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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Phillipa on July 1, 2007, at 12:22:00
Well the prescription is based on trying cytomel too but it's supposed to cause anxiety my main problem and if benzo tolerant as you all say what do I do any ideas? Thanks Phillipa
Posted by Glydin on July 1, 2007, at 21:51:47
In reply to So Do I Try The Cytomel With Sythroid?, posted by Phillipa on July 1, 2007, at 12:22:00
If your TSH is so very elevated it would appear to me your body is trying to chase itself and get both your T4 and T3 levels up, so I would tend to believe dosing them together would be right. H. Thyroiditis is dodgey to deal with as it can swing back and forth between hypo and hyper states. What was your last ANA? Have you had an actual scan done recently?
Yes, thyroid abnormalities can be a big cause of anxiety problems so getting it WNL may be a critical part to treating your anxiety issues. If it were me, I would follow the doseage protocol ordered and see how it goes. I know new additions of meds can get you all freaked out but the alternative doesn't seen to me to be a great choice. In med phobiclike folks, it's a challenge but I think if you can try and exert an attitude of what you are doing may be a good answer and try to move your focus to the good potential as opposed to the freaking out anticipation of problems before they happen part, it would be helpful. I know - believe me, I do know well - it's difficult to go against what seems to be a natural engrained behavior for us, but it can be done.
Posted by Phillipa on July 1, 2007, at 22:29:59
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Glydin on July 1, 2007, at 21:51:47
Glyndin opposite. The level has to come down. Before the spider or whatever bit me it was 2.5 still high for the endo he wants to see it down to at least l. Last week up to 9 when hospitalized first time the TSH was up to 22. More synthroid and a lot of benzos when they worked straightened it out for 9years. The endo said take synthroid with valium at 5am when I wake for bathroom as we go to bed at l:30. Then take the cytomel with breakfast the pharmacist we talked with in person today said this was perfectly fine as I've been on valium. Can you imagine how many people are on zoloft and don't know the insert says not with synthroid. Only SSRI wonder why? Love Jan
Posted by Phillipa on July 1, 2007, at 22:35:07
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Glydin on July 1, 2007, at 21:51:47
Oh asked about a scan as none has ever been done by any doc over the years. The endo said unless nodules or goiter or to check for cancer no go. And last ANA was l:l60 this labs values had under 4o as normal. None done in about 8 months. And I really don't want to know as when lymes was active it was l:2280, Love Jan ps it has been fluctuating between l:160-1-320 for at least ll years. Negative for lupus, Ms, sjournes, Renauds.
Posted by Glydin on July 1, 2007, at 22:47:28
In reply to Re: So Do I Try The Cytomel With Sythroid? » Glydin, posted by Phillipa on July 1, 2007, at 22:29:59
> Glyndin opposite. The level has to come down. Before the spider or whatever bit me it was 2.5 still high for the endo he wants to see it down to at least l.
~~~ Yes, your TSH needs to decrease and it is indicating your body is trying to make itself raise your T4, T3 and Thyroxine levels and is unable to do so therefore it keeps pumping out the stimulating hormone, right?
Supplementation giving you adequate levels would bring the TSH down, right?
Posted by Glydin on July 1, 2007, at 22:48:26
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by Phillipa on July 1, 2007, at 22:35:07
> Oh asked about a scan as none has ever been done by any doc over the years.
~~~ I'd want one but that's just me.
Posted by Phillipa on July 2, 2007, at 0:00:35
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Glydin on July 1, 2007, at 22:47:28
Correct. And I asked for a scan my niece gets one each time she goes to the endo. They feel my neck and feel no goiter . Once in the hospial a resident in endo thought she felt a nodule called the attending he said no. I'll have to google this one too. Love Jan
Posted by Phillipa on July 2, 2007, at 0:07:50
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Glydin on July 1, 2007, at 22:48:26
I agree Love Jan
Information and Resources Font SizeA A A Thyroid Scan
A thyroid scan uses a radioactive tracer and a special camera to measure how much tracer is absorbed from the bloodstream by the thyroid gland. During a thyroid scan, the camera takes pictures of the thyroid gland from three different angles. The radioactive tracer used in this test is usually iodine or technetium.A thyroid scan is done to diagnose problems with the thyroid gland. A thyroid scan may be done to evaluate thyroid nodules, or it may be done along with a radioactive iodine uptake test (RAIU) to evaluate thyroid function.
A thyroid scan can show the size, shape, and position of the thyroid gland. It can also detect areas of the thyroid gland that are overactive or underactive.
Another type of thyroid scan, a whole-body thyroid scan, may be done for people who have had thyroid cancer that has been treated.
Why It Is Done
A thyroid scan is done to:Determine whether thyroid nodules are present.
Determine the cause of an overactive thyroid gland (hyperthyroidism).
Determine whether thyroid cancer has spread beyond the thyroid gland. A whole-body thyroid scan will usually be done for this evaluation.
How To Prepare
Before having a thyroid scan, tell your health professional if you:Have any allergies to medications, including anesthetics.
Take any medications regularly. Be sure your health professional knows the names and doses of all your medications. Your health professional will instruct you if and when you need to stop taking any of the following medications that can interfere with the test results.
Thyroid hormones
Antithyroid medications
Medications that contain iodine, such as iodized salt, kelp, cough syrups, multivitamins, or the heart medication amiodarone (Cordarone, Pacerone)
Are allergic to iodine. The radioactive tracer used for this test may contain iodine. However, even if you are allergic to iodine, you will probably be able to have this test because the amount that may be used in the radioactive tracer is so small that your risk of an allergic reaction is very low.
Have recently (within 4 to 6 weeks) had any tests in which you were given radioactive materials or had X-rays that used iodine dye. Receiving iodine contrast material prior to a thyroid scan can interfere with test results.
Are or might be pregnant.
Are breast-feeding.
Have ever had a serious allergic reaction (anaphylaxis) from any substance, such as the venom from a bee sting or from eating shellfish.
Before a thyroid scan, you need to sign a consent form that says you understand the risks of the thyroid scan and agree to have it done. Talk to your health professional about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).Before a thyroid scan, blood tests may be done to measure the amount of thyroid hormones (TSH, T3, and T4) in your blood.
Do not eat for up to 2 hours before the test.
Before a thyroid scan, you will either swallow a dose of radioactive iodine or be given technetium intravenously. When and how you take the radioactive tracer depends upon the tracer used.
Iodine (taken by mouth before the test) may be taken up to 24 hours before the test.
Technetium (given by intravenous injection) is usually given 20 to 30 minutes before the test.
Radioactive iodine can be taken as a liquid or capsule. The iodine has little or no taste.
Just before the test, you will be asked to remove your dentures (if you have them) and all jewelry or metal objects from around your neck and upper chest area.
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WebMD Medical Reference from HealthwiseLast Updated: October 13, 2004
Posted by Phillipa on July 2, 2007, at 0:09:22
In reply to Re: So Do I Try The Cytomel With Sythroid? » Glydin, posted by Phillipa on July 2, 2007, at 0:07:50
Looks a lot like it's used before diagnosis. Or hyperactive. Confusing Love Jan
Posted by twinleaf on July 2, 2007, at 2:34:01
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Phillipa on July 2, 2007, at 0:09:22
I had a scan and a biopsy- not because i had an actual lump, but because one side of my thyroid was fuller than the other- this was done to rule out cancer, but also to diagnose the Hashimoto's. If you would feel more confident asking for a scan or biopsy - I guess there's nothing to biopsy, though!- by all means, do so. From what I remember of your posts about this, you have had Hashimoto's for quite a long time, with no lumps, so those tests may not tell you anything you don't already know. I did post above about how my treatment has developed. The Cytomel in small doses, either with or without Synthroid, has been SO helpful- both for weight and depression, and hasn't given me any problems. As far as I can see, it's completely side-effect free.
Posted by Glydin on July 2, 2007, at 6:58:33
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Phillipa on July 2, 2007, at 0:09:22
> Looks a lot like it's used before diagnosis. Or hyperactive. Confusing Love Jan
~~~ If levels have been stable for quite some time and there had been such a change and if I hadn't had one in years, I would want a look see for my own info and wondering.
I know you have other factors that might be contributing in your case.
I suppose your endo would be the one to discuss it with. Perhaps they have a good rationale for not thinking one is needed. I would want that explained to me.
Posted by Phillipa on July 2, 2007, at 20:18:00
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by twinleaf on July 2, 2007, at 2:34:01
Twinleaf see no need for a Scan so it helped with weight and energy as I need to borrow some for now. Thanks for the encouraging words. Love Phillipa
Posted by Phillipa on July 2, 2007, at 20:20:37
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by Glydin on July 1, 2007, at 22:47:28
Glydin yes. Hence trying the cytomel as the conversion of T3 supposedly goes through some feedback loop and the cytomel brings energy to muscles at least that how the Nurse Practioner who you see inbetween explained it. Love Jan
Posted by tendency on July 4, 2007, at 10:20:41
In reply to So Do I Try The Cytomel With Sythroid?, posted by Phillipa on July 1, 2007, at 12:22:00
My 2 cents: I've been treated for hypo-thyroid for the past year. My endo (and I've gone through several endo's before finding this doc - he's one of the best IMO) ALWAYS says you must combine cytomel and synthroid. He's a pioneer in treating the thyroid and says this is the only combo that consistantly works. His model is to take ~80% of your body weight in t4 (synthroid only - no generic) and then 10% of the t4 dose as cytomel. So, for me, I take 150mcgs of t4 and ~18mcgs t3. He bases the final dosing on blood levels of total t3/t4. He likes to see these in the high upper normal range. One last note, according to him it can take up to 18 months to get the full effect from this regimen. Good luck!
Posted by Phillipa on July 4, 2007, at 21:48:52
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by tendency on July 4, 2007, at 10:20:41
Well not at l50 highest wt ever has me on 5mcg of cytomel and 88mcg of synthroid. Since I'm not good at math how does this compute. By the way the weight gain is over two months. Weighed l28 all my life and that includes when I took synthroid l25mcg with breakfast and vitamins. And when will this tiredness start to abate as I fight it my riding 7.5miles daily on my bike and trying to be out of the house shopping or such each day. Love Phillipa
Posted by Phillipa on July 4, 2007, at 21:51:18
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by tendency on July 4, 2007, at 10:20:41
Tendency why the upper half of normal as mine says he'd like to see a l. New normals for best results are l-3. Love Phillipa
Posted by tendency on July 4, 2007, at 23:57:11
In reply to Re: So Do I Try The Cytomel With Sythroid? » tendency, posted by Phillipa on July 4, 2007, at 21:51:18
upper half normal is for total t3/t4. yes, TSH will be very low, below 1 if taking a replacement dosage of exogenous t3/t4.
Posted by Phillipa on July 5, 2007, at 0:02:17
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by tendency on July 4, 2007, at 23:57:11
Last fall I went to .03TSH. Had some diverticulitis and hence thyroid all over since then. Was at 2.5 till bitten by something and took antibiotics and it rose to 9. Hence the cytomel he said it would be a good time to try it. Will I lose some of the weight? Love Phillipa
Posted by tendency on July 5, 2007, at 9:27:39
In reply to Re: So Do I Try The Cytomel With Sythroid? » tendency, posted by Phillipa on July 4, 2007, at 21:48:52
I'd say based upon your weight youd want to be taking about 100mcg t4 and 10-15mcg t3. another thing to experiment is taking the t3 is two doses - 1/2 when you wake up and 1/2 about 4-5 hours later as it has a very short 1/2 life.
with aerobic exercise the t3/t4 should help you loose weight.
Posted by Phillipa on July 5, 2007, at 18:51:55
In reply to Re: So Do I Try The Cytomel With Sythroid? » Phillipa, posted by tendency on July 5, 2007, at 9:27:39
Thanks tendency so really the dose needs to come up of the cytomel? No bloodwork for 6 weeks and only increased synthroid by one half a pill. Was taking a half one day a week. So why the tiredness when it used to cause extreme anxiety? I don't get that. Love Jan ps thanks for the math calculating.Anxiety when TSH high. Funny this one pdoc in the beginning said he wanted it this high around 6-9?
Posted by tendency on July 5, 2007, at 21:36:20
In reply to Re: So Do I Try The Cytomel With Sythroid? » tendency, posted by Phillipa on July 5, 2007, at 18:51:55
> Thanks tendency so really the dose needs to come up of the cytomel? No bloodwork for 6 weeks and only increased synthroid by one half a pill. Was taking a half one day a week. So why the tiredness when it used to cause extreme anxiety? I don't get that. Love Jan ps thanks for the math calculating.Anxiety when TSH high. Funny this one pdoc in the beginning said he wanted it this high around 6-9?
yes - if you're only at 5 mcg of cytomel that's too low according to what I know. However, you need to run blood tests to arrive at the proper final dosing. I'd think you would need 10-15mcg of t3. I'd go to 10mcg then test total t3/t4 via blood work. you'll want these to both be in the high upper normal range. if the t3 is not then i'd go to 15mcg - probably 7.5mcg bid once when waking second dose 4 hours later.
tiredness can be caused by lots of things, of course, however if you're not religiously following a thyroid regimen it can come from to little/to much t3/t4, missing doses etc. it's extremely critical that thyroid hormone replacement be followed RELIGIOUSLY. same time, every day (or as close as possible). you can't miss doses.
get a total t3/t4 and tsh test done. have no idea what the pdoc (and what the hell do they know about endocrinology? - mine didnt even know which tests to order i had to tell him) was thinking about wanting the TSH above 6. no way. that's hyper-thyroid. with proper t3/t4 replacement therapy you TSH will be well below 1 .. think mine is around .2.
-matt
Posted by tendency on July 5, 2007, at 21:41:26
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by tendency on July 5, 2007, at 21:36:20
PS - the anxiety can be caused by hyper-thyroidism. it's very paradoxical depending on patient..agitation/anxiety are classic hyper-thyroid symptoms, however (of course numerous other abnormalities can present w/ these symptoms..).
Posted by Phillipa on July 5, 2007, at 22:03:13
In reply to Re: So Do I Try The Cytomel With Sythroid?, posted by tendency on July 5, 2007, at 21:36:20
Matt the endo said that the low TSH of .03 was hyper. For me the high TSH when first got hasimotos of 22 sent my anxiety through the roof. But what I don't understand is that the endo said to take with my 5mg of valium during the night when I wake-up which now have been doing since fall. And the cytomel okay with breakfast and his nurse said the opposite dont take with the valium and they must be taken together. So still waiting for a call back for four days. And why would zoloft be the only SSRI they say to watch or not take with synthroid and the valium too. But the endo knows I'm on valium. No one in all the years ever mentioned meds affecting with synthroid goggle synthroid get the phamphlet site and read it amazing. Love Phillip/Jan
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