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Highly sensitive to Cytomel

Hi everyone,

So I had labs done about 3 weeks ago. Here they are:

Ferritin, Serum: 71 ng/mL (30-400)
Triiodothyroine, Free, Serum: 2.7 pg/mL (2.0-4.4)
Thyroxine (T4), Free (Direct): 1.23 ng/dL (.82-1.77)
TSH: 4.470 uIU/mL (.450-4.500)
Reverse T3, Serum: 15.3 ng/dL (9.2-24.1)
Vitamin D, 25-Hydroxy: 38.9 ng/mL (30.0-100.0)

FT3/RT3: 17.6

So, because my FT3/RT3 ratio is below 20, my doctor put me on 5 mcg of Cytomel, twice per day. I have been taking the first dose with breakfast, and the second dose about 5-7 hours later. The first day I took it, it was great. I felt amazing. I thought all my problems would be fixed in no time. However, about 5 days later I am consistently getting a bad response to the Cytomel. I get extremely irritable, tired, and sweaty. I feel awful. I feel like I could punch a wall. I would guess that my body temperature is dropping as well. It's been 16 hours since I took that 5 mcg dose, and I still feel lingering symptoms. So I suspected this was an adrenal insufficiency problem and I started to take Pregnenolone with the Cytomel. The pregnenolone definitely helped, but obviously not enough. Basically, I'm not sure what to do here. Around here, 5 mcg sounds like a larger dose, but I've seen other forums discuss taking 10, 12.5, 25 mcg at once. If I took that much I'd be in the ER. Should I cut it in quarters or halves and try just 1.25 or 2.5 mcg? Any advice would be greatly appreciated. I would love to know why I am so sensitive.

Thank you.

asked Mar 3, 2015 by Ray Peat is a God

3 Answers

Have you experienced estrogenic side-effects from the thyroid? Bloating, puffiness, irritability, fatigue, emotionality....?

How do you know you even need thyroid, besides the useless labs ratios?

answered Mar 4, 2015 by freshness

Irritability for sure. I definitely need the Cytomel. I've had "chronic fatigue" for years. It all started with the mono, which is typically associated with high Rt3 levels. The Cytomel should clear this out from what I understand. I think I need smaller doses, that's all.

Take magnesium and possibly increase calories. Problem (most likely) solved.

answered Mar 4, 2015 by Fluke
Okay, thanks! Magnesium helped.  What about pregnenolone is that something that could be of help?
Just curious what type/brand of magnesium do you recommend?

I would definitely try dividing the dose even smaller - eg. 2.5mcg doses 4x a day, always with meals.

I would also increase calories and in particular sugars (fruit and/or white sugar). Have you logged into Cronometer? Maybe you could post a daily diet example.

It's fairly common to get these stress symptoms when changing/starting T3 dose. For me it took a few months to stabilize, sugar and not going hungry was key.

Where is your TSH at? You might also want to take some T4:

"When I used only Cytomel, any little stress would make me suddenly hypothyroid, and my heart would stop several times in a minute; when I started using some thyroid, USP, that contained both T4 and T3 it stopped happening. " - RP

answered Mar 4, 2015 by ilovethesea

Hi there: I had the same response except I couldn't take even as much as you! Decrease your amount daily, now I just nibble on the small dose of Cytomel per day & that's all I need. I was tested by my doctor after taking such a small amount & thyroid is normal now. She said keep doing what i'm doing. May not take very much at all...listen to yourself, I tried the 5 mcg amount & practically went thru the roof! I was irritable to the extreme, almost manic. Listen to yourself... :)

If you can't tolerate 2.5 mcg try 1mcg.

"[Thyroid is the only thing that safely lowers cholesterol,] but when your stress hormones are very high, you shouldn't take more than about one microgram of Cytomel at a time, and should accompany it with things like milk and orange juice. " - RP

By the way... being tested by your doctor doesn't necessarily mean you don't have hypothyroidism anymore. Do you measure temps and pulse?

"T3, by lowering stress, sometimes reveals a low basal metabolic rate, that was hidden by high stress hormones. The body produces about 4 mcg of T3 per hour, so taking more than that can interfere with regulatory processes. It's helpful to use the resting pulse rate, and the 24 hour temperature curve, along with other signs, such as mood, appearance of veins on the hands, etc. The peak temperature should be in the afternoon. " - RP

I am finding that I need 1 mcg per day.  Yes, just 1 for a whole day.  I could probably get away with none at all.  Is this normal?  STTM people would say I need hc.  Maybe my reverse t3 has cleared already? It's weird I'm warmer but at the same time I don't necessarily feel 100%.  Also my appetite is very small.
Do you mean you can't tolerate more than 1mcg per day without stress symptoms, or do you mean that your temperature and pulse stay good with only 1mcg per day? I think the RT3 forum says most people take at least 6 weeks for it to clear.