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Introduction

According to the American Thyroid Association approximately 12% of the US population will develop some type of thyroid condition during their lifetime – most likely hypothyroidism.

Hypothyroidism is a condition in which the thyroid isn’t producing enough hormone, often making it necessary for a medication to be prescribed to alleviate the symptoms.

There are a few different types of medications used to treat hypothyroidism.

One of the more commonly prescribed thyroid medications is Cytomel.

Cytomel is an FDA-approved tablet medication used to replace the T3 thyroid hormone.

It is the second most commonly prescribed T3 thyroid medication for the treatment of hypothyroidism as well as other thyroid-related disorders.

This is a synthetic T3 hormone medication also known as Liothyronine Sodium, with Cytomel being the most common brand name used in the United States.

Cytomel was originally approved by the FDA for medical use in 1956 and continues to be used with much success.

Medical Use of Cytomel

Cytomel is strictly used in the treatment of thyroid-related disease. The most common thyroid disorders that warrant the use of Cytomel include:

Mild Hypothyroidism

Mild hypothyroidism is the most common disorder that Cytomel is prescribed for.

Hypothyroidism is the disorder in which the thyroid is under-producing the T3 and T4 hormones.

The majority of patients will be prescribed 25 MCG of Cytomel to be taken daily.

Due to the potent nature of Cytomel and in effort to prevent side effects, doctors will begin with this lower dose but increase the amount over a period of 2 weeks.

Typically patients with mild hypothyroidism will be kept on a maintenance dosage of anywhere from the original 25 MCG up to 75 MCG on a daily basis.

Congenital Hypothyroidism

Congenital hypothyroidism only differs from mild hypothyroidism in that it only affects infants.

Congenital hypothyroidism is essentially hypothyroidism in infants, caused by either a birth defect in the thyroid, being born with an iodine deficiency, or an otherwise unknown issue affecting the thyroid metabolism.

Dosage for congenital hypothyroidism is typically 5 MCG to start, with an increase to the desired amount over a period of less than a week.

Depending on the severity of the hypothyroidism, infants may require 20 MCG daily until a year of age.

If hypothyroidism is still present this may be increased to 50 MCG at one year of age to 3 years of age.

From 3 years of age on up an adult dosage may be used.

Simple Goiter

A simple goiter is the name given to goiters that form due to a known issue with the thyroid gland.

Goiter can be present with mild hypothyroidism, as goiters form due to the thyroid gland not produce enough hormones.

However, simple goiters may also form due to dine deficiencies.

Treating goiters with Cytomel is done gradually, with 5 MCG to start and an eventual dose of 25 MCG.

Most often a dosage between 25 MCG or 50 MCG is the maximum needed to control goiter, but an increase to 75 MCG is possible.

Both the elderly and the very young must be give small doses to start and increase in dosage must be done with great care, especially when the patient was previously on a different type of T4 medication.

Myxedema

When hypothyroidism is left untreated and reaches a level of critical medical emergency it is called myxedema.

Myxedema is a name to describe severe hypothyroidism. Myxedema is also known as Myxedema Crisis.

Mild Myxedema symptoms are treated with a starting dose of 5 MCG, reaching a peak of up to 100 MCG daily.

Due to the nature of Myxedema this slow increase in Cytomel dosage is important, so long as a crisis level hasn’t yet been reached.

Myxedema Coma

When Myxedema Crisis is left untreated the patient may enter Myxedema Coma.

This is the most severe repercussion of untreated hypothyroidism and, as the name suggests, leaves patients in a near comatose state.

Brain function diminishes, hypothermia sets in, and other common pre-coma symptoms will show.

This is a potentially fatal level and considered a life or death medical emergency. Unfortunately once this level is reached, Myxedema comes with a high mortality rate, even with exhaustive medical interference.

If a patient is in pre-coma or entering a Myxedema coma dosage can vary wildly, and therefore there is no true recommended dose.

Once in this state Cytomel tablets are obviously no longer used, but rather the liothyronine sodium (what Cytomel is made of) is injected intravenously.

Thyroid Suppression Therapy

Cytomel may also be used in certain thyroid suppression therapies.

Most often this means Cytomel is prescribed to patients with thyroid cancer as a means of preventing hypothyroidism from setting in to prevent further growth or regrowth of cancer within the thyroid.

The use of Cytomel in thyroid suppression therapy has been successful but is fairly experimental as dosage is largely determined on a patient-to-patient basis.

Studies have found it to be successful when also prescribed with a low-iodine diet.

Treating patients in this way is therapeutic and not something given as a daily maintenance medication for a prolonged period of time.

Depending on the severity, Cytomel may be given in 75 to 100 MCG doses for one week.

Side Effects of Cytomel

Overall Cytomel is a very safe drug and rarely do patients experience side effects.

That being said, occasionally unusual reactions to this medication may occur, particularly in those given a high dose by their doctor.

The most common side effect is hair loss.

This hair loss is more likely to occur in children that are given Cytomel, though it can happen in adult men and women. It isn’t known why this happens, but the hair loss is temporary, growing back as the body adjust to Cytomel.

Very serious and sudden hair loss will warrant an appointment with your doctor, however.

It is rare to have too much of the thyroid hormone present in your body, but if given too high a dose of Cytomel is possible to experience more severe symptoms, like:

• Headaches or migraines
• Difficulty controlling mood (mood swings)
• Unusual irritability or other mood changes
• Feeling nervous or anxious
• Sweating and feeling easily overheated
• Diarrhea or symptoms similar to an upset stomach
• Women may experience changes in normal menstruation

These symptoms would be considered less severe, but if you experience them it is important to consult your doctor immediately.

A pharmacist may also be a good source of advice on whether you should reduce your dosage until you can get ahold of your doctor.

Severe reactions to Cytomel are rarely seen, but if suspected you must seek medical attention as soon as possible.

These red flags include:

• Chest pain or feelings of tightness
• Heart palpitations or flutters
• Pounding or racing heartbeat
• Swollen extremities (particularly ankles and feet)
• Shortness of breath
• Sudden lethargy
• Dizziness or feeling faint
• Rashes developing on skin
• Facial itching or swelling (common signs of an allergic reaction)

As with any medication, if you ever feel unwell after starting a new drug you should call your pharmacist or doctor for more information.

Though Cytomel is quite safe compared to other prescription medications, even if you’re just experiencing slight headaches or feel like your mood has changed in any way, don’t hesitate to consult a medical professional.

Interactions of Cytomel

Although your doctor should have gotten your medical history from you prior to starting you on Cytomel, it’s important to educate yourself for your own safety.

It is possible for Cytomel to not just interact with other medications, but also with certain diseases.

If you have cardiovascular disease there is a potential for Cytomel to cause previously mentioned symptoms of irregular or racing heartbeat.

This can be quite serious in patients with underlying heart issues.

Cytomel can also exacerbate issues in patients with diabetes, adrenal disease and epilepsy.

If you take a multivitamin and didn’t mention this to your doctor, you should call and double-check if they dosage given is still correct if you take any type of mineral supplement.

Multivitamins with minerals may possibly reduce the effectiveness of Cytomel, particularly those with vitamin D3 and B12.

There are a number of medications that could possibly interfere with Cytomel in a negative way.

Due to the high number it is important that you ensure your doctor has a complete list of current medications you are on.

The most common drug interactions with Cytomel are linked to the medications like:

• Adderall
• Prednisone
• Gabapentin
• Clonazepam
• Levothyroxine
• Synthroid
• Tramadol
• Trazodone
• Metformin
• Xanax
• Wellbutrin XL

If you are on any of these medications and have also been prescribed Cytomel, you should double-check with your doctor to ensure what you’ve been prescribed is safe.

It is also important that you consult your doctor prior to start any new medications or supplements, or increasing doses of your other medications, first.

Your doctor may have given you a stronger or weaker dose of Cytomel to prevent interactions with your other medications, so by increasing your other medication dosages your doctor may likely also need to change your Cytomel dosage.

Controversies of Cytomel

While there is little controversy over Cytomel being effective, there is some debate over T3 and T4.

As previously mentioned, Cytomel is a thyroid medication that works as a hormone replacement for the T3 hormone.

What many people don’t realize about their hypothyroid disorder is that the thyroid actually produces two types of hormones – Triiodothyronine (T3) and Thyroxine (T4).

The thyroid produces more T4 hormone than T3, with majority of the T3 that is produces coming from the body itself converting T4 to T3.

Both hormones are important, and both play major roles in the body’s metabolism and energy.

The T3 hormone is a stronger hormone and T3 medication, like Cytomel, has a stronger effect than T4 medications.

T3 medications are absorbed much much rapidly in the GI tract, which cause cause slight thyroid toxicity in some patients.

Despite T3 medications being stronger, which could potentially cause side effects, more doctors are starting to believe that the old method of relying on T4 isn’t as effective.

The idea that T3 medications like Cytomel are a better choice for patients that can handle its stronger effect isn’t new either.

A study done back in 1999 found that patients with hypothyroidism currently taking T4 medications had an improved quality of life when also given T3 like Cytomel.

Another study published in the European Thyroid Journal determined that 49% of patients in the trial felt significantly better on a T3 and T4 combination.

This thorough research was originally done to disprove the idea that T4 alone was always the best option or that the favorable addition of T3 was a mere fluke.

Though there is still more research that needs to be done, it goes without saying that Cytomel could be an excellent addition to T4 medication if your finding your current medication isn’t giving you favorable results like weight loss, increase in energy or happier mood.

Conclusion

Cytomel is an excellent T3 thyroid medication and one that has been used with much success for many years.

It performs well on its own as a standalone treatment for hypothyroidism, but it also is a great addition to a T4 medication plan to help alleviate further thyroid symptoms.

References

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