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Does Cytomel Help with Weight Loss? Dosing guide + How to use it

Cytomel can help boost your metabolism and lead to weight loss, ESPECIALLY in certain hypothyroid patients. 

Does that mean every hypothyroid patient should take it? 

Not by a long shot.

I love this medication and use it frequently, but there are some things you should be aware of if you are considering using Cytomel or Liothyronine. 

​Not taking it correctly may lead to negative side effects...

So let's talk about how to use it CORRECTLY.​

More...

What is Cytomel & Why does it work so well? 

Cytomel is a thyroid medication that contains PURE T3 Hormone.

Recall these basics from thyroid physiology:

T4 = INACTIVE hormone and must be converted to T3 to become active <--- this is what most Doctors prescribe (Think Synthroid, Levothyroxine, Tirosint

T3 = ​ACTIVE thyroid hormone, does NOT need to be converted <--- most Doctors do NOT prescribe this medication (Cytomel, Liothyronine, SR T3)

What is Cytomel

Reverse T3 = Inactive thyroid metabolite that can form from T4 in the presence of inflammation, stress, poor diet, and nutrient deficiencies. 

T4 can turn into T3 or Reverse T3 depending on the conditions of the body.

​So if you have hypothyroidism and you are taking a T4 only medication, you are relying upon your body to do the converting process for you. 

This is why so many patients on T4 only medications do so poorly - their body doesn't convert well.

But if you give someone T3 only medication, you don't have to rely on the body for converting T4 to T3.

Thyroid conversion with leptin resistance

Instead you bypass this conversion process and allow for more thyroid hormone to enter into target cells and tissues without reverse T3 competition. 

This provides an instant burst of thyroid hormone to the body and makes it a MUCH more powerful medication.

This also helps explain why Cytomel and Liothyronine can cause symptoms if used in high doses.

​And this also may explain why Doctors in general are not as comfortable prescribing this medication to patients (even though so many benefit from taking it). 

​This is also why some body builders use T3 medication to boost metabolism and burn fat before competitions. 

How Cytomel Causes Weight Loss

​In order to understand why Cytomel causes weight loss you need to understand what the thyroid does in the body. 

​Your thyroid helps control your Metabolism and Basal metabolic rate

​What that means is your thyroid really helps to control your WEIGHT and the amount of fat you are burning on a daily basis. 

​As many of you know:

Low thyroid hormone = weight gain (one of the primary symptoms of Hypothyroidism)

thyroid hormone and metabolism

​But why doesn't that weight go away once you start taking Levothyroxine or T4 hormone? 

It has to do with the conversion process I mentioned above.

If you give the body T4 hormone and it does NOT turn it into T3 then your cells will NOT get the thyroid hormone they need and your metabolism will STAY low.

You can read this blog post for much more info on this conversion process and how it leads to weight gain.

You can also read this post for more info on why levothyroxine doesn't cause weight loss in many patients. 

Thyroid diet 4 week plan side bar

Cytomel (or other T3 medications) on the other hand DO increase thyroid hormone in the body and thus can help boost metabolism and lead to weight loss. 

If that's the case then you are probably asking...​

Should you take Cytomel?

​Great question, and the answer is not as straight forward as it seems. 

If you've been reading this so far you are probably wondering why you AREN'T taking T3 medication already.

Or you're getting ready to go ask your Doctor to prescribe it to you...

Well, hold your horses.

​Cytomel and other T3 containing medications aren't the best for everyone, but based on my experience most people tolerate them quite well. 

How do you know if you tolerate them?

Most patients who need T3 have one or more of the following:

  • High levels of Reverse T3 (> 15)
  • History of Leptin resistance (or leptin level > 12)
  • History of Diabetes, Pre diabetes or Insulin Resistance
  • History of Bipolar disorder or a strong family history of Depression, suicide or other mental health disorders
  • History of Fibromyalgia, Chronic fatigue syndrome or Chronic pain syndrome
  • Someone who does NOT feel well on T4 only medications (Synthroid, Levothyroxine, Tirosint, etc.)

​Basically these conditions all are associated with a higher demand for thyroid hormone or a condition known as tissue level hypothyroidism

​Tissue level hypothyroidism describes a condition where your blood levels of thyroid hormone may appear normal, but your tissues are starving for thyroid hormone.

Tissue level hypothyroidism

This may explain why so many hypothyroid patients are unhappy despite getting "treatment" with T4 only medications. ​

If you believe you have this condition THEN T3 might just be the medication for you. 

I've also attached a guide below to help you find which thyroid hormone is the best for YOUR body based on a number of factors:

Please feel free to share or pin this to your wall for later viewing. ​

Patients who benefit from cytomel

Cytomel Dosage and How to Use it Safely

Because ​Cytomel is stronger than T4 only medications you should use some caution when starting and titration your dose.  

​I recommend that EVERY patient who is using T3 medication do these two things:

  • Monitor their resting heart rate (resting pulse) every morning
  • Monitor their basal body temperature each morning

​Why?

Cytomel and other forms of T3 will directly increase your metabolism thus resulting in a higher body temperature AND it will directly increase your heart rate by acting on cardiac myocytes.

By monitoring these variables you can ensure that you do NOT get too much T3 hormone and tip the balance in favor of hyperthyroid symptoms. 

Try to keep your pulse and resting heart rate within these ranges: ​

  • Body temp no higher than 98.6
  • Resting heart rate no higher than 80-90 beats per minute while resting (note this is different from your resting heart rate while sleeping)

​I recommend using these metrics instead of recommending certain dosages because the variability between individuals is huge. 

I have some patients who do great on 5mcg of Cytomel or T3 and some who do well on 100mcg of Cytomel or T3 daily. 

​Whenever starting Cytomel make sure to start LOW and titrate SLOW. 

A typical starting dose may be as low as 5-10mcg with an increase in dose by 5-10mcg every 10-14 days.

More sensitive patients should obviously start out lower and patients who have been on T3 previously can generally tolerate titrating to higher doses more quickly.

Cytomel vs Synthroid

​Instead of thinking of Cytomel vs Synthroid I want you to think of them as a complementary pair. 

Some people do benefit from Cytomel only (in higher doses), but many people do well on a combination of T4 and T3.

That means adding Cytomel to your current dose of Levothyroxine or Synthroid.

​When it comes to power, Cytomel definitely is STRONGER than Levothyroxine.

But...

You are much more likely to get our Doctor to ADD Cytomel to your current dose of T4 than you are to get him/her to switch you to T3 only.

With that in mind it's probably better to ​focus on the ratio that you need to lose weight and feel better. 

For this I recommend shooting for a ratio of 80/20 of T4:T3.

For instance:

If you were taking 100mcg of T4 you would want to be on around 20mcg of T3.

Simply adding T3 to your existing dose of T4 may improve your overall symptoms by helping to drive down Reverse T3 levels and by directly activating cellular transcription.

Cytomel & T3 vs NDT

I referenced Levothyroxine and Synthroid above because the great majority of patients are on these medications. 

But what about natural desiccated thyroid medications? 

Is Cytomel better than NDT?

Instead of thinking about which thyroid medication is best you should consider the specific needs of your body. 

NDT contains a static combination of both T4 and T3. 1 grain of NDT equals about 38mcg of T4 and 9mcg of T3. 

If you calculate out the ratio you will see that NDT still contains the majority of T4 thyroid hormone. 

This means that even on higher doses of NDT patients are still susceptible to reverse T3 pooling. 

In a general sense the sicker the patient (more medical problems, high blood pressure, cholesterol issues, insulin resistance, etc.), the more likely they are to need higher doses of T3 compared to T4. 

So again T3 can compliment patients already using NDT quite well.

The addition of Cytomel and liothyronine to existing doses of NDT provides an additional boost of T3 and skews the ratio of T4 to T3 more in favor of T3.

This allows for less competition at the cellular level between T3 and Reverse T3 which can result in more weight loss and less symptoms. ​

  • Note: If you are adding Cytomel to an existing dose of NDT due to reverse T3 pooling issues you will likely need to decrease your total dose of NDT to reduce serum levels of T4. 

​Sustained Release T3 (SR T3) vs Immediate Release T3 

There are 2 forms and flavors of T3:

  • Immediate release: Cytomel and Liothyronine
  • Sustained release T3: Compounded and generally bound to methylcellulose

Why would you care about how quickly the T3 is absorbed into your body? 

It turns out that immediate forms of T3 are rapidly absorbed and spike serum T3 levels in the body within 1-2 hours after ingestion. 

The fact that serum levels are high isn't really the problem, the problem is that some tissues (mostly cardiac tissues) are very sensitive to T3 hormone. 

Most thyroid hormone activates cellular response through a nuclear receptor and through changes in genetic transcription (changes in enzymes, DNA, etc.). 

But in cardiac tissue T3 has a direct ionotropic and chronotropic effect. 

That means in higher doses it can directly cause an increased heart rate and increased force of contraction. 

This is often felt as palpitations or an increased sensation of the heart beat. 

​Generally the sensation of palpitations is more concerning to the patient than it is medically relevant, but obviously too much constant force on the heart is not a good thing either. 

This is where SR T3 comes into play...

Patients who are sensitive to T3 or who have a tendency to lean towards heart palpitations tend to do better on sustained release version of T3.

The delayed release allows for more stable serum levels of T3 which means your cardiac tissue doesn't get hit with high doses all at once.

​SR T3 can also be used in patients who want fewer inactive ingredients in their medication because compounding pharmacies can control what ingredients they formulate the T3 with (to some degree). 

thyroid metabolism reset poster for side bar

​This is helpful for patients who are very sensitive to medications, supplements and generally have adverse reactions to inactive ingredients. 

A few things should be noted about SR T3 however:

1. SR T3 can be tougher to digest so isn't necessarily the best choice in patients who have multiple GI issues or difficulty with absorption.

2. Due to digestive issues SR T3 may not be fully absorbed which means that the dose is less efficacious than IR T3 versions. This means that 10mcg of IR T3 will not necessarily equal 10mcg of IR T3 (usually about half or so).

​If you are considering changing to SR T3 consider these prior to transferring over. 

Cytomel Symptoms & Side Effects

If you are starting T3, Cytomel or SR T3 then there are some side effects you should be watching out for.

Most side effects come from taking too much medication and result in hyperthyroid-like symptoms but the symptoms from cytomel tend to be a little bit different from overt hyperthyroidism. 

Most common side effects from taking Cytomel: ​

  • Hair loss (usually goes away after 2-3 months)
  • Heart palpitations
  • Increased heart rate
  • Increased body temperature, hot flashes or warm flashes
  • Weight loss (most common) weight gain (uncommon but does happen)
  • Jittery sensation or increased anxiety
  • Headaches
  • Loose stool or diarrhea

​These tend to be the most common side effects when starting or increase dosage of Cytomel but are not necessarily common side effects. 

When ​you are replacing thyroid hormone that is deficient in the body you should only have positive side effects from taking the medication. 

If you are experiencing negative side effects you are most likely taking too high of a dose or you didn't titrate slow enough.

Occasionally when starting ​Cytomel or other T3 medications the starting dose can be over stimulating and may temporarily cause some of the symptoms above. 

Usually these symptoms will subside, especially when starting out on a low dose, but sometimes nutrient deficiencies and other hormone imbalances can make it difficult to tolerate T3. ​

Positive side effects of Cytomel:

  • Weight loss
  • Increased energy
  • Decreased hair loss
  • Increased cognition and improved memory
  • Decreased brain fog
  • Improved sleep

When starting T3 you should experience most of these symptoms. 

Improving T4 to T3 Conversion with other Thyroid Medications

​What if your Doctor isn't willing to prescribe Cytomel? What are you supposed to do? 

If you can get your Doctor to test your free T3 levels and show that they are quite low most physicians are willing to add in T3 hormone, but that isn't true of every doctor.

If this just isn't an option for you then you will want to focus on T4 to T3 conversion and do whatever is in your power to increase this conversion process.

If you can't get T3 by simply taking thyroid medication then you can help promote T4 to T3 conversion by altering various factors in your body.

You can read more about how to do this naturally here.

​If you can promote T4 to T3 conversion then you will necessarily reduce T4 to reverse T3 conversion. 

By reducing T4 substrate and "forcing" your T4 to convert to T3 you are effectively lowering the reservoir of T4 that is capable of converting to reverse T3.

This has a great impact on your body and your symptoms.

The higher your free T3 the more active your thyroid hormone is, the lower your reverse T3 the higher your metabolism will be.

​But realize the opposite is also true:

The lower your free T3 and the higher your reverse T3 the slower your metabolism will be and the more likely you will be to experience symptoms of hypothyroidism. ​

Cytomel Reviews & Case Studies

I've included some Case studies from my practice of patients who have used Cytomel, Liothyronine and T3 to help with weight loss. 

You can read them here: 

I've found that up to 60% of patients that come to see me need T3 in some form (either Cytomel, Liothyronine or SR T3). 

If you are taking some other form of thyroid hormone (levothyroxine, synthroid or even forms of NDT) and you aren't getting improvement in your symptoms or you aren't noticing weight loss then improving your T3 levels might help.

Generally adding T3 or Cytomel isn't enough to cause significant weight loss by itself, but it is almost always required in order for the body to get into "fat burning mode". 

As you can see from the case studies above T3 is always PART of the therapy, and in some cases therapy revolves around thyroid dosing, but other therapies are almost always required for 40+ pounds of weight loss.

Wrapping it up

Cytomel is a powerful thyroid medication that can help boost metabolism and lead to lasting weight loss in certain patients. 

Having said that, Cytomel is NOT for everyone. 

Use the information in this post to help determine if Cytomel would be helpful for your case and remember that each person is unique. 

If you decide to try Cytomel out then I recommend starting with a low dose and titrating SLOW. 

While using Cytomel make sure to monitor both your resting heart rate and basal body temperature to ensure that you do not over dose yourself. 

Now I want to hear from you!

Have you used Cytomel successfully to lose weight? Did it work for you? Why or why not?

Leave a comment below!

Dr. Westin Childs
 

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 126 comments
LaTisha - July 18, 2016

Question~ if I’ve had a total thyroidectomy wouldn’t it make sense to take more T3 than T4, since I don’t have a thyroid gland to convert it? What do you do in that case? I am currently on 88mcg of Synthroid and 10mcg of Cytomel. My doctor increased the Cytomel by 5mcg 4 weeks ago due to my levels being so low.

Help is greatly appreciated.

Reply
    Dr. Westin Childs - July 18, 2016

    Hey LaTisha,

    Yes, most people do better with more T3 after TT – but it really depends on the person.

    Reply
    terri - July 18, 2016

    I could be wrong but I don’t think the conversion of T4 to T3 takes place in the thyroid gland. I believe the liver does this work.

    Reply
Daniela - July 18, 2016

Dear Dr. Chailds,
Thank you for the great paper. It came just on time for me. I am 50 years old from Bulgaria. I am living with my Hashi since May 2007. Until last week I was on T4 only(Levothyroxin) medication only. For the past winter I was taking 200 mcg daily of T4, the lab tests have been relatively normal – TSH and T4 have been normal, TgAt and A-TPO a bit over the maximum. At the beginning of March, so to prepare for the summer, I have started to decrease the dosage of T4 and for 45 days I have decreased the dosage of T4 to 150 mcg daily. Unfortunately TSH went up to 7,62 mIU/ml (reference from 0,27 to 4,2), T4 is close to minimum level 11,55 ng/l (9,30-17.00), T3 is 1,74 ng/l which is below the minimum (2-4,4); Reverse T3 is 61 pg/lm (0-83). The antibodies went over three times above the maximum range. Finaly and luckily I have found endocrinologist who prescribed me a combo therapy 125 mcg T4 + 25 mcg T3. I have started the therapy on July 11th but with lower dosage of T3=12,5 mcg. I was aware that I have to introduce it slowly. Today I have tried to take 25 mcg, but I was not feeling well, especialy my pulse went up.
The question: For how long I could continue T4=125mcg + T3=12,5mcg therapy before to take the prscribed T3=25 mcg? When I could expect the weight loss effect of T3 (I am also fighting with overweight)? How long I could stay on T4+T3 therapy? Can I try T3 therapy only? Thank you in advance for your reply!

Reply
    Dr. Westin Childs - July 19, 2016

    Hey Daniela,

    Pure T3 like Cytomel doesn’t always work the best. If you are super sensitive to the T3 by itself you may do better on a T4/T3 combo like NDT or a SR T3. If your thyroid is contributing to your weight then you should expect to lose some weight within 1-2 months.

    Reply
    Daniela - July 25, 2016

    Dear Dr. Childs,
    In addition to what I have asked a few days ago, this is to clarify if I could split the prescribed daily dose of 25 mcg T3 into to portions – 12,5 mcg in the morning 30 minutes after taking the T4, and 12,5 mcg T3 in the afternoon three hours after the lunch meal, arround 4-5 PM. Thank you in advance.

    Reply
      Dr. Westin Childs - July 25, 2016

      I would recommend you follow the instructions that your prescriber has given to you. I can’t make recommendations because I don’t know your personal history, etc.

      Reply
Louise foreman - July 18, 2016

Hi I’ve read your article with great interest . I was on levothyroxine a few years ago . Was still hypo despite being increased to 200 mcg . Usual symptoms fatigue . Very dry skin . Brain fog . Pain week arms wrists painful hands etc . I then went to see dr and she sent me to oncology as I had a lump . After biobsy I was told thyroid cancer . I had partial thyroidectomy in Dec 2011 . Results were Hashimotos .
Then in the spring of 2012 I was diagnosed by rheaumatoligist with fibromyalgia .
I was pmd by a man on fb said have you heard of ndt . I had not . So I looked it up researched it and thought what have I got to lose .
I’m just existing not living. So I ordered Armour wow the difference was amazing I felt alive . I came out of my shell again . I made sure my ducks were in a row . I just forgot to pace myself . So burnt out after a few weeks . I increased little by little . Then I tried thyroid s . Wp thyroid and finally thyroid with t3 that’s where I am tday I walk I enjoy life still I have little pain sometimes I get tired but I’m constantly on the go doing things I enjoy . I’m from the uk and we can’t get anything except levo on NHS which is very sad . But realise now it’s all controlled by the pharma companies so if we want our health back we need to learn to take control of it . We need to teach our Drs too And learn to live again

Reply
    Dr. Westin Childs - July 19, 2016

    Hey Louise,

    Thank you for sharing your story! I feel like so many people are out there suffering needlessly because they just don’t know any better. In my experience many patients with fibromyalgia do very well with NDT + T3 or T3 alone.

    I’ve also noticed that after partial thyroidectomy the labs look deceptively “normal” even though many patients light up once they get on thyroid medication. Just another reason you can’t trust the lab tests in isolation.

    Reply
Lourae Fitzgerald - July 19, 2016

Dr. Childs I recently convinced my doctor to add T3 because even though my blood work was ‘normal’ on Levothyroxine, I was still not feeling well. I have been following you for about a month and have been reading all your articles. I’m only on cytomel for about a week so no noticeable difference. But I know it takes time. Thank you for the information and education. It really helps us lay people understand what is happening in our body.

Reply
Rebecca - July 19, 2016

Hi Dr. Childs,

Thanks for your great article! A functional MD put me on 5mg of Cytomel about five months ago. I had suffered hair loss among my many hypothyroid symptoms. My T4 was always in the normal range. Ever since I started taking Cytomel my hairloss has gotten very very bad. My doctor keeps telling me it will level out and grow back but neither is happening, and it’s gotten to the point of being very severe and noticeable. Do you have any thoughts on cytomel causing hairloss and what I should do? Cytomel has been wonderful at reducing and eliminating all of my other symptoms so I’m reluctant to go off it. Thanks!

Reply
Evonne Bruce - July 19, 2016

I’ve been on Cytomel as I’m taking 10mg a day. I still have a very low Basal Body tempature of 97.8, and I take it along with 150mg of Armour Thyroid. But no weight loss at all for me. Doctor doesn’t want to increase Cytomel because of fear of it damaging my heart. My last T3 was at 3.17 which no no where to the optimal range of 3.71. I haven’t lost any weight but I haven’t gained either. I am also a diabetic and was insulin resistant at the age of 20 when I was as skinny as a nail. I’m trying to find a doctor who is willing to increase the Cytomel to get it into the optimal range so the weight comes off of me. I am going to print this off and take this article with me when I see any new doctor in hopes that it will help me out. I am now going to take my resting pulse rate as well and chart it along with the charts I have on my reading of my low body tempature. So is it my understanding that with the body tempature and resting heart rated that when they are both good that a person then has found the right dosage of Cytomel to be on, correct? But if body temp is still low and pulse is still low that the person isn’t on the right dosage right? And what happens say when you get a normal body temp, but plus isn’t in the range you stated or visa versa how does that work with finding the correct doseage of one is correct and the other one isn’t?

Reply
    Dr. Westin Childs - July 19, 2016

    Hey Evonne,

    It doesn’t quite work that way because not everyone needs T3. Most patients with insulin resistance do have some degree of thyroid resistance and most do benefit from T3, however. I wouldn’t expect your weight to fall off once you increase your T3, it’s far more likely that your weight won’t decrease at all – especially if your fasting insulin is > 10.

    Reply
tina - July 19, 2016

Hi Dr. Childs –

I have tried the cytomel 5mg. I also take T4 as well. I notice the cytomel is too strong for about 4 hours and then I get a slump starting in the afternoon as it wears off. Any suggestions on this? Do you happen to know if most people prefer the brand or generic cytomel?

Thank you

Reply
Wendy - July 21, 2016

Hi Dr Childs,
I was wondering in reference to Rebecca’s question regarding the hairloss on Cytomel. I too have been suffering hairloss as my primary hypothyroid symptom, fatigue comes and goes…my labs are “normal”. I’m on 50mcg Synthroid and have been for years. Hashimotos indicator is around 15, Reverse T3 elevated but not crazy high and I do notice gut issues the past year I’ve never had before. I was considering adding a T3 Med to my regime but any further hair loss will devastate me…seriously. I have 1/3 of the hair I had 1 1/2 years ago. I’ve done everyting…Biotin, Bi-est Cream & Bio-Progesterone, Vitamins, Minerals with Selenium, Got off Gluten for over 3 mos….I feel like I’ve tried everything. What are your thoughts on Cytomel and hair loss? Does it EVER help with hair loss?

Reply
    Dr. Westin Childs - July 21, 2016

    Hey Wendy,

    It seems in my patients it tends to cause more hair loss than hair growth, though I have seen it help in the past as well.

    Reply
MM - July 24, 2016

How would you introduce T3 with T4? Would you take them both together at the same time? What’s the best protocol? Thanks

Reply
    Dr. Westin Childs - July 24, 2016

    Hey MM,

    There is no best protocol, it depends on the person, their labs and symptoms.

    Reply
    lisa - July 24, 2016

    You take the T4 first thing in the morning by itself of course with only water wait a half an hour then take T3, then wait a half an hour.

    Reply
Sandy - July 24, 2016

Hi Dr. Childs, I have been taking Levothyroxine (125mcg) for several years and Doctor added Cytomel (5mcg) 8 months ago. No weight loss, still fatigue, no energy and brain fog. Recently went to a holistic care provider who strongly recommended I wean off the Levothyroxine and start taking thyroid tissue concentrate instead. He also recommended raw brain tissue concentrate as well, what are your thoughts on glandular treatments?

Reply
    Dr. Westin Childs - July 24, 2016

    Hey Sandy,

    5mcg of cytomel is generally a baby dose (sometimes it’s enough, but usually not). I’m generally not a huge fan of brain tissue if it’s bovine sourced due to the small risk of bovine encephalopathy.

    Reply
Pamela Barraclough - July 24, 2016

Sir I ve been on 150 mg of thyroxine for 13 years . I once mentioned t3 to my doctor and he laughed at me it’s so frustrating because when I read articles like yours that seem to know and understand what we go through . What can I do about it when in England they don’t actually give a dam.

Reply
Diana - July 24, 2016

What if you can’t tolerate synthetic hormone long term? I have Hashimoto’s and as a result of this autoimmune condition, leaky gut is one of the factors involved which means at some point I am unable to oonvert T4 to T3 efficiently. I’ve been advised that traditionally doctors only know to raise the dose (repeatedly) and we actually get worse due to the build up of cellular tissue waste – the outward signs of this is puffiness in the face, hands & feet. Which I am already experiencing.

I went from Armour 60mg to Armour 30mg with 2- 5mcg Liothyronine. Now I am to increase Liothyronine to 3 pills for 3 days then increase to 4 pills for 3 days then change to Levothyroxine 75mcg 1/2 tablet every day with 1 tablet Liothyronine 25mcg.

This is all very confusing to me. Synthetic hormones scare me due to the Hashimoto’s. Can I actually expect positive results when I am already suffering ill affects? It’s hard to question my doctor’s protocol. Can’t I switch to another NDT without adding a synthetic form?

I am going to be adding Selenium with Non-gmo sunflower seed oil vitamin E, & Zinc to help with absorption plus Naturcidin & Probiotic 50B for leaky gut.

Reply
    Dr. Westin Childs - July 24, 2016

    Hey Diana,

    All thyroid medications are bioidentical. The vast majority of hormones outside of thyroid medications are synthetic in the sense that they are created in a lab from other constituents. NDT is porcine based, but the hormones are still identical at the molecular level. It’s less about being synthetic or “natural” and more about what your body needs and that takes trial and error.

    Reply
      Diana - July 24, 2016

      it’s the fillers in the different medications that can give us trouble.

      Reply
        Dr. Westin Childs - July 25, 2016

        I understand, but the fillers are a different story altogether. Even the various NDT medications have different amounts of fillers/etc. In addition if the fillers were an issue you could always try tirosint which has VERY few. At the end of the day you might be better off on Wp thyroid over naturethroid or armour over both – it just depends and there’s no way to find out without trial and error.

        Reply
Nat - July 25, 2016

Hi Dr. Childs,

Could you explain how taking Cytomel (T3) helps to actually lower Reverse T3. I understand its giving the body directly active thyroid hormone but how does it force the body to release the revere T3?

I’ve had symptoms of low thyroid for 2-3 years but have never been diagnosed and put on medicine (fatigue, cold hands & feet, low basal temperature).
I tested Reverse T3 for the first time ever and it came back at 21.
TSH 2.78, Free T3 2.6 pg/ml, T4 6.6 No Hashimotos antibodies
I immediately started taking zinc, selenium, B6 and was already taking high dose iodine.
Do you suggest Cytomel only for a patient with high Reverse T3 who has never taken any thyroid medication?

thanks

Reply
    Dr. Westin Childs - July 25, 2016

    Hey Nat,

    T4 is the reservoir for reverse T3. If you give the body T3 you will naturally reduce the amount of free T4 and therefore reduce the reservoir for the creation of reverse T3. The left over reverse T3 is then metabolized and eliminated.

    Reply
Mario - July 25, 2016

Hi Dr, can you pls explain the protocol of taking t4 and t3 together? Do you take both at the same time? I’m on levothyroxine 100 mcg. Would I take 20mcg t3 with it or at a later time during the day? Thank you

Reply
    Dr. Westin Childs - July 25, 2016

    Hey Mario,

    There are several ways to do it:

    Take them both at the same time, take 1 then take the other 30-60 minutes later, take 1 in the morning and 1 at night – it just depends on what works best for you and your schedule.

    Reply
Susan - July 25, 2016

Dr. Childs, When i was first diagnosed with hyperthyorid 18 years ago my Dr. put me on Levoxyl and cytomel. A year later i had lost a lot of weight. I went from a size 1x to a size 10. wow and i felt great. But 6 years ago he took me off every thing and put me on just levothyroxine 100 mg. Ever since that time i have put on almost 70 pounds. I am now a 3X. I have talked to my Dr. about takeing me off this but he said no.. I went to see an endocrinologist and he said that all my symptoms were all in my head and that i needed a grasto by pass. My Dr. said that if i didn’t want that i should get the lap ban done. I just want to cry.. This is so not fair.. All i want is my life back..I’m going to try to see him this week. It’s been over a year since i last saw him and i need to get my thyroid tested again. Here’s hoping that things will change for the better.

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Sarah - July 28, 2016

Hi, what are the side effects of cytomel? I currently take levothyroxin but am unable to shift weight. Are you aware of any natural alternatives that act in the same way? Thank you.

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Esra - July 29, 2016

Can cytomel cause rage? I tried adding 5mcg to 88 synthroid and had incredible irritability and had to stopd after a week. I am now on Armour 60 and I am 5pounds overweight and I cannot lose it, even if I do it all comes back within 2 days.

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    Dr. Westin Childs - July 29, 2016

    Hey Esra,

    I’ve seen some weird side effects from thyroid medication but never rage. It could be due to the medication but I would look into other things as well: new supplements, etc.

    Reply
      lisa - July 29, 2016

      Also I wanted to add maybe you are over-medicated. Maybe you need to drop the T4 down to 75 mcg with the cytomel. For example, my endo had me on 75 mcg of tirosint and 5 mcg of cytomel and I kept wanting to sleep all day so I bumped it up to 88 mcg. I am only 100 mcg of tirosint without T3. I don’y know your starting dose of T4 but it should be lower when adding T3.

      Reply
    lisa - July 29, 2016

    Ersa,

    We are on the same regimen. I know the cytomel caused me to be nervous at first. What I did was alternated T4 and T4 and cytomel. Your body has to get used to the cytomel and this can take some time. I know at first I felt strange taking it. Also, it may be the fillers that you are reacting to. I would try alternating days and then if you are still reacting to it try one with hypoallergenic fillers at a compounding pharmacy. For example, I am normally on 100 mcg of tirosint and I alternated it with 88 mg of tirosint and 5 mcg of cytomel. In about a month or so I was able to tolerate the cyotmel. Also, I have the 5-10 pounds of weight issue as well. I had to be very strict my with diet, NO SIMPLE CARBS and I only eat 2 meals a day and exercise about 4 days per week. I have lost only 5 pounds. Once a week I do an all day fast once per week eating only dinner, to reset my metabolism as that is how I lost the 5 pounds in the first place but i do a lot of weight training and don’t want to sacrifice muscle loss. So far that 5 pounds has been staying off – now just another 5 to go.

    Reply
Hadassah - August 1, 2016

I had T.T. 23 years ago . And was put on Synthroid only of cause . I did well for a while . Till last summer I crashed . With lots of muscle cramping high blood pressure weight gain and anxiety . Could not turn or get out of bed . I went to a Dr. who was nice enough to add 5mcg of T3 and changed me to 150 Levoxyl .My new Dr . feels I’m not getting enough Levoxyl and not enough T3 . When I explained him that I don’t do well on to much T3 he was very surprised . I get very lethargic tired and my concentration is very bad . My body temperature is 97.8 and can’t get it higher . And my energy level is not great . He would like to switch me to NDT . He first took blood work to see my RT3 and other markers . Based on that he will determine how to proceed with my protocol . My question is NDT vs Cytomel which is the preferred way to dose for T3 ? I pretty much figured out for myself that I do much better on more T4 and a little mix of T3 . Thank you in advance .

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    Dr. Westin Childs - August 1, 2016

    Hey Hadassah,

    There is no preferred way, you have to find what works for your body. Some people have no problems with T4 to T3 conversion and do VERY well on T4 medication only. Some people react very poorly to cytomel and others very poorly to NDT – it just depends.

    Reply
Hadassah - August 1, 2016

Thank you .

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Rene - August 23, 2016

Long story: I have tried both T4 only (Levoxyl) and T4/T3 Combos (Armour/levoxyl) and Armour only over the past 8 years. Nothing has ever worked and I have been so crippled I couldn’t walk without help. My muscles literally do not flex, my joints feel like they are full of cement. My weight has been horrible. I have gained 70 pounds. My last medication attempt was T4 only (levoxyl) and I was taking 400 mcg a day with ZERO affect. None. It was like taking sugar pills. I’ve always had super high RT3 values and have been treated twice for chronic lyme disease. (long term antibiotics) I have been tested and I do not have celiac disease and am not allergic to gluten. My adrenals were tested and my levels of cortosol, protesterone, etc., were all SKY HIGH. My body is OD’ing on cortosol, not too little.

My doctor agreed to let me switch to Cytomel. I started out at 1/2 a 25mg tablet 3x a day (4 hours apart). Within 11 days I have gained 8 more pounds! I feel a great deal better, though lingering pain in muscles, etc. I have more energy and so on but I’m just shy of 200 lbs now and I’m GAINING continuously. My appetite has not increased and my diet has not changed. I try to eat a moderate balanced diet, no starvation diets, etc. My resting pulse is 74. I plan on slowly bumping up my T3 higher but the weight gain is scaring me.

I can’t find much evidence on the internet of people on cytomel gaining even more weight! It is my hope and prayer that I am simply on too little.

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Eugenia - August 27, 2016

Hello Dr,
a question about Reverse T3. Is it possible to fix that overactive conversion to rT3 without having to resort to Cytomel? If yes, how? If not, is it possible to stop taking Cytomel after the patient has lowered his rT3 using the drug after a few weeks/months?

Regarding lifestyle: I sleep a lot, wake up at 6 AM and go walking, and I’m using Chris Kresser’s Paleo version for 2 years now: Paleo + fermented-only dairy + white rice + soaked legumes. I’m doing Paleo overall for 5 years now, in various forms.

Problems persist you see, and absolutely everything points to rT3 problems. In fact, 4 years ago I went Paleo-ketogenic for 3 months, and I got hypothyroid-galore (feeling frozen in the middle of the summer etc). Since then, I never really recovered, even if I started eating more carbs. I still do Kresser’s Paleo due to celiac disease and metabolic syndrome (I haven’t lost any weight on paleo all these years btw, but I still do it for the rest of the health benefits it brought me).

Thx!

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    Dr. Westin Childs - August 27, 2016

    Hey Eugenia,

    Generally something is causing the reverse T3 problem to begin with, so if you can reverse that problem then you probably won’t need to use cytomel in the process. And, yes, some people can lower their reverse T3 with cytomel and then switch medications provided they find the cause of elevated reverse T3.

    Reply
Julee - September 3, 2016

Excellent comments! Been taking armour thyroid since 2013.Was fine until formula changes. Switched to compounded T3 several Different doses addedT4 to no avail. Put on synthroid AWFUL for me. In desperation back on armour 15 mg did fine for few weeks going astray again. So this pm txt my Dr mentioned cytomel she called in lowest dose. Do you suggest taking both armour and cytomel?
Thank very much for your time. Julee W

Reply
    Dr. Westin Childs - September 3, 2016

    Hey Julee,

    Unfortunately I can’t provide medical advice specific to you unless you are my patient, you will have to talk to your doctor about dosing and medication.

    Reply
Kate - September 3, 2016

I had a hysterectomy and have gained 20lbs. I am on 50 mg of cytomel and 25mg synthroid but it does not seem to be helping. Would it be possible to take 100 mg of cytomel and lose weight. Would I lose more with taking only the cytomel? Please note I do not take generic medications.

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    Dr. Westin Childs - September 3, 2016

    Hey Kate,

    Your weight gain after your hysterectomy is not due to your thyroid but most likely other hormone imbalances, taking more T3 to try and off set these imbalances will likely cause more harm than good.

    Reply
Tammy Meyers - September 7, 2016

I have been taking many different kinds of thyroid meds since I was diagnosed with Hashimoto’s in March of 2015. The only reason I knew I had a thyroid condition was because my TSH showed 14.8 in my annual blood work and my TPO was 1680. I had no symptoms besides weight gain and to be honest, my diet was unhealthy so I figured that was the problem. Since then, my blood work as always come back norml except for my TPO level. It is gradually reducing though. I am down to about 600 now. I started taking synthroid, was switched to armour, told by an internist to stop taking meds because I didn’t really need them, and then put on Cytomel by itself by my family doctor. I am at a loss. Can I just stop taking these meds like my internist said? I feel like my antibody level was high and affecting my thyroid and now that I am working on my diet, I should be okay. Any advice would be greatly appreciated. I don’t feel bad, so why should I be taking meds???

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    Dr. Westin Childs - September 7, 2016

    Hey Tammy,

    Unfortunately I can’t give you medical advice. I would touch base with the physician who put you on the cytomel to ask why you are on it and go from there.

    Reply
Suli - September 8, 2016

Hello,

Thanks for this website and all the informative posts. I’ve just found it today and look forward to reading through more.

About Cytomel: in 2009, I found an L.A. doctor’s website that said that many women with Hashimoto’s produce excess Reverse T3 and that taking T4 might make this worse by stimulating more Reverse T3 which could slow down the metabolism even more. He said some women patients of his were only needing 800 calories a day to maintain their weight, thus making them gain on even low-calorie eating. I went to my doctor with this and he agreed to put me on Cytomel only. Over the course of a year and a half, I lost 60 pounds (which put me at about 168-170 pounds. I still had weight to lose, but felt much better. My weight loss stalled after a while, and I had to stop going to him (the clinic no longer took my insurance). I ended up off thyroid meds for a while, maintained my weight for a while, then slowly gained 30 pounds. That held for more than a year. I went to another doctor finally; she put me on Synthroid, was not comfortable with Cytomel. My weight held, but my symptoms weren’t fully relieved. She put me on Armour and I gained 30 more pounds in under six months. Finally, I found my old doctor at a new clinic. He put me back on Cytomel. I lost about 10 pounds. I later had to change doctors again. The new one has me on 25 mcg Cytomel and 50 mg Tirosint. I haven’t been able to lose anymore for the last four months. So I’m still up 50 of the 60 total regained pounds. I feel fairly healthy other than having to carry so much weight around (low cholesterol, normal blood pressure, etc.). All of this time, I’ve eaten as well as I know how (organic, keeping higher carb foods to one meal a day, etc.). (Sorry, I know I’m sweeping over my history without enough detail, but am trying to not make this be too long.)

Re the weight gain on Armour: I did some searching and discovered that they changed their formula a couple of years ago after being bought by another company. I found a consumer site where a lot of other people reported gaining quickly on their new formula, even after having been on it for years with previously good results. Do you recommend another brand?

Re T4 and weight gain: Can taking T4 actually make someone not lose weight or gain weight beyond just being inert? Can it stimulate Reverse T4? Does Reverse T4 slow the metabolism down or just do nothing?

Lastly, do you have any suggestions for how to move forward? I’m in Minnesota. Thanks so much.

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Joshua - September 9, 2016

Hello,

Thank you very much for this article. I can’t tell you how frustrated I have been with doctors who simply don’t care to prescribe T3 even when the symptoms make it clear this is what is needed. I had intense inflammation in my body for months due to bug bites on my legs. I would go into my doctors and complain about hypothyroid symptoms and they would see that my TSH level was high but would just increase my Synthroid dose. WHY! My body can’t convert t4 to t3! So frustrating!

Finally I did my own research and too my health into my own hands. I practically had to lie to get a prescription. And now for the first time in months I feel normal! I can’t tell you how angry this makes me that I was sick for 4 months for no good reason other than the fact that the doctors could care less about my health because prescribing t3 wasn’t what they wanted to do.

Seems crazy that we let people remain sick and refuse to give them the drugs that will allow them to lead a normal healthy life. Why do we do that?

Reply
    Dr. Westin Childs - September 9, 2016

    Hey Joshua,

    I wish I had a good answer for you. Many physicians are just scared because they aren’t familiar with how to dose, what to do about side effects, etc. There are providers out there willing to work with you, but I agree it shouldn’t be so difficult to find help. Unfortunately that is the way it is right now and I don’t see that changing in the foreseeable future.

    Reply
Kat - September 15, 2016

For the last 3 weeks I have been on Cytomel only 25 mcg in the morning 5 am. Then approx. 1/2 hour later .5 of Cortef. I am finding that my face is much puffier and there is swelling in my legs and feet. Could it be the Cortef??

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    Dr. Westin Childs - September 15, 2016

    Hey Kat,

    Cortef can cause swelling, but that can happen from cytomel as well.

    Reply
      Kat - September 15, 2016

      So, should I cut out the Cortef for now?? My labs showed that my adrenals were adequate…I think I should just stick with the Cytomel?
      Thank you.

      Reply
        Kat - September 15, 2016

        I forgot to mention, my temperature has been very low 96ish…and never getting much higher than 97.

        Reply
        Dr. Westin Childs - September 15, 2016

        You will have to discuss those changes with the doctor that prescribed the medications, I can’t provide you with medical advice unless you become my patient.

        Reply
Melanie Rekola - September 23, 2016

Hey Dr. Childs,

When through some large (40 lbs) weight gain in a matter of 2 months about 8 years ago, extreme fatigue, dry as a bone, low libido and it took a year for any doctor to believe me that my Thyroid was the culprit as I was on Thyroid and my TSH was apparently “perfect”. Eventually I found a doctor that finally tried cytomel and I felt so much better. Weight came down to near normal, my energy level came back up as so did my libido. Started at a low dose and come up to 25mcg and everything was smooth sailing for years…then it happened again but to a slight lesser degree. I tried naturopathic doctor at that point who put me on straight armor thyroid and it was horrible. All symptoms returned and after a 9months I gave up and got my regular endo to try increasing my cytomel dosage but have gradually been having to increase it further as my free t3 and free t4 are none existent in my blood work. I am now on 100mcg cytomel currently and feel I am “getting by” but not nearly 100%. As when my dosage increases I feel better. no heart palpitations, nothing. Though when that naturopath had me on 240 mg armor daily I had major heart palpitations!! P.S. I also eat a very healthy and low carb/low refined diet and exercise daily. I am also type 1 diabetic for 30+ years now. I have tried the combo of cytomel and sythroid but sythroid never seem to do a thing.
I need to know, what is the maximum dosage of cytomel? Any other suggestions?

Reply
    Dr. Westin Childs - September 23, 2016

    Hey Melanie,

    I can’t provide you with specific medical advice over the internet like this but I would recommend you either find someone local who is knowledgable with T3 or go back to your naturopath for further assistance.

    Reply
Amy Quinn - October 1, 2016

Good morning,

I am a female and 46 and I had a total thyroidectomy nearly two years ago. (Multiple nodules/thyroid cancer) I have not gained or lost weight – maybe a variance of 2-5 lbs. In the two years prior to my surgery, I went from a lean 132 lbs to a not so lean 150. I am currently on 137 mcg synthroid and 10 mcg T3. I take my synthroid and 5 mcg first thing in the morning and then another dose of 5 mcg before bed.

I eat a mostly clean diet (low carb) probably to be honest 80% of the time. I exercise vigorously 4-5x a week.

I would LOVE to get back to my 132 lbs of lean and fit and am frustrated that no matter what I do, the scale does not budge. Should I be on a higher dose of T3? I have no side effects from my current dose.

Should I be taking the T3 at different times of day?

Help! So confused by all of the conflicting info on the internet and my Endo is ultra conservative (which is good) but I don’t think she understands how frustrating 20 lbs of weight gain can be.

Thank you!

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Lekalo - October 9, 2016

Dear Dr Childs,
I am a 43 y.o. woman with multiple and rapidly growing nodules in my thyroid. They are benign so far, but don’t stop growing and now my doctor sent me to talk to a surgeon about TT. It will happen, and I am extremely concerned about weight gain. I am already about 20 lbs overweight (never lost the baby weight) and I have a 6 year old that needs me active. My knees hurt as it is (arthritic spurs in both) so I cannot wait to gain an extra 20 lbs+ to do something.
All my levels seem to be within range, but again…the nodules keep growing. I do not want to get the surgery without knowing that I did everything possible to prevent the weight gain associated with TT.
I have never taken hormones. What do you suggest I talk to my doctor before the surgery? start medication before? or after? only T3? both T3 and T4? I want to be armed with ideas, because if I have to change my endo, I rather do it now than when I am in the middle of a weight struggle.
Thank you so so much!

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Anne - October 13, 2016

I had my thyroid removed years ago. I take 112 mcg of synthroid and a doctor started playing with the meds and my functions dropped terribly and I gained 18 lbs in less than 6 months. This is when I finally asked to see an endo for help. He started me on Liothyronine. How long until I notice a difference, in both energy and weight. I understand that most thyroid functions are slow to react, and it has only been 25 days, but nothing has changed – in fact, i’ve gained 2 more lbs. and I’m just as tired as ever. The first 2 days I felt like a go getter, but then nothing.

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michelle frankie - October 14, 2016

IM confused about something can NDT create RT3..the goal is not to get that at all right? Why take synthetic t4 if there is gonna be any debate about whether or not this is happening?

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    Dr. Westin Childs - October 15, 2016

    Yes, the T4 in NDT can turn into reverse T3. You don’t necessarily want or need pure T3, your body needs it only when there is demand and taking too much will provide it with more than it has need for. Hormonal balance is under strict regulatory control (in the normal state).

    Reply
      michelle frankie - October 15, 2016

      Thank you also I was wondering if you have high cortisol really easily how should u play that is there additional adrenal stuff i should take so my cortisol doesnt spike? I absolutely luv relora but was wondering if theres anything else I seriously do not need cortiosl to raise i have lymes and my cortisol and adrenaline is totally peaked. Thank you
      SIncerely
      Michelle
      Frankie

      Reply
saima - October 15, 2016

hi,i want to start t3 medication have ask my doctor and he says it raise the heat rate so he doesnt prescribe it to me on the other hand i eagerly want to try it out because im tired of being teired and sluggish and sleepless with low energy levels,sometimes it is hard to focus on something all the interests are gone imean i dont feel like doing things like once i did before.my recent reports are;
TSH:5.493
FT4:1.07
FT3:2.10
plz tell me what to do.

Reply
    Dr. Westin Childs - October 15, 2016

    Hey Saima,

    Unfortunately I can’t give you medical advice so you will either need to become my patient or take those labs to your current provider.

    Reply
Cassidy - October 17, 2016

Can taking too much Cytomel lead to weight gain? I used to take 40mcg and now I take 75. I have started rapidly gaining weight and becoming depressed about it.

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    Dr. Westin Childs - October 17, 2016

    Hey Cassidy,

    Yes, in some people it does appear to cause weight gain – I can’t really explain why, it’s just something I’ve noticed in a very small subgroup of patients.

    Reply
Inna - October 19, 2016

I was born and lived in Kiev till 1995, which is close to Chernoble. In 2008 post a stressful event, I gained 30 lbs in a month and no matter what I did I could not get rid of it. In 2010 I tried the HCG and 500 cal a day diet with no luck again. At this point, I was tested and diagnosed with hypothyroidism and prescribed .25 of Cytomel. After taking the medication it took me about 2 years to get back to my normal weight and state of health and energy. I have since moved to Aspen CO and had to switch doctors. We do not have a local endocrinologist and I have been monitored first by an internal medicine doctor. She insisted that if I continue to take Cytomel that I will never have children, develop osteoporosis by the time I’m 40, etc. She placed me on Armour. It was the worst experience of my life. After taking it for about 3 weeks I began to feel dizzy and unable to focus my vision. After complaining to her about the side effects she recommended I see an eating disorder specialing, why I am not sure. Needless to say, I stopped seeing her.

Reply
    Dr. Westin Childs - October 19, 2016

    Hey Inna,

    Most physicians are not familiar with T3 dosing so they tend to shy away from recommending the medication to patients.

    Reply
Kate - October 29, 2016

Hi!
Thank you for this article. I am currently on Tirosent 50mcg AM and 10cytomel around lunchtime. I have lost significant muscle mass while on this medication and i want to stop taking it. I am nervous that stopping cold turkey will cause a large amount of fat gain and my lethargy will return. I am a powerlifter which is why i am concerned. I have been told i am on a small dose and the rebound should not be too bad. Do you agree? (i have never had weight issues previous to taking the drug)
thank you

Reply
    Dr. Westin Childs - October 29, 2016

    Hey Kate,

    I definitely wouldn’t recommend that you stop taking any medication without physician supervision, I would go back to the physician who recommended you take the medication to begin with.

    Reply
michelle - November 14, 2016

Hi!

I am 7 months post-thyroidectomy and was on 137mcg of Levothyroxine. In the 7 months after my thyroidectomy, I have gained 35 pounds, have terrible widespread muscle aches and joint pain, extreme fatigue, and forgetfulness – all with normal thyroid levels. I finally convinced my doctor to add T3 to my levothyroxine and have for the past three days been taking 100mcg of Levothyroxine and 25mcg of Liotyronine once daily. Can I expect any weight loss or lessening of the muscle aches, joint pain, and fatigue? My doctor is unconvinced that the addition of T3 will do any good. How long does it usually take to see any difference, if there will be any?

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Petra Andree - November 25, 2016

Hallo Dr. Childs,

I’m 50 yeaars old an have hashimoto since 10 years. For a short time it went quite good unter L-Thyroxin (german T4). But Later it did’t an I got depressed and gained weiht ( 25kg in 1 year). After a long time I found a doctor in Berlin, and she treats me via skype. We tried natural hormones, but I got into pooling. So since 14 weeks I’m on t3-only (Thybon). I startet with 75 a day, splitted into 5 doses. After weeks I increased an at the moment I take 120 a day. I have a little more power, but not really so much more.I’m monitoring my temperature, bloodpressure and pulse every day. It’s allways the same and ok. Perhaps the temperature is a little bit low. I’m 1,64 m and have 90 kg. So here my question: Could it be that a little person like me needs even more than 120 T3 a day? What reason could it be, that I don’t respond to t3 so much as others do? Could there be a sort of resistance? I got my blood results yesterday. TSH suppressed, T4 suppressed and T3 near 100% of the range. Thanks for answering. regards Petra

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Jarod - November 27, 2016

Hello Dr. Childs,

I’m a 40-yr-old male with hypothyroidism. I still display many of the symptoms of hypothyroidism despite lab results being “within range”. I finally talked my PCP into giving me Cytomel and he prescribed 5mcg once a day. Does that sound like an adequate dose for a 200lb man? Judging from earlier posts it doesn’t. I’ve been on less than a week and so far I’ve noticed a period of increased body temperature soon after taking it.

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Tim - November 30, 2016

Wow man, so glad I found your blog. Not surprised so many deal with this.

I had hyperthyroidism, they gave me radiation, went hypo, and blew up like the lady who sings when it’s all over. Ok, I’m being hyperbolic. But I went fro my skinny like a zombie to beer belly like by dad bar buddies.

I started working out like crazy. Although I can put on muscle, body fat follows like crazy. So I try to cut, I lose weight, but almost seems like just muscle, not much fat.

All I ate was rice and veggies and chicken for a year. Starved myself even still couldn’t get my body fat to go.

I’m in gym 4 to five days a week. But in a lot of muscle, but I’m also fat.

My tsh is around 2 now, took a year to get it there. I do get tired, but I fight it.

However, sadily my doctor won’t give me T3, he is one if those. I don’t have any if the predisposed issues with heart.

I’m not sure what I’m gonna do, but I’m gonna get help. Because I was getting depressed working so hard only to fail while watching everyone around me work half as hard and look amazing. I get it, it’s not about aesthetics, but that hurts.

Thank you, you’ve gotten a life long reader here brother. God bless you!

Reply
    Dr. Westin Childs - December 2, 2016

    Hey Tim,

    Thanks for reaching out and I hope you find the information helpful.

    Pertinent to your case you will find that hypothyroidism can certainly lead to low levels of testosterone which in turn would make both weight loss and muscle growth very difficult. If you haven’t already I would be sure to check both free and total testosterone levels in addition to total T3 levels and reverse T3.

    Men tend to tolerate hypothyroidism better than women due to receptor activity but I find that most men need more T3 than women to get symptomatic improvement. I would certainly consider searching for a provider who is willing to treat both thyroid and testosterone levels if necessary.

    You can find further reading here: https://www.ncbi.nlm.nih.gov/pubmed/15142373

    Reply
Sandra - December 2, 2016

Dr Childs, everything i am reading makes sense, but also very confusing. I had a partial Hysterectomy 4 years ago, gained 50 pounds, I have been on bio identical progesterone, testosterone and estrogen for the past 2 years now, all my rage, hot flashes, night sweats and lack of sleep are under control! but the weight will NOT move, i have done every diet, fasting, and my recent last attempt my hormone Dr suggested was HCG, and i did not lose ONE pound!! even the dr was shocked, if i was gaining, we would say, I am over eating, i have maintained 185-187 pounds for the past 3 years, since i am constantly on some diet, Dr did all types of Test, T3 T4 reverse, yada yada, my primary says i am pre diabetic, (by one point), my blood pressure can be a bit high, but all this started after hysterectomy. I am going to get a referral for endocrinologist on Monday Dec 5th, what do you suggest i ask for? I am desperate now, i cant take this weight anymore! even Juicing did NOTHING!!!!

Reply
    Dr. Westin Childs - February 19, 2017

    Hey Sandra,

    Generally most patients have to look outside of the insurance model to find the type of care I am advocating on this site.

    Reply
Charlotte - December 5, 2016

Hi Dr. Child’s,

I started on Levothyroxine 25 mg + Cytomel 25 mg in March. By June, I was suffering from palpitations and severe hair loss. I stopped the Levothyroxine three weeks ago and have my doctor suggesting two ideas – either start NDT 60 mg with no Cytomel or NDT + Cytomel 25 mg. I want to get my next step as sure as I can, because of my hair loss, have you experienced patients presenting with these issues? If so, is NDT + Cytomel or NDT (alone) the fastest way to stop the hair loss and get levels back to normal?

Reply
Allie - December 9, 2016

I was dx with Hashimoto’s 7 years ago at 43 yrs old after going undiagnosed for 10 years. Now, at 50, I have quit responding to Levothyroxine 125 mcg and have been increased to 150 mcg, but still suffer from dysfunctional metabolism (at 200lbs, I’m the heaviest Ive ever been in my life, but eat quite wisely), horrible fatigue, brain fog, and extreme joint and muscle aches. My quality of life has plummetted because I have zero energy, hair loss, dry skin, brittle nails and ache all over. I can barely walk my two dogs. My recent fasting blood work and metabolic panel had my glucose at 115 (fasting), AST is 9, WBC 3.89, HCT 34, MCHC is 37, B12 is 747 (untreated); my Free T4 is 1.5, Free T3 is 3.1, and TSH is 3.1, and Thyroglobulin antibodies are 77. After one month on 150 mcg Levothyroxine and B12 shots 1 x week, my symptoms remain with zero weight loss. Further, I feel I am in danger of being labeled a hypochondriac by my medical professionals. I have been prescribed Adderall for adult A.D.D. just to function effectively at work.

A recent hormone panel has my testosterone at l9, FSH at 8.0, LH at 5.0, estradiol at 53.90, progesterone at <0.20, and cortisol at 11.8. I am so disheartened because my doctor continues to say "all my levels are normal" but I feel no relief.
I have vitaligo and a history of heart arythmia and depression and suicide on my father's family side. I am convinced it is because on this autoimmune connection/dysfunction. I am very interested in trying Cytomel at a low dose, but I am worried about my heart arrythmia and the Adderall I am taking. I am also taking Atenolol, Citalopram as well.

My question…(1) should I ask for a reverse T3 and Leptin resistance test before I ask to try T3? Should I try T3 and T4 combination or just low dose T3 with careful monitoring of my temperature and heart rate? I am so desperate for relief, but I feel I am in this alone with my doctors. ANY ADVISE AND COUNSEL you can lend me would be so appreciated!

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    Dr. Westin Childs - December 9, 2016

    Hey Allie,

    The first place to start is always with testing because you need/should get that data prior to any treatment.

    Reply
      Allie - December 14, 2016

      I will of course get the testing first. Are those I mentioned in the above comment sufficient? What tests do you suggest I complete first?

      Incidentally, I applauded and respect you greatly for sharing your expertise, case histories and experience with the patients suffering with thyroid disease whom you have helped. You give me hope in spite of this very complicated heath issue.

      Reply
        Allie - December 14, 2016

        Sorry Dr. Child’s, by the tests I referred to meant: leptin levels, reverse T3, reverse T4, and TSH. Is this a sufficient screen? Would you suggest any other testing?

        Reply
Abby - December 9, 2016

Dr. Childs,

I have been trying to lose weight. I am currently on 137 mcg levothyroxine and 5mg of cytomel BID. Im weighing about 200lbs. Are their any weight loss ex: Advocare, etc… I had a thyroidectomy in 2008 for papillary thyroid cancer. It seems I lose a few pounds and gain a few pounds.

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    Dr. Westin Childs - December 9, 2016

    Hey Abby,

    I’m not really sure what you are asking in your question, if you can elaborate I may be able to point you in the right direction.

    Reply
Anita - December 27, 2016

I thoroughly enjoy reading your articles and want to thank you. I had a total thyroidectomy 4 months ago and have been feeling awful every since on synthroid 200 mcg. I was finally able to get my doc to prescribe cytomel and for the past few days I have been on cytomel only 50 mcg. I am feeling better and have more energy. Not sure if the dose is too high but apart from a slight headache no side effects so far. I was already experiencing hair loss on synthroid so hopefully that part will get better. Hopefully I will now be able to lose the 22 pounds I gained in 4 months on synthroid

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    Dr. Westin Childs - December 27, 2016

    Hey Anita,

    I’m glad you were able to start up on Cytomel. Are you sure it’s 50mcg and not 5mcg? Most physicians prescribe in the 5-10mcg range.

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      Anita - December 28, 2016

      Yes ithe bottle says 50 mcg tab of liothyronine sod. I was wondering why it was so high but aside from the slight headache I’m feeling pretty good. Do you thing that’s too high? I be been on 100, 125, 150, and last 200 mcg levothyroxine and felt absolutely horrible. No energy, hair loss, eyebrows falling out, dry itchy skin and a 22 pound weight gain. It has been horrible

      Reply
        Dr. Westin Childs - December 28, 2016

        It isn’t necessarily too high or too low. I have some patients on as little as 5mcg and some on 100mcg, it really just depends on the person and what factors influence their T4 to T3 conversion and T3 activity in the body.

        Reply
Antoinette - January 6, 2017

I have been taking Synthroid (brand) for years with no luck. Last year my endo switched me to Armour and that was terrible. It made my Hashi symptoms worse and I developed uticaria on my chest and neck. I was at the end of my rope and very frustrated. My endo then switched me to Tirosint and the relief was almost instant. No more uticaria and my energy level increased slightly. I was still complaining about hair loss, weight gain, body pains, and fatigue on the Tirosint so the doctor added 10mcg of Cytomel twice a day. I have to say that the addition of Cytomel changed my life! My energy level increased dramatically and my puffiness in my face disappeared. I still have body pains but I feel “normal” for the most part. I go back to the doctor at the end of this month and was going to ask if I could take the 10mcg of Cytomel twice a day, and add 5mcg midday. Thoughts?

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    Dr. Westin Childs - January 6, 2017

    Hey Antionette,

    It’s a reasonable approach to take. Most patients do much better on T3 but the amount of T3 they need varies wildly. The 20mcg you are taking might just be a small fraction of what you ultimately need, but even 20mcg is pushing what most endo’s are willing to prescribe.

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Bev - January 9, 2017

Hello Dr. Childs,

I’ve watched your video and read your other article on Cytomel. I had RAI in January 2016 for Graves Hyperthyroidism. After a year of adjusting my levothyroxine, my levels are “normal” (actually TSH is borderline hyper), however, I have all the symptoms of hyPOthyroidism. I have gained 20 lbs, fatigue, depression/anxiety, joint pain and stiffness, intolerance to cold, arthritis in hip, hoarseness) I had spoke to my endocrinologist last year about trying me on naturthyroid and he wouldn’t do it. Finally he has agreed to try me on Cytomel along with Levo though he says it’s risky for cardio issues and he does not think I will see any improvement whatsoever. I have my levels rechecked next month and if stable, I will begin the cytomel. At this point, I’m willing to try it because I know that something is not right and am willing to take the chance! The weight gain has been unbearable for me and along with the other symptoms, I do not even know who “I” am anymore. I pray this is my answer!

Bev

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    Dr. Westin Childs - January 9, 2017

    Hey Bev,

    The tiny doses of T3 that most providers give generally don’t make a huge difference (I’m guessing you will probably start with something like 5mcg per day). And in most cases it usually requires more than just focus on thyroid hormone for optimal results (you must address other hormone imbalances).

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Zenyatta - February 2, 2017

Hi Dr. Childs,

Your posts and resources have been wonderfully helpful to me as I’ve recently (last fall) learned that the 20 years of low TSH is actually Hashimoto’s. Some debilitating symptoms that presented last summer have benefitted markedly from the addition of liothyronine to my synthroid regimen (4 weeks in on 5mcg, 2x a day, along with 150mcg brand Synthroid qd). My TSH continued to rise and t3 fell, while t4 was stable, despite an increase from 134mcg synthroid and a recent rT3 test was at the very highest end of the reference range. Very happy with the changes the T3 have made so far! Very happy to have a solid relationship with my endocrinologist who intends to work with me to ensure my balance of synthroid and liothyronine are spot on.

I do have a question, as one of the symptoms that started last year was significant hair loss and I’m wondering if there’s a connection with all my symptoms, the need for T3, and perhaps Iron? Does iron play a part in converting t4 to t3, or could a lack of tissue t3 impact my body’s ability to process and absorb iron?

Thanks,

~Z

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Emily Bentz - February 11, 2017

Is there an explanation for why I feel spacey and generalized anger and unhappiness when I am on t3? My t3 levels are low making me hypo so I know that I need the t3 but it changes my personality. I am currently on compounded slow release 5mcg. I can tell after 12 hrs when it wears off because I feel happy again. Any advice would be greatly appreciated.

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Stephanie - February 18, 2017

I am trying a new approach by going to a natural path after decades of little help from stanDard dr. I was on armour 90 and the dr. Took me off of that to a component of liothyronine/thyroxine Sr 20/70 mcg. I was told to immediately stop the armour as it was working against me and take naps or whatever I had to until my others came in the mail. I was off 6 days and today took my first dose, but am worried now because you warn to ease into it starting with low doses. Should I be concerned about the dosage? -Stephanie

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    Dr. Westin Childs - February 19, 2017

    Hey Stephanie,

    You will have to discuss that with your current physician. There are many factors involved when determining starting dose and I don’t know the whole story so I can’t really comment on your situation.

    Reply
Rene' Sebens - February 21, 2017

Hi, I have just switch to Naturthroid I was on Synthroid for 10 years. On my last doctor visit all of my labs Free T3, Free T4 were normal my TSH was .31 This was a new provider a functional medicine MD and acupuncturist, she is leaving but will help me get started we talked about Cytomel to add. my question is I think my doseage is wrong I am taking Nature Throid 118mcg and my Synthroid was 137mcg, and should I take it under my tongue? and should I split it and take morning and later afternoon? Thank You for any response.

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    Dr. Westin Childs - February 21, 2017

    Hey Rene,

    Many factors go into deciding when and how much to take your thyroid medication, I wouldn’t be able to provide you with this kind of information without a detailed history so I would recommend you take those questions to the physician who originally prescribed you the medication.

    Reply
Leslie - February 27, 2017

Hello,
I had my thyroid removed in 2009. I started with Synthroid…after 2 years it all of a sudden stopped working. Then I went to Tirosint, which was ok. My bloodwork always said it was in the normal range. Then the weight gain started….and kept going. I feel terrible. I kept telling my MD. this can’t possibly be as good as it gets. I would cry, for no reason. He put me on Lexapro. So, 5 years ago I moved to Panama. The only med available is Eutirox. I spoke with an MD here and started on it. I though it would be easier than shipping med in. It works ok…keeps my levels in the range they should be BUT…continued weight gain, fatigue, joint soreness and back pain. I am exhausted all the time. I would like to try adding some T3 and have read your complete article. The thing is, down here, you go to the pharmacy and get it yourself with no RX. I have no idea what to do. Should I start with the 5-10mcg?
Thank you

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Aysha - March 7, 2017

Hi Dr Childs,

I tried introducing 5mcg of T3 to my Levo but after a few days I experienced terrible insomnia and was forced to stop after 9 days. I experimented with dosing at different times of the day but it made no difference. My Free T3 is low in range. When I took it in the afternoon I experienced afternoon fatigue. I’d really appreciate your advice. Please help.

Thanks
Aysha

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Michele - March 10, 2017

My Doctor prescribed Liothyronine (25 mcg). In your opinion, is this too high a dose to start for a borderline low thyroid? I’m really concerned with the hair loss side effects I’ve been reading about. Would starting with a lower does and slowly increasing the mcg over time increase the odds to not experience side effects? I realize you can’t give me personal advice so I’m posing this question anecdotally and of course will consult my physician about my concerns once I understand more.

This is an excellent blog and I appreciate all the information you are sharing.

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