomel. What do you think of this? He says I can take them together. What are the Cytomel rules? I'm worried that it's too much to start with although the package insert supports this dose. I think that if it doesnt' work he will say "told you so" and want to go back to Synthroid. I welcome all thoughts anyone has...I'd like to hear why the doctor is an idoit and why the doctor is doing the right thing. I"m open to all sides of the issue.Now for the T3 part. He tells me in the office that measureing free T3 is only helpful in rare cases. But he ordered free T3 for my labs in 8 weeks to see how the meds are doing, although he didn't tell me I just noticed it on the lab request. Weird. So I asked the nurse doing the paperwork if I ought to get it tested with lab work that was being ordered yesterday to get a baseline. She knocked on the door to the next patient and interuppted...wonder how he felt about that! He said not to run it today. Does that make any sense. Someone doesn't like to be told what to do!So should I get my T3 tested myself before I start taking the Cytomel? Any help or opinion is greatly appreciated.Warmly, Carol

February 27, 2005

Hi Carol,

I just went to an endo for the first time last week. Thankfully he was one on

the " top docs "

list and seems to be very nice and willing to work with me on what I want. I

was at 75mcg

Synthroid, with my last TSH being 5.47. This endo wants my TSH at the low end,

and he

was just going to give me more Synthroid, but I asked him if I could try Cytomel

as well,

and he agreed to do it. So he gave me 75 Synthroid/12.5 Cytomel. That sounds

like it

would probably be comparable to what your doctor prescribed for you. I've read

other

people's concerns about starting T3 too high, but I haven't felt anything yet

(it's only been

3 days though.) I haven't had a free T3 (or any T3) test yet. Hopefully this

endo will test

me in 10 weeks when I go back.

I'm sorry you're having a difficult time with your doctor; believe me, I know

how it feels.

Let us know what you decide to do,

Carol H from Seattle

> These are my latest labs:

>

> T3 Uptake 36.3% Range 25.0-35.0

> T4 Free 1.3 .7-1.5

> TSH 4.26 .30-5.00

>

> Antibodies

> Thyroperoxidase 56.3 0-2.0

> Thyroglobin AB .3 0-2.0

>

> So now he wants me to take 88 mcg Synthroid, which I take in the

> generic form...levothyroxine...is that right? And add 25 mcg of

> Cytomel. What do you think of this? He says I can take them

> together. What are the Cytomel rules? I'm worried that it's too

> much to start with although the package insert supports this dose.

> I think that if it doesnt' work he will say " told you so " and want

> to go back to Synthroid.

>

February 27, 2005

Thank you so much everyone for your wonderful words of wisdom and

encouragement! When I joined this group I was so deep in the mental

fog, despair part of hypo that it was so very hard for me to learn

anything even though I spent hours online reading. Now I'm catching

up!

If you don't mind, I'll brainstorm a little with you all. I leave

on Thursday for 2 weeks. I could see if I can get into the lab and

check the results online...and I could take the Cytomel as soon as

the labs are done. I'd be doing it just to see and many of you have

shared how you've done without labs so I'm going back and forth on

whether or not to get the lab work. And while knowing free T3 is

important, if I base on how I feel I know I need something. I also

feel like I might want to add something to my arsenal for doing

battle with the doctor. I'm going to think some more on that one.

I've had the pills for two days now and I'm very aware that

I've " wasted " two days of feeling better. BUT, I felt pretty sure

that if I took all 25mcgs at once I could have the reactions I've

been reading about. Carol H in Seattle...maybe since you have a

smaller dose you don't get the reaction? I'm scared by what I've

heard and think that even if I take 12.5 I'll feel better about it

and can work up from there. So I think it's definetly wise to split

the dose...empty stomach, thanks Topper, couldn't find that

anywhere...package doesn't say. So I think I'll quarter or split

the tab and whatever dose I decide make sure it's even throughout

the day, or maybe it's better to say space according to my needs.

I feel childish saying that I feel like the doc might be setting me

up to fail. He didn't want me on Cytomel because the studies don't

support its effectiveness. He did offer it though, I didn't have to

fight for him to offer it, but he still would rather have upped the

synthroid to 100. I think he's waiting for me to say it didn't work

so he can say lets do it my way. Arghhhh!

I will find a new doc, but every new doc takes a long time to get

into, so while I wait I need to have someone to give me the drugs!

I'm not quite ready to do it on my own. While I respect everyone

who has done it and will do it myself if I have to, I want to hold

out some kind of faith that there is a doc somewhere in this major

metropolitian area that I live in who will work with me! The office

that I go to is on the top doc list, but it is the other guy's name

not my doc and they won't switch me...already asked.

Goodness gracious, I can ramble on! Wouldn't have seen me doing

this 6 months ago!

Thanks again everyone!

Carol

>

> Hi Carol,

>

> I just went to an endo for the first time last week. Thankfully

he was one on the " top docs "

> list and seems to be very nice and willing to work with me on what

I want. I was at 75mcg

> Synthroid, with my last TSH being 5.47. This endo wants my TSH at

the low end, and he

> was just going to give me more Synthroid, but I asked him if I

could try Cytomel as well,

> and he agreed to do it. So he gave me 75 Synthroid/12.5 Cytomel.

That sounds like it

> would probably be comparable to what your doctor prescribed for

you. I've read other

> people's concerns about starting T3 too high, but I haven't felt

anything yet (it's only been

> 3 days though.) I haven't had a free T3 (or any T3) test yet.

Hopefully this endo will test

> me in 10 weeks when I go back.

>

> I'm sorry you're having a difficult time with your doctor; believe

me, I know how it feels.

> Let us know what you decide to do,

>

> Carol H from Seattle

>

> > These are my latest labs:

> >

> > T3 Uptake 36.3% Range 25.0-35.0

> > T4 Free 1.3 .7-1.5

> > TSH 4.26 .30-5.00

> >

> > Antibodies

> > Thyroperoxidase 56.3 0-2.0

> > Thyroglobin AB .3 0-2.0

>

> >

> > So now he wants me to take 88 mcg Synthroid, which I take in the

> > generic form...levothyroxine...is that right? And add 25 mcg of

> > Cytomel. What do you think of this? He says I can take them

> > together. What are the Cytomel rules? I'm worried that it's

too

> > much to start with although the package insert supports this

dose.

> > I think that if it doesnt' work he will say " told you so " and

want

> > to go back to Synthroid.

> >

March 6, 2005

Carol

I have found out, since having a B12 serum run a yr ago, that the

methylmalonic urine test is a much better test of finding out if one is low

on B12. Also, where there is already the type of red blood cell pattern

concerning B12 and/or Folic Acid anemia, may as well go ahead and get the

Red Blood Cell Folate done, too, but also, for Folic Acid testing, the

Homocysteine test is a sure bet for this one also. If it is high, then

Folic Acid should also be instituted at around 1 to 2 grams, initially.

That is going to be 1000 to 2000 mcgs, which is anywhere from 2 and 1/2 to

5 times the minimum daily requirement put into our OTC supplements. They

don't put any more in there than that because taking a lot of folic acid can

" cover up " a B12 deficiency, when a person doesn't know whether or not they

have one, and neurological damage can continue, even though the red blood

cell anemia is corrected with the Folic Acid in higher amts. So the best

tests to have for both of these are:

B12 Serum, coupled with the Methylmalonic Acid urine test and

Serum Folic Acid test, the Red Blood Cell Folate test, coupled with the

blood level of Homocysteine.

You can both of these done through www.healthcheckusa.com, if you can't get

a doctor to run them or he/she doesn't know much about them. knows

a LOT about lab results and which tests to run, and she helped me with my

results awhile back.

Re: Med Change--Cytomel--Opinion Please

>

> Thanks Dawn!

>

> I was so MAD when I left the office. So I sort of got what I wanted

> in that my meds are different now, but I really do think that the

> natural stuff is the better option. I was mad because if that

> condescending attitude so many docs have. What is with that? I

> teach people things and I acknowledge what they know and I would be

> horrified if I ever made anyone feel the way so many doc make so

> many of us feel.

>

> I'll be sure to get the B12 tested either myself or if I can get

> some doc somewhere to test it! I am seeing an alternative doc (DO)

> in April...holostic or natuopath or something, but a real doc with a

> specialty practive in alternative meds.

>

> Thank you, thank you!

>

> Carol

March 6, 2005

Expensive??? It costs $102 to get all your electrolytes (potassium,

chloride, sodium, calcium, etc...), red blood cells with different parts to

them, white blood cells with differentials (neutrophils, etc....), all

cholesterols and then your own personal risk factors with the proportions of

HDL to LDL, kidney and liver function testing, serum iron with the ferritin

to boot, many others, plus the Free T3, Free T4, and the TSH. It's a long

list of tests, including your fasting blood sugar. How can $102 be

considered expensive, when, in a doctor's office, all this costs $400 to

$500, unless you have insurance that pays around 90%? Plus insurance only

cover what THEY want to cover. Plus the doctor is making the god syndrome

decision on which tests you will have run?! Believe me, HealthCheck is NOT

expensive, in fact costs around 1/4 the cost of all that. Clinics are a

business with an overhead, just like any other, and the business managers in

them decide to mark up the cost because, after all, the clinic is a " middle

man " , ordering the tests from a lab. The ghouls and bloodsuckers! You cut

out the middle man when you can order your own tests. This has become

illegal to order your own just at the tail end of last yr, in the state of

New York. Do you think that the medical business world is not at play here,

in these government decisions? HealthCheck has made the U.S. news because

of this, specifically HealthCheck, though there ARE other direct services in

this country that do the same thing. They can run any test you want, on

request, though it may not be listed on their site, and are very cheap, in

comparison to ANY doctor's office. Things like scans and such, though,

would always require a doctor's order to accomplish, and this is something

that can't be done on your own, even if you knew how, I don't THINK.

Re: Med Change--Cytomel--Opinion Please

>

> Hi,

>

> I'm in MN. It was so easy for Topper to get the lab work, I thought

> I would if I had to. So expensive though! Should I get the Free T3

> checked before I start the Cytomel?

>

> Thanks,

> Carol

March 21, 2005

T3 looks good.

T4 just a hair low.

TSH way high.

>

> Hello All,

>

> These are my latest labs:

>

> T3 Uptake 36.3% Range 25.0-35.0

> T4 Free 1.3 .7-1.5

> TSH 4.26 .30-5.00

>

> Antibodies

> Thyroperoxidase 56.3 0-2.0

> Thyroglobin AB .3 0-2.0

>

> I had my gp run these labs, but as you can see there is still no

> Free T3. The endo who was content to leave my meds until my appt in

> late March, but I wasn't okay with that, so I went in on Friday (A

> phone call wasn't okay with him...I had to go in...that bugs me).

>

> Anyway I told him that I am still feeling these symptoms:

>

> having a hard time falling asleep

> waking up in the night

> leg cramps at night

> achy muscles

> tiredness

> cold intolorance, sometimes not always

>

> I think I feel about 75% back to myself, before I was running at

> maybe 15%, so this is an improvement to be sure, but I'm not

> satisfied. I think I can expect to be at 100%. If I'm wrong about

> that I won't accept it until I've exhausted all options.

>

> Endo says that any symptoms I'm feeling aren't thyroid related

> because my numbers are fine. He decides to test some other things.

> Okay...I'm actually fine with that, why not...but Hello?!?! These

> are thyroid symptoms! The levels are not fine!!! When I mention

> the levels being not fine, he says, " Well the lab values ARE out of

> date, we go by the new lab values " Like I only know about lab

> values based on the piece of paper in my hands! And the numbers

> aren't in line with new guidelines!!!!!! So I bring up that the

> AACE supports what I'm saying. Then he agrees to talk about meds.

>

> Have been on Synthroid for about a year at varying doses. Currently

> I'm at 88. Endo's choice was to up that to 100. My thought is that

> I've tried for a year and I'm ready to try something new. I asked

> about other options like T3 or natural. He did the song and dance

> about natural being unreliable. The T3 argument was new to me. He

> said that there was a small study that showed T3 T4 combo was good

> but that taking a closer look at the study showed it to be a poor

> study and futher studies didn't prove the combo any good at all.

> But he gave it to me anyway, against his better judgement.

>

> So now he wants me to take 88 mcg Synthroid, which I take in the

> generic form...levothyroxine...is that right? And add 25 mcg of

> Cytomel. What do you think of this? He says I can take them

> together. What are the Cytomel rules? I'm worried that it's too

> much to start with although the package insert supports this dose.

> I think that if it doesnt' work he will say " told you so " and want

> to go back to Synthroid.

>

> I welcome all thoughts anyone has...I'd like to hear why the doctor

> is an idoit and why the doctor is doing the right thing. I " m open

> to all sides of the issue.

>

> Now for the T3 part. He tells me in the office that measureing

> free T3 is only helpful in rare cases. But he ordered free T3 for

> my labs in 8 weeks to see how the meds are doing, although he didn't

> tell me I just noticed it on the lab request. Weird. So I asked the

> nurse doing the paperwork if I ought to get it tested with lab work

> that was being ordered yesterday to get a baseline. She knocked on

> the door to the next patient and interuppted...wonder how he felt

> about that! He said not to run it today. Does that make any

> sense. Someone doesn't like to be told what to do!

>

> So should I get my T3 tested myself before I start taking the

> Cytomel?

>

> Any help or opinion is greatly appreciated.

>

> Warmly,

> Carol

March 22, 2005

,

Thanks so much for your help. I was on vacation the last couple of

weeks and I made it a point to not pick up any of my thyroid stuff

so I could relax and not get sad, mad, fired up with nowhere to go

etc. It was a good thing for me...vacation was wonderful and

relaxing. However, now I've pretty much forgotten what I was

working so hard on learning in the weeks before I left. I don't

regret it though...this consumes my life and I needed a break!

Well back to it. I started the Cytomel by quartering 25mcg tabs and

taking one in the am and one in the afternoon. This is in addition

to 88 synthroid. About mid vacation I was getting annoyed about

watching the clock and started taking a half tab in the am and

nothing in the afternoon. Don't know that it matters at all, can't

tell any kind of difference either way, but some new things to note:

Friday and today I've had awful headaches, I think my sleeping has

gotten better and my left eye doesn't want to focus with contacts---

it's better with glasses. Old symptoms: still pretty cold and it's

warming up around here so that stinks.

About the expense of self testing. I agree wholeheartedly that this

isn't as expensive as the clinics. I do have insurance so it would

take a bit of change from my pocket to pay, but let me say that I do

believe it is worth it. I'm paying out of pocket for a DO in

April. I would pay thousands upon thousands of dollars to be whole

and well again. But I don't know what I'm doing just yet. I'm

scared. I don't want to shell out tons of money and feel the same

way I do when I leave the endo. Life is good around here but we

can't throw money away...well, who can? That's why I'm here, asking

for knowledge to best enable wise choices. I miss my old self so

very much.

Warmly,

Carol

> Carol

>

> I have found out, since having a B12 serum run a yr ago, that the

> methylmalonic urine test is a much better test of finding out if

one is low

> on B12. Also, where there is already the type of red blood cell

pattern

> concerning B12 and/or Folic Acid anemia, may as well go ahead and

get the

> Red Blood Cell Folate done, too, but also, for Folic Acid testing,

the

> Homocysteine test is a sure bet for this one also. If it is high,

then

> Folic Acid should also be instituted at around 1 to 2 grams,

initially.

> That is going to be 1000 to 2000 mcgs, which is anywhere from 2

and 1/2 to

> 5 times the minimum daily requirement put into our OTC

supplements. They

> don't put any more in there than that because taking a lot of

folic acid can

> " cover up " a B12 deficiency, when a person doesn't know whether or

not they

> have one, and neurological damage can continue, even though the

red blood

> cell anemia is corrected with the Folic Acid in higher amts. So

the best

> tests to have for both of these are:

>

> B12 Serum, coupled with the Methylmalonic Acid urine test and

> Serum Folic Acid test, the Red Blood Cell Folate test, coupled

with the

> blood level of Homocysteine.

>

> You can both of these done through www.healthcheckusa.com, if you

can't get

> a doctor to run them or he/she doesn't know much about them.

knows

> a LOT about lab results and which tests to run, and she helped me

with my

> results awhile back.

>

> Re: Med Change--Cytomel--

Opinion Please

>

> >

> > Thanks Dawn!

> >

> > I was so MAD when I left the office. So I sort of got what I

wanted

> > in that my meds are different now, but I really do think that the

> > natural stuff is the better option. I was mad because if that

> > condescending attitude so many docs have. What is with that? I

> > teach people things and I acknowledge what they know and I would

be

> > horrified if I ever made anyone feel the way so many doc make so

> > many of us feel.

> >

> > I'll be sure to get the B12 tested either myself or if I can get

> > some doc somewhere to test it! I am seeing an alternative doc

(DO)

> > in April...holostic or natuopath or something, but a real doc

with a

> > specialty practive in alternative meds.

> >

> > Thank you, thank you!

> >

> > Carol

March 22, 2005