![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by gardenergirl on July 9, 2004, at 0:39:59
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by Pfinstegg on July 8, 2004, at 19:29:00
You know, I am puzzled now, too. It's been over a year since I've been on it. My levels are testing more central normal now...in the 2's. I'll have to talk with my doc. about this. Actually, someone else prescribed it who was covering for my doc. when he was called up to serve during the early part of the war. So we may have to rethink the whole thing.
Thanks for catching that and for your input.
gg
Posted by gardenergirl on July 9, 2004, at 0:44:39
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by Pfinstegg on July 8, 2004, at 19:29:00
Come to think of it, maybe my first TSH was around 6....which would be high TSH indicating low thyroid function, right? Oh, the memory and logic don't work so well this late at night with a sinus infection.
But I think when I was saying low, I was thinking thyroid function, not TSH. But I'll check week after next. I'd better start a list for that appt.
Thanks,
gg
Posted by SLS on July 9, 2004, at 1:11:51
In reply to Cytomel vs. Synthroid, any opinions?, posted by gardenergirl on July 7, 2004, at 8:05:32
Hi GG.
I did a bit of research on the Net in the hopes that I could find information comparing the efficacy of T4 versus T3 when used to treat unipolar depression. There really are no direct comparisons. However, one abstract that I can't find right now reported an abnormality in T3 measurements, but not T4. I wish I could find the darned thing. Anyway, it made for a pretty compelling case for using Cytomel. The great majority of the successful use of thyroid hormone augmentation of antidepressants reported in the literature is of T3. Since you are already taking T4, I would take advantage of the opportunity to try a T3/T4 combinatioin.
The following link describes a case of bipolar disorder for which such a combination of T3/T4 was used. The website offers some good information about thyroid function and mood illness in general.
http://www.psycheducation.org/thyroid/combostory.htm
http://www.psycheducation.org/thyroid/studies.htm
As often happens, however, there are researchers who report conflicting results:
All in all, I would probably go for adding T3 to the T4 if I were in your position.I hope this is of some help. Let us know what you decide and how you do.
Good luck!
- Scott
Posted by KaraS on July 9, 2004, at 3:28:27
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by SLS on July 8, 2004, at 16:27:27
> For my depression, T4 worked better than T3. T3 actually made it much worse. I am most probably bipolar. Perhaps T4 is better for bipolar disorder than for unipolar disorder. High doses of T4 have been used with some success to treat rapid cycling presentations. Actually, I'm not sure that T3 is any better for depression than T4. It may be that it was the first thyroid hormone chosen arbitrarily in the early studies to investigate. Subsequent work relied on the earlier work without considering the posibility that T4 was of equal or perhaps greater value. I believe that T4 does possess biological properties other than acting as a substrate for its conversion to T4. Maybe someone else can comment on this.
>
>
> - Scott
>
Scott,
I didn't know that about T3 not being good for bipolar disorder. Maybe there is no one size fits all answer here just like there is no one antidepressant that is best for everyone. I'm curious as to whether you've tried something like Armour that has both T3 and T4 etc. There are some doctors who believe that the T3 in Armour is too high (it's about 25%) and that you should take an amount that is closer to what humans naturally produce (more in the 5-10% range). I wonder what effect that would have on you.
Kara
Posted by SLS on July 9, 2004, at 8:22:48
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by KaraS on July 9, 2004, at 3:28:27
Hi Kara
> I didn't know that about T3 not being good for bipolar disorder.
I don't know whether it is or not, but it certainly is not good for whatever it is I suffer from. My case is very atypical.
> Maybe there is no one size fits all answer here just like there is no one antidepressant that is best for everyone.
Yeah. These things with the brain are a real pain in the butt.
> I'm curious as to whether you've tried something like Armour that has both T3 and T4 etc.
No. But according to the website I found and posted above, that is an excellent idea.
> There are some doctors who believe that the T3 in Armour is too high (it's about 25%) and that you should take an amount that is closer to what humans naturally produce (more in the 5-10% range). I wonder what effect that would have on you.
Me too. Thanks for caring. :-)
Be well.
- Scott
Posted by Sad Panda on July 9, 2004, at 11:19:42
In reply to Re: Cytomel vs. Synthroid, any opinions? » gardenergirl, posted by SLS on July 9, 2004, at 1:11:51
I take 300mcg of T4 myself, it raised both my T3 & T4 levels & lowered my TSH. T3 is only given here when T4 fails, the biggest difference between the two is the price. :)
Cheers,
Panda.
Posted by Pfinstegg on July 9, 2004, at 12:57:33
In reply to Re: Cytomel vs. Synthroid, any opinions? » Pfinstegg, posted by gardenergirl on July 9, 2004, at 0:44:39
Oh, O.K! If your TSH was as high as 6, you should definitely be taking T4 and T3. I think the upper limit of normal has recently been revised downwards, so that a TSH of even 3.5 or 4 may be indications for treatment. Levels that high can definitely contribute to infertility, so that's a good move on the part of your doctor. If you have a TSH of 2- that's completely normal. It could even safely go to about 1.
I have atypical depression, like you. I was also hypothyroid -TSH of around 5. I took synthroid at first, but after reading the NEJM article, I asked my endocrinologist if I could take half of the replacement dosage as Cytomel. I think it really helped, although it's hard to say, because I also started taking a combination of low-dose Lexapro and Wellbutrin, had several courses of TMS, and began psychoanalysis! But, in any event, the depression is under excellent control now. I really thank God for Babble, as it's where I learned about TMS and Cytomel, as well as about people who were taking sub-therapeutic doses of AD's and finding them side-effect free and helpful enough.
I do hope to hear that the replacement T4-T3 helps in your goal to become pregnant. As a note of encouragement, I did not have any difficulty getting pregnant when my thyroid was normal- it got abnormal after my son was born. I think your doctor is doing exactly the right thing.
Posted by KaraS on July 9, 2004, at 19:02:25
In reply to Re: Cytomel vs. Synthroid, any opinions? » gardenergirl, posted by Pfinstegg on July 9, 2004, at 12:57:33
Good advice and it's so nice to read about a success story! One thing I wanted to add though is that some of the more progressive thyroid doctors are now saying that a TSH level of 0.5-2.00 is probably where you should be particularly for those with anergic depression. They suggest that even someone with TSH just over 2.00 could benefit from a small amount of added thyroid hormone.
Actually there's another thing I wanted to add which is that there are other thyroid tests besides the TSH. These measure things like T3 levels, uptake %, conversion levels of T4 to T3, antibody levels (as in Hashimoto's thyroiditis) etc. Just another thing to keep in mind because you can have a good TSH number but still have thyroid problems if some of these other factors are off.
Posted by Pfinstegg on July 9, 2004, at 19:46:31
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by KaraS on July 9, 2004, at 19:02:25
Thanks! I'm going to print out your post and bring it to my next endo appointment, just to be sure we're covering all the bases!
Posted by gardenergirl on July 10, 2004, at 9:35:46
In reply to Re: Cytomel vs. Synthroid, any opinions? » KaraS, posted by Pfinstegg on July 9, 2004, at 19:46:31
Okay, if I am understanding what everyone has said, then the syntroid is giving me T4 and I should consider that I may need T3 as well. Now here is the question. Are y'all saying I should ADD cytomel to the synthroid? or take it instead? Or try Armour (sp?) as it has both? I'm getting a bit confused again.
Thanks,
gg
Posted by Sad Panda on July 10, 2004, at 9:59:44
In reply to Ok, question just to make sure I understand, posted by gardenergirl on July 10, 2004, at 9:35:46
> Okay, if I am understanding what everyone has said, then the syntroid is giving me T4 and I should consider that I may need T3 as well. Now here is the question. Are y'all saying I should ADD cytomel to the synthroid? or take it instead? Or try Armour (sp?) as it has both? I'm getting a bit confused again.
>
> Thanks,
>
> gg
>Hi GardenGirl,
I would add T3 to T4. Your thyroid makes a little T3 & a lot of T4. Most of your body's cells convert T4 to T3 as required for their own usage, but some cells can't do this & rely on your Thyroid's T3 output. Doctors prescribe T4 first before adding T3 because a big bottle of T4 costs $10 while a small bottle of T3 costs closer to $80 (in this country). Ultimately, your blood test is the guide.
Cheers,
Panda.
Posted by Pfinstegg on July 10, 2004, at 10:00:02
In reply to Ok, question just to make sure I understand, posted by gardenergirl on July 10, 2004, at 9:35:46
You'll probably get different answers to your question- some people like to use Armour, which has T3 and 4 in it, but some people don't, because it's made from slaughtered beef, and they are slightly concerned about contaminants, including the remote change of BSE.
I do think you are on very safe ground if you take half of the suppement as T4 (synthroid, or levothyroxin), and half as T3 (Cytomel). This way, you can be sure that your body is getting enough T3, which is the form it actually uses. It may also have an antidepressant effect in addition to the Nardil- it's been helpful to me in that way. To ensure the maximum chances of becoming pregnant. you would want your TSH between 0.5 and 2, so it's worth getting regular checks for that. Actually, for the AD effect, my endocrinologist wanted mine between 0.4 and 1. You might be able to find out on the web what TSH level is considered most favorable for getting pregnant. I haven't looked, but I'm sure it's out there somewhere!
Posted by SLS on July 10, 2004, at 11:16:23
In reply to Ok, question just to make sure I understand, posted by gardenergirl on July 10, 2004, at 9:35:46
Hi.
To treat hypothyroidism, a really good endocrinologist will also look at the ratio between T3 and T4 and prescribe accordingly. However, this is not always true when treating depression. Sometimes, supratherapeutic (hyperthyroid) dosages of T3 or T4 are used, regardless of baseline thyroid status. However, this is a strategy that I think would be contraindicated during pregnancy.
There is a synthetic T3/T4 combination product called Thyrolar (Liotrix) available in the US, but I don't know if it makes sense to take something where the ratio is fixed. It's probably expensive, anyway.
You would probably have to add only a small amount of Cytomel to the T4 you are already taking to glean benefit.
- Scott
Posted by KaraS on July 10, 2004, at 15:03:48
In reply to Re: Ok, question just to make sure I understand » gardenergirl, posted by Pfinstegg on July 10, 2004, at 10:00:02
> You'll probably get different answers to your question- some people like to use Armour, which has T3 and 4 in it, but some people don't, because it's made from slaughtered beef, and they are slightly concerned about contaminants, including the remote change of BSE.
I don't know of any risk of BSE from pigs.
>
> I do think you are on very safe ground if you take half of the suppement as T4 (synthroid, or levothyroxin), and half as T3 (Cytomel). This way, you can be sure that your body is getting enough T3, which is the form it actually uses. It may also have an antidepressant effect in addition to the Nardil- it's been helpful to me in that way. To ensure the maximum chances of becoming pregnant. you would want your TSH between 0.5 and 2, so it's worth getting regular checks for that. Actually, for the AD effect, my endocrinologist wanted mine between 0.4 and 1. You might be able to find out on the web what TSH level is considered most favorable for getting pregnant. I haven't looked, but I'm sure it's out there somewhere!
Posted by Pfinstegg on July 10, 2004, at 20:49:21
In reply to Armour comes from pigs - not cows!, posted by KaraS on July 10, 2004, at 15:03:48
Thank you for correcting me. Pigs are safe.
Posted by KaraS on July 11, 2004, at 4:30:46
In reply to Re: Armour comes from pigs - not cows! » KaraS, posted by Pfinstegg on July 10, 2004, at 20:49:21
> Thank you for correcting me. Pigs are safe.
Thank goodness - because I've been taking Armour for quite a while now!
Posted by TofuEmmy on July 11, 2004, at 22:34:52
In reply to Re: Armour comes from pigs - not cows! » KaraS, posted by Pfinstegg on July 10, 2004, at 20:49:21
> Thank you for correcting me. Pigs are safe.
Weeelll...the pigs are not EXACTLY safe, since they are now in the pill! Pigs are not, in nature, in a pill form. :-)
Em
(Hi GG!!!!! Miss you!!!!)
Posted by KaraS on July 12, 2004, at 0:59:55
In reply to Re: Pigs are safe! » Pfinstegg, posted by TofuEmmy on July 11, 2004, at 22:34:52
> > Thank you for correcting me. Pigs are safe.
>
> Weeelll...the pigs are not EXACTLY safe, since they are now in the pill! Pigs are not, in nature, in a pill form. :-)
>
> Em
>
> (Hi GG!!!!! Miss you!!!!)
Touche!
Posted by KaraS on July 12, 2004, at 1:06:03
In reply to Re: Cytomel vs. Synthroid, any opinions? » KaraS, posted by Pfinstegg on July 9, 2004, at 19:46:31
> Thanks! I'm going to print out your post and bring it to my next endo appointment, just to be sure we're covering all the bases!
Go to this site for the chart:http://www.thyroid-info.com/thyroidtests.htm
There's lots of other good info on this site as well. Just keep in mind that this chart was put together before the medical community powers that be lowered the upper limit of the TSH level that they consider to be in the normal range. So the chart says the upper limit is 5.5 when I think it's officially considered to be about 3 now.
Posted by gardenergirl on July 12, 2004, at 9:25:13
In reply to Re: Pigs are safe! » Pfinstegg, posted by TofuEmmy on July 11, 2004, at 22:34:52
Posted by Pfinstegg on July 12, 2004, at 20:06:49
In reply to Pfinstegg: here's a thyroid tests chart for you, posted by KaraS on July 12, 2004, at 1:06:03
Who knew that pigs took the pill! I was just referring to BSE. Thanks so much for the thyroid article link. My endo has an upper cut-off of about 3.5.
Posted by BarbaraCat on July 14, 2004, at 13:57:15
In reply to Cytomel vs. Synthroid, any opinions?, posted by gardenergirl on July 7, 2004, at 8:05:32
Any of you who know me on this board know that I'm on the 'Ms. Natural' end of the spectrum. I see a naturopath, and am very health-conscious. I have had hypothyroidism for most of my life and have been on all of the meds. Have been on a natural T3/T4 for many years. My naturpath insists on a natural product.
Just recently I increased my lithium, which created a need for an increase in my thyroid med. My regular doctor insisted I go back on levothyroid, T4 only, because the increased dose would mean increasing T3 as well if I stayed on the natural. Having an anxiety disorder, it was not wise to increase T3 since T3 can cause spikes in thyroxine and increased adrenaline. If I felt the T4 alone was not doing it and I needed to add T3, he'd do it.
Getting to the point, I feel much better with T4 only! The higher dosage has caused my fibromyalgia pains to decrease, my focus and energy level is good and I don't feel so jittery. In the past, when I had to increase the natural thyroid I would get anxiety, heart palpitations, sweating, etc. just to get my TSH values at an optimal range. I never thought I'd be saying this, but for me, the synthetic is working better. I'm no longer convinced (and some recent research supports this) that all depressed people categorically need T3. My pdoc has tried T3 therapy as an AD augmentor and said he has found it to be without value.
Some of us have an inability to convert T4 to T3 and in that case T3 is necessary, but when T3 is not necessary it can cause it's own set of uncomfortable problems. My suggestion is to start with T4 and see how it goes. Take your temperature 3 times a day for 3 days at same time of day (on waking, before lunch, before dinner). Average should be greater than 98. Tests should always include TSH as well as free T3, T4, and thyroid antibodies. If your doctor is really hip, he/she will order a reverse T3 test as well. - BarbaraCat
Posted by Ilene on July 14, 2004, at 15:48:07
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by BarbaraCat on July 14, 2004, at 13:57:15
My pdoc has tried T3 therapy as an AD augmentor and said he has found it to be without value.
>I know it doesn't work for everyone, but adding Cytomel to Marplan has worked for me. (In the interests of full disclosure, I have to admit I'm having what I hope is a temporary relapse.)
I don't see how your pdoc can so categorically dismiss T3 therapy when no single AD works for everyone. I found several ADs to be personally "without value" , but in the wonderful world of mental disorders everyone's mileage differs.
I.
Posted by KaraS on July 14, 2004, at 16:43:18
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by Ilene on July 14, 2004, at 15:48:07
I think it's safe to say that no one size fits all here. There are too many variables based on individual chemistry and other individual health issues involved. You just have to experiment and see what is right for you - just like with antidepressants.
I have been on the synthetic T4 as well as Armour (natural T4+T3). I notice a slight difference in energy and metabolism level so I prefer the Armour. I could survive just fine on T4 alone however. There is also the issue of having to get the Armour from an animal which I do at times feel guilty about. Neither the Armour nor the T4 have had any success in potentiating any antidepressant that I have been on. Maybe Cytomel/T3 alone would. It's something I plan to try in the future.
Good luck to all of you in finding what works best for you.
Posted by BarbaraCat on July 14, 2004, at 16:46:59
In reply to Re: Cytomel vs. Synthroid, any opinions?, posted by Ilene on July 14, 2004, at 15:48:07
> I don't see how your pdoc can so categorically dismiss T3 therapy when no single AD works for everyone. I found several ADs to be personally "without value" , but in the wonderful world of mental disorders everyone's mileage differs.
>
**I don't think he's making a blanket statement about T3 therapy, only that he didn't see that it made a difference in his own practice. He's a big proponent of fish oil and good nutrition and will give a new product the old college try. I think he's more than willing to consider anything that might help. He feels that proper thyroid levels are critical, but he personally didn't find T3 as effective as he had hoped. But just because he didn't see value in it doesn't mean he covered all bases or missed something valuable. He's made some blunders with my med protocol.Hope your downturn resolves soon. It sure is a drag when you start feeling well and then the rug gets pulled out. Take care. - Barbara
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.