CYTOMEL (T3)

[Guest guest]

.... FROM ThyCa LISTSERV MEMBERS:

1. The purpose of Cytomel is to help you feel better than going " cold turkey "

off your levothyroxine. It is totally for your comfort and convenience; if you

find you are feeling hyper or ill, or uncomfortable in any way, you can always

lower or spread out your dose.

2. Be alert for the earliest signs of hypo/hyper symptoms.

For some, starting hypo feels like your body and brain have shifted into low

gear and are moving v-e-r-y slowly. Hyper typically feels like a triple

espresso: jittery, overly irritated by ordinary things, fast heart rate, bowel

motility, but it can also mimic hypo symptoms (helpful, huh?)

3. Gradually increase Cytomel over the weeks as the levothyroxine gradually

leaves your body (remember it takes six weeks for T4 to completely leave your

body).

Increase or decrease T3 dose by 1/2 a pill as your body needs it, not

necessarily on a fixed schedule. Generally, you need to be off all meds,

including Cytomel, at least two weeks before scanning or ablation.

4. Some find it helpful to split the daily dose between morning and afternoon.

5. You may feel a difference the same day you change dosage, but in reality the

full effect of the change isn't felt for a few days. (A half life of 18 to 24

hours means steady state is reached in 4.5 to 6 days.)

6. Before starting on Cytomel, you should be off levothyroxine (or

post-surgery) for several days or a week in order to let the T4 level drop down

a little first.

7. Keep a calendar or note book with your pill bottle. Write down the amount

taken each day and note any symptoms changes.

Some of us do great on Cytomel, but not everyone does. Some prefer to allow

their levothyroxine dwindle down gradually, while others prefer the convenience

of having a few more weeks feeling almost normal.

“I started out with one pill, after three days was jittery and screaming at

kids. Cut back to 1/2 pill and felt better. In a couple days I was dragging, so

back up to one pill. Felt very good for a week, then starting to slow down, so

up to 1-1/2 pills. Feeling good for a few days. Then I was freezing all night

and dragging in the morning, so up to 2 pills and feeling better by evening. I

ended up at 2-1/2 per day (62.5 mcg).”

“I am one of the ones who thinks [Cytomel] is a godsend while preparing for

scans.

I have used it prior to all 6 of my scans. I take it for 28 days and then

discontinue its use for the last two weeks prior to scanning. It keeps my

energy level up and I feel perky and 'normal' for those 28 days. Once I go off

Cytomel, I crash into hypo hell quickly as all the T4 (Synthroid) has been

depleted from my system over the prior 28 days. Those who go off Synthroid with

no Cytomel as substitute report a more gradual slowing down. “

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HOW SHOULD CYTOMEL BE TAKEN?

" Both iron and calcium tablets should not be taken together with thyroid

pills.... Cytomel is also a thyroid hormone, so the same precautions apply. "

-- Arturo R. Rolla,MD

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" When Cytomel (L-T3) is used to mollify the discontinuation of

levothyroxine, the typical dose is 25 mcg given every 12 hours (total

daily dose 50 mcg). Sometimes this creates peaks of L-T3 which cause

symptoms, which can be alleviated by splitting the pills and taking

12.5 mcg four times daily (same total dose of 50 mcg).

" For some patients, particularly those who were on levothyroxine

dosages of 112 mcg or less, the optimal Cytomel dose may be 1/2 pill

(12.5 mcg) three times daily or sometimes twice daily.

" Dosages in excess of 50 mcg daily are rarely needed and usually cause

thyrotoxic symptoms in patients used to 200 mcg or less of levothyroxine.

This Cytomel therapy should be discontinued 2 weeks prior to I-131

scanning, when performing the traditional scan preparation. "

********* B. Ain, M.D.

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HOW SOON DOES CYTOMEL TAKES EFFECT?:

“The half-life of levothyroxine is 7 days [a half life is how long it

takes until

1/2 of it is out of your system...]. It takes from 6-8 half-lives, when

resuming any medication, for the level of the medication to reach its ultimate

steady-state level in the body.

" For levothyroxine (Synthroid, Levothroid, Levoxyl, etc.), this means

that it will take fully 6-8 WEEKS for the levels to come back to normal.

“When stopping levothyroxine, the curve is identical although reversed.

That is why the TSH level does not typically become sufficiently elevated for

I-131 scans or therapy until 6 weeks after stopping the medication.” --

B. Ain, M.D.

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ADDITIONAL INFORMATION:

Cytomel web site:

http://www.jmedpharma.com/html/products_1_cytomelpresinfo.html

MyThyroid.com :

http://www.mythyroid.com/drugs.htm

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