Reality: with Dr. Ain input: Re: Cytomel dosage &

[Guest guest]

(I.. like you.. am a patient)

Hello ladies,

Everything being equal.. most people taking more than 0.175 mcg. of t4

(thyroxine) are in need of doing so because of poor med. taking habit or of poor

absorption occurrence in the gut. Those that take 0.100 - 0.125 mcg. and are

able to target the suppression range of < 0.10 tsh.. have excellent gut

absorption capability. And probably good habit as to med. taking.

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Whether going-to or coming from the hypo state for testing.. it would only

be in _vary_ rare circumstances that ANY physician would prescribe 25 mcg. of

Cytomel 3--times-per day.. for ANY reason! While it is true that some people

are eight feet tall, this is a rare exception.

And so too with thyroxine medication.. it is rare that anyone would need more

than 300 mcg. of t4 or the t3 (Cytomel) equivalent, in a 24 hour period for tsh

suppression. (there are rare exceptions)

If someone (for the sake of discussion) was on a suppression dose of

thyroxine, the daily dose of which is 0.150 mcg. and then immediately started

(for the purpose of becoming hypo for testing) 0.075 mcg. of Cytomel while at

the same time discontinuing the 0.150 mcg. of t4 (thyroxine) would, ON THE

FIRST DAY, have in their system an amount equal to approximately _450 mcg. of

thyroxine!!! That's enough to stop one's heart if conditions are just " right " .

So many experience trouble taking Cytomel. I think it is most often due to too

great an amount of t3 being in the system already. And yet, an incompetent or

uneducated physician may be still adding more.

Reflection: how can the body reject a hormone that itself produces? It may do

this when it has too much. And the felt hyper effect(s) of too much t3 may be

experienced with the introduction of an extra amount from t3 (Cytomel) which

should be administered in quantities in keeping with the rate of depletion that

is occurring from having stopped the t4, thyroxine. A good balance must be

maintained. If this is done " just right " most untoward effect should be of

minimal notice.

Nick

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" Dear ThyCa Members:

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. " (Dr. Ain Date: Tue, 07 Nov 2000 11:22:54 -0500)

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" Levothyroxine, administered orally, is essentially completely absorbed

(85-100%) in nearly all patients (who do not have celiac disease, short gut

syndrome, or who co-administer their levothyroxine with iron pills, sucralafate,

or cholestyramine). " (Dr. Ain Date: Wed, 26 Jul 2000 09:44:38 -0500)

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" I start patients back on their full levothyroxine dose and utilize a

co-administered Cytomel dose which is planned to TAPER OFF over 2-3 weeks

as the T4 level rises in the patient's blood. Cytomel is not advocated

past that initiation period. " (Dr. Ain Date: Fri, 12 Nov 1999 17:29:57 -0400)

" Rapid relief of hypothyroidism is aided, in stable patients without cardiac

disease, by supplemental liothyronine administered as a tapering dose over two

weeks (Cytomel, 25 µg twice daily for 5 days, 12.5 µg twice daily for 5 days,

then 12.5 µg each morning for 5 days). [Ain KB: Management of thyroid cancer. In

Diseases of the thyroid (Braverman LE, ed). Totowa, N.J., Humana Press, Inc.,

1997, pp 287-317.] " (Dr. Ain Date: Fri, 10 Sep 1999 08:37:16 -0400)

" Dear ThyCa members:

" The half-life of levothyroxine is 7 days. 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. " (Dr. Ain Date: Wed, 05 Jan 2000 20:40:23 -0400)

At 2/1/02 09:55 AM, you wrote:

>Hi ,

>I don't like Cytomel either. I had to be careful about when I took it

>otherwise I couldn't sleep at night. To me it felt like staying up too late

>and drinking too much coffee to make up for it. You are tired, nauseous and

>jittery. Unfortunately it gets worse when you are off it and hypo (at least

>for me). The only time I am glad to take the Cytomel is after a treatment

>when I'm very hypo and I know the Cytomel will kick in after a day or so.

>You are on a pretty low dose of Cytomel, most people take 25mcg 2 to 3 times

>a day so you might already be feeling the effects of hypothyroidism. As far

>as work it really varies. I was able to continue work but I have very

>understanding co-workers and I warned them I would be in a really bad mood

>(I get very, very irritable when I'm hypo).

>I like your idea of pampering yourself!

>

>Papillary CA, TT1/2001, RAI 150mic 3/2001, RAI 200mic 10/2001

>

> Newbie

>

>Hello!

>I can't believe I'm just finding this group now...

>

>A Dr. noticed a huge lump in my neck in 1998, but said it was " just

>an enlarged thyroid " and " not to worry about it. " Lesson #1: Don't

>ask GP's questions about thyroid issues. SEE AN ENDO!!!!!

>

>After I got done with college I finally got medical insurance and saw

>an endo. In Aug of 2000 I had a partial thyroidectomy for that lump:

>a 7 " tumor. They were supposed to biopsy the tumor while I was in the

>hospital, but forgot to schedule it. A week after I went home,

>they found follicular cancer. While I recovered I became really hypo.

>8 weeks later I had my 2nd surgery to remove the rest of my thyroid

>and 4 weeks after that I had my RAI. That was a treat! On

>Halloween... Everyone asked if I was going to glow in the dark! Ha

>ha!!! I had to be quarantined for several days, so I made into a my

>own spa: movies, candy, popcorn, nail polish & mud masks in the

>hospital! If ya gotta be by yourself, why not make the most of it,

>right?!!

>

>I've been on .150 mg of synthroid ever since. I'm a few months late

>for having my 1 year scan (mostly because I changed dr's). About 2

>1/2 weeks ago I started what I call my " de-tox. " Now I'm on .25 mcg

>of Cytomel and will probably have my 1 yr scan the first week of

>March.

>

>Since I've been on the Cytomel I've been having lots of headaches and

>feel really achy. I keep reading that it's normal. Does it get worse?

>And the 2 wks of nothing before the scan- is that down right

>horrible? Should I expect I won't be able to work? It's not easy as

>it is--just no motivation!! My husband says I'm pretty funny to watch

>tho-- I'm hyper for the first hour after I take a pill, then

>everything goes into slow motion!

>

>I'm really curious about other's experience on Cytomel...so write!!

>Well... it's great to finally find this! and lot of " experienced "

>thyca's to get info from!!

>

>Take care!

>

>

>

>

>

>For more information regarding thyroid cancer visit www.thyca.org. If you

>do not wish to belong to this group, you may UNSUBSCRIBE by sending a blank

>email to thyca-unsubscribe

>

>

>