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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Do I need to add Cytomel along with Levothyroxine after experiencing shortness of breath and fatigue when diagnosed with Hashimoto's disease?

Answered by
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Dr. Elona Xhardo

Endocrinologist

Practicing since :2008

Answered : 707 Questions

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Posted on Wed, 5 Sep 2018 in Thyroid Problem and Hormonal Problems
Question: I have had Hashimoto's for 18 years. Seemed to be stable for years on 88mcg Levo. In 2011 I went up to 100mcg. In 2016 I went uf to 112mcg. Checked again in January 2018 and TSH was higher than I am comfortable and my T3 was low so we tried 125 for a couple days and then decided to instead, keep 112mcg and add 5mcg cytomel. A week into the new regimin, Started being hyper emotional (really hyper emotional), not sleeping but super tired, shaky, achy, headache. I missed two days of work, no cold/flu symptoms. I Stopped the cytomel, waited 3 days and checked my thyroid. TSH had gone up, T4 didn't move and my thyroid antibodies came down. My doc didn't check T3. I am not sure what dose to take, 112 or 125. I don't know if I should add the cytomel. I don't even know if this was all related, but still feel short of breath, not sleeping well, but now also constipated and dragging. Thoughts
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Answered by Dr. Elona Xhardo 1 hour later
Brief Answer:
No need to add Cytomel. Take 125 mcg Levothyroxine.

Detailed Answer:
Hi,
I have gone through your query.
I can understand your concern.

I have seen your attached report.
The doses of Levothyroxine has adjusted accordingly to the TSH result.
So when you are under thyroid hormone replacement therapy it is necessary to check only TSH.

I see that all your TSH results are within the normal range.
The optimal (target)levels are between 1-2 and this correspond even with the level where the majority of patients typically report feeling their best. You confirm that this is correct.

Your actual TSH level is higher than the optimal level and (which is the most important thing) you have symptoms of hypothyroidism like feeling tired, not sleeping well and constipation.
For this reason, if you were my patient I will suggest using 125 mcg levothyroxine.

I don't recommend Cytomel(liothyronine or T3) because this drug has a rapid onset of action and can produce symptoms of hyperthyroidism in synergy with the residual effect of Levothyroxine because residual effects of the other thyroid preparation (levo) may persist for the first several weeks of therapy.

To conclude: In my opinion, you should take 125 mcg Levothyroxine, you should feel better.
It is recommended to repeat the TSH test 6 weeks after you start the new doses.

Let me know the result and let me know how do you feel about the new doses.

Hope this is helpful.
Best regards.
Dr. Elona Xhardo

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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