![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by dcruik518 on September 9, 2008, at 18:32:33
Hi,
Until a few days ago, I was taking Nortriptyline as a way to augment the NE effects of Pristiq. The combination worked well. However, I put 16 lbs on in less than three weeks, and I'm already overweight, so I had to stop the Nortriptyline. I'm wondering if any of you might recommend a primarily NE-type tricyclic that doesn't cause weight gain or at least not so much.
I thought about desipramine but Stahl's guide says it's just as likely to cause weight gain. I'm also thinking about Straterra, but I've tried it before and it didn't help as much as the Nortriptyline.
Thanks,
DRC
Posted by Phillipa on September 9, 2008, at 23:06:01
In reply to tricyclics that don't cause weight gain?, posted by dcruik518 on September 9, 2008, at 18:32:33
I don't know any did you google them and I'd imagine it would be dose dependant. I guess you have to weight the benefits against the weight gain. Can you take that med metforame sp? to help keep weight down. Just a thought. Phillipa
Posted by yxibow on September 10, 2008, at 3:37:37
In reply to tricyclics that don't cause weight gain?, posted by dcruik518 on September 9, 2008, at 18:32:33
> Hi,
>
> Until a few days ago, I was taking Nortriptyline as a way to augment the NE effects of Pristiq. The combination worked well. However, I put 16 lbs on in less than three weeks, and I'm already overweight, so I had to stop the Nortriptyline. I'm wondering if any of you might recommend a primarily NE-type tricyclic that doesn't cause weight gain or at least not so much.
>
> I thought about desipramine but Stahl's guide says it's just as likely to cause weight gain. I'm also thinking about Straterra, but I've tried it before and it didn't help as much as the Nortriptyline.
>
> Thanks,
> DRCThey vary but the weight gain I believe is dose related and is affected by how muscarinic/antihistamic the agent is.
-- Jay
Posted by Phillipa on September 10, 2008, at 12:55:38
In reply to Re: tricyclics that don't cause weight gain? » dcruik518, posted by yxibow on September 10, 2008, at 3:37:37
My google search revealed that they are all weight gaining. Think you should also google as lots of side effects. Love Phillipa
Posted by bleauberry on September 11, 2008, at 20:28:09
In reply to tricyclics that don't cause weight gain?, posted by dcruik518 on September 9, 2008, at 18:32:33
Desipramine is a good choice. Protriptyline also, except more side effects.
Honestly, if the combo was doing you good, you might consider staying with it, be glad you found it, and use your newfound stableness to take control of eating patterns. No sugars, low carbs, high proteins, tons of veggies, limited fruits, tons of water. What is worse, feeling really bad or gaining some poundage? No one wants to get heavy, but depression is worse. You can control the depression because you already discovered how. Now you need to work on the weight. You can control that too. It might be unreasonable for us to expect that we can keep on eating the way we always have or living our lives the way we always have when we are taking some medication that alters our biochemistry. We have to adjust to that and accept it as a happy challenge as part of the deal to be well. Maybe??? Just a thought.
I was gaining a ton of weight on Zyprexa, and few meds are more guilty than that one. But I was able to stop it and reverse it by careful choices of what I put in my mouth. I ate all I wanted to, sometimes a lot, but it was all the right stuff and none of the wrong stuff. And I also burned a lot of calories. No laying around watching TV all the time. Move a lot, do stuff. Being well mentally allows you to take control and do these things and be glad you are well enough to.
Posted by bulldog2 on September 12, 2008, at 15:01:08
In reply to Re: tricyclics that don't cause weight gain?, posted by bleauberry on September 11, 2008, at 20:28:09
> Desipramine is a good choice. Protriptyline also, except more side effects.
>
> Honestly, if the combo was doing you good, you might consider staying with it, be glad you found it, and use your newfound stableness to take control of eating patterns. No sugars, low carbs, high proteins, tons of veggies, limited fruits, tons of water. What is worse, feeling really bad or gaining some poundage? No one wants to get heavy, but depression is worse. You can control the depression because you already discovered how. Now you need to work on the weight. You can control that too. It might be unreasonable for us to expect that we can keep on eating the way we always have or living our lives the way we always have when we are taking some medication that alters our biochemistry. We have to adjust to that and accept it as a happy challenge as part of the deal to be well. Maybe??? Just a thought.
>
> I was gaining a ton of weight on Zyprexa, and few meds are more guilty than that one. But I was able to stop it and reverse it by careful choices of what I put in my mouth. I ate all I wanted to, sometimes a lot, but it was all the right stuff and none of the wrong stuff. And I also burned a lot of calories. No laying around watching TV all the time. Move a lot, do stuff. Being well mentally allows you to take control and do these things and be glad you are well enough to.Sometimes adding t3 can alleviate the weight problem. yes and dietary changes. High protein plus low amouns of complex carbs plsu plenty of fiber should alleviate that problem.
Posted by Phillipa on September 12, 2008, at 19:00:02
In reply to Re: tricyclics that don't cause weight gain?, posted by bulldog2 on September 12, 2008, at 15:01:08
Don't they usually change your metabolism? Phillipa
Posted by desolationrower on September 12, 2008, at 20:40:00
In reply to Re: tricyclics that don't cause weight gain? » bulldog2, posted by Phillipa on September 12, 2008, at 19:00:02
Yes you are right some antidepressants might only increase appetite but many drugs especially the antipsychotics which block histamine and dopamine mess with how one's body percies its energy state to be and so promote weight gain and a shift to storing fat at expense of muscle.
-D/R
Posted by Phillipa on September 12, 2008, at 23:57:16
In reply to Re: tricyclics that don't cause weight gain? » Phillipa, posted by desolationrower on September 12, 2008, at 20:40:00
So you don't feel they affect metabolism? Love Phillipa
Posted by bulldog2 on September 13, 2008, at 12:27:36
In reply to Re: tricyclics that don't cause weight gain? » bulldog2, posted by Phillipa on September 12, 2008, at 19:00:02
> Don't they usually change your metabolism? Phillipa
Yes hence the t3 plus dieatary changes that flush calories thru your body.
Posted by dcruik518 on September 13, 2008, at 14:46:01
In reply to Re: tricyclics that don't cause weight gain?, posted by bulldog2 on September 13, 2008, at 12:27:36
Thank you all for your insight. Cytomel might be worth a try. DRC
Posted by Phillipa on September 13, 2008, at 19:55:57
In reply to Re: tricyclics that don't cause weight gain?, posted by dcruik518 on September 13, 2008, at 14:46:01
I tried cytomel and the endo said it's like coffee and has a very short life only a few hours. Phillipa
Posted by bulldog2 on September 13, 2008, at 20:32:16
In reply to Re: tricyclics that don't cause weight gain?, posted by Phillipa on September 13, 2008, at 19:55:57
> I tried cytomel and the endo said it's like coffee and has a very short life only a few hours. Phillipa
I wish you wouldn't post incorrect info without researching the truth. I have a link that states that cytomel t3 has a half life of 2 1/2 days NOT A FEW HOURS AND IS NOTHING LIKE COFFEE!!!
T3 is ther active form of thyroid and is very active in weight loss depending on dose.
My wife put on lot of weight on zoloft and used 20 mcg of cytomel (t3) and lost 50 pounds. before starting the t3 the diet was not working and I suspect it was due to her age and the thyroid slowing down. When she started t3 the weight starting coming off. Now she has backed down to 10 mcg. I think she plans on staying on that dose as it works well with her zoloft.http://www.kingpharm.com/kingpharm/uploads/pdf_inserts/Cytomel_Web_PI.pdf
Posted by bulldog2 on September 13, 2008, at 20:40:32
In reply to Re: tricyclics that don't cause weight gain?, posted by Phillipa on September 13, 2008, at 19:55:57
> I tried cytomel and the endo said it's like coffee and has a very short life only a few hours. Phillipa
If your endo said that I suggest you find a new endo. Anyone and that includes the most casual observer who knows anything about thyroid knows cytomel is very potent and can cause weight loss and does not have a half life of three hours.
Personally I feel that a few quality posts that have accurate info are worth more than many posts that really add nothing of substance and quality info to the topic.
Posted by Phillipa on September 13, 2008, at 22:33:34
In reply to Re: tricyclics that don't cause weight gain?, posted by bulldog2 on September 13, 2008, at 20:40:32
Bulldog your're absolutely correct. Couldn't agree more Phillipa
Posted by Phillipa on September 13, 2008, at 22:59:20
In reply to Re: tricyclics that don't cause weight gain?, posted by bulldog2 on September 13, 2008, at 20:40:32
A lot of reading but this article on cytomel gets to effects with tricyclics scan if you like. Hope it makes a bit of sense and offers some advise that is of interest. Phillipa
Indications and Usage
Thyroid hormone drugs are indicated:As replacement or supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis. This category includes cretinism, myxedema and ordinary hypothyroidism in patients of any age (pediatric patients, adults, the elderly), or state (including pregnancy); primary hypothyroidism resulting from functional deficiency, primary atrophy, partial or total absence of thyroid gland, or the effects of surgery, radiation, or drugs, with or without the presence of goiter; and secondary (pituitary) or tertiary (hypothalamic) hypothyroidism (see WARNINGS).
As pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimotos) and multinodular goiter.
As diagnostic agents in suppression tests to differentiate suspected mild hyperthyroidism or thyroid gland autonomy.
Cytomel (liothyronine sodium) Tablets can be used in patients allergic to desiccated thyroid or thyroid extract derived from pork or beef.
Contraindications
Thyroid hormone preparations are generally contraindicated in patients with diagnosed but as yet uncorrected adrenal cortical insufficiency, untreated thyrotoxicosis and apparent hypersensitivity to any of their active or extraneous constituents. There is no well-documented evidence from the literature, however, of true allergic or idiosyncratic reactions to thyroid hormone.
WarningsDrugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.
The use of thyroid hormones in the therapy of obesity, alone or combined with other drugs, is unjustified and has been shown to be ineffective. Neither is their use justified for the treatment of male or female infertility unless this condition is accompanied by hypothyroidism.
Thyroid hormones should be used with great caution in a number of circumstances where the integrity of the cardiovascular system, particularly the coronary arteries, is suspected. These include patients with angina pectoris or the elderly, in whom there is a greater likelihood of occult cardiac disease. In these patients, liothyronine sodium therapy should be initiated with low doses, with due consideration for its relatively rapid onset of action. Starting dosage of Cytomel (liothyronine sodium) Tablets is 5 mcg daily, and should be increased by no more than 5 mcg increments at 2-week intervals. When, in such patients, a euthyroid state can only be reached at the expense of an aggravation of the cardiovascular disease, thyroid hormone dosage should be reduced.Morphologic hypogonadism and nephrosis should be ruled out before the drug is administered. If hypopituitarism is present, the adrenal deficiency must be corrected prior to starting the drug. Myxedematous patients are very sensitive to thyroid; dosage should be started at a very low level and increased gradually.
Severe and prolonged hypothyroidism can lead to a decreased level of adrenocortical activity commensurate with the lowered metabolic state. When thyroid-replacement therapy is administered, the metabolism increases at a greater rate than adrenocortical activity. This can precipitate adrenocortical insufficiency. Therefore, in severe and prolonged hypothyroidism, supplemental adrenocortical steroids may be necessary. In rare instances the administration of thyroid hormone may precipitate a hyperthyroid state or may aggravate existing hyperthyroidism.
PrecautionsGeneral
Thyroid hormone therapy in patients with concomitant diabetes mellitus or insipidus or adrenal cortical insufficiency aggravates the intensity of their symptoms. Appropriate adjustments of the various therapeutic measures directed at these concomitant endocrine diseases are required.The therapy of myxedema coma requires simultaneous administration of glucocorticoids.
Hypothyroidism decreases and hyperthyroidism increases the sensitivity to oral anticoagulants. Prothrombin time should be closely monitored in thyroid-treated patients on oral anticoagulants and dosage of the latter agents adjusted on the basis of frequent prothrombin time determinations. In infants, excessive doses of thyroid hormone preparations may produce craniosynostosis.
Information for Patients
Patients on thyroid hormone preparations and parents of pediatric patients on thyroid therapy should be informed that:Replacement therapy is to be taken essentially for life, with the exception of cases of transient hypothyroidism, usually associated with thyroiditis, and in those patients receiving a therapeutic trial of the drug.
They should immediately report during the course of therapy any signs or symptoms of thyroid hormone toxicity, e.g., chest pain, increased pulse rate, palpitations, excessive sweating, heat intolerance, nervousness, or any other unusual event.
In case of concomitant diabetes mellitus, the daily dosage of antidiabetic medication may need readjustment as thyroid hormone replacement is achieved. If thyroid medication is stopped, a downward readjustment of the dosage of insulin or oral hypoglycemic agent may be necessary to avoid hypoglycemia. At all times, close monitoring of urinary glucose levels is mandatory in such patients.
In case of concomitant oral anticoagulant therapy, the prothrombin time should be measured frequently to determine if the dosage of oral anticoagulants is to be readjusted.
Partial loss of hair may be experienced by pediatric patients in the first few months of thyroid therapy, but this is usually a transient phenomenon and later recovery is usually the rule.
Laboratory Tests
Treatment of patients with thyroid hormones requires the periodic assessment of thyroid status by means of appropriate laboratory tests besides the full clinical evaluation. The TSH suppression test can be used to test the effectiveness of any thyroid preparation, bearing in mind the relative insensitivity of the infant pituitary to the negative feedback effect of thyroid hormones. Serum T4 levels can be used to test the effectiveness of all thyroid medications except products containing liothyronine sodium. When the total serum T4 is low but TSH is normal, a test specific to assess unbound (free) T4 levels is warranted. Specific measurements of T4 and T3 by competitive protein binding or radioimmunoassay are not influenced by blood levels of organic or inorganic iodine and have essentially replaced older tests of thyroid hormone measurements, i.e., PBI, BEI and T4 by column.
Drug InteractionsOral Anticoagulants
Thyroid hormones appear to increase catabolism of vitamin K-dependent clotting factors. If oral anticoagulants are also being given, compensatory increases in clotting factor synthesis are impaired. Patients stabilized on oral anticoagulants who are found to require thyroid replacement therapy should be watched very closely when thyroid is started. If a patient is truly hypothyroid, it is likely that a reduction in anticoagulant dosage will be required. No special precautions appear to be necessary when oral anticoagulant therapy is begun in a patient already stabilized on maintenance thyroid replacement therapy.
Insulin or Oral Hypoglycemics
Initiating thyroid replacement therapy may cause increases in insulin or oral hypoglycemic requirements. The effects seen are poorly understood and depend upon a variety of factors such as dose and type of thyroid preparations and endocrine status of the patient. Patients receiving insulin or oral hypoglycemics should be closely watched during initiation of thyroid replacement therapy.
Cholestyramine
Cholestyramine binds both T4 and T3 in the intestine, thus impairing absorption of these thyroid hormones. In vitro studies indicate that the binding is not easily removed. Therefore, 4 to 5 hours should elapse between administration of cholestyramine and thyroid hormones.
Estrogen, Oral Contraceptives
Estrogens tend to increase serum thyroxine-binding globulin (TBg). In a patient with a nonfunctioning thyroid gland who is receiving thyroid replacement therapy, free levothyroxine may be decreased when estrogens are started thus increasing thyroid requirements. However, if the patients thyroid gland has sufficient function, the decreased free thyroxine will result in a compensatory increase in thyroxine output by the thyroid. Therefore, patients without a functioning thyroid gland who are on thyroid replacement therapy may need to increase their thyroid dose if estrogens or estrogen-containing oral contraceptives are given.
Tricyclic Antidepressants
Use of thyroid products with imipramine and other tricyclic antidepressants may increase receptor sensitivity and enhance antidepressant activity; transient cardiac arrhythmias have been observed. Thyroid hormone activity may also be enhanced.
Digitalis
Thyroid preparations may potentiate the toxic effects of digitalis. Thyroid hormonal replacement increases metabolic rate, which requires an increase in digitalis dosage.
Ketamine
When administered to patients on a thyroid preparation, this parenteral anesthetic may cause hypertension and tachycardia. Use with caution and be prepared to treat hypertension, if necessary.
Vasopressors
Thyroxine increases the adrenergic effect of catecholamines such as epinephrine and norepinephrine. Therefore, injection of these agents into patients receiving thyroid preparations increases the risk of precipitating coronary insufficiency, especially in patients with coronary artery disease. Careful observation is required.
Drug and Laboratory Test Interactions
The following drugs or moieties are known to interfere with laboratory tests performed in patients on thyroid hormone therapy: androgens, corticosteroids, estrogens, oral contraceptives containing estrogens, iodine-containing preparations and the numerous preparations containing salicylates.Changes in TBg concentration should be taken into consideration in the interpretation of T4 and T3 values. In such cases, the unbound (free) hormone shouldbemeasured. Pregnancy, estrogens and estrogen-containing oral contraceptives increase TBg concentrations. TBg may also be increased during infectious hepatitis. Decreases in TBg concentrations are observed in nephrosis, acromegaly and after androgen or corticosteroid therapy. Familial hyper- or hypo-thyroxine-binding-globulinemias have been described. The incidence of TBg deficiency approximates 1 in 9000. The binding of thyroxine by thyroxine-binding prealbumin (TBPA) is inhibited by salicylates.
Medicinal or dietary iodine interferes with all in vivo tests of radioiodine uptake, producing low uptakes which may not be reflective of a true decrease in hormone synthesis.
The persistence of clinical and laboratory evidence of hypothyroidism in spite of adequate dosage replacement indicates either poor patient compliance, poor absorption, excessive fecal loss, or inactivity of the preparation. Intracellular resistance to thyroid hormone is quite rare.
Carcinogenesis, Mutagenesis, Impairment of Fertility
A reportedly apparent association between prolonged thyroid therapy and breast cancer has not been confirmed and patients on thyroid for established indications should not discontinue therapy. No confirmatory long-term studies in animals have been performed to evaluate carcinogenic potential, mutagenicity, or impairment of fertility in either males or females.
PregnancyCategory A
Thyroid hormones do not readily cross the placental barrier. The clinical experience to date does not indicate any adverse effect on fetuses when thyroid hormones are administered to pregnant women. On the basis of current knowledge, thyroid replacement therapy to hypothyroid women should not be discontinued during pregnancy.
Nursing Mothers
Minimal amounts of thyroid hormones are excreted in human milk. Thyroid is not associated with serious adverse reactions and does not have a known tumorigenic potential. However, caution should be exercised when thyroid is administered to a nursing woman.
Geriatric Use
Clinical studies of liothyronine sodium did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Pediatric Use
Pregnant mothers provide little or no thyroid hormone to the fetus. The incidence of congenital hypothyroidism is relatively high (1:4000) and the hypothyroid fetus would not derive any benefit from the small amounts of hormone crossing the placental barrier. Routine determinations of serum T4 and/or TSH is strongly advised in neonates in view of the deleterious effects of thyroid deficiency on growth and development.Treatment should be initiated immediately upon diagnosis and maintained for life, unless transient hypothyroidism is suspected, in which case, therapy may be interrupted for 2 to 8 weeks after the age of 3 years to reassess the condition. Cessation of therapy is justified in patients who have maintained a normal TSH during those 2 to 8 weeks.
Adverse Reactions
Adverse reactions, other than those indicative of hyperthyroidism because of therapeutic overdosage, either initially or during the maintenance period are rare (see OVERDOSAGE).In rare instances, allergic skin reactions have been reported with Cytomel (liothyronine sodium) Tablets.
OverdosageSigns and Symptoms
Headache, irritability, nervousness, sweating, arrhythmia (including tachycardia), increased bowel motility and menstrual irregularities. Angina pectoris or congestive heart failure may be induced or aggravated. Shock may also develop. Massive overdosage may result in symptoms resembling thyroid storm. Chronic excessive dosage will produce the signs and symptoms of hyperthyroidism.
Treatment Of Overdosage
Dosage should be reduced or therapy temporarily discontinued if signs and symptoms of overdosage appear. Treatment may be reinstituted at a lower dosage. In normal individuals, normal hypothalamic-pituitary-thyroidaxis function is restored in 6 to 8 weeks after thyroid suppression.Treatment of acute massive thyroid hormone overdosage is aimed at reducing gastrointestinal absorption of the drugs and counteracting central and peripheral effects, mainly those of increased sympathetic activity. Vomiting may be induced initially if further gastrointestinal absorption can reasonably be prevented and barring contraindications such as coma, convulsions, or loss of the gagging reflex. Treatment is symptomatic and supportive. Oxygen may be administered and ventilation maintained. Cardiac glycosides may be indicated if congestive heart failure develops. Measures to control fever, hypoglycemia, or fluid loss should be instituted if needed. Antiadrenergic agents, particularly propranolol, have been used advantageously in the treatment of increased sympathetic activity. Propranolol may be administered intravenously at a dosage of 1 to 3 mg over a 10-minute period or orally, 80 to 160 mg/day, especially when no contraindications exist for its use.
Dosage and Administration
The dosage of thyroid hormones is determined by the indication and must in every case be individualized according to patient response and laboratory findings.Cytomel (liothyronine sodium) Tablets are intended for oral administration; once-a-day dosage is recommended. Although liothyronine sodium has a rapid cutoff, its metabolic effects persist for a few days following discontinuance.
Mild Hypothyroidism
Recommended starting dosage is 25 mcg daily. Daily dosage then may be increased by up to 25 mcg every 1 or 2 weeks. Usual maintenance dose is 25 to75 mcg daily.The rapid onset and dissipation of action of liothyronine sodium (T3), as compared with levothyroxine sodium (T4), has led some clinicians to prefer its use in patients who might be more susceptible to the untoward effects of thyroid medication. However, the wide swings in serum T3 levels that follow its administration and the possibility of more pronounced cardiovascular side effects tend to counterbalance the stated advantages.
Cytomel (liothyronine sodium) Tablets may be used in preference to levothyroxine (T4) during radioisotope scanning procedures, since induction of hypothyroidism in those cases is more abrupt and can be of shorter duration. It may also be preferred when impairment of peripheral conversion of T4 to T3 is suspected.
Myxedema
Recommended starting dosage is 5 mcg daily. This may be increased by 5 to 10 mcg daily every 1 or 2 weeks. When 25 mcg daily is reached, dosage may be increased by 5 to 25 mcg every 1 or 2 weeks until a satisfactory therapeutic response is attained. Usual maintenance dose is 50 to 100 mcg daily.
Myxedema Coma
Myxedema coma is usually precipitated in the hypothyroid patient of long standing by intercurrent illness or drugs such as sedatives and anesthetics and should be considered a medical emergency.An intravenous preparation of liothyronine sodium is marketed by Jones Pharma Incorporated, under the trade name Triostat® for use in myxedema coma/precoma.
Congenital Hypothyroidism
Recommended starting dosage is 5 mcg daily, with a 5 mcg increment every 3 to 4 days until the desired response is achieved. Infants a few months old may require only 20 mcg daily for maintenance. At 1 year, 50 mcg daily may be required. Above 3 years, full adult dosage may be necessary (see PRECAUTIONS, Pediatric Use).
Simple (non-toxic) Goiter
Recommended starting dosage is 5 mcg daily. This dosage may be increased by 5 to 10 mcg daily every 1 or 2 weeks. When 25 mcg daily is reached, dosage may be increased every week or two by 12.5 or 25 mcg. Usual maintenance dosage is 75 mcg daily.In the elderly or in pediatric patients, therapy should be started with 5 mcg daily and increased only by 5 mcg increments at the recommended intervals.
When switching a patient to Cytomel (liothyronine sodium) Tablets from thyroid, L-thyroxine or thyroglobulin, discontinue the other medication, initiate Cytomel at a low dosage, and increase gradually according to the patient's response. When selecting a starting dosage, bear in mind that this drug has a rapid onset of action, and that residual effects of the other thyroid preparation may persist for the first several weeks of therapy.
Thyroid Supression Therapy
Administration of thyroid hormone in doses higher than those produced physiologically by the gland results in suppression of the production of endogenous hormone. This is the basis for the thyroid suppression test and is used as an aid in the diagnosis of patients with signs of mild hyperthyroidism in whom baseline laboratory tests appear normal or to demonstrate thyroid gland autonomy in patients with Graves ophthalmopathy. 131I uptake is determined before and after the administration of the exogenous hormone. A 50% or greater suppression of uptake indicates a normal thyroid-pituitary axis and thus rules out thyroid gland autonomy.Cytomel (liothyronine sodium) Tablets are given in doses of 75 to 100 mcg/day for 7 days, and radioactive iodine uptake is determined before and after administration of the hormone. If thyroid function is under normal control, the radioiodine uptake will drop significantly after treatment. Cytomel (liothyronine sodium) Tablets should be administered cautiously to patients in whom there is a strong suspicion of thyroid gland autonomy, in view of the fact that the exogenous hormone effects will be additive to the endogenous source.
Posted by Deputy Racer on September 13, 2008, at 23:56:12
In reply to Re: tricyclics that don't cause weight gain?, posted by bulldog2 on September 13, 2008, at 20:32:16
> >
> I wish you wouldn't post incorrect info without researching the truth.Please don't post anything which could lead others to feel accused or put down, even if you think they are wrong. If you'd like to correct what you see as incorrect information, please do so in a civil manner.
If you have any questions regarding the posting policies on this site, please read the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil Follow ups to this action should be directed to the Administration board and should themselves be civil.
Dr Bob has ultimate authority over all administrative issues on this site, and may choose at any time to revise or reverse any action taken by a deputy.
Deputy Racer
Posted by bulldog2 on September 14, 2008, at 9:46:18
In reply to Please be civil » bulldog2, posted by Deputy Racer on September 13, 2008, at 23:56:12
> > >
> > I wish you wouldn't post incorrect info without researching the truth.
>
> Please don't post anything which could lead others to feel accused or put down, even if you think they are wrong. If you'd like to correct what you see as incorrect information, please do so in a civil manner.
>
> If you have any questions regarding the posting policies on this site, please read the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil Follow ups to this action should be directed to the Administration board and should themselves be civil.
>
> Dr Bob has ultimate authority over all administrative issues on this site, and may choose at any time to revise or reverse any action taken by a deputy.
>
> Deputy RacerIncorrect info can cause people to make the wrong judgements about their meds. I feel we have a moral obligation to get our facts straight for the safety of fellow members.Possibly do we need posts reviewed before posting? This has happened on more than one occassion.
Posted by Deputy Racer on September 14, 2008, at 12:56:13
In reply to Re: Please be civil, posted by bulldog2 on September 14, 2008, at 9:46:18
> >
> Incorrect info can cause people to make the wrong judgements about their meds. I feel we have a moral obligation to get our facts straight for the safety of fellow members.Possibly do we need posts reviewed before posting? This has happened on more than one occassion.It's fine to disagree with someone, however the guidelines at PsychoBabble require that disagreement be expressed in a respectful manner. The warning you were given was directed solely at your manner of expressing disagreement.
If you're not clear about the civility guidelines here at Babble, it might help to review the FAQ, located at http://www.dr-bob.org/babble/faq.html#civil The best general advice I can offer on the subject is simple: apply the Golden Rule. If you're unsure whether what you've written is civil, imagine how you would feel if it were written to you. If you believe your feelings might be hurt, it's worth trying to rephrase it before posting.
Any further follow ups to this should be directed to the Administration board.
Deputy Racer
Posted by dcruik518 on September 15, 2008, at 16:18:27
In reply to Re: Please be civil » bulldog2, posted by Deputy Racer on September 14, 2008, at 12:56:13
Phillipa, you seem like a really nice person and and it seems like you do better with social support than technical stuff. We do appreciate your presence.
Posted by Racer on September 15, 2008, at 17:44:31
In reply to Re: Phillipa, posted by dcruik518 on September 15, 2008, at 16:18:27
Posted by Phillipa on September 15, 2008, at 20:13:19
In reply to Re: Phillipa, posted by dcruik518 on September 15, 2008, at 16:18:27
Yes your're absolutely correct thanks for wanting me here. Certainly no expert just really own experiences with meds. Love Phillipa
This is the end of the thread.
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