I have been through the Cytomel Hell and it took several months to finally be able to take it. I could not tolerate even 5 mcg. I would get symptoms of irritability, like PMS, also depression and suicidal thoughts after a few hours. Thankfully the thoughts would stop after about 12 hours of not taking a dose, but I could not take the Cytomel. Because I was so sick at the time with low thyroid I was so scared because I could barely get out of bed due to lack of energy and I could not tolerate any thyroid medication, synthetic or natural. I was about to give up on the Cytomel but I had no other choice. But with persistence and time I figured out what to do and succeeded. I now am taking the full dose and my life has turned around. My energy has come back. Hopefully this information can help you too.
But, it was hell at first. Here is what I did:
1. check iron status
2. check adrenal status
3. check if you have a reverse T3 problem
Both have to be optimized in order to accept the medication.
I got my adrenals tested (saliva testing only is accurate, not blood) and found I was very low in cortisol,so I started taking Hydrocortisone. Very often following a depleted adrenal system it takes weeks to months to get strong enough to take the Cytomel. Many doctors are not aware of this. Your adrenals have to have been medicated for awhile (if they are low) before attempting to start the Cytomel.
I took Iron bisglycinate (Blue Bonnet brand) this is the best absorbed brand because they use Albion chelated iron, it is the highest absorbed 18 mg day for one month only. My labs were low.
It took three full months of taking the Hydrocortisone before I could take the Cytomel. I started very slow, with 5mcg a day and increased to 25mcg after two weeks. I slowly increased to about 120 for a short time and then went down to 75, which is the stable dose now. Month by month my energy has slowly increased and now I am functional again.
This medication is a life saver but getting started is very difficult for many people. What's missing is the guidance on how to start it up. Unlike other medications where you can just start to take it full dose, this one you may have to even get the adrenals and iron status changed before it can be taken at all.
I got my guidance from the Yahoo Group http://health.groups.yahoo.com/group/RT3_T3/
This is the website for treatment by Cytomel medication for folks with reverse T3. They will tell you what tests will show if you have this.
These groups have details on what kind of iron testing and adrenal testing.
In any case, don't give up on the Cytomel, especially if you have a reverse T3 problem.
Hope this has helped and encouraged,
Great info! Thank you. Very helpful & encouraging.
I take Cytomel, actually a compounded generic. Haven't experienced the awful problems you have, but am struggling to get the proper dosage. After several years, my doses (5mcg, twice daily) are still low, too low I believe. Arguing with my doctor for proper tests & to use Armour. An uphill battle. I may have to pay for my own adrenal testing.
How often do you have cortisol tested using Hydrocortisone?
10 mcg of Cytomel daily is a negligible dose. Dosing is 75 - 125 mcg daily in divided doses. This is if you are taking T3 (Cytomel) only. This is for folks with high reverse T3 and/or autoimmune antibodies present (Hashimoto's).
Also, Cytomel's efficacy varies with the brand. If it is compounded it may not be strong like the brand name Cytomel. This difference in strength may be titrated out later if you find a dose that works.
Do you have high reverse T3 or Hashimoto's?
Are you only on Synthroid with the 10 mcg compounded T3?
As you probably know Saliva Adrenal testing is about $100 -140 depending on lab. No prescription is needed. Cortisol testing after a person has begun taking Hydrocortisone is at the discretion of the doctor and what type of testing he/she uses. (urine, blood, saliva). There has been some debate as to the best method for testing Cortisol levels after starting to take HC. Some people monitor amounts based on body temperature stability, (which I do not personally think is accurate, but that is just me) and some go with variations on what amounts are considered standard care. These ranges can be very inappropriate for a specific individual, though. Some people need quite a lot more than is considered "normal" care, especially if there is a hidden, perhaps systematic infection such as Epstein Barr, pathogens picked up from travelling, H pylori for example. Just a few examples that I have heard of. In any case there is wide variations in dosing of HC and it is not just standardized. I can point you to some more resources if you have an interest. Just let me know.
Take Care and hope you feel better soon.
I'm taking liothyronine only, no Synthroid. Compounded because my first endo believed I needed that small a dose. I disagree. I have Hashimoto's. Wow, knew my dose was small, but not that miniscule!
Just had RT3 done & that wasn't easy.
Free T3 2.8 range 2.3-4.2 Previous 2.4
Free T4 0.94 range 0.65-1.52 Previous 1.13
Reverse T3 20 range 11-32
Not sure what the RT3/FT3 ratio is. The calculator I found doesn't list the measurements the lab used for RT3--ng/dl.
Your thoughts are much appreciated. I have a doctor's appt on Monday & am trying to present a good case for what I need.
What unit is the Free T3?
Just for kicks, this is a scholarly article that may be of interest regarding reverse T3.
Free T3 is pg/ML. Thanks!
So, I need much higher T3, but what about that my T4 is also low?
Free T3 and RT3
A healthy FT3/RT3 ratio is 20 or greater. Less than 20 is an indication of High reverse T3. This is treated by Cytomel only 75-125 mcg daily. No T4 is given as this will metabolize into more reverse T3.
RT3 pmol/L These results need to be changed so that the ratio is correct. Multiple FT3 by 1000 then divide the result by RT3.
Ex. FT3 5.4, RT3 567
(5.4 × 1000) ÷ 567 = 9.5
RT3 nmol/L These results will give the correct ratio. Divide FT3 by RT3.
Ex. FT3 5.9, RT3 0.38
5.9 ÷ 0.38 = 15.5
RT3 pg/mL These results need to be changed so that the ratio is correct. Multiple FT3 by 1000 then divide the result by RT3.
Ex. FT3 2.6, RT3 258
(2.6 × 1000) ÷ 258 = 10
RT3 ng/dL These results will give the correct ratio. Divide FT3 by RT3.
Ex. FT3 403, RT3 25
403 ÷ 25 = 16
RT3 pg/mL These results need to be changed so that the ratio is correct. Multiple FT3 by 10 then divide the result by RT3.
Ex. FT3 397, RT3 474
(397 × 10) ÷ 474 = 8.3
RT3 ng/dL These results need to be changed so that the ratio is correct. Multiple FT3 by 100 then divide the result by RT3.
Ex. FT3 2.9, RT3 23
(2.9 × 100) ÷ 23 = 12.6
RT3 ng/dL These results need to be changed so that the ratio is correct. Divide FT3 by 0.0154 then divide the result by RT3.
Ex. FT3 4.5, RT3 30.3
(4.5 ÷ 0.0154) ÷ 30.3 = 9.6
The calculators were taken from a document in the Reverse T3 Yahoo group
Greatly appreciate you taking the time to copy all that! My ratio is 9.09. Pitiful.
Clealy, I need a much higher T3 dose. But, then what's done about my low T4? Is T3 stabilized & then T4 added? My goal is Armour, or another natural product. I'll see about tests for iron & cortisol you mentioned that effect RT3.
Yes, that ratio is quite low. Mine was 13 when I found out and I was so fatigued I could not function. I required naps, could not keep up with basic housework and could not work. What's most sad is that this started after the birth of my son in 2007 and the doctors were so uninformed. They let this basic thyroid problem go for nearly 5 years and during that time I struggled to take care of my baby and family.
I was even told by my woman gynecologist that my thyroid was fine and that I needed to wake up every mornaing, have some green tea and look out the window at the sun and great the day. There are many horror stories like this.
Your doctor doesn't know what he is doing. With a ratio that low you must feel horrible.
I would highly recommend http://www.thyroid-rt3.com
This is the website for treatment by Cytomel medication for folks with reverse T3.
When your ratio is low and you have the reverse T3 problem the only treatment is Cytomel ONLY treatment. You do not use T4. You do not use Armour or any other treatment that includes T4. This is because the T4 is the problem. T4 converts into reverse T3.
I was skeptical about using T3 only because I don't like to take medications for anything. I am very natural. But, the T3 from Cytomel is bio-identical. It is exactly the same hormone as produced in the body. But I thought I still wanted to go natural and someone gave me concerns about not getting all the other thryoid hormones without the Armour.
I tried the Armour, and I becme worse immediately I could not tolerate it. It was clear that it was not going to help.
Then I went to the Cytomel, supported my adrenals (which was a very big part for me to do in my case, it might not be so important for you), and then slowly worked up the Cytomel. I have gotten my life back and my energy level, 9 months after starting a decent dose is now 80-85 % of normal. So I can certainly excercise now for the first time in years.
So don't be scared of taking T3 only. There are lot's of success stories on the reverse T3 group.
Your doctor probably won't agree with this, as he is clearly outdated on his information if he will not give you even a liveable dose of T3 at this point.
Hope you feel better soon.