Cytomel Side Effects: Complete List + Dosing Guide for Patients

Cytomel Side Effects: Complete List + Dosing Guide for Patients

Cytomel is the most powerful thyroid medication which means that it can also have some powerful side effects. 

If you're taking Cytomel and wondering if you are experiencing side effects then sit tight because we are going to dive into everything you need to know about this medication. 

For instance...

Did you know that Cytomel can help with weight loss but that it can also cause hair loss in certain patients?

Unfortunately, many Doctors aren't used to prescribing Cytomel so many patients are left to figure it out for themselves. 

And that's why I created this guide - to help:

  • People who have just started taking Cytomel
  • People who have been taking Cytomel and are wondering if their side effects are caused by the medication itself or from some other cause
  • People who are curious to know if Cytomel can be used to help them improve their quality of life
  • People who want to know if this medication will help them with weight loss
  • People who are struggling with hair loss and believe it may be due to their medication
  • Those who just want to know more about Cytomel, how it works, why it's different and what benefits it provides to the body


Positive Side Effects of Cytomel

First off:

If you didn't already know - Cytomel is a thyroid medication used to treat people who have a sluggish thyroid. 

But that's not all it can do. 

It can also be used off-label to treat certain psychiatric disorders such as treatment-resistant depression and treatment-resistant bipolar disorder. 

For now, we are going to focus on how it helps to treat the thyroid but much of this information will be relevant to you regardless of why you are using it. 

Cytomel is the brand name for the generic T3 medication known as liothyronine, but both medications contain the same active ingredient known as triiodothyronine

It's most frequently used to treat the following conditions:

And what you need to know about Cytomel is this:

It is the active form of thyroid hormone, meaning that it is the most powerful thyroid medications you can take. 

As a quick primer:

T3 is the active thyroid hormone while T4 is considered to be the inactive thyroid metabolite. 

Both are technically 'active' in the body but T3 is hundreds of times more active than T4 (1). 

It should be differentiated from other thyroid medications like Armour thyroid, Nature-throid, WP thyroid, levothyroxine, and Synthroid.

One thing you need to understand about thyroid medications is that generally, you should NOT be experiencing negative side effects when you take these medications. 


Because, presumably, you are taking the hormone to replace a deficiency inside of your body. 

If all you are doing is replacing that deficiency then you shouldn't experience negative symptoms only positive effects. 

Assuming you aren't reacting to any of the fillers or binders in the medication itself and you are on the right dose of thyroid medication for YOUR body, then several things should happen:

  • Your hypothyroid symptoms should be improving
  • Your weight should be dropping
  • Your hair should be falling out less
  • Your energy should improve
  • Your mood should improve
  • You should not be anxious or depressed
  • Your sleep should improve

Basically, all of the symptoms you were experiencing due to hypothyroidism should be improving, not worsening. 

If you are experiencing any other symptoms (especially negative side effects) then that may be an indication that you are reacting to the fillers or binders in the medication or that your dose is not correct.

We will talk about how to find out if your dose is too high or too low, but for now, we will focus on what to do if these fillers or binders are causing you side effects. 

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Inactive Ingredients in Cytomel

All medications contain a combination of both active and inactive ingredients. 

The active ingredient is the ingredient that causes all of the physiologic benefits of the medication. 

In this case, the active ingredient in Cytomel is triiodothyronine or L-T3. 

The inactive ingredients help to stabilize the active ingredients and act as a carrier to prevent the breakdown of the active ingredient (2) in the stomach and so on. 

They also are added to change the color, shape or consistency of the capsule/pill. 

The problem with these inactive ingredients is that certain patients may actually negatively react to them. 

This may put you in a situation where you don't react to the active ingredient (because you need it) but you may be reacting to the fillers/binders/inactive ingredients in the medication. 

And determining what you are reacting to can be difficult at times. 

For reference, Cytomel contains the following inactive ingredients:

Inactive ingredients of cytomel
  • Calcium Sulfate
  • Gelatin
  • Starch
  • Stearic Acid
  • Sucrose
  • Talc

It's been my experience that many patients who use Cytomel and react negatively to it, are often reacting to the inactive ingredients, especially starch or gelatin. 

The good news, if you are one of those people who react negatively to the fillers, is that it is possible to compound the active ingredient into a formulation which contains fewer inactive ingredients. 

Formulations such as sustained release T3 can be created by compounding pharmacies. 

It should be noted, however, that even the sustained release T3 formulation is not without faults. 

Sustained release T3 (or SR T3) contains high amounts of methylcellulose (3) which can also cause similar problems and reactions in certain patients.

Bottom Line: If you are having negative reactions to Cytomel it may not be due to the active ingredient but instead due to the inactive ingredients.

The Complete List of Side Effects of Cytomel

This list will breakdown all of the possible reactions you may be experiencing while using Cytomel. 

When it comes to side effects there are 3 main categories that you want to be looking at:

  • Hypersensitivity reactions
  • Overdosing
  • Underdosing

Each category comes with a set of unique symptoms and understanding where you fit can help you determine if you need to switch medications or simply alter your dose. 

1) Hypersensitivity Reactions

Hypersensitivity reactions are fairly common and can range from mild to severe, depending on the person. 

These symptoms tend to come from the inactive ingredients, fillers, binders, preservatives, and dyes in the medication. 

Hypersensitivity symptoms from cytomel

Symptoms of hypersensitivity to Cytomel may include: 

  • Rash, Hives or Itching
  • Swelling of the Face or extremities
  • Tingling sensation in the hands or face
  • Nausea or vomiting
  • Headaches
  • Difficulty breathing (rare but serious)
  • Tightness in the chest (rare but serious)

If you experience any of these symptoms, and if they persist even after changing or altering your dose, then you may need to switch medications entirely. 

Your best options may be to switch to the generic liothyronine medication or switch to a compounded SR T3 formulation. 

2) Excessive Dosing

Perhaps more common than hypersensitivity reactions are those reactions caused by the dose of the medication itself. 

Cytomel, as the most powerful T3 medication, is prone to causing symptoms that may mimic hyperthyroidism if used in high doses. 

These side effects are potentially very serious and if you experience any of them you should seek advice from the provider who gave you the medication. 

Their presence indicates that you will need to adjust your dosing or go off of your medication completely. 

In many cases, however, you may be able to simply adjust your dose downward to eliminate them. 

Sometimes, even though the dose may be appropriate, you may be extra sensitive to small increases in T3. 

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You can prevent some of this by simply increasing your dose in a slow and controlled manner. 

A slow titration upwards may prevent symptoms such as heart palpitations, anxiety and so on. 

If symptoms persist despite lowering your dose then make sure to check your nutrient status and make sure your adrenals have been addressed. 

Symptoms which may indicate your Cytomel dose is too high include: 

  • Rapid heart rate (This is why I recommend tracking your heart rate while taking Cytomel or Liothyronine)
  • Tachycardia
  • Irregular heart rate
  • Palpitations (Sensation of rapid heart rate but heart rate remains normal)
  • Shortness of breath
  • Sensitivity to heat
  • Weight gain <----- Rare, but can happen
  • Hair loss <----- Typically temporary but sometimes it can persist
  • Increased sweating 
  • Jittery sensation or increased anxiety 
  • Dizziness or lightheadedness
  • Chest pain or chest discomfort
  • Diarrhea or loose stools
Complete list of side effects of cytomel

3) Insufficient Dosing

Last, but still important, is the idea that you may be on the right medication but your dose may not be high enough. 

If you experience symptoms from this condition then it's important to realize that these symptoms are not caused by the medication itself but by a deficiency in thyroid hormone in your body. 

The symptoms that indicate your dose is not high enough include the same symptoms that correlate with hypothyroidism. 

The persistence of symptoms such as fatigue, weight gain, constipation, hair loss, and depression may be an indication that you need to continue increasing your dose. 

Will Cytomel Help me Lose Weight?

I've written extensively on this topic before and you can check out the entire post here

But in the meantime let's cover some basics:

Yes, Cytomel and liothyronine can absolutely help you lose weight - but only if used correctly and for the right reasons.

Even if you didn't want to take my word for it after treating hundreds of patients you can take a look at this study as a reference (4):

Metabolic effects of Liothyronine and cytomel

In this study, patients were either given T3 (Cytomel or liothyronine) or T4 (Synthroid or Levothyroxine). 

These patients were given 'dose equivalents' of each medication as measured by their TSH. 

Basically, they gave both groups enough thyroid hormone to normalize their TSH down to the same level which was somewhere between 0.5 and 1.5 U/mL. 

The researchers found that those who took equivalent doses of LT3 had reduced body weight and better cholesterol levels without experiencing any negative side effects. 

Those who took T3 lost an extra 4-5 pounds without making any changes to their diet or lifestyle (highlighting the impact that thyroid hormone has on the metabolism)

Cytomel and weight loss

Similar results have been found in other studies which compare LT4 medications to thyroid medications which contain T3. 

So, given that they tend to work better than LT4 why do most doctors fail to prescribe Cytomel?

Much of this has to do with their lack of knowledge on the topic and the fact that they haven't seen these new studies. 

This allows for a unique opportunity in which you can bring these studies to your doctor to see if they will be willing to give them a try. 

Even though Cytomel can help with weight loss doesn't necessarily mean that it's right for everyone. 

Many patients are extremely sensitive to the T3 in Cytomel and it may cause side effects like heart palpitations, anxiety, or panic attacks. 

In addition, you shouldn't use Cytomel for weight loss if you don't have hypothyroidism. 

Doing so may put excess strain on your body, heart tissue, and other organ systems. 

Bottom Line: Cytomel can help with weight loss, but it should be used cautiously because it is a powerful thyroid medication. 

Can Cytomel Cause Weight Gain?

While it doesn't make any logical or intuitive sense that Cytomel could cause weight gain, I have seen it happen in a handful of patients. 

In addition, it is also listed as a potential side effect of the medication:

Weight gain on cytomel

You can take comfort in knowing that this side effect happens very rarely and I've only seen it a handful of times. 

With an occurrence of about 1% or less, it's not a side effect that you should worry about before you consider using this medication. 

It's not clear to me why Cytomel would cause weight gain but I suspect it's likely a reaction to a filler or binder within the medication itself. 

I believe this to be the case because of all the patients I know who have gained weight on the medication still experienced an improvement in their hypothyroid symptoms and they only experienced a mild weight gain of 3-5 pounds. 

This would lead me to believe that the medication is still working to enhance thyroid function in their body and that the weight gain is caused by some other variable. 

If you do gain weight on Cytomel it is worth switching to SR T3 to see if the problem still persists or switching to Natural Desiccated Thyroid if that fails.  

Cytomel and Hair Loss

One of the main symptoms that patients with hypothyroidism struggle with is hair loss. 

And, I don't want to alarm you here but Cytomel can actually make hair loss worse. 

Don't let this scare you away from trying this medication though, because the hair loss associated with it is only temporary. 

In some patients (around 10% by my estimation) Cytomel can temporarily make hair loss worse for about a 3-4 month period. 

The good news is that this hair loss is temporary and should resolve on its own without any intervention on your part. 

cytomel causes hair loss

The problem with this symptom is that it may stop certain people from continuing with their medication because they don't know that it's temporary. 

No one really knows for sure why it causes worsening hair loss but I believe it may be due to an increased demand on the hair follicles which is exacerbated by other nutrient deficiencies. 

You can imagine a scenario in which there is a strong signal sent through your body which triggers the growth of hair, but unless you have the building blocks to create the hair it may make the problem worse. 

Something similar may occur in individuals who suffer from hair loss when starting Cytomel. 

If you fit into this category then you'll want to take certain hair growth nutrients including Zinc (5), Selenium, Iron and so on. 

You can find a list of reasons why thyroid patients experience hair loss and how to fix them here

If your hair loss persists after 3-6 months and after replacing all of your nutrient deficiencies then it may be time to consider other options.

In these cases, it's best to lower the dose of Cytomel or switch to SR T3 or NDT if possible. 

How to find the Right Cytomel Dosage for Your Body

When starting any medication it's important to realize that your dose will depend on YOUR body. 

That means you shouldn't base your dose off of what has worked for other people.

You may need more or you may need less.

In my practice, the average dose of T3 varies from 5-50mcg with some people needing even less than 5mcg and some needing more. 

To find your optimal dose I recommend using a combination of these four areas when titrating:

#1. Your Thyroid Lab tests

Whenever you make any changes to your thyroid medication you should always follow and take stock of what is happening to your thyroid lab tests

These lab tests reflect the serum changes of thyroid hormone in your body and they can tell you if what you are doing is working or not. 

When starting Cytomel you will want to pay particular attention to your Free T3, Total T3, Reverse T3 and Sex Hormone binding globulin.

These lab tests are more important than assessing the TSH because they give you information as to how your body is processing and utilizing free thyroid hormone. 

Another helpful measure is to evaluate your free T3:reverse T3 ratio which can give you an idea of how much competition there is at the cellular level. 

The higher your reverse T3 is the more competition exists between thyroid receptors for T3 and rT3. 

You can also evaluate your TSH but you should remain cautious when doing so because T3 is about 3x more potent (6) than T4 at lowering the TSH. 

Instead, use the other measures and lab tests listed above to get an idea of how well your body is utilizing serum levels of T3. 

If your body is utilizing the T3 and Cytomel correctly then your Free T3 should be increasing, your Reverse T3 should be decreasing and your SHBG should be increasing. 

#2. Your Basal Body Temperature

Basal body temperature can be used as a surrogate marker of thyroid function, but like the other areas here should NOT be used in isolation.

Cytomel and other forms of T3 have been shown to increase Basal body temperatures (usually in supraphysiologic doses (7)).

And this makes sense when you think about how thyroid hormone works:

Thyroid hormone helps with cellular energy production which helps generate heat (8). 

Low thyroid hormone = low energy production = low body temperature. 

Now, while that's true there are also many other things that can cause low body temperature including several medications. 

The more medications you are on (Like beta blockers) the less accurate your basal body temperature becomes. 

Despite this, I still recommend following the body temperature while on T3 containing medications. 

#3. Your Resting Heart rate

Cytomel and T3 thyroid hormone have a direct effect on the heart and cardiac tissue.

Cytomel causes an increase in the force of contraction and an increase in the heart rate (9).

The main difference between the heart and other tissues when it comes to thyroid hormone is the effects at the cellular level:

T3 has both nuclear and extranuclear effects (10) on the heart. And that's important because the extranuclear effects cause an increase in heart rate via calcium channels. 

This is important because other cells in your body have to take in thyroid hormone via the nucleus and process changes through genetic transcription (11). 

That's a bunch of mumbo-jumbo to say that the effects of thyroid hormone on the heart are more rapid than the effects of thyroid hormone on other tissues.

Which means your heart can be more sensitive to the medication, even though your other cells still need the hormone.

However, when titrating your dose it's ALWAYS important to monitor how it affects cardiac tissue because it is very sensitive.

#4. Your Thyroid Symptoms

The main reason you are probably on thyroid medication is to reduce the symptoms of hypothyroidism you are experiencing!

So it makes sense that while you increase your dose of Cytomel or T3 your hypothyroid symptoms should decrease, right?

Well, that is true for the most part but it's important to remember that not all of your symptoms are necessarily related or caused by thyroid dysfunction. 

For instance, your fatigue may be caused by a combination of hypothyroidism plus adrenal related issues plus nutrient deficiencies. 

In this case, it doesn't make sense to titrate up your Cytomel until your fatigue disappears because you won't be addressing the underlying cause.

While it is helpful to monitor your symptoms as you increase your dose, don't rely completely on your symptoms alone as this may lead to overdosing (12). 

Cytomel Reviews & Case Studies

Remember that Cytomel can be used in combination with other medications for a more powerful medication combo.

I will frequently use Cytomel in combination with NDT.

And even though many providers aren't comfortable with this combination, some endocrinologists and PCP's may be more likely to add Cytomel to your Levothyroxine dosage.

Sometimes even adding as little as 10-20mcg per day to your dose may improve your symptoms dramatically.

To see some case studies on T3 and how it can help with weight loss and improving symptoms please see this post.

Do you Need to Switch Thyroid Medications?

While there is no perfect thyroid medication that everyone HAS to be on, Cytomel certainly has its place in many patients. 

In general, the more complex a patient is the better they tend to do on Cytomel.


Because chronic infection, chronic pain, chronic illness, insulin resistance, leptin resistance all put a brake on your thyroid conversion process and favor the production of Reverse T3.

When you take T3 only medication like Cytomel, you are not providing your body with the substrate to produce Reverse T3 so these levels often decrease dramatically.

I generally recommend Cytomel who patients who fall into these categories:

  • Patients with very high reverse T3 levels (often > 15 or even higher)
  • Patients with Insulin resistance, pre-diabetes or diabetes
  • Patients with Leptin resistance (Serum leptin levels > 10)
  • Patients with a personal history of Bipolar disorder, severe medication-resistant depression or a family history of both
  • Patients with fibromyalgia, chronic fatigue syndrome or chronic pain syndromes
  • Patients who have very complex medical histories and have been sick for decades
  • Patients who have failed NDT or T4 only medications

Remember that these are just recommendations and you shouldn't live or die by these guidelines. 

At the end of the day, you are a unique individual and you should be treated as such. 


Cytomel is the strongest of the thyroid medications because it contains T3 instead of T4 like most other medications

It can be used in conjunction with other thyroid medications or by itself and it can also be compounded in various forms to delay its release into the bloodstream. 

Side effects from Cytomel are generally caused by either a hypersensitivity reaction to the binders and fillers inside of the medication or due to the dosage being too high. 

If you experience side effects due to the binders or fillers, you may be able to changes medications to SR T3 to get around these side effects. 

If you experience side effects due to your dose, then you may need to address underlying nutrient deficiencies before raising your dose. 

If these symptoms still persist then it may be necessary to switch to NDT or T4 medications. 

Now I want to hear from you:

Have you taken or are you currently taking Cytomel?

Have you experienced any adverse side effects?

Is it helping you feel better? Is it helping you to lose weight?

Why or why not?

Leave your comments or questions below! 

References (Click to Expand)

cytomel side effects

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

156 thoughts on “Cytomel Side Effects: Complete List + Dosing Guide for Patients”

  1. Dr. Childs,

    I am on 1/2 grain NDT and 30 mcgs of T3 daily in divided dosages. I am slowly titrating up the T3. I have high cortisol and am treating adrenals. Since I dropped my NDT dosage and added T3, my RBC, hemoglobin, and hematocrit have become mildly elevated. My primary doc referred me to a hematologist. I’ve read these levels can be elevated with hyperthyroidism and T3 but I am definitely hypo and labs reflect that. I’ve also read Cushings can cause this but I don’t have Cushings. Do you know if elevated RBC, hemoglobin, and hematocrit can be a side effect of taking T3? Thank you for your input.

    • Hey Lou,

      Lots of things can cause an elevation in RBC and HGB, but in general it’s not something you want to have because it increases the thickness of your blood. I have never seen T3 do it in the doses I use, but I don’t know what you are using so I can’t say for certain. I would make sure you touch base with your Doctor so he is in the loop.

      • Thank you for your reply Dr. Childs. I know it can be endocrine related but haven’t put the pieces together. I also have high cortisol and have read that could cause RBC and HGB elevations but Cushings is always mentioned. I don’t have Cushings. Also, I have lost almost 18 lbs since starting T3 a little over two months ago. I’m still taking a low dose while titrating up. When can I expect the weight loss to stop? Thank you.

        • The weight loss doesn’t necessarily stop unless you find out what is causing it. You will have to determine if it is medication related or filler related and then treat from there.

        • Did you change your diet and/or workouts at all? I just started taking T3 and have some weight to lose but don’t wish to lose too much. Thank you in advance!

  2. I’m on Synthroid 175 mcg once a day and cytomel 25 mcg twice a day find them or one of them to cause constipation and severe constant hot flashes and have not lost any weight. I’m sensitive to gluten also

    • Hey Brenda,

      The hot flashes are most likely secondary to the combination and dosages you are on, I wouldn’t say it’s necessary due to one medication or the other.

  3. I had Graves 20+ years ago, had RAI and became hypo, did well on synthroid for decades, then last 5yr gained 50# for no reason; my reverse t3 is 30; I have seen MD, ND and nobody can solve the issue; I have been on t3 as much as 50mcg .. no change in symptoms.
    I do have extreme work stress and I am sure that is a contributor, I exercise daily, I am vegan, eat clean, always have .. I am at a loss.
    I take zinc, vit d, vit b6, iron, vit c, asheaganda, rodiola, tumeric .
    Any info appreciated.
    Thank you, Dana

  4. I was diagnosed with secondly hypothyroidism r/t pituitary 3 yrs ago and gained 35# in 1 year – even while training for 3 triathlons. My T3 was always very low but T4 and TSH remained normal. My Endo recently added cytomel and my T3 increasedt to 114 but I continued to gain weight while my TSH dropped to 0.01. So we recently stopped the cytomel. My T4 stays at 1.0 no matter what we do. II tried Armour thyroid but didn’t feel well while taking it so switched back to Levo. I follow a GF diet (r/t sensitivity), I go to the gym 5d/wk and cannot lose the weight – in fact I haven’t been able to lose 1#!!! My FG has remains constant at 83 and my insulin =6 but my chol went from 179 to 229 in one year. We tested cortisol levels (via urine sampling) and it was low normal range. I don’t understand why I gained weight nor can I lose any weight. What should I consider talking about with my Endo? TIA!!!!!!

  5. Dr put me on NDT Cd not get above 1.5 grain had rt3 of 56
    heart palps n totally manic
    so dr put me on t3 only 75 mcg then raised it to 125 mcg,,,, heart issues so bad think my heart is blowing up,,,saw cardiologist he put a 48 hr monitore on me,,see him in a few days,,,believe I have Brady cardia or afib now,,,also they just found a mass in my rt lung,,,the dr who gave me NDT never ran nothing but the old TSH test on me Switched back to levo 2 weeks ago,,,palps still bad not sleeping,,,no Drs know what to do now,,,labs all sky high now below zero except TSH high,,, I go back to Endo in Oct I’m going to blast him,,,he knew I was and have been horribly sick n did no labs on me,,,now he has done perm harm to me,,,SO NOT TAKE NDT OR T3 WITHOUT GETTING COMPLETE LABS 1st INCLUDING CORTISOL SALIVA TEST DONT MAKE MY MISTAKE

    • Hey Terry,

      I disagree that you need a salivary cortisol level prior to taking NDT or T3, but your story does point to the danger of using these medications without the proper knowledge base.

  6. Have not felt well physically or mentally in last 15 yrs. Had thyroid cancer with thyroidectomy in 1997(my mother did also). Put on synthroid, been on ever since. On 100 mcg for last 8 yrs. Consistent weight gain, metabolism issues, type 2 diabetes, high blood pressure, cholestrol above normal, have bipolar disorder(diagnosed in 2012). Increase in weight since throidectomy of 60 lbs. After following you, got my Family Medicine Dr. to check Reverse T3 it was high at 39. She would not try NDT said I needed to go to endo. Saw my Rheumatologist last week for check up he added 5mcg of liothyronine to my 100 mcg Synthroid. I felt better on second day of taking it. I don’t know if this small dose is what I need? If my reverse T3 is 39 I may have to find a functional med. Dr. to help? I have many many health problems right now and had one kidney removed in 2003 stage 1 renal cell carcinoma, no chemo or radiation needed. Don’t really know how to approach all this.

    • Hey Paula,

      The best thing you can do is find a physician willing to work with you and help figure out what is going on. It’s too difficult to say what is happening with limited information and without blood work.

  7. I’ve been taking 88 mg if Synthroid for mos to treat my Hashimotos. I was also on Cytomel 5 mcg. I run and am an active woman. Been getting a pot belly and close to 10 lb weight gain in past 8 months. Hair falling out, fatigue, brain fog, depression and anxiety to mention a few symptoms. My Endo Doctor took me off Cytomel. That’s all he said or did to help with my symptoms and told me to see him in 6 wks!
    Does this sound like the best to do is take away the T3?
    Thank you in advance. Just frustrated. Hypothyroid inherited tendency from Mother.

    • Hey Renee,

      I’m not clear why your doctor would remove T3 from your regimen, you will have to ask him about that. In general, that doesn’t make a lot of sense but I don’t have all the information he has.

  8. Dear Dr. Childs,

    Great article. One question, when you prescribe t3 medication, do you advise to split the dose 2 or 3 times a day? And if so, what times of the day are the best to take it? Thank you in advance.
    Warmest regards,


  9. Hashi’s sufferer: After 8 years of trying Armour only, Levoxyl only, and Armour/Levoxyl combos in every possible dosage and nothing working, my Doctor finally agreed to put me on Cytomel. In 8 years, my symptoms continued to get worse until I was almost completely crippled. Saliva testing revealed my body is overdosing on cortisol and just about every other hormone. I have too much testosterone, etc. Last checked my Reverse T3 numbers hit 70. Lab testing also shows no celiac disease of any kind. I am not allergic or sensitive to gluten. Going gluten free for 2 years had no effect on my symptoms.

    Finally after 3 years of begging, I got Cytomel. While my symptoms are 50% better my weight has BALLOONED. I gained 8 pounds the first 10 days I was on it, I am now gaining about 5 pounds every 3 weeks or so with NO end in sight. I also have difficulty sleeping and insane sweats. I’m on the maximum my heart/pulse can take. Any lower dosage of cytomel and the weight gain INCREASES. I can’t handle gaining so much weight so rapidly. I’ve tried sticking it out on Cytomel to get my RT3 numbers lowered…. But I can’t handle this insane weight gain with no stopping.

  10. Hashi’s sufferer: After 8 years of trying Armour only, Levoxyl only, and Armour/Levoxyl combos in every possible dosage and nothing working, my Doctor finally agreed to put me on Cytomel. In 8 years, my symptoms continued to get worse until I was almost completely crippled. Saliva testing revealed my body is overdosing on cortisol and just about every other hormone. I have too much testosterone, etc. Last checked my Reverse T3 numbers hit 70. Lab testing also shows no celiac disease of any kind. I am not allergic or sensitive to gluten. Going gluten free for 2 years had no effect on my symptoms.

    Finally after 3 years of begging, I got Cytomel. While my symptoms are 50% better my weight has BALLOONED. I gained 8 pounds the first 10 days I was on it, I am now gaining about 5 pounds every 3 weeks or so with NO end in sight. I also have difficulty sleeping and insane sweats. I’m on the maximum my heart/pulse can take. Any lower dosage of cytomel and the weight gain INCREASES. I can’t handle gaining so much weight so rapidly. I’ve tried sticking it out on Cytomel to get my RT3 numbers lowered…. But I can’t handle this insane weight gain with no stopping. ”

    I’m currently taking Cytomel 37mg at 8am, 37mg at Noon, and 25mg at 4pm.

  11. Dear Dr. Childs,

    Thank you for a very helpful website. After my wife was diagnosed with hypothyroid and hashimotos, she has been taking Naturethroid, which has been a great help. However, every time she increases her dosage over 40 mg, she gets very noticeable bloating and a pressurized feeling in her abdomen. Both these side effects can be there to some extent all day, but it is usually less so each morning and increases throughout the day. Moreover, the same symptoms have occurred no matter what form of thyroid she uses to make the increase (alongside at least some Naturethroid as a base), including Naturethroid itself, generic levothyroxine, levothyroxine prepared in a low allergen capsule (only 1 extra ingredient, which was a sugar) at a compounding pharmacy, or Cytomel. So, up to 40 mg of thyroid and things are fine; more than that in any combination and these strong symptoms appear. Do you know what could be causing this? Her body clearly needs more thyroid, but it also seems not to accept as much as she needs, and we haven’t been able to find any help diagnosing what would cause these symptoms, either online or from our integrative doctor.

    Thank you for your help and your commitment to serving the thyroid/hashimotos community!

    • Hi Marcus,

      Thyroid hormone has both non genomic and genomic effects in the body. Sometimes, due to sensitivity, ceratin cells in may get too much thyroid while others may not get enough. This concept is referred to as tissue level hypothyroidism and can be tricky to treat. Your best bet is to find a physician knowledgable to help tease out the details.

  12. I have low thyroid,bottom of the scale. I have been taking cytomel25mcg in combination with synthetic 100mcg.for over ten years. I have gone from 145 lbs to 208 lbs. I have tried to get my doctor to up my customer dose with no avail. My psjrchaircatrist

  13. i was on cytomel for 4 months , my liver GGT is now 190 from 69 . It can be a side effect from taking cytomel ?
    i have history of high GGT – the doctors can’t figure out the cause ,

  14. Dr. Childs,

    My LLMD (Lyme literate doctor) has started adding Cytomel (compounded form that only has olive oil as the filler from Women’s International Pharmacy, Phone: 800.279.5708) to many of his patients with great success.To determine if a patient needs it he takes the Total T3 and divides it by the Reverse T3. This yields a number that should be at least 12. If it is under 12, the patient needs the addition of Cytomel.

    The compounded form is one third of the cost of the brand name Cytomel but you must request it.

    • Hey Alicia,

      Thanks for the comment. I like the method your physician is using, I generally prefer to use free T3/reverse T3 but total T3 certainly has value as well. I can’t speak to the absorption of T3 in olive oil but other SR T3 generally works ok provided the patient doesn’t have GI issues.

      The cost for 30 days of cytomel at 5mcg dosing is around $11.00 cash price if you use (, so either way it should be very affordable.

  15. My wife has tried numerous combinations of different forms of thyroid, including naturethroid and cytomel, but whenever she gets over a certain amount (about 40mg of naturethroid or its equivalent), she gets significant abdominal bloating and pressure that she never has at other times. I wrote about it a bit more in a post above.

    Do you have any ideas what could be causing this and how to counteract it?

    Thank you,

    • Hi Melissa,

      The answer to the question is to look into SIBO as the potential cause of these symptoms and treat if necessary.

  16. Why do you say “Remember that T3 is the active thyroid hormone, while T4 is the inactive thyroid hormone.

    It should be differentiated from other thyroid medications like Armour thyroid, Naturethroid, Wp thyroid, Levothyroxine and Synthroid.” ??
    How is T3 in WP Thyroid different than the one in Liothyronine or Cytomel ?

    • The T3 in liothyronine is the same active ingredient in WP thyroid and other formulations of NDT. How they differ is in the inactive ingredients and how that alters assimilation and absorption in the body. This can alter dosing in each person and may in part explain why some patients need higher doses of T3 than others.

  17. I took cytomel 10mcg in the morning brought my level from 7.9 to 2.2 then my level went to 3.6 then 6.8 So the dose was raised to 15mcg a day 10mcg in the morning and 5mcg evening. brought levels back to 2.6 it is making me restless like revved up can’t sleep no appetite can you tell me why? Why did it work so well at first then levels dropped then raise the dose levels back to normal then these side affects?can you help?

    • Hey Paulette,

      It seems you are functioning under the impression that your TSH (I assume this is what you are referring to when you say “my levels”) equates to proper thyroid function and adequate tissue levels of thyroid hormone. At such low doses of thyroid hormone (even T3) your TSH is largely unhelpful, it’s really only helpful to say pituitary thyroid hormone levels are low. And what you are experiencing is a perfect example of how dosing based on the TSH falls short: you remain symptomatic with a relatively “normal” TSH.

      You should be evaluating your native thyroid conversion to determine if your body even needs high levels of T3 thyroid hormone. Your reaction may be secondary to high serum levels of T3, cardiac sensitivity to the T3, too much T3 too soon, or simple a reaction to inactive ingredients in the medication itself. It’s hard to say with this information, but this should at least give you an idea of where to start.

  18. I’ve been taking synthesis and 10 mg of cytomel. Lately I’m freezing all day then in the afternoon I get hot then cold back and forth. Until I go to bed then I get really hot and have to have a window open all night so it gets down to around 53 degrees or less. My doctor to to stop and take half of dosage. It seemed to get better for 4 or 5 days then it went back to being hot and cold. So I decided to stop taking the cytomel altogether after 3 days it seem a little better. I’m going to stay off it for a week or two and see what happens. I hope it works because it’s driving me crazy. What do think?

  19. So, I am just starting out with thyroid medications after feeling like death for 3 years. I finally found a Dr. who noticed that despite my other thyroid labs being “normal”, my FT3 was 2.3 on all my labs looking back over the past few years. All other labs were comfortably in “optimal” ranges, TSH 0.8-1.5. etc, but also discovered a antithyroblogulin of 248 IU/ml from 2014. She started me out on NatureThroid 1/4 gr to 1/2 gr, which I responded to immediately. It was like a miracle, I had energy! I had a real blood pressure (always very low), better blood sugar regulation, resting heart rate actually came down and was more regular, on and on. After about a week, I started feeling overhyped and hyperfocused, with headaches and anxiety attacks. I inhaled your posts and some thyroid books and found that my rT3 was 17.1 and my ratio was 13.1. I thought I was a poor converter. I also a strong family hx of bipolar (mother) and I tend to be on the anxious side. I have switched to 5 mcg of Cytomel and it seems to be too strong, so I have been taking 2.5 mcg every morning for about 3 weeks. Initially, I have a surge that can cause some anxiety but then feel great. Lately I have been taking the remaining 2.5 mcg in the afternoon about 3-4pm and it is making me very panicky, with anxiety attacks but no racing heart. Basal temps are fine. So I have stopped the PM dosing. I know I have struggled with adrenal fatigue in the past (LOW cortisol), and I am currently in Nurse Practitioner program and Kresser’s functional medicine program as well as working on my masters in nutrition (stress). Could this be the reason for being sensitive to the cytomel? I don’t want to stop it because I feel great but I am concerned about reacting to such a low dose. Iron is good, diet is good, taking zinc/brazil nuts etc. My MD is not savvy on the rT3 so much and is very skeptical about Cytomel. Have you seen reactions on such low doses? It’s almost like I really need energy, even the PM dose now that I am getting used to the AM dose, but my body cannot handle the energy. Like my body is intentionally down-regulating my energy. Ideas?

  20. I know that your medical advice is limited as you aren’t aware of our personal medical history, however, my question is: do you see hash patients have success (or are they ever prescribed) only Cytomel alone vs. Tirosint? I have hashi (was originally diagnosed with Graves in 2010). I recently switched to NDT (Naturethroid) 7 months ago and have seen an increase in ALL antibodies, as well as a recent issue with hyper symptoms suddenly (T3 jumped to 4.9 and TSH 0.001 in one month). We aren’t sure if I was simply overmedicated or the NDT (113.75/130 dose) caused an autoimmune flare up (especially w/ antibodies increasing so much). I have been holding ALL thyroid medication for almost two weeks, we are checking labs weekly. I believe I will need to start medicating again very soon, as I am noticing hypo symptoms (including resting HR in the 50’s @ times). I want to be prepared and informed when my Endo is ready to prescribe…I am leaning towards trying Tirosint but was also curious about only Cytomel as a Tx option. My reverse T3 was 17 when it was last checked a few months ago. I know I have a lot going on but I have made considerably lifestyle changes (diet and vitamins) recently and I just want some advice on which thyroid med would be a good option to start over with…

  21. Hello! I am on cytomel due to a conversion problem with T4. My rt3 was close to 230. NDT also did not work – the worst side effects being hair loss and lots of it! I had no hair loss before Hashi diagnosis but started with 5p mcg of Levo, also on NDT and has FINALLY slowed on 75 mcg of cytomel only. Are there any other options to help with hair loss? Is 75 mcg too much to take at once? It doesn’t seem to bother me. Is it OK to take cytomel long term? Appreciate your response!

  22. I did well with just 5mcg Cytomel, but when (faulty?) labs meant an increase to 10mcg, my life fell apart. 25 lb weight gain in three months, deep depression, crazy mental fog. Switched to NT, and all symptoms ceased, but can only tolerate 1/2 grain (dizzy, aggression, tired). Still experiencing fatigue. Tried adding 2.5 mcg Cytomel to 1/2 NT but even that caused negative affects on mood. Awaiting DUTCH results for adrenal and hormone levels. Anything else to be watching for? should I request rT3 testing? Thanks for your awesome site! Keep the excellent content coming!

    • Hi Amy,

      Reverse T3 testing is a good place to start and make sure to check for thyroidal inflammation (through antibody testing) if you haven’t already.

  23. What do you do for NO thyroid. Dad’s Hypoglcemia and Mothers Mito. No force of life in my body, no strength. Crashing for off and on for 12 yrs. I am a super active person. Had Hashi.


    • Hi Berlaine,

      The same concepts apply for people without a thyroid, for instance if you provide them with T4 only medication they still must convert it in the body.

  24. I just started cytomel. I currently take 150mcg of Levo, and added 25mcgs of Cytomel. I know most people have a problem with excitability and jittery feelings. I am having the reverse reaction. I am so tired I almost cannot function. Is this normal? I have only been taking T3 for 3 days, but those days have been spent on the couch sleeping until around noon. My hope is that this is a temporary symptom while my body adjusts. Should I cut back on my dose, up the dosage? I’m so tired of not feeling well. My TSH levels look good. Yet I’m still symptomatic. After running my T4 and T3’s we found that they were abnormally low for how high my TSH was. My doctor thought that T3 would help bring those numbers up and relieve the symptoms. I feel like I’m right back where I was when my TSH was 6.25. Please help. My GP has told me that he is out of his element, and it’s a 3 month wait to get into my Endocrinologist.

    • Hi Joanna,

      It can take up to 6 weeks for thyroid medication to kick in, you might simply be in this phase of treatment. Your best bet is to give it time and then recheck your labs.

  25. My doctor put me on 5 mcgs of Cytomel in addition to Synthyroid. I recently switched Pharmacy’s and when I compared my new bottle to the old one, my new one said 5mcgs, but my old one said 50 mcgs. I have now finished that entire bottle. I called my doctor, she said to check with the pharmacy. I’ve taken all these pills everyday for the last 3 months and now have elevated blood pressure and retain water terribly. I’ve stopped taking them for now but will start with the 5 mcg dose tomorrow. Could they actually have given me 50 mcgs of this medicine? or was it a type-o? and if it was 50, could I have damaged something by this high amount?

    • Hi Kim,

      Mistakes in medicine happen more frequently than most people realize so it’s certainly possible you were either given the wrong dose or some other error occurred. Temporary high doses of T3 should not cause any long term problems, however.

    • Hi Julianna,

      I’m not sure I understand the question! Some people do experience various symptoms while switching thyroid medication but I wouldn’t consider fatigue a common symptom.

  26. I am currently coming off of Zoloft. I am on 25 mg now. I am slowly weaning myself off of it. I was diagnosed with Hashimotos hypothryoid in 1984. I have been on .50 mg Synthroid and 2.5 mcg Cytomel daily. I have tried Lexapro, Celexa, and Zoloft. I take a low dose but the side effects are awful. Would increasing the Cytomel and reducing the Synthroid help with the anxiety and depression. I know I have a chemical imbalance and need advice.
    Barb Canter

    • Hi Barb,

      The answer is potentially but there’s no way to know without evaluating your symptoms in context with your labs. Your next step should be to get a complete thyroid panel and then go from there.

  27. I had very high Rt3 and have never done well on t4. I did not have hair loss when i was hypo. Immediatley when starting synthroid and later cytomel, I have major hair loss that only improves when i lower the dose substantially. Problem is, I feel great on the higher dose and have no hyper symptoms except for the hair loss. I am afraid to continue taking 50 mcg per day (split dose) because I will go bald! It is so depressing. I have searched everywhere for someone who knows the answer to this. My iron isn’t optimum. Have you heard of a relationship between iron levels and cytomel? Thank you so much for any ideas or input!!

  28. I am currently taking Synthroid 125 mcg. I have a rash all over my body and stinging and itchy sensation I can hardly deal with. I have to take Benedril to slow the itching. Should I ask my doctor about switching to a SRT3? At my wits end about this stinging and itching. Also have small welts over large portion of my body. Thank you.

    • Hi Caroline,

      You would probably have to do some more digging to figure out what was causing your symptoms. It’s possible that it’s related to your Synthroid but I would only suspect that to be the case if it started right after you started taking the Synthroid medication.

  29. Hi Dr. Childs,

    My Family Doctor prescribed a 5MCG tablet of LIOTHYRONINE for me every morning. It has caused my sugar levels to go up. I quit taking it because my breath became fruity smelling and I was worried that it was putting my body in a dangerous state. Can you tell me how to counteract this rise in sugar in my blood while on this medicine? I considered taking alpha lipoid cid but have read that it can interfere with he effectiveness of the medicine being absorbed . Thank you for your info you post here. It is very enlightening and encouraging .

    • Hi Karen,

      The changes in blood sugar when using T3 are usually temporary but it’s a good idea to keep an eye on them for the first 2-3 months after starting. Another consideration would be to simply start at a lower dose and slowly increase your dose over time.

      Glad you find the information helpful!

  30. Diagnosed with Hashimoto’s some 18 yrs ago and have always done ok on Synthroid. Almost 3 yr ago, I moved and sought a new PCP…well, she looked only at TSH and before she was finished I had dropped from 125mcg to 88 mcg. Needless to day, I gained, was a slug and lost 1/3 of my hair. Yeah, she was killing me. Found a new guy who didnt care about numbers, but said how do you feel. I began a recovery. Recently, we dropped my again 125 to 112 and added 5 mcg of livo twice a day. I am on Bystolic and my A1C runs about 5.8 so there’s another issue. I’ve been on the livo for 2 wks and I am feeling a lot better and my energy level is up and all is well, EXCEPT I almost constantly feel like my hiatal hernia is an issue again. I have had a couple of episodes where I would miss a heart beat. This isn’t a new thing…in fact, I’ve probably been on the betablocker 6 yrs for that…but many of the hiatal symptoms are much like heart attack symptoms. I must say it’s a bit disconcerting, but I can dance 3 nights a week and walk a mile+ and the symptoms don’t intensify. So my question I guess comes down to “Can Cytomel intensify hiatal hernia symptoms?” I am having no other issues at all….this is just weird and only started after I began the livo. Thank you for your time.

    • Hi Gail,

      I don’t see a physiologic reason for how cytomel would intesify your hiatal hernia symptoms. You might be experiencing acid reflux or some other symptom related to cytomel use which would be worth looking into.

    • Hi Alicia,

      The absorption will be better if it’s taken without food, but some people can get away with taking it with food if they experience GI related issues. It’s just a matter of monitoring thyroid levels to determine absorption if you choose to take it with food.

  31. I began taking Cytomel after my t3 level was low at 64. (I am also taking synthroid 10pmcg/day.) It helped energy and fog brain;but only lasted about 4 hours. I then needed another dose in the afternoon. I began to have constant nausea from it. I have no sensitivities to the fillers. It helped me so much, but can’t take the nausea….help please!

    • Hi Linda,

      You might consider switching to SR T3 over the immediate release formulations or using liothyronine over cytomel or vice versa.

  32. Dr. Childs,
    20 years ago I was diagnosed with Graves’ disease and I was given radioactive iodine to basically kill my thyroid function. I was then put on synthroid which worked for awhile and then was sent to a specialist which told me my t-4 didn’t convert to t-3. 15mcgs were added to my t-4 meds and that worked for awhile. Now my t-3 fell well below normal but my tsh is suppressed so they call me an enigma because my t-4 numbers fall within “the labs” regular “normal zone”. However I am experiencing every symptom of hypothyroidism you could name. Extreme fatigue. My whole body hurts (I do have chronic pain from a car accident so that another issue) but that’s not the pain. It’s my joints and bones. I’ve gained 20lbs in less then 2 months and I was doing yoga everyday. Now I just sleep all day and night. Would you suggest raising my t-3 or being on t-3 only or Armour because that is what they want to go to next. Armour. This has been going on for a year. The ups and downs. I have been advocating that they treat my symptoms and stop looking and numbers because it’s hasnt worked in a year. It’s only increasingly getting worse. My t-3 is at 1.9 and at my lab normal is 2.3-4.2 pg/ml TSH 0.07 yet my t4 total and free t4 are both within normal not even high normal like more low normal. Please help before I lose my mind!!
    Thank you

    • Hi Laura,

      Thanks for reaching out and sorry to hear about your struggle. I think you may be considered an enigma simply because you don’t fit the standard treatment but that doesn’t mean you are doomed to feeling terrible. I’ve discussed the nuances of thyroid hormone management including how to determine which medication you should be on in this post here:

      I would take a look at that which outlines which tests you should be looking at and how to interpret them.

  33. In 46. Hypo and Hashi. Used to only be on .075 levo. Then just this week started 5mcg cytomel. My main symptoms historically have been the feeling of racing heartrate, acid reflux and throat pressure. Recent ultrasound showed no nodules or swelling of the Thyroid. Also I take metoprolol to take the edge off heart palpitations. I’m worried that while the cytomel may improve my numbers, the heartrate problem may get worse (anxiety, etc). I’m going to begin to also address the deficiencies I have in iron and D. Any advice on this and also how to find a thyroid doc that I don’t have to teach? Thanks.

  34. Have been onSynthroid for 15 years. The last increase was 100 to 112 when T3 was a little low. Did not raise T3. 6 mos. later T3 was low at 64. I was having anxiety and panic feelings at evening only…..rising in the morning and after being awake 2 hours needing to lie back down for 2 hours, feelings of lethargy, pasty bm’s, feelings of depression, severely dry legs and arms. Finally started on 5mcg of cytomel…..within2 weeks, I felt like all my symptoms were resolving. I felt great! Like a new woman. Now it’s been 2 months and I feel later in the afternoon that I get somewhat lethargic. I would like to try 2.5 cytomel in the afternoon, but my doctor refuses. She tells me she is afraid I will have a thyroid storm. I have never heard of a thyroid storm…my T3 has only risen to 72 since I’ve been on cytomel for 2 months. Its barely normal. I think I would do well on a small amt of cytomel in the afternoon. How do i convince my doctor to let me try the small increase?

  35. I was on Synthroid only for 24 years, and felt horrible all the way down the line. I had partial thyroidectomy, then full thryoidectomy 15 years apart for recurrent cancer. The providers have consistently focused on maintaining my TSH <1, at least since the second surgery, but my list of hypothyroid symptoms remained very long. I had my primary switch me to Armour, and felt great for a few days, then tired again. Then 30 days later, titrated to 2 grains Armour (from 1 grain) and again felt great for about a week, then tired again. Overall, I have less mental fog, the puffiness inmy face and some of the body inflammation I experience seems to be going down; my T4 number is adequate, but TSH is well over 5. I changed to a new Endocrinologist (I have a love/hate relationship with these folks in general because they operate almost entirely by empirical numbers, not symptom I experience) and she has now placed me on T4 and Cytomel (first dose is tomorrow). The reasoning I get is that because the last cancer I had was "intermediate" we need the TSH to come down again, but she thinks the ratio of 1:4 in NDT will make my T3 too high. She did reduce my dose of T4 from 350mcg twice a week/175mcg 5 days a week, down to 137.5 mcg daily and 5mcg Cytomel twice daily. My concern is that no doctor I've asked seems to want to look at Reverse T3, and she didn't even want to look at my T3 because I've been on Armour NDT. It seems to me that if I have too much T3 from NDT my body would just convert it to Reverse T3-dod I have that wrong? I am giving this 30 days but will insist on Nature-Throid if my symptoms return and/or worsen. Do I have to be so concerned that NDT has the 1:4 T4/T3 ratio and humans have 11:1? Advice appreciated!

  36. I am currently on 10 mcg of Cytomel, my RT3 has been stable since 12/16 through 12/17. Around 12.4. My most recent blood work in Jan 18 saw a rise to 24.4. I’m very confused why this jump in 3 months time. My dr put me on a dose of iodine because my iodine levels were low. Could this have caused the jump in rt3. Also I do read a lot and came across an interesting article which states severe calorie restriction could cause your rt3 to rise. That being said. I did a bone broth detox 3 days two times. Which i’m Certain now could have had this effect. My doctor was very quick to add another 5 mcg of Cytomel. My question is in your opinion is this the correct procedure. I have also read that the only way to flush your system of rt3 is to increase dose. Your thoughts please

  37. I was placed on T3 then began feeling like my head was a matchstick, that butter had been poured over my face, my blood pressure which had been somewhat high SKYROCKETED up to as high as 225/120, my hair wouldn’t take color, the anterior portion of my tongue became numb and my toes became numb! I was a MESS. I’ve been on synthroid for years and stable. I’d seen a new Dr who had run some genetic tests and found I was a “poor methylator”. I switched from Cymbalta to Fetzima & began losing the horrible wt gain it caused along with some other medication. BUT this T3 issue was horrible! It was actually my hair stylist that figured out the problem & NOT the Dr who whose automated BP unit errored out 3 times! That rather angered me. After realizing all these symptoms were caused by T3,I stopped it. In the past 6 weeks since, my tongue is almost back to normal. My BP still has bouts of being up to around 180/105 despite divided doses of a total daily dose of clonidine of 2.1 mg, Bystolic 40mg BID and aldactone 25mg. I’d previously had fibromyalgia and been on chronic pain meds. It seems some dosage of opioid pain med helps keep it under control as I have a degree of arthritis and it appears pain activates what must be a sensitive sympathetic nervous system as it affects my bp & even a low dosage of opioid helps control it. I’ve taken 2 ER Tyl TID since I stopped all narcotics 5 months ago. So this is my history. Aft this same time I went off the pain meds as was fortunate my fibro abated after 17 years and I detoxed easily with Saboxone, starting the T3 about 2 months after I was halfway thru that. How long should it be before I should expect all effects to abate, esp that affecting my BP & hair so I can color it again?

    • Hi Kara,

      Not that I can recall, if you have a history of autoimmune disease then it may be worth looking into Sjogren’s syndrome.

  38. Hi there, I just started Cytomel 11 days ago, and I am now experiencing my heart racing and shortness of breath. I am 51 and experiencing perimenopause. To top it off my mom passed away almost 2 months ago, so I have the perfect storm of stress. I thought that balancing out my thyroid would help, but now I’m more stressed than before!! I’m only taking 5mcg along with 150 mcg of Synthroid (which I’ve been on for years). My TSH was 3.8, free t4 was on the high end of normal and free t3 on the low end. My total t3 was in the abnormal range of low. Anyway, I don’t know what to do! This morning, I only took Synthroid. May take Cytomel later, but I don’t know if I should. Maybe just take half? Thanks!

  39. Hi Dr.Westin Child’s, I’ve been reading so many of your articles which have helped me understand my condition so much and I just wanted to thankyou for that and also ask you a few questions I’m 1 month post total thyroidectomy and rite after the surgery I was started on Cytomel in the beginning I was at 25mcg twice a day then I mentioned to my surgeon that I was on 100mcg synthroid before surgery so he started giving me 100mcg of Cytomel 50 in the morning and 50 at night, yesterday I went to an endocrinologist and was surprised by how much Cytomel I was taking and decided she wanted to put me back on synthroid at 137 mcg and take me off of Cytomel but I feel like that’s a bad idea because I was feeling good on Cytomel and finally started losing weight unlike I was doing before which was just taking 100 mcg of synthroid! I’m 185lb and 5.2 also I’m a 22 years old female even though I don’t have any more information to provide so that you can advise me a little better but any insight from you would be greatly appreciated. Thank you so much

  40. Hi Dr. Childs,
    I want to really thank you for all the info you share about T 3 and hair loss which I have yet to find anywhere else.
    I have been on a T4 T3 combination dose for about a year now. I have been experiencing a lot of hair loss. At first, it was assumed to be due to starting the new medication and sudden shifts in hormone levels. It did get better for a few months with lots of hair growth. But recently my hair has been falling out more and more although my free T3 and free T4 are both in range (on the upper side). I’m on a 10mcg T3 daily dose along with my levothyroxine.

    Do you think that the T3 is making the hair loss worse? since the dose is so low do think to stop it would have much impact?

  41. I am diagnosed with Hashimotos & Hypothyroidism. I have been on generic levothyroxine which did not work well. Then I was placed on armour 30 mg which made my joint pain better but made me very irritable and I still could not lose weight. Then I went to Cytomel 5mg. Finally, I was losing weight but then I developed A-Fib & my t-3 was elevated above the normal range. I now am on 2.5mg Cytomel and 50mcg of Synthroid brand name for the last 3 months and just found out I still have an irregular heart rate and have not had the weight loss like when I was on the 5mg of Cytomel. I just had labs drawn and the plan if my levels are normal are to try the sustained release Cytomel at 5mg and lover the Synthroid to 25mcg. But if I am going to have a-fib it’s not worth it??? Right??? Could the sustained release be better for me? Should I just get off the Cytomel altogether? Please help.

  42. Had a TT last September. Endo only started me on 50 mcg of Levo. Since I have no thyroid do I need T3 only or do I need the Levo and add T3.

  43. I have been taking Cytomel for several months now. 5mcp.

    I have gained 15 pounds, I am still exhausted, getting up to do anything requires a lot of effort

    I do suffer from chronic pain and I also take 150 mil of Wellbutrin. I know I have inflammation.

    I am at a loss here bc I don’t know what to do. Should I see another dr? Should I increase the dosage? Should I add T4?

    I wish I could find someone to give me an actual answer and steer me in the right direction. I can’t keep gaining weight and feeling exhausted all the time. Between this and the chronic pain, I have no quality of life.

    Thank you.

  44. Thank you for the thorough article on Cytomel. I’ve been using it for 5 years and have never suffered the symptoms suffered by many ppl that have hypothyroid. I’m surprised how many still don’t prescribe it or even have awareness of the medicine. I really feel like it has contributed greatly to my very good health. Again thanks for taking the time to pen such an informative piece. The article was quite helpful.

  45. I have been taking 88mcg T4 for 5 years, added Cytomel 5 mcg, 2 x day about 15 months ago. Reduced cytomel to 1 mcg/day due to palpitations and Dr saying yah was too low. Still having palpitations, and increased swelling in left leg/foot as well as left side of face/neck… could this be an effect of cytomel?

  46. Hi! I had total thyroidectomy 15 years ago – I’m 45. My naturopath has me on 125 mcg of levothyroxine and 25 mcg of liothyronine. She recently bumped that does up to 35 mcg – which I don’t seem to be handling well. My face is burning and flushed and I have a swollen chin. And I’m feeling an ‘icy/hot’ sensation in my legs/feet/arms/torso/neck & scalp. she doesn’t think my symptoms are from the T3 although they began when we increased the dose. And she had me increase it gradually over a period of weeks with increases of 2.5 mcg each week until I got to 35 mcg from 25. I felt much better at 25. So I’m going to ask her again if I can stay at 25 mcg. I’m just wondering if you suspect these side effects/symptoms are from the liothyronine? thank you!

  47. Hi Westin,

    What is a typical starting dose for Cytomel? My doc prescribed 25mg. and I got an awful headache. I’ve been on Armour for 20 years with a suppressed TSH.

    Much thanks!

    • Hi Allie,

      The starting dose is generally up to the physician and what they are comfortable with. I will generally start anywhere from 5mcg to 25mcg (depending on the history, what meds they are on, etc.). If there is any concern then it’s probably a good idea to start at a lower dose.

  48. Hi
    I had been on Synthroid 150 ugr for years. I am 44. I experienced extreme paralyzing fatigue and weight gain. Although I exercised a lot and watched what I ate, I actually recorded everything I ate. I still do.
    2 years ago endocrinologist put me on Synthroid 100ugr and 12.5 Cytomel instead of 150 ugr. Not quickly, but after a few months, my fatigue improved so much that I felt like I got a new chance in life. My weight gain didn’t change, but at least I could maintain it but I couldn’t lose any. I tried every diet or cleanse possible, nothing worked, I guess because my calorie intake is not much anyways.

    2-3 months ago, my fatigue was back, I had heart palpitation, foggy days, which I could not concentrate or remember, severe constipation, and I started gaining weight again. I went to my family doctor, TSH test was ok. He told me “IT IS IN YOUR HEAD!”
    It got worse with feeling pressure in my throat; I gained 8 pounds in 3 weeks. If I list the exercises I do, you won’t believe it. I even started going to fitness classes 6 am, which I thought maybe it helps. I do intermittent fasting 5 days a week.

    I did another blood test 3 days ago. It showed my TSH is very low!!! Although I have all the symptoms of Hypo. Doctor reduced my Synthroid to 75 ugr and still 12.5 Cytomel. Although I should be happy that I am taking less drug, I am devastated as I am so scared to gain weight more.

    All my other Hormones were normal (Except T3 or T4, I wasn’t tested for them). I am supposed to go for a blood test in 6 weeks with TSH and Free T3, T4. I am so scared that by then I am obese.

    Do you think 45 mg Cytomel and 25 ugr of Synthroid is a better combination maybe rather than Synthroid 75ugr and 12.5 mg Cytomel? I read all these research articles but none of them says anything about the best dosage of the combination. Which is better? T3>T4 or T4>T3

    I am just so tired, physically and emotionally. I put so much effort and use so much energy to just be normal and I don’t get anywhere. I read your articles and they are the best so that is why I thought to reach out.

    Thank you for your help

  49. Hello, I’ve been on Cytomel Pfizer for 3 years now, I feel better relief from my Hypothyroidism BUT sometimes my eyes swell up with fluid. Also I will get fluid on my ankles and fingers. All over really but those areas are very apparent. It’s uncomfortable but very worrying. I used to think I needed more when this happens but increasing the dose slightly would make it worse and I immediately reduced my Cytomel only to see the fluid come down. This is very scary for me. I don’t know if it’s something serious like fluid congestion from overdose or a reaction to the fillers.
    I’ve been hypo for 20 years. I don’t do well on thyroxine at all. And ndt’s are not great. I have regular b12 injections for Pernicious Aneamia. I’m gluten free lactose-free, never drank or smoked. Also, I can’t lose any weight.
    I take 62.50 mcg Cytomel
    Tsh 0.01
    Ft3 5.6
    I’m in the UK

    Thank you, if you can shed any light on this problem I appreciate it.

  50. Hi there, I’m on Cytomel 62.50 mgc day. I get severe swelling on my eyelids and face, also ankles and fingers and it’s related to my dose. I thought it was because it wasn’t enough but it subsides if I reduce my dose. Is it a sign of overmedication. Oedema. Or fillers.



    So it’s possible for someone to take just t3 alone as a treatment and be fine? I’ve tried 2 different ndt in the passed and hair loss increased for over 6 months and my rt3 was over 15. My NP recently prescribe 5mcg of just t3 and frankly in a little scared to try it as I’ve read many people have massive hair loss (which I can’t afford) and I’ve read t3 only should not be the only treatment for being hypo I’m in range for labs however low end for t3 Does taking 5mcg of just t3 as a treatment sound acceptable to you? I’m in dire need of guidance. My shbg is on the lower end as well I’m 49 never any thyroid issues before.

  52. I am currently taking 5mcg of Cytomel and have only been taking it for 5 days and I’ve noticed that I have a pain in my side seems to be my kidneys, is there a side effect for this drug? I am also taking b12 sublingual 2,500 daily, would the b12 be affecting my kidneys and is there a way to relieve the pain. Thank you

  53. I’ve been taking synthroid since 2005 and just witching the past 6 months my doctor added cytomel to my regimen and I have noticed an increase in hair loss to the point that I will be bald by the end of the year. Do you think this is due to the cytomel? Or could it be due to something else. I have never had any issues with hair loss like this in the past.

  54. Is generic Cytomel as effective? I take 10mcg. I have afib ay times. Take 50mg metoprolol. Is it interfering with Cytomel? I’m a mess.

    • Hi Lisa,

      Yes, generic still works quite well. And yes, your beta blocker may be interfering with your thyroid function.

  55. I just added 5mcg of Cytomel for a Total of 25mcg about a week ago. 15mcg in the am, 10mcg in the afternoon. After adding this last 5mcg I feel great EXCEPT my heart rate is considerably faster. About 90 best per minute where I’m usually 60. Will my body adjust to the increase dosage, should I cut it back to 2.5mcg or stop completely? Besides the heart rate, by adding this last 5mcg, almost all of my hypo symptoms have resolved!! I want to keep feeling this good but don’t want to have a heart attack

  56. Hi Dr. Child’s
    I am a 65.5-year-old who has been on Thyroid Meds since I was 28. Started on Synthroid then a few years later Cytomel was added.
    I generally have no issues…this year my Cytomel was raised to the highest level I had ever taken. 10 mcg in the am and 15 in the pm. I had been experiencing fluctuating mania off and on for several months prior to the change in the Cytomel. I had been taking 10 & 10.
    I never had problems when I took 5 &10 with either 50 mcg if Synthroid or even 100. After the last change of dosage, I went into a tailspin, thinking I was having a major BiPolar episode. I saw my Meds Doctor and he ascertained that I was experiencing a “ Thyroid Induced Mania. He had me stop the Cytomel immediately! He felt the dosage was way too high…one of my first doctors who was the head of the Endocrinology Dept at one of the largest teaching hospitals on LI, once told me…”you should not only go by the numbers but more importantly by how the patient feels!!!”
    I am back on both Synthroid 100mcg and 5 & 10 on the Cytomel. I am noticing that my palms are flushed( warm and pink). Could this mean my Cytomel dosage should be dropped back to 5 & 5?
    I also recently started taking my Thyroid Meds at night. I don’t want to wait 30 min for my am Coffee. I take it 3 hours after Dinner. Then wait at least an hour to take my sleep supplements.
    For the first time, I am having a very hard time trying to lose approx 10 lbs. In the past all it took was dropping my carbs, sugar drinking more water and walking. Doing all these things now and can’t seem to lose anything! Could being off my Meds for a few weeks cause this?
    Thank you

  57. Dear Dr. Childs,

    I just started T3 the generic name brand, for a low T3 though I have a normal T 4. I have just seen a functional medicine doctor and had a battery of labs. He said I was not converting T4 to T3. I am somewhat chronically overweight but mostly want to do this to bring my T3 levels up. However, I have been experiencing an upset stomach since taking this medicine for the 1st time today, 5 μg.

    Any tips on how to get by the GI upset? Will this pass?I have been prescribed 5 μg 1 to 2 twice A-day.

    I also started bio T natural pellets with estrogen and just a small p.o. amt of progesterone gel caps at night.

    • Hi Shannon,

      Sometimes T3 is hard on the stomach. Even though it may reduce absorption, you may need to ultimately try taking it with food. But just realize that this strategy does impact the absorption of both T3 and T4 so you should do it under physician supervision.

  58. Hi! I am currently on Cytomel Tab 5 mcg, as well as Synthroid 112mcg. I’ve been on thyroid medication since 2004, recently added Cytomel around 2016. My weight is my biggest problem ( obese category ), fatigue, body aches, dry mouth, no energy, to name a few. I’m not sure if I’m on the right dosage or medications. I don’t feel any different or better in all these years. Any advice from you would be greatly appreciated, Thank you.

  59. I have been using Synthroid and Cytomel for a long time. My doctor says my thyroid test shows that I’m at the hyperthyroidism level now. I am getting too much thyroid medication for my system now. So he told me to titrate it down by taking half one day and next a whole one for six weeks then get tested again. If it still shows I’m getting too much I take half a day for six weeks and be tested again, and so on and so on until I’m not using Cytomel at all. For some reason the phlebotomist and him said it had been told to them that Drs. are trying to get patients off this medication. They gave me no reason why.

    The symptoms of hyperthyroidism I’m having are awful. Especially since I have bipolar and fibromyalgia, which of course have the same symptoms. I’m considering calling my Doctor and asking if I can titrate down faster.

    I have just lost a whole lot of weight (for my health). If I stop taking Cytomel will I gain weight? Also you mentioned giving this medication to people who have bipolar and fibromyalgia. If I stop taking the Cytomel will my bipolar and fibromyalgia get worse.

    Hope you can help me with my questions. Thank you very much for giving me the opportunity to try and get answers to my questions.

    • Hi Karen,

      It’s really difficult to say for sure because I don’t know your personal history. I would say that most people who stop T3 (if they need it) may gain weight back and start to feel worse, but that isn’t necessarily the case in everyone. If your dose is too high, however, then dropping your dose to a normal level shouldn’t cause those symptoms.

  60. My free t4 is 1.0, my total t3 is 93, my TSH is 3.480, and my reverse t3 is 12. I sometimes have episodes where my heart rate increases to 125 but not extremely often and panic attacks. My doctor just added liothyronine 5 mcg to my Tirosint 50 mcg. Will this make my increased heart rate or panic attack episodes more frequent or worse?

    • Hi Lisa,

      It’s possible, but it’s also possible that it could help reduce the frequency of your tachycardic episodes! It just depends on what is causing them.

  61. Dr. Childs,
    I am a complete mess. It’s been a steady decline in my health since I turned 40. (I am 47 now). I am anything but normal with thyroid replacement. In a nutshell here is my story. At 23yrs I had Graves, did the ablation and do ok for 10 yrs or so. Mid 30’s other issues-adrenal and no progesterone left. In my early 40’s estrogen is gone now and I got into big trouble with replacement with Synthroid – I no longer converted and my reverse t3 was making me sick. I got on Dr. Wilson’s protocol for the SR t3. My life was instantly better! In the last 2 years I was placed on estrogen because that was gone too (with progesterone replacement since I was 35yrs). I have started many supplements ranging from turmeric, omega 3’s, ACV, digestive enzymes, probiotic, selenium, HCL, Cinndrome X and I was feeling like a million bucks. My current SR t3 is 42.5mcg in the morning and 37 mcg at night. Two issues- My heart has started racing (since April) , heat bothers my heart too, as well as small amounts of alcohol-it races anywhere from 100-160 bpm when I do any of the above. Secondly, I am gaining MORE WEIGHT (I HAVE LOST NONE SINCE I STARTED THE SR T3). I have made diet eliminations and I am gaining, gaining and gaining. I excercise 4-5 x’s a week. I just had labs drawn and its horrific. My tsh is now 24.9 – which explains the weight gain (from 4.6/ 9 months ago) and my free T3 is 2.63. I am strictly on the sr t3-no t4 due to my conversion issues. What in the world has happened? I have been reading everything I can with sr t3 replacement. A couple of possibitlies – that some people require more of a “punch” to get the replacement hormone into the cells than SR can provide and that immediate release x 1 dosing a day dose best. Another possibility is that my estradiol patch could be causing issues. So I am thinking I should try and get my PCP to place me on IR T3 to see if I can get this mess straightened out. What are your thoughts on going from SR replacement to IR?? It seems crazy to get the T3 only one time daily since I take twice daily now. Please help with this nightmare. On my last leg with it for sure.

  62. I have just recently being switched from 60 mcg NDT to 25mcg Cytomel + 88mcg levothyroxine. All I can say is that it took me nearly 8 years of advocating for myself and finding the right MD before someone finally agreed to try Cytomel.

    A lot of doctors resort to a conventional treatment of hypothyrodism with levothyrpxine and steer clear from Cytomel. I can understand why, it is a very powerful drug after all and needs to be used with extreme caution.

    It is so frustrating though that they won’t even consider to talk about it even when hypothyrodism symptoms keep persisting for years.

    My lab is due within next couple of weeks as we obviously would want to monitor T3, T4 and TSH levels closely, but so far I am already seeing a great improvement. Perhaps it is a placebo effect, but I finally do not feel cold all the time and hurray, I actually feel energetic first time for who knows how many years. My sleep has improved dramatically in the last couple of weeks, no more waking up few times at night which is amazing on its own.

    I personally take Synthroid at night before going to bed, at least 2 hours after my last meal and Cytomel in a morning. So far it works well for me, just waiting for the lab results.

    I love the fact that Cytomel can be taken with food, that allows me to eat my breakfast without any issues. It was always a pain to take Synthroid in a morning and then wait for an hour to eat or even (the horror!) to have coffee.

    Does the coffee affects Cytomel absoption at all? I’ll have to talk about it with the pharmacist because I figured if you can take it with food, coffee should not be an issue like with Synthroid, but I could be wrong.

    Could the whey isolate potentially interfere with Cytomel absorption? It seems to me that all dairy would be off limits for few hours after taking the medication due to its calcium content. Is it the case for the whey and soy protein powders as well?

  63. Hello,

    I have been on t4 meds 100mcg but my t3 is never optimal and always low end of normal around 3.5 to 4.5 ( Normal ft3 is 3.5 to 6.5 with 5.5 above being optimal. my t4 is in normal range but MY tsh is always above the roof and my hypo symptoms are mostly light headed , fear, lack of interest, energy and off balance feeling as if I am standing but going left n right in my head….the moment I hv Xanax or have an alcoholic drink , I am a much better person when it comes to energy , moods , interest etc….
    I may have a reverse t3 issue….If I introduce t3 med of cytomel then how much do I need to start with to bring it to optimum levels….I wish it to bring ft3 levels between 5.8-6
    . Do I need to cut down on t4 meds to introduce t3 meds? If I reduce my t4 to 75mcg then how much of t3 do I start with..and if I keep my t4 meds at 100mcg then at what mcg of t3 cytomel do I start with ? Can I take both t3 and t4 together in morning empty stomach like how I always do for my t4 meds ? Thanks a ton

  64. Dr. Childs,
    what would be the best thing to use to break up a 100mcg pill into smaller doses? At first I thought distilled water would work, but now I am not so sure. Would the water work OK? What about an Oil like olive, coconut, or mct?
    Thank you,

  65. I have been on Cytomel (T3) only treatment for hypothyroidism for many years now. Currently I am on 75mcg of Cytomel daily. I have been crashing in the afternoons and recently learned that Cytomel can cause insulin resistance. Which I suspect is what causes some of your patients to gain weight. My question is that when I dropped my dose of T3 down to 50 mcg I felt dizzy when walking outside and even feel a little nausea. It this withdrawal or under dosing or something else?

  66. I had my thyroid removed 6 days ago and was immediately put on 1.5 Liothyronine 25mcg pills per day (so ~37.5mcg every morning). Previous to surgery my resting bpm, according to my Fitbit, was 74-80. Since starting the Liothyronine it has jumped to 85. Where it used to be 54-60 when asleep, I’m now at 80. Sitting on the couch watch tv and it’s 102. I’m not experiencing any other symptoms (yet?), but this one has me a bit freaked out. I don’t see my dr for another 1.5 weeks. Will this level off on its own? Is there something more I can do?

    I’m 43 years old and about 225 lbs. I was hyperthyroid (Graves) previous to surgery. Hurthle cells on one side couldn’t be confirmed as benign via biopsy, so my doctor wanted it out. I take 5 gr of Ferrous Gluconate every other evening.

  67. I was hoping you could clarify something regarding the hypersensitivity. I have been following your blog and thank you for all of your help. I have been blessed with a PA who is listening to all the information I am bringing her from you and she has started me on levo and lab improved to a little over 2 so far but symptoms stayed the same. She then added 5mcq of liothyronine in addition to levo. I felt a pretty quick change in energy just from that first 6 weeks on the med but then the boost in energy subsided. My overall issues were weight gain, very tired, hair loss, and cold. I felt less cold, hair is ok, but I was still very tired and not losing weight after changes in diet/exercise. I wanted to get to a good level to address all of these issues so she increased it to 10mcg for only a few days so far. I now have a rash over my left hip???? I never struggle with any skin issues so this is very strange for me. The plan was to revisit every 2 weeks for lab work and then to increase as long as I was tolerating the meds and labs looked good. Should I continue on this path if a rash is present or does that mean I should just go back down to 5mcg?

  68. Hi I was wondering if you had advise for me. I’ve been on 50mcg of t4 for a year with little benefit. It did help water retention but not energy, hair loss, or memory. So I started t3 5mcg and did great until the second week my chest hurt and had high heart rates. Resting rate was 107-133! Super high for me. I am so saddened because I felt so good on the t3. What do you suggest? Thank you, Mary

  69. Hi! Can frequent urination which starts in an hour after taking thyroid medication and going on for couple of hours be the side effect of T3? Could it be an exess of T4, or both? My son has elevated rt3. He is taking 75 mg Synthroid, 90 mcg Nature Throid and 5mcg slow release t3 twice a day . He has all symptoms of hypo – depression, especially in the evening, constipation, dry skin memory problems etc. Plus this unbearable frequent urination in the morning. What are your thoughts? Thank you.

  70. I have been treated with time-release T3 for Wilson’s temperature syndrome for the past nine months, and the improvement has been dramatic. I have been on a number of doses of T3, from 7.5mcg to 75mcg. During that time I have found that my appetite was greater on the high doses. I mention this because of the discussion in the article that some people do gain weight on T3, and this could be the reason. I did gain weight a few pounds on the protocol myself.

    • Hi Susan,

      Typically, the increase in appetite is also associated with an increase in metabolism (which is why the appetite increases in the first place) so it should be weight neutral. My feeling is that the weight gain associated with T3 is probably fairly complex and has to do with multiple issues but appetite may be part of that equation.

  71. I have been on 75mcg of Synthroid and never felt good but was told I was in the normal range. Went to another doctor to be put on T3 since my doctor refused. Had no energy, gained 20lbs and had aches in my legs. The doctor left my synthroid at 75mcg and added 5mcg of T3. I started feeling better after a few weeks and had two great never felt better weeks only to have it completely stop and back to the old symptoms. Now he left me on 75mcg of synthroid and reduced my Cytomel to half of the 5mcg. Still feel horrible and no energy and now legs and arms ache. Why would he reduce my Cytomel? I’m so confused on this. I thought he would increase my Cytomel or reduce my synthroid. I don’t understand at all. Please if you can tell me why he might have done this and how long before seeing results reducing the Cytomel. Been a week and no energy and still hurting. I just want to have a life again.

  72. I had thyroidectomy due to thyroid cancer 6 years ago and since there were/are still 2 small nodules left , my Endo tried to stop the growth of the nodules by high doses of Synthroid (apparently was a successful approach).
    I have been on 100mcg,125mcg,137mcg,165mcg of Synthroid over last 6 years.

    for the past 2 years I have been soooo out of energy and not feeling good and finally my Endo put me on Cytomel 5mcg 2 times a day and she told me that the effect of Cytomel stays in the body only for 5-6 hours and if I take it only in the morning , I will feel tired later in the afternoon which is really true.

    I have been taking it for last 2 weeks in combination with 137mcg Synthroid, the Cytomel effects I felt so far is:

    1- Excessive sweating and feeling hot ( at the gym and on regular base)
    2- Bad Headaches for the first week
    3-Insomnia ( this really bothers me as I wake up at 2 am and cannot go back to sleep)
    4-my energy level and mode improved

    I just lowered my Synthroid ( as per my Endo instruction to keep the Synthroid level unchanged for first 2 weeks) to 125mcg .

    Is the Insomnia due to Cytomel or the Synthroid ?

  73. Thank you for all the great information! I have taken Armor Thyroid for over 20 years. Over the past 4 years I have noticed it is not as effective, and I gained 20 pounds in 3 months last winter and couldn’t get off the couch. No motivation. My nurse practitioner just added Cytomel. I think I’m beginning feel better. More energy and motivation, less brain fog, etc. I have noticed that I have been getting acne. Hard lumps with no core. I never have acne. I also take Bio identical hormones. Could you address how Cytomel can interact with HRT and should I reduce my HRT levels while taking Cytomel?

  74. I have been put at a low dose if cytomel which is 5mcg morning and 5 mcg afternoon, before that I used to take Synthroid 75 4 days a week and Synthroid 50 mcg for the rest of the week (3 days) my free t4 was high normal but free t3 were low normal (3.8 pmol/l) lab reference is (3.5-6.5).
    After a few days of starting cytomel, my body got swollen, had pain in all joints and my body was too hot, was sweating at night time.
    So my doctor suggested to take half a tablet of 5mcg for a week then increase it to 1 whole tablet for 2 weeks then see if I can tolerate adding the other 5mcg tablet afternoon.
    Now I’m on the 1/2 5mcg tablet and again started to notice swelling and painful joints and my heart rate is getting a bit higher.
    I don’t know what to do should I stop it completely?

  75. Aloha,
    I had my thyroid removed in 2012.
    Since then it has been an emotional rollercoaster ride.
    For years my synthroid medication has been adjusted between 100mcg to 125 mcg and 112mcg..
    due to my TSH being up and down and up and down..
    For the past 7 months I’ve been on 112mcg of synthroid and have not had to adjust my meds but my
    On 5/30/19 my TSH was at 0.08 t4- 1.5
    And on 8/4/19 TSH 0.17 t4- 1.5
    But currently I have put on a few pounds with little change in my diet..
    So I asked to have cytomel added to my regimen..

    So she changed my
    Synthroid to 75mcg
    And added Cytomel 25mcg
    I have been taking it for 2 Weeks and I think I my dose of cytomel maybe to high?
    I am uncertain because it’s only been two weeks..
    Currently I feel
    Withdrawn and I don’t like that feeling..
    I have read that my endo should be testing a few different thyroid test but the only labs that are ever down is
    My TSH and T4..
    Please help me..

  76. Hello Dr. Childs-

    I was diagnosed with Hashimoto’s Hypothyroidism in 2012 and was placed on treatment with Synthroid, which initially improved my symptoms tremendously. In 2013, I was also diagnosed with panic disorder, PTSD, and OCD and placed on a treatment with SSRIs and Clonazepam. I stopped SSRIs in 2018 and tapered off Clonazepam only taking it rarely as needed for anxiety or panic attacks.

    In October 2019, I had my regular visit with my endocrinologist when I expressed to him that I was still experiencing significant fatigue and inability to lose weight despite active attempts. My bloodwork then was: TSH 1.84, T3 0.88, T4 1.33. He suggested we try an alteration to the thyroid medication: the Synthroid dose was decreased from 100mcg to 75 and Cytomel 0.5 was added. In December, my labs were: TSH 1.21, T3 0.95, T4 1.00.

    In January 2020, I started having severe anxiety and panic attacks again without a specific trigger. They have been progressively getting worse.

    My question is: is it possible that my current anxiety and panic attacks to be, in fact, side effects of Cytomel? If this hypothesis is true, how quickly would my symptoms improve once I stop Cytomel? I sent a message to my endocrinologist and asked to have another set of labs done (he initially suggested a reassessment in the spring) and I am awaiting a response. Meanwhile, I just wanted to ask for your medical opinion.

    Thank you for reading and I am looking forward to your response.

    • Hi Delia,

      Yes, Cytomel can cause panic attacks and anxiety and it goes away rapidly upon cessation of the medication (if it’s related).

  77. Hi! I have been on Armour Thyroid for 11 years and my doctor recently added the smallest amount of Cytomel to my regimen to battle fatigue. For the first two weeks my energy, mood, libido and sense of well being reverted to the best it’s been in a decade. I am 46 and use progesterone cream for perimenopause symptoms. I am now 2 weeks before my period and the cramps have returned! The T3 literally took away this pain the day of, only to return. I know the addition of T3 causes menstural “changes” but is menstural cramping 2 weeks out a common symptom? P.S. My RT3 and T4 are on the low end… Thank you

  78. Last year, my endo suggested that I have partial peripheral thyroid resistance and prescribed a large dose (50mcg twice daily) of Cytomel.

    For years I’d been unable to lose about 20 pounds of extra weight. My body just seemed to want to store fat no matter how much I exercised or dieted (I was even fasting twice a week!). I’d been to a host of doctors and while my thyroid tests were always “normal” I did have a doc who tried other thyroid meds (Armour) in increasing doses, but with no effect.

    To my astonishment, the Cytomel worked. Amazingly. Within weeks the weight was off and I was eating like a normal person again. I couldn’t believe it, after all those years.

    But now, 7 months later, all of my problems have suddenly come back with a vengeance. I’ve gained the weight back, practically overnight it seems. My efforts to combat it with restrictive dieting are again doing nothing for me. I’m getting other hypo-ish symptoms – shedding hair (have to take it out of the shower drain every morning), get a hot/flushing feeling in my face all the time now etc.

    My endo has said to try raising the dose to 75 mcg/twice daily. I started that the other day. So far there is zero apparent relief from this. He says he has patients who go much higher and that this can happen with thyroid resistance. But I am deeply worried that there is something more broken in me that has made this stop working and that there’s no getting it back and that the weight is here to stay.

  79. My question is about adding Cytomel onto T4. Do you usually lower the patients amount of T4 before adding Cytomel? My FT4 levels are 1.7, which seems to be optimal however if you add cytomel on top of that will it raise the FT4? My FT3 has dropped to 2.6-2.8 and I seem to feel better when those FT3 levels are higher. My Dr recommended taking 2.5 mcg of cytomel. This seems pretty low. When I try to switch back to Synthetic T4 combined with cytomel after a few days I’m back to feeling terrible like I did on T4 only. Does it take awhile for the T3 to move up and to feel better? Thanks

  80. When I first started liothyronine I felt amazing. Then the panic and anxiety set in and now it seems that I can even take the T3 without a horrible panic attack. I don’t know what to do at this point. Would it be the fillers? Could it be I should’ve titrated more slowly? I was originally on 10mcg, then 15mcg, back down to 2.5 twice a day then all the way down to 1mcg for the whole day.

  81. Hi
    I began to experience weight gain of approximately 4-5 lbs per year over a 4 year period with mo change in diet or exercise. Endocrinologist chalked it up to my age at that time— late 50s— and hormonal changes. Saw a functional medicine MD who began me on keto diet where i had great success—
    Lost 13 lbs and never felt better. Slept better. Joint pain disappeared. While thyroid labs were in reference ranges she felt I needed a T3 boost and prescribed 5mg daily of Cytomel. I had all the low thyroid symptoms too. I have taken both
    compounded and regular brands. About a year or so later began to put weight on again, felt the joint pain worsen, hair fall out again. Resumed keto diet as before with no success whatsoever. In fact, it caused me to gain weight. Just had recent labs drawn and T3, T4, AND TSH all
    LOW. Just at low end of lab references ranges. I’m meeting w my PCP and functional medicine MD next week re this and would like second or third opinions so I am armed with information. I have all the classic s/s of hypothyroidism and my hair loss has worsened suddenly
    I do not suffer from depression, thankfully. But joint pain, dry eyes and mouth are back.
    Any insight greatly appreciated

  82. Do you have references for the possible weight gain caused if dose of cytomel is too high? I have no thyroid due to cancer, and have been increasing my dosage of cytomel to get in “range” for FT3. My TSH is very low, FT4 also on the low end of normal, FT3 in the higher end of the range. But I am gaining weight, tired, loosing hair…many hypo symptoms…but I am also short of breathe. My pulmonologist and cardiologist think I am over medicated. I am starting to agree…it was the weight gain that was throwing me off as I had assumed that was due to too low a dosage of Cytomel, not too high.

  83. Hi there,

    Are the hypersensitivity reactions from the methocel in SR compounded Cytomel an allergic reactions? I recently trialed an SR Cytomel for the first time and experienced tingly/burning through my hand, arms and head. Will I have the same reaction at a lower dose? I can treat same with Benadryl but feel that if I try again at a lower dose the reaction will be worse as it would be a second exposure. What are your thoughts?

  84. Can you explain the difference between generic vs cytomel as they are both embossed with KPI 115? The generic is distributed by Greenstone LLC, which is a subsidiary of Pfizer, however KPI is King pharmaceutical. What is going on here?

    I picked up a new bottle of the Liothyronine substituted for Cytomel. I noticed the first day that I took 10mcg split and felt tired. I usually only take 5 mcg and that’s enough. Second day started with 2.5mcg and third day I knew something was wrong. Usually, from even 2.5 mcg I will feel some relief and normal body temp rise to 98.6. By the third day I was so cold and body temp dropping. I called the pharmacy and explained that I was not getting any therapeutic response and something was very off. You can’t take liothyronine and not have some response and I wasn’t having the same response as previous refills. The pharmacist agreed and said he’d give me another bottle. I switched from NP Thyroid back to synthetics so I could control the amount of T3 and consistency but now I’m having issues with the potency of synthetic T3. I have not had any issues with absorption of this T3 previously and it is the same maker. Is this something that happens?

  85. I’m looking forward to my doc visit with a PCP that actually holistically looks at the entire body. I’ve been diagnosed with hypersomnia. My T2 diabetes has turned into Late-Onset Type 1. It was discovered around 5 years ago that my T3 was 2.2, and so, my naturopathic doc put me on Nature-Throid. OMG. I was awake for the first time ever. Then, my endo here took me off of Nature-Throid. The thyroid symptoms are ever increasing again. My T3 is back to 2.2. My RT3 is at 39. My TSH and T4 are normal, as are other types of thyroid tests. I can’t lose weight. Despite not eating much (I’m rarely even hungry), I’m rapidly gaining weight. My skin is dry. My hair is falling out. I show all the symptoms of having underactive thyroid, which from what I understand, is due to the RT3. I’m really, really hoping my new PCP will be able to put me on Cytomel. I’m tired of regular docs telling me I just have to live like this. I’ve been tired my whole life, since I was very young. I suspect some of this might be due to genetics and the DIO-1, 2 and 3, but I have to see a geneticist first to confirm.

  86. Dr.
    Before being hyperthyroidism, with 7 nodules, them due iode radiation, so now I take 100mc levothyroxine because now I’m hypothyroidism, i gained 40pounds in 2 years, never feel energy, extremely inflammation, dont sleep well. I tried to lose weight nothing work. Please help me.

  87. Just started to see if it does anything positive. Nothing in anyway has helped give back t4t3 short of 3 yrs. Should have been given sr t3 long time ago. Took 20 mcg lio….twice today. No side effects.


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