Mary Shomon article on T3 - easy read

A fairly easy read for those not that familiar.

See:

http://thyroid.about.com/od/hypothyroidismhashimotos/a/Thyroid-Patients-Do- You-Need-T3-Natural-Desiccated-Thyroid.htm?nl=1

Hopefully that link works.

Most people will need their t3 in upper part of the range as she mentions. If you have not had your free t3 tested, you can ask your doctor to put it in next labwork.

But warning to the newbie who never took t3, never go from all day t4 meds and a suppressed TSH to next day adding lots of T3. Best if you withdraw some t4 for a few days to a week and slowly add the t3 in right measures to give you the same TSH as your goals.

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A small “free t” testing with t3 adding infomation for people on just t4 medication who have had a TT, and may want to convert to combined t4/t3.

WHAT IS GAINED BY A COMBINATION T4/T3 VERSUS T4 ALONE
Treating an average, low normal, or below normal free t3 with cytomel and supplements geared for conversion can bring:
* help in reducing weight – less cravings
* lessen headaches and brain fog
* increase hair that was lost via T4 suppression or from low free t3
* clear up dry skin issues
* lessen anxiety
* better mood and will help even things a bit especially due to T4 caused mood swings
* better physical symptoms, and so much more

The majority of Endocrinologists (Endo) will not give a prescription for cytomel to thyroid cancer patients due to pretty much false claims about what it does (see a few myths below). A very few docs will go with as little as if it feels good to do cytomel, then prescribe it, but that is very few who go by feel and symptoms alone. The rest of Endo are ok with cytomel will want something a bit more numeric, but will hopefully work with your symptoms too. Basically there are two areas when looking at the numbers you get on "free t" testing. The free tests should potentially be around the same area of the range (conversion) to show you convert ok, and the second is that they want us ideally near the top of the range particularly on free t3 perhaps less so on free t4.

Note: You can take your t4 med any time before testing, but they advise not taking any t3 med, if you are on any, right before testing as it will show free t3 higher than it runs during the day.

FREE t4
Free t4 reference ranges I have had on testing
Lab1: 0.7 to 1.7 ng/dL
Lab2: 0.89 to 1.8 ng/dL
Many people on purely t4 run near the top of the free t4, but you might not if you convert well. Numbers over the top of the range on free t4 probably mean you do not convert well.

FREE t3
Free t3 reference ranges I have had on testing
Lab1: 2.6 to 4.4 pg/mL
Lab2: 2.3 to 4.2 pg/mL
I do the very best when my free t3 goes over 4. If you are below the reference ranges on free t3 you will likely have some of the issues mentioned at the top of this information. You may have, or likely will have some of that in-between ranges. Most people will feel best, and do best when free t3 goes over 4 or to the top of the normal range on free t3. If you test in the middle ground on free t3, you may want to check reverse t3 to see if the body is rejecting some of the t3. If you test somewhere like 2 to 3, or a low normal, you likely will have symptoms of low free t3 already and I believe these ranges will be pushed higher someday.

SUPPLEMENTS
Work with your docs on
* Vitamin D3 and K2
* Selenium
* Iron such as Iron bisglycinate

FALSE CLAIMS ABOUT T3
Myth: That you can’t regulate TSH if giving cytomel in conjunction with T4. Fact: If you get your TSH to targets for your cancer risk on T4 alone, you can simply remove exacting amounts of t4 and add t3. The amount of t3 needed by the person does vary so it takes visits and rechecking.

Myth: Bad reactions happen constantly with cytomel. Fact: Bad reactions happen because at a suppressed TSH you have to convert to T4/T3 more carefully, more on that below.

Myth: T3 causes anxiety. Fact: T4 alone causes mood swings, adding t3, no matter what the target TSH is, will help even the mood and reduce anxiety caused by T4 mood swings.

HOW TO ADD T3 (Must subtract t4 to do it!)
If you get a prescription for cytomel, your prescription for T4 should come down if you want your TSH to stay the same. If your TSH needs to come down or up to meet thyroid cancer suppression goals you need to factor that in. If you get a prescription depending on where you want your TSH be sure to factor the cytomel into the picture before you start.

You should take cytomel split in half two times a day to give a level feel, or see if you can get a compounded version.

Although some charts and info show on a mcg basis that cytomel equals the effect of 4x the mcg of levo or synthroid that is not how I came out. My radiation oncologist who puts people on cytomel for manual hypo and RAI, says his 30 years of doing it taught him to estimate a 25 mcg cytomel equals about double in mcg for levo to subtract (so subtract 50 mcg T4 if you get 25 mcg cytomel). I estimate 2x is closer to reality for me when I converted to combo some years ago. Although my effect was about 2x (or perhaps slightly higher) any given person may need to subtract as much as 4x of the t4, although I didn’t.

Warnings:
* If you are on pure t4 and suppressed level of TSH: You should definitely take out your t4 meds days to weeks ahead before starting t3. There are too many stories of people who jump from TSH 0.1, all on t4, to sudden switch to adding 25 mcg t3 and it pushes the TSH too far and they get bad reaction so conversion has to be done with care in our suppressed state with reducing the t4 first and ahead.
* High BP patient: Cytomel can spike the BP a few days when you first take it, go slow and wait till you adjust.
* Levels of feeling alert: If you have been in a brain fog fairly long you may not be used to the alert level cytomel can give. Give yourself time to adjust. If you are new to TT you may notice cytomel leaving you more alert, you will need that to feel normal eventually as t4 often leaves a foggy, and non-alert feel.

Low value prescriptions of cytomel, like 5 mcg and 10 mcg may not do all that much to free t3. They would not for me anyway. To get a more substantial effect on free t3 levels if you are low you likely will need more than that.

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Wow, that's a lot of info. My TSH has been less than .02 since January 2012. I have reduced my synthroid a few times in the last 8 months but still suppressed at less than .02. I am currently on 175 daily of synthroid. My only negative symptom is that I am very low on energy. I just can't seem to get going in the mornings and am tired early in the evening. I started taking testosterone a few months ago but it really hasn't helped with the energy. My endo told me that he is willing to give me cytomel with the synthroid. I wanted to wait and see if the testosterone helped. Now I'm ready to work on adding T3. So, in your experience, should I reduce to 150 of synthroid for approx one full week and then add 25 of cytomel per day (split in half, one in morning and one in afternoon)? Do you take your first dose in the morning at the same time you take the T4? You didn't mention "energy level" above. Do you think it helps with energy as well?

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Hi Bradbdad,

Energy: The reason I don't mention energy is I feel it is indirect help. You feel alert enough to do what you did before, so thus you do it. But it does not make you more energetic, it takes away the craay feel that stops you. I call that indirect help sort of.

Taking time: I do take my first half at 5 am with Levo, second half usually mid afternoon or so, sometimes as early as noon if I need it.

Reduce t4 first: Your TSH is very suppresed level, you may want to let it float up to 0.1 or so but that is a seperate issue. If I were you I would start with reducing synthroid to 100 to 125 mcg, get a 25 mcg prescription for t3, add a few days later at 1/4 pill two times a day for several weeks, then go to 1/2 pill twice a day. For a male that takes meds ok, I think that might be slow enough. Med sensitive or smaller weight (many women), or so on might need to go way slower. I could easy do it like I mention for my BP. I would definately go down to something like 100 to 125 mcg synthroid though. They will have to retest a few times of course. It took my docs two reductions on the t4, not all in one reduction.

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Thanks. I'll give it a shot and let you know in a few months.

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You took a Lot of time on this and I appreciate it. I will have to read it over again as my lab results come in during this journey. It was interesting. Thank you!

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Hi BioMed,

Thanks for this very informative post. I am a little confused now on what I should be going for on my TSH (no suppression for me).

Cabro mentioned this about my testing and getting t3/t4 tweaked...

“If your doctor is at the point with you where you are trying to work on balancing your T3 and T4, you no longer look at TSH. It is going to be uber-suppressed. It just goes hand in glove with this. After a dose change, your T3 and T4 show up in your blood within 2-3 weeks, max. So you can measure them with a blood test around 2 or 2-1/2 weeks, get your dose tweaked, and then go along and do it all again. No more six week waits for a blood test. “

This is incredibly valuable info to me and endo should have mentioned this to me! I’m at 3 months on t3 and now I could have sped this torture up. Just upsetting to me because this is really hard.

But where do I want my TSH goal now? Since I am not having it suppressed? Will it be low like cabro said and I don't address it anymore? Or am I just doing the combo (t3) adjusting at this point and then we see where TSH ends up when my frees are brought up?

In my case both frees were quite low and tsh was high and perhaps this is why he didn’t substitute the levo out for cyto? Or am I just really being ignored here, and levo will ALMOST LIKELY need to come down and cyto needs to come up to say at least ~ 88levo/12-15cyto (as BioMed keeps iterating) . I'll see this week.

Now, tho my dose is 5mcg, I can now easily tolerate up to 25mcg a day but I’m still not feeling great and things are still changing like crazy. Must be patient. I know if I returned to 5mcg dose I would crash by the end the day. So I will keep it higher (~10) than he prescribed, because I HAVE TO WORK. I'm worried that he'll chastise me as he has done in the past...

BioMed you said....”The free tests should potentially be around the same area of the range (conversion) to show you convert ok, and the second is that they want us ideally near the top of the range particularly on free t3 perhaps less so on free t4. “

I still don't get this because my frees were so low, but they were in the same area of the range (meaning the low end, but both near the same VALUES in the ranges—at the low end), does it possibly mean I convert, but it's just all too low a hormone amount? I had RT3 in the test, so I'll be able to glean from that.

Still feeling lost and don't really mean for you to answer all these questions! I'd like to go in this week with GOALS, something he has never had with me. This appointment is the defining appt of our ten year relationship, it's make or break. If he does not become more proactive with me now I will drop him. Thanks for all this great information. Looking forward to health…thank you so much for putting this all out here. So valuable.

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four_winds: Maybe cabro who did way more dose changes can answer more on the process of changes than me, I only have done a few dose changes in going on four years...

I'll bet when you started way back post TT your free t4 used to shoot up, and perhaps now it no longer does. Many of us put on pure t4 have our free t4 way up high.

Maybe somehow your ability to make t3 was long ago compromised by external factors, and your body stopped absorbing t4 because it won't convert it, just to do what it could. That does not mean you convert though you are in the same area of range (low) it means your body gave up on t4 since it can't use it right so it now just absorbs what it uses. Many years of too high a free t4 might do some damage, and sometimes I see people with way too high a free t4. Mine started way too high which my Endo fumbled around with quite a bit but never really tried to do anything about much.

Maybe you burn the t4 and t3 real quick so it never shows in blood levels for some reason.

You might be one who really benefits from the supplements more than others as that might be the issue from the long term, Vit D + K2, selenium, iron, maybe others too B12, Folic acid. Much of that they can test.

I definately think you will know more as you get your free t3 numbers but I suspect you need much more cytomel to get your levels up, and that supplements might help you more so than most four_winds.

If I was really far out, I might aim for TSH of 1 or 1.5. What does your doc say the aim is if any? I agree pushing your free t3 up might get your TSH where it needs rather than an exact target though.

Hope you find answers, I read all your posts though, and will chip in when I can.

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Thanks Bio, appreciate it so much. Got my results, all except RT3:

Combo therapy started May 2012 - 5mcg cytomel/100 levo
-----------------------------
6/28/2012:
FT4 .9 [.8 - 1.5]
FT3 2.1 [2.2 – 4.0]
TSH 2.85 [.358 3.740]
------------------------------
8/31/2012:
FT4 1.1 [0.8-1.5]
FT3 2.5 [2.2-4.0]
TSH .553 [0.358-3.740]
------------------------------------
WOW!
By golly, I'm bringing this system up to snuff and it feels like I'm lifting the titanic. HA HA!

Sodium 138 [136-148]
Potassium 3.9 [3.5-5.1]
Chloride 105 [98-108]
Co2 24 [21-32]
Anion Gap 9 [6-16]
Glucose 85 [60-100]
BUN 17 [3-21]
Creatinine .70 [0.60-1.00]
Calcium 8.8 [8.5-10.1]

Iron and TIBC
Iron 55 [50-170]
TIBC 341 [250-450] ug/dL
Iron Sat L 16 [20-55] %

Vitamin D, 25 – Hydroxy
D2 <5
D3 22
D2 D3 Total 22
<20: Insufficiency
Hypovitiminosis D: 20-30 ng/mL
Sufficiency: 30-100 ng/ML

I have no idea what all this means yet. That BUN level is high (too much t4? straining the kidney?) Iron and Vit D look dreadfully low, as are others as I suspected. I've made drastic changes in the last month, I hope these numbers bump up with increased supplements and healthier habits on my next draw.

Numbers are better, yes? WHOOHOO! Victory is mine, or at least getting closer...I hope. Feeling positive today. Knew my dose needed to be higher .

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I'm real glad you are starting to find answers four_winds. You notice your FT4 came up as you added cytomel which is only t3, and as you work on the supplement issues. I think your body had gone into a long reject mode of some sort, not taking in what it could not use in the t4 you have been taking. Definate need for D and iron and you are working on that. And going up more on the t3 is good. You could cut some t4 if you need to as well. You have had a longer path than most of us without getting treatments you need, but good to see you are starting to get it now. I hope things keep going the right way with more cytomel, iron and D.

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Hey, four_winds, Good to see you posting here. Your calcium looks low-ish to me. Just wondering....Easy to take Citrical, which also has a bit of D3 in it.

Thanks, BiomedEE, for all the resources.

four_winds, I don't know that you need to decrease T4. Time and the numbers will tell. And it depends on how you feel, really. If TSH at .5 brings about anxiety or more impatience, then I would want less T4. (I do want less T4 but I can't have it!) But your numbers are showing exactly what I said about TSH not being what you look at with this. At least for me and my doctor it isn't. Also, let us know whether the doctor gets the boot or not. Remember not to burn any bridges while you are standing on them. ;-) In other words, get copies of **all** your records and line up the new endo first. You are very practical, so I doubt that you need that reminder. But being out of whack messes with our brains, so I threw it in.

I am the oddball here. I take 5 mcg T3 every 3-/2 hours, up to 4 times a day. I have a short day, due to additional medical issues. Some days I have to take 10 mcg to get out of bed. Depending on what I have to do or what my schedule demands of me, I could probably use 20 mcg 4-5 days a week and 25 mcg 2-3 days. I'm just taking it as it comes and trying to make heads or tails of it, which is hard to do with sleep issues and the resulting inconsistency in schedule. I hope that you will continue to find hope and encouragement.

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Oops. I meant I am on 15 or 20 mcg and probably need 20 four or five days a week.

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Hi cabro...you are not the oddball here, no oddballs. I actually have a similar regimen. I'm now able to take a 5 mcg at ~4:30 am (after 4 months!) and a 5 mcg at 12-1 pm. Then, if I get signs of hypo by 4pm, which can be cold extremities (my big sign), also the shakes...which are slightly different than what a t3 tremor sometimes feels like--if I may differentiate, these are very different and I've identified them, crucial!) I'll take the additional half, for a total around 12.5. Yet, as you said, some days I need it some days I don't.

With these dietary changes (slowly but surely) and actually drinking water conscientiously I expect my poor labs to really punch up in the next few draws.

Interesting about the t4...I don't get it. All I did was add t3, how does t4 go up?

Cabro, you are saying with suppressed tsh, if I lower the t4, I'll have less anxiety? Very interesting, I'd like that! Terrible side effects with t4, but the t3 is helping counter it. I guess I'd have to see where those numbers end up when the t3 levels are higher to make the determination on t4.

Thank you for all the assessment and care, I really appreciate this information and I hope anyone curious about t3 can learn a little bit about it's "process" through these posts. I will take it easy on my endo...I want to give him a chance. I'm much less hostile with some t3 in me, actually, it's quite wonderful...

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The same thing happened to me with T3 added. My T4 went up without a T4 med increase. Bizarre. My amateur thinking mind wonders if the T4 goes up because it is no longer having to work so hard to convert, since the T3 is being supplied. Thus, some of the extra T4 sits around and says, "Hey, I don't have to do this" and it shows up in the blood. [ very scientific - haha ]. And it made my endo want to decrease my T4 at the same time he changed my T3. I said No, because then we wouldn't know which change worked. He agreed to go with me on that for two weeks, and lo and behold, the T4 leveled out some. So, we still wanted to lower it but only by 46 mcg per week. I search and search for logic in these anomalies, but so often it's not there. I just don't have the knowledge. And gosh, we need more research!

As for the anxiety and T4, I think so, but I defer to your doctor. I just know that when I have too much T4 without the T3, I was emotionally volatile, cranky and always on edge. So if that's anxiety then count me in. You note that you are much less hostile with some T3 in you. Me, too! :)

I'm glad you are able to differentiate your symptoms and have help now with the T3. My hands and feet aren't cold in the summer, but they sure are in the winter. I'll be interested to see if T3 helps that.

You've mentioned dietary changes, but I don't think I know what they are. Can you share?

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If I understood it the reason ft4 may go up on certain cases (lets not call them basket cases), is the t4 is being converted all to reverse t3 instead of the free t3 which can be used. Somehow taking actual t3 (cytomel) helps clear out, or actually stop the reverse t3 conversion process. Something like that is what I caught from stop the thyroid madness stuff (STTM), at least that is what I thought I understood if my brain was not in reverse mode when I read something about it.

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OK sorry I'm a blabber. Well, I'll be sure to report my RT3s when I get those, they may provide some insight to the t4 question.

cabro: the description you made of high t4 side effects...how do I describe this...because I've been in hypo for so very long, so many years, your words matched precisely my personality, not the side effects of alot of t4 (non-productive t4 too). The hypo had taken over every facet of my physical being and personality. It is only with the t3 lifting the severe symptoms of hypothyroidism that I am even able to recall what I used to feel like and be like. Now, that's just terrible. But I'm alright and moving on with it. What a transformation I am experiencing. I still cringe when I see people posting about T4 only regimen/long term and their energy and fog problems. It truly illicit's a physical reaction on my part. I am thankful a bunch of people get on up there and chime in, it's so valuable. It's our best defense for a proactive patient.

Diet: I'm serious about fluids, I've been remiss. That's changed. A lot more water and less diet sodas, total, real hydration (a state I am very rarely in, I am awful about this, numbers don't lie). Cannot ever see giving coffee up in this realm.

Really cut out the processed foods. Really did and it's been hard. Haven't eaten out in 4 months. Increased raw veggies and lots of fiber, but still have a sweet tooth, ugh. I've added a multi-vit, but am going to get a better quality one, taking floradix for iron (duodenal ulcer, it's nice on the ulcer), L Tyrosine, Selenium (all away from t4 dose time, but can't avoid t3 midday dose interference).

No soy, no cruciferous and much, much less gluten. Gluten is hard to eliminate altogether at this point and I still want to live. :-) I was a vegetarian for 22 years, from '84 - '96, so a serious soy, gluten and cruciferous overdose occurred for 22 years! I am now quite sure this helped disable thyroid production as well as other variables, as I put together the timeline of my health from a young age.

If grains, then whole grains when I can. I notice I get hypoglycemic or something if cyto wears off because I really crave refined sugar in the evenings and that's always around the time of the possible zombie dead zone crash.

I saw a great description from a post from kisiephish on Aug 4 where she described, "I feel like I'm walking through sludge. Like my limbs are made of lead." It's very much like that for me as well sometimes. I wonder what that incredible exhaustion really means. I have no point of reference... Is it me coming out of coma and then kind of flipping out and going through a huge cycle of physcial change--change at HAVING FUNCTION for the first time in my body? Maybe, so naturally it's going to cycle.

Yes, properly medicated, it's going to cycle up and down, naturally, like a body does, instead of be in this state, this dead zone that I have been in for so long-- that I CANNOT describe very well because I was in it so long everything of me became redefined. In the belly of the beast...that's what it felt like. No clue what was going on. I digress.

I wonder if that "I've-never-been-so-tired-in-my-life" exhaustion we all seem to know is too much t3, or if I just didn't take it in time (likely), or if my body is still just getting used to it, or if it's the dreaded excessive adrenal fatigue that I feel like I've traded my life for, just to get some quality of life back. Oh well, too bad is how I feel right now about that. :-) There are so many things I've felt in the last 3-4 months that are new and I really haven't a clue what they are or how to perceive them. What a wonderful process. Let's get it over with. :-) I am in uncharted waters.

Just like when I adjusted to t4 ten years ago, I recall my whole digestive tract had to make adjustments and it was a little inconsistent at first, but now I see my digestive system beginning to really settle into a routine, and with dietary improvement even better, hopefully.

All this clean living and I've still got lots of work to do, but everything in moderation and I'm not being freakishly obsessive about everything, balance is so important. So I'll still enjoy a beer and see what it does to my t3 count. :-)

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Got the RT3: 212 [90-350]. Have to look this up after work. Seems high.

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http://www.stopthethyroidmadness.com/rt3-ratio/

2.5 pg/ml / 212 pg/ml = 11.8

Should be 20 or higher, so they say.

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Now I'm in over my head. I thought I would work on understanding the whole RT3 concept, but when my endo said that he thought one needs to be stable for a year or so for it to have meaning, I decided that was not for me right now and maybe my head would be clearer anyway after a year of stability (wouldn't *that* be nice!). However, I hope to learn from you two and find out what all this could mean.

four_winds: I, too, was hypo for years, no telling how long. I have other health issues that have left me so very tired. So much of my life is a blur of daily battles to fight through the fatigue and pain, put up a good front, tap as much of my brain power as possible and just survive. How I know about "walking through sludge!" When I finally - after 40+ years of struggling - ran so completely out of steam, I went on disability. Within 18 months I had two new diagnoses and one of them was hypothyroidism. The other was Meniere's Disease, which made the entire 40+ year journey look like a picnic. Some things in our lives put things in perspective very quickly, and Meniere's did that job very well.

Thanks for letting me know about your dietary changes. With Meniere's, I was on a diuretic and became a faithful water drinker and that continues 6 years later after going off the diuretic in 2010. I give in to my sweet tooth and do eat some processed foods, but Meniere's also requires a low-sodium diet, and I am still on that. My northern European ancestry will not allow me to forego protein, so I stick with meat. Not that long ago, I realized I was only eating chicken, so I have tried to add a few other meats to my diet. I am forcing myself to eat raw veggies, which for some reason I no longer like at all. I should probably try some juicing but it will be next year before I can buy a juicer. So I will treat myself at a juice bar from time to time until then. I had to give up caffeine with the Meniere's diagnosis. That alone was as bad as the salt and other restrictions. Thankfully, Peet's and Starbuck's decaf coffees are pretty decent. I was willing to do **anything** to keep the vertigo at bay. Anything.

Do you leave off the cruciferous because of implications for the thyroid? I was going to use that to justify my dislike for them but realized that I eat so much dairy, a little cruciferous is probably a joke by comparison. Soy has almost no presence in my diet. I tested allergic to it years ago, but I suspect that has all changed.

I am still up and down. Down is not as drastic for as long anymore but it is still either a day in bed or a day with little functioning. This is quite a journey, but the good days make it worthwhile. I often what the people I see on the good days would think if they saw me on all the others. LOL

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I hope others benefit from the T3 info, some of us are complex but really most people that need t3 are not that hard to treat with cytomel, nor are they so complex.

I think I had a reverse t3 only before my TT, way back some years, when I was looking at a t4 to t3 conversion issue that runs in my family. I think it is hard to use reverse t3, and as the STTM people say you need to use it in reference to another number not as a standalone number. For me, not sure about it. I do well with cytomel and not well without cytomel. Supplements help, but do not cure the problem. I don't know that reverse adds lots to the table for me, but thinking about getting it here some time.

@cabro: I did go through some up and down but not that much like you seem to. I sure hope you get answers, maybe it would be good to get a reverse t3 for you next labs. You said your iron is bad, did you ever try iron bisglycinate the so called "comfort" iron? At least for me I do not get migrane but when my free t3 goes low I feel like a headache might be coming on, which in your case might be meniere or meniere like. That adds a super layer of complexity since you have that. Are you on Topamax or aldosterone or what for meniere? Those are powerful meds that might affect things greatly perhaps. Don't know. Have you ever had a visual field to see if you have a visual field defect or other good retina check? Just because all that stuff gets connected in there in the vestibular, eye, and brain systems. Just some ideas that pop into brain. You are most complex.

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BiomedEE: LOL, yes, I am most complex. I drew a very interesting hand of genetic cards. It is my ferritin that is bad, not my serum iron. My endo said it is genetic. I am a genetically low ferritin person and no amount of supplements or infusions will change my iron stores. My body can't do it. I have Barrett's Esophagus, so loading me up with iron causes problems in the GI tract. I haven't tried to take iron in years, other than I.V. push (slow), which still did not bring up my ferritin. My endo said, "Right; it's because you are genetically low ferritin."

I, too, do well with Cytomel (more of the time) and without it I don't do well at all. I can only speculate about how many decades I dragged around with low T3, before my TSH finally went up high enough to be diagnosed and 4 years later came the thyca diagnosis. I do get a headache for a bit when I crash from T3 in the evenings. I wonder why that is.

I was on Valium and meclizine for Meniere's attacks; nothing in between other than Dyazide which is no longer needed. I do still adhere to a low sodium diet, prophylactically. Meniere's Disease was diagnosed by a neurotologist. After 3 years, I had a brief surgical procedure to open the round window and treat the middle ear with low dose gentamicin to kill off the vestibular nerve. Gentamicin is also ototoxic, but by the time I agreed to the surgery my hearing was 85% gone in that ear (of little to no use). So I was willing to assume the risk. Being a trained classical musician, losing my hearing in one ear was very traumatic. The treatment diminished my hearing another 5%, but by then that was a small sacrifice to get rid of the disabling vertigo. Had the first procedure not been effective enough, I could have had two more intratympanic gentamicin treatments.

Since I've had visual flashes and floaters, I have been under the care of a good retinologist for several years. Those retina checks are blinding and painful, and dilating my eyes for them leaves me with a headache. I had cataract surgery this year, but my dry eyes from RAI are making it difficult to correct my vision; this after years of thinking it was the cataracts, exclusively. And so it goes on and on....! I am definitely like an old car that needs some new parts!

Thanks so much for your input. It's nice to have input and another overview, since my internist is the only other person who sees the big picture. (We won't go into the spinal injuries.....)

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