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 which does NOT need to be converted to become active <--- Most Doctors do NOT prescribe this medication (Cytomel, Liothyronine, SR T3 (1))

Effects of cytomel on various tissues in the body

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 negative 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 patients benefit from taking it). 

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

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

How to Calculate "Optimal" Free T4, Free T3, & Reverse T3 Ratio: 

Calculating these ratios is important because it can help you determine if your efforts are on the right track and whether or not your medications are working. 

Download more free resources on this page

How Cytomel Causes Weight Loss

In order to understand why Cytomel causes weight loss, you need to understand the importance of thyroid hormone in your fat cells and mitochondria. 

Your thyroid helps control your metabolism and helps set your basal metabolic rate (2). 

​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)

​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.

This benefit has been shown in at least one study (3).

In this study, patients were given LT3 medication in place of their usual thyroid medication at equivalent doses and the researchers found that patients who switched experience an average of 4-5 pounds of weight loss without any other changes

These patients also experience an average reduction of 3-8% body fat.  

All of these were seen simply by changing the dose and without adding in any other therapies!

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. 

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?

The answer is not as straightforward as it might seem. 

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, hang on a second.

Effects of T3 on liver function and fat break down

Cytomel and other T3 containing medications aren't ideal for everyone, but based on my experience many 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 (4). 

​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 (5). 

The presence of any of the medical conditions (or symptoms) listed above may be an indication that you would benefit from using T3 medication. 

Cytomel Dosage and How to Use it Safely

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

It is estimated that T3 is about 3-4 times more potent at altering the TSH when compared to LT4 (6). 

Because of this, it's wise to monitor both your resting heart rate and your basal body temperature each morning if you decide to use this medication. 

​Why?

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

By monitoring both of these variables you can ensure that you are getting an adequate dose while preventing excessive dosing or 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 70-80 beats per minute while resting (note this is different from your resting heart rate while sleeping)

These variables, if combined with thyroid lab testing for total T3 and free T3, will help you determine your ideal dose. 

I recommend using these metrics instead of one-size-fits-all dosing recommendations because the variability between individuals is very large depending on factors such as sensitivity and genetic variance. 

Some patients may do well on small doses of Cytomel (5-10mcg per day) whereas others may need considerably more. 

For instance:

Studies have shown that, in the setting of treatment-resistant depression, Cytomel dosing can be as high as 70-100mcg per day (7). 

If you decide to start Cytomel make sure you start at a low dose and titrate or increase your dose up slowly over an extended period of time (weeks to months). 

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 start out at even lower doses while patients who have previously tolerated T3 medications in the past may be able to start at higher doses. 

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.

In fact, I would say the majority of people need some combination of T4 and T3 medications because this mimics the natural production of thyroid hormone from your thyroid gland

In a practical way, you can achieve this combination by simply adding Cytomel to your existing dose of Levothyroxine or Synthroid. 

By using both T4 and T3 you will be able to provide your body with both immediate and long-term hormones. 

When it comes to sheer power, Cytomel definitely is stronger than Levothyroxine.

Despite this, you are much more likely to have success in asking for a small dose of T3 compared to asking for a large dose. 

Many physicians are aware of the emerging research which shows that patients prefer combination therapy to monotherapy with LT4. 

When using combination thyroid hormone you will want to shoot for a ratio of close to 80% T4 and 20% T3 as this matches what your thyroid produces naturally

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.

This is just a rough estimate, however, as each person may need slightly more or less. 

You can, and should, also direct your dosing based off of your thyroid lab tests such as TSH, Free T4, and Free T3. 

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, each grain of NDT has about 38mcg of T4 and 9mcg of T3. 

If you calculate out the ratio you will find that the majority hormone in this formulation is T4 (about 76%). 

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

So, even though the medication contains some amount of T3 it may not be sufficient for certain patients.  

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 fewer symptoms (8). 

  • 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

T3 comes in two different varieties:

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

They both contain the active ingredient triiodothyronine but differ in how quickly they are absorbed into your gastrointestinal tract after ingestion. 

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 a few hours after ingestion (9). 

The fact that your serum levels rise in this time-frame isn't really the problem.

The potential problem is that some tissues (mostly cardiac tissues) are very sensitive to T3 hormone.

The majority of thyroid hormone receptors in the cells respond through a nuclear receptor which results in changes to genetic transcription (changes in enzymes, DNA, etc.).  

But, in cardiac tissues, T3 has a direct ionotropic and chronotropic effect (10). 

This means that higher doses of T3 can directly result in an increased heart rate and an increased force of contraction in the heart. 

These changes may manifest clinically as heart palpitations or a rapid heartbeat. 

Generally the sensation of palpitations is more concerning to the patient than it is medically relevant, but obviously, an increased 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 the 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 a high dose 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). 

​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 ingested will not necessarily equal 10mcg of SR T3 ingested.

If you are contemplating switching from IR T3 to SR T3 it's important to consider these variables as they may alter your dose. 

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. 

Common side effects of Cytomel include: 

  • 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 patients experience when starting or increasing the dosage of Cytomel but that doesn't mean that they are necessarily common. 

When you are replacing thyroid hormone that is deficient in your body you should only have positive side effects. 

If you are experiencing negative side effects then that may be an indication that your dose is too high or that you increased your dose too rapidly over a short period of time. 

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. 

You'll know that Cytomel is working if you experience any of the following positive side effects: 

  • 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 and none, or very few, of the negative side effects listed above. 

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 this isn't true of all Doctors.

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.

Factors such as taking certain supplements, adopting a healthy exercise routine, changing up your diet, and reducing your stress can all impact thyroid conversion. 

​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 and 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.

Conclusion

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 overdose 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!

References (Click to Expand)

This post was most recently updated on August 1st, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

288 thoughts on “Does Cytomel Help with Weight Loss? Dosing guide + How to use it”

  1. 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.

  2. 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!

    • 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.

    • 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.

      • 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.

  3. 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

    • 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.

  4. 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.

      • I noticed a difference immediately in my energy levels. Is that just placebo effect then? Should I be expecting to get more energy, even possibly anxious as I continue taking it?
        Thank you for all the information in this post!
        I am currently taking 75mcg synthroid once a day, and 7.5mcg SR T3 every 12 hours. I have been on the SR T3 for 5 days.

  5. 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!

    • Hey Rebecca,

      Cytomel and T3 can definitely increase hair loss. I have had many patients complain of similar symptoms.

  6. 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?

    • 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.

  7. 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

    • Hey Tina,

      Each patient is very different, you will have to use trial and error along with a knowledgable doctor to figure out what works best for you.

        • Each dose of T3 is only “effective” for three to six hours. YOU are the ONLY one who knows if it lasts YOU three hours, four hours, five hours or six hours. Each dose of T3 is completely gone from the body in TWO days, so you can and should increase every third day (either by adding another dose or by increasing a dose you’re already ingesting. IF your dose lasts you only three hours, and you are able to sleep eight hours, you’ll need, essentially, six doses a day. Increase “slowly” to determine if you’re “allergic” to the FILLERS. If your dose lasts you six hours, and you can sleep eight hours, then you’ll need at least three doses a day.

          I’m thyroidLESS, ingest ONLY T3. My body temp AVERAGES 96.4; my “lack of energy” is due to an adenoma on my left adrenal. I’m not symptom-free, but I’m not sitting in a wheelchair dying of congestive heart failure not one of about 30 different men with M.D. after their names could explain, while religiously ingesting a ONCE-daily SUPPLEMENTAL dose of a generic T4-ONLY drug based solely on my annual PITUITARY lab test result anymore either.

          Labs aren’t using accurate reference ranges; TSH and FT3 lab tests’ results are time- and gender-specific (women need more T3 than men; FT3 peaks at 3-4 Am and bottoms out at 3-4 Pm; all healthy thyroids directly secrete more T3 during colder temps outdoors). It’s NOT possible to replicate a healthy thyroid from the OUTside IN, but you CAN “recover” to a point where you’re not just existing or barely surviving. The FT3 converted from FT4 is NEVER “enough” FT3 for ALL cells, and the FT3 converted from FT4 is ALSO only effective for three to six hours. FT4 needs seven to ten days to be converted, which is why you wait 10-14 days to increase a dose of T4. Again: each dose of T3 is only effective for three to six hours, and is completely gone from the body and brain in TWO days.

          INGESTED hormones aren’t as easily absorbed nor as easily used by cells as SECRETED hormones, so, in general, you must ingest MORE than a healthy thyroid would secrete. So, if your doc doesn’t know how much (in mcg) of which hormones a healthy thyroid secretes, or when it secretes them, chances are he won’t know how much to prescribe or what instructions to put on your prescription bottle. In other words, doctors prescribe supplementation rather than replacement, because replacement requires an understanding of how a healthy thyroid actually works AND how the various meds CAN’T work the same way.

          I’m REPLACING both the FT3 I would convert from FT4 AND the T3 a healthy thyroid would directly secrete FOR me AS A WOMAN. See the current Family Practice Notebook online for FT3 reference range. The 2002 edition of the Family Practice Notebook said, for FT3, men test between 2.3 and 5.0 and women test between 4.25 and 6.19, so a reference range of 2.0-4.0 or 2.4-4.2 doesN’T include healthy women who have a healthy thyroid (they’re diagnosed as hypER nstead)!!!

          WHEN the “acceptable standard” of “care” permeating all specialties of HUMAN medicine is “practiced” on chimps, it’s called the punishable crime of CRUELTY. The outcomes of “practicing” cruelty on one in every eight women and only God knows how many men, children and infants are: abuse (T4-only), neglect (no or not enough T3), permanent disability, bankruptcy and murder. Chimps were “retired” from “medical service” effective 12/31/15. Humans areN’T substitutes for chimps!

          Don’t “settle” for cruelty, especially if you are a thyroidLESS woman and some man with initials after his name thinks he knows how to be YOUR thyroid FOR you, from the OUTside IN. Personally, I get “irregular beats” when I’m required to not ingest any T3 before a blood draw. This increases my chances of heart attack or stroke, exponentially, so I no longer consent to purposely become hypO by no longer paying for lab tests. When you’re ingesting T3, doctors think hypO symptoms are hypER; my experiences (and those of others) prove otherwise….

          • I’m sorry to report that Barb passed away from heart failure at the end of 2017. While she was a valiant thyroid warrior and was able, by self treating with T3 only, to progress from being in a wheelchair and near death from poor thyroid care to leading a relatively normal life that included the birth of beloved twin grandbabies, her heart just couldn’t take it anymore. Barb reacted very badly to T4 even when combined with T3 and felt that T3 singularly was her only option, but it is not known whether her T3 only regime contributed to her death. What is known is that the years she had out of the wheelchair and especially the time she had taking care of the twins were happy ones. I wish she had had more time. RIP.

  8. 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?

    • 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.

      • So, sounds like Cytomel is NOT a good option for women. We cannot live without our hair. My hair loss keeps me housebound most of the time and I’m not even on that drug. I guess I’m a bit confused as to what does and does not work to balance hypothyroidism. I am status post TBI 28 years ago, undiagnosed for adult growth hormone deficiency due to the TBI for 20 years, with replacement hormones for pituitary, thyroid, HRT, and sometimes the adrenal glands. I take 50 mg Triosint (T4) and 150 NP (T4/T3) and still feel awful, can’t lose weight, etc, etc. I don’t understand why we are given man-made T4 when natural thyroid contains both T4 and T3?

        • Hi Deborah,

          I would encourage you to read through this article which may outline why you are having issues with hair loss: https://www.restartmed.com/thyroid-hair-loss/

          There are many reasons hypothyroid patients struggle with this issue and it’s not as straightforward as taking or avoiding certain medications. That article may help shed some light on the complexities of that particular issue.

          Also, it’s not that cytomel causes hair loss always, it’s just a potential and reversible cause of hair loss in some patients.

    • Hi,

      Did you ever fix your hair loss? Look up diamataceous earth. It will grow your hair fully back.

      Cheers

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

    • 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.

  10. 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?

    • 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.

  11. 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.

    • Hey Pamela,

      Unfortunately the only option I am aware of is to pay out of pocket for a private Doctor in the UK.

  12. 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.

    • 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.

        • 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.

          • I have been taking NDT for several years. I have fibromyalgia. I am exhausted all the time. Would cytomel be possibly helpful?

          • Hi Jennifer,

            Possibly, but you would need to check your thyroid lab tests before you used the medication to determine if it was necessary.

  13. 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

    • 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.

  14. 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

    • 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.

  15. 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.

    • Sarah, you may have to do what I did, fire your doctor, and keep firing them till you find a doctor that realizes you Are proactively watching your health. I went through 4 endocrinologists before my current doctor. Also, I had my DNA health deciphered handed it to my doctor, here’s my user manual, utilize it- don’t guinea pig me. After reading my paperwork, my Dr. Discovered my body doesn’t synthesize levo.

  16. 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.

  17. 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.

    • 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.

      • 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.

    • 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.

  18. 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 .

    • 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.

  19. 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.

    • Hey Rene,

      To date I have had exactly 1 patient gain weight on cytomel, I don’t know the mechanism but I’ve seen it happen.

  20. 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!

    • 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.

  21. 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

    • 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.

      • Dr Childs. I have tried so many times to call and get you to see my daughter but it has been impossible to get a hold of you. In December 2016 my daughter had a total thyroid removal (no cancer but full of nodules). She has hypothyroidism takes 137mcg of Levothyroxine and finally the doctors about 2 months ago added 25mcg off CYNOMEL. She has to loose about 30 pounds she has lost 10 in one month but it has been super hard. In June we learned she was LEPTIN resistant (range 3-11 she had 59). And about one month ago we learned she was insulin and Glucose resitant (3 hour test ; at the 3rd hour result showed Prediabetic insulin 222 and Glucose 195) so she has been on 1000mg of METFORMIN in the morning and 1000mg METFORMIN with dinner. We tested HBA1C after one month of being on METFORMIN and thank God she is controlled 5.0. She is on a very low carb diet, excersizing 2 hours a day (aprox) 5 days a week. She does present rapid heart rate 100 rating pulse; EKG is normal but her thyroid hormones look great now. And she feels good; (T3 total 1.73 (0.69-2.15), T3 Free 4.93 (2.39-6.79), T4 total 10.53 (4.5-12.5) T4 free 1.41 ( 0.60-2.00) , TSH 0.1 (.25-5.00). Do the hormones look good to you???
        But still hard to loose weight. What else can we do????

  22. 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.

    • 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.

  23. 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???

    • 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.

  24. 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.

  25. 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?

    • 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.

  26. 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??

  27. 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?

    • 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.

  28. 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!

  29. 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!

  30. 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.

    • Hey Anne,

      You may never notice a difference if your dose is too small. Most people notice a difference within 4-6 weeks.

  31. 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?

    • 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).

      • 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

  32. 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.

    • 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.

  33. 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.

    • 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.

  34. 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.

    • Hey Inna,

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

  35. 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

    • 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.

  36. 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?

  37. 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

  38. 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.

  39. 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!

    • 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

  40. 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!!!!

    • 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.

    • Sandra, Have you found any solutions yet? I am exactly your age and weight, and I take estrogen patches and progesterone tablets for hot flashes which are under control. But nothing helps the weight gain! I take 15-20 mcg of Cytomel (straight T-3). I feel good, but miserable due to the weight gain.
      Thanks, Lisa

  41. 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?

  42. 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!

    • Hey Allie,

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

      • 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.

        • 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?

  43. 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.

    • 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.

  44. 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

    • 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.

      • 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

        • 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.

  45. 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?

    • 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.

  46. 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

    • 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).

  47. 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

  48. 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.

  49. 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

    • 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.

  50. 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.

    • 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.

  51. 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

  52. 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

  53. 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.

  54. Your reading bave helped me so much. I tried to schedule a paid consult but they said you were not taking any more clients. I have hashimotos and recent tests showed hight T3 and high RT3 (23) if I have T3 pooling how much T3 should I take to decrease the RT3 but also help me? I have extreme fatigue, keep getting sick, gained weight. I assumed no T4 until RT3 is lower but I don’t know how to dose the T3 since labs showed this was high too. Also do you recommend any good doctors in the NYC area? Thank you so much!

  55. Hi Dr Childs, I have had a total thyroidectomy due to cancer. I take NDT which has been lower as my tsh was suppressed. Though i felt fine. Problem is now i have gain weight and have constipation, even though my diet is good.I don’t eat meat or dairy. Doctor is happy with my tsh levels now. Do you have any suggestions.
    Thankyou Jennifer

  56. I’ve gone thru 5 endocrinologists to date……..NONE will discuss adding T3 to my levothyroxine. I have all but given up. Lost my thyroid due to cancer. I even called the CVS pharmacy and the pharmacist said he doesn’t have hardly anyone who prescribes cytomel…… maybe a couple prescriptions a year??? HOW, do I find someone that will even consider it. Talk about frustrating.

    help!

    • Hi Kim,

      It can be difficult to find someone. Generally your best bet is looking outside of the insurance model.

  57. I take 175microg. of levothyroxine with 50mg cytomel daily. I have lost weight finally. I was diagnosed with advanced thyroid cancer and goiter at 30 y/o. After a few years of adjusting my levo dosages, I researched hormone therapies for thyrodectomy patients and discussed my options with my PA. I also pay cash for appointments and medications, which I feel gives me more options and leverage than those using traditional doctors. My biggest health challenge continues to be extreme fatigue.

  58. This was a wonderful article as I have been exploring recently. I am 50 and was diagnosed with hypothyroidism when I was 26 years old. It runs in my family amongst most of the women. I was on Synthroid only until about 10 years ago when my dr. put me on Cytomel as well. I started with 5 mcg. My Synthroid doses have changed over the year based on lab work.
    I am currently on 112 mcg Synthroid and 10 mcg Cytomel. I am feeling all the symptoms again lately: extreme fatigue, brutally dry, weight gain (even though I am a gym rat), etc. I am dry to the point that my skin hurts to be touched sometimes.
    Would an increase in just Cytomel likely help? Or would it be an increase in both?
    I am definitely going to be bookmarking your site!

  59. I have Hashimoto’s and after starting the Cytomel, I am starting to feel a bit better. My son also has Hashimotos and is morbidly obese. We got the “chubby kid” talk for years and nobody would listen to me about my undiagnosed thyroid issues when pregnant with him. He is only on 112 mcg levothyroxine and has severe symptoms, still. His TSH was 3.79 and T4 was like 0.9 at last lab. His endo did not want to put him on anything different. Is T3 safe for adolescents to take? I am taking him to see an APRN May 5th because I know how they run the clinic I am taking him to and think they listen to patients and are up to date on current evidence and guidelines. What are your thoughts on this? (He is 5’7 and 230 lb at 12 years old- He was a 7 pound full term baby, no complications at delivery, and though he was always pretty tall, he was really thin (10th percentile) until he weaned at 27 months old). Also to note, when he was first diagnosed, his triglycerides were in the 400s, and, though A1c was fine, he has some acanthosis nigricans, so I am worried he is developing T2DM (his younger brother has Type 1). Thoughts?

  60. Is there a range for optimal TSH, FT3. and FT4 on Cytomel only? I’ve read these tests aren’t meaningful when on T3 only. The lab reported my T3 is above normal & T4 was below normal and TSH was normal which I’d expect 3 hours after taking T3. I feel better being off Synthroid.

  61. Hi ,
    I had a near total thyroidectomy in April 2010. I was initially placed on Synthroid 100mg then I was increased to 115 to to 135 to 150 and I’ve been on 175 for almost 2yrs. I workout 3-5 days a week.Im on all natural vitamin supplements by Youngevity &it has helped me tremendously. I eat fairly healthy ect. But Im often tired, lethargic,Moody,no energy ect. I dont know what it feels to be normal. I do have good days but i habe those days i really have to still push myself to say active. I’m 36yrs. I dont think my T4 is Not being converted to the active T3 because I’m gaining weight in spite of exercising ect. I’m 20 lbs heavier than my normal weight .What do I do???

    • Hi Virginia,

      Nowadays I don’t prescribe armour thyroid very often, I usually prefer WP thyroid if I’m using NDT.

  62. Hi Dr. Westin Childs,

    Thank you very much for writing this article. I have been working to treat a persistent, inexplicable weight gain for about 1.5 years now, and this article was like a glass of water in the desert.

    I eat incredibly lean, and exercise regularly, however, had a surgery in November 2015 and ever since then, my weight slowly climbed from 140 to 156 and it won’t budge. I have tried the following:

    -Baby dose of cytomel (5 mcg), no results
    -Baby dose of Liothyronine, no results
    -One grain of Erfa Thyroid (i.e., desiccated), no results

    My labs all show the lowest end of normal, however, a new GP agreed to try me on 15 mcg of Cytomel in conjunction with an adrenal support supplement from my naturopath. I started on May 5th; I weighed myself about 10 days later and my weight was the same. To be honest, I was very discouraged. Is this unreasonable? I read that cytomel’s effects are immediate; is this not the case?

    Any input would be greatly appreciated – again, thank you so much for taking the time to write this article.

    Warm regards,

    Natalie

    • Hi Natalie,

      If you’ve already tried cytomel and it didn’t cause weight loss then it’s not likely to cause significant benefits in incrementally smaller doses. T3 is more of an augmentation to weight loss, than a true weight loss therapy itself. You can find more information about layering medications, supplements and therapies for weight loss in my guide here: https://www.restartmed.com/hormone-mastery/

    • Hi Natalie,

      I am having the same issue. I am not on 75mcg and nothing. While everyone is looking thousands of pounds…nothing for me. Lets connect and share what works. Please e-mail me at [email protected]

      I would like to connect with you.

      Galina

  63. Loving this article! I am currently self medicating T3 and T4 and used to take 150 T4 but have switched to 125 T4 and 25 T3. Does that sound OK or too much T3?

    • Hi Emily,

      Each person requires a different amount of T3 based on existing resistance, reverse T3, body weight, metabolism, etc. so I can’t really say for sure.

  64. Here is my question: Does a high Reverse T3 level suppress your TSH? I ask this because I have midrange Free T3, normal range Free T4 and total T4 and my TSH is now below .1, but my RT3 is a nasty 34. Also, can allergies be the cause of a high RT3?

    • No it doesn’t suppress your TSH. Your TSH is likely suppressed because of whatever medication you are taking.

  65. I’ve read reports of generic Cytomel causing acid reflux and heartburn that improved on (expensive) brand name Cytomel. Any reports of this?

    • I’ve never personally dealt with this, but it wouldn’t surprise me. It’s relatively easy to switch from brand to generic and would be worth the extra money if it didn’t cause reflux in some patients.

  66. Hello,

    My doctor put me on Cytomel and I’ve been taking it for 3 weeks. I absolutely have zero rise in pulse or body temperature. I started with 25mcg and now on 75mcg and still nothing. I dont understand how is that possible and why its not increasing my body temps. I’ve noticed that my body temperature went lower actually. Can you explain what would be the reason and what should I do. Its a bit frustrating. Should I increase the dose? Please explain to what do u feel is going on.

  67. Hello Dr. Childs, I have been taking 25mcg of Cytomel alone for about a year now. My most recent lab results show that my T3 is high (5.4) and my T4 is low (.23). Do these results indicate too high of a dosage of Cytomel, or possibly, too low of a dosage? I feel fine with exception of increased hair loss recently. Thank you very much.

    • Hi Kileen,

      There’s much more to interpreting your lab results when taking T3 including other factors such as sex hormone binding globulin, total T3, body temperature and resting heart rate. I discuss how to interpret lab results when taking T3 in my weight loss guide.

      • How come you answered Kileen question but skipped mine and didnt answer me? Thats strange. I asked a question few days before Kileen

  68. I have 3 years of labs with 2 different meds and unmedicated.
    My current situation is I have heart palpitations, sweating 24/7, weight gain, headaches, foggy. Was just raised from 25 two weeks ago to 37.5 Levoxy t4, 5 Liothy twice a day, 200 mg Selenium, Vit C, Turmeric, Probiotics refrigerated 5b sacchromyces boulardi and Bio MOS, 10b acidophilus Bifidus, vit D, occasionally Lysine. I weigh 185, 5’6″, late stage Lyme for 5 years treated with antibiotics, wormwood, licorice, Black walnut. Adrenal adenoma 14mm. 9mm nodule on liver benign appearance, Cyst ovary 2.2cm, uterine thickness being monitored. Healthy everywhere else. My resting heart rate 75, temp and blood pressure normal for last 5 or so years before that 96 was my healthy temp since I was a teen with blood pressure consistently 90/60 with good energy and I’m almost 50 now.
    2017 25-t4,10-t3: 1.11 TSH, Total t3 98, 0.7 Free t4
    2016 Unmedicated: 5.98 TSH, 2.9 Free t3, 0.9 Free t4
    2013 2gr Armour : 0.03 TSH, 6.3 Free t3, 1.0 Free t4, 13 Reverse t3
    I felt great with the 2013 dose when labs were done, lost patches of eyelashes though. 3 months later I gained 5lbs was sluggish depressed.
    After reading about too much t4 and I had recent reaction to raising it I dropped Levoxy to 12.5 today and want to raise Liothy from 2-5mcgs a day to 3 since I crash at 4 ish every day and wake up at bedtime. I have permission from my Doctor to change the meds. What are your thoughts on my history and current situation please?

  69. Hi Dr. Childs,

    Your website is the only one that made sense and provided all the information about hypothyroidism/hashimoto for me. I’ve been on levothyroxine for 10 years now. I’m 36yrs old. I started off at 25mcg Levo and it went up 25mcg with 2 pregnancies so I was at 75mcg. The doc said I was fine to stay at 75mcg since my labs looked fine. Recently, o started bloating, frequent urination, gaining weight, hair loss, depression..etc. I workout 5 days/week and ea clean. I’ve always been heathy. I knew something was wrong with my thyroid so I went to my physician and asked them to do a test- he only checked tsh and t4, and later after reading your site – I asked for full panel thyroid test and found out I had Hashimoto. I’ve been on gluten, dairy and soy free. Also, had more rt3 and t4. So I asked to be on cytomel. He put me on 5mcg and lowered my Levo to 50mcg. I felt awesome after taking cytomel-energetic, losing weight, positive,but been on for 3 weeks and now I’m feeling the same bloating, depression and fatigue. Do you think I need to up my cytomel to 10mcg? Also, I also think it’s adrenal issues. I was planning to take Ashwagandha. I already take zinc,selenium and multivitamin. Please advice if the symptoms could be a sign that I need to up my cytomel?

  70. Hi Dr. Childs,
    I’m 41 and have been on levoxyl for nearly 10 years. I was first diagnosed when trying to get pregnant. TSH was around 3.5 so not super high but they wanted it around 1 for pregnancy. I’m on 50mcg but I just switched endo’s and he noted that my free T3 was still low at 2.6 despite my TSh being 1.8. I’m not overweight (5’2″ 119 lbs) but I do feel “puffy” for me (weight was around 108 before starting levoxyl 10 years ago)and cannot shed a pound despite clean eating and running 20 miles/week. Do you think cytomel might be right for me? Oh and temp is super low…96.8 -97.2. Thank you!

  71. Thanks for your article. Can you please recommend a doctor in Vancouver, Canada that understands this? I need help,thanks

  72. Hello dr westchild.

    I have a question about the ft3 ratio?
    My reverse t3 is low o.33 0.22_0.54.
    So I think my rt3 is good but my ft3 is 4 3.1_6.8 so my ratio is not good 12.7.

    Do I have a rt3 problem because of the ratio. Can you tell more about this? Or not because the rt3 is normal?

  73. Hi there,

    I had a total thyroidectomy four years ago.

    I am 5″10 and 160 pounds and always have been. I was on an extremely high dose of sybthroid to keep my tsh suppressed. I am now on a more normal dose.

    My t3 was low with a high dose and it is low with this normal dose. I show zero hypothyroid symptoms besides being tired. All of my blood and cortisol tests are perfect. My t3 ratio is off. It is just below the normal range. Any idea why?

    That being said I am going to add .5mcg of cytomel to my 125 mcg of sybthroid a day.

    Last time I tried this I puked for five days straight. I quit after that and want to try it again. I do not want my heart rate to raise. It is resting in the 50s currently. Any advice if this is a good idea? I take 125 mcgs synthroid 9 times a week and will add. 5mcg of cytomel. Let me know your thoughts.

  74. Hello 😉

    Thank you for taking the time to read and help everyone, it’s so generous and life changing… I’m currently on 100mcg synthroid with 25mcg cytomel (1/2 in the am 1/2 afternoon)… I also have adrenal fatigue and I’m taking adaptogens plus adrenal cortex.. it seems in getting hyper..I feel Palps and I’m shaky dizzy foggyv etc. .. I’m wondering what the next dose down would be? I have to be very specific with my doc for dosing… as he prefers to just scribe synthroid…

  75. What dose do you suggest a person with high reverse T3 take of Cytomel (liothyronine)? Here are my 2017 and 2015 thyroid test results (With Free T4 & Reverse T3):

    My Thyroid test results (With Free T4, Reverse T3, & Thyroid Antibodies Tests):

    2015 Result (38 yrs old) 2017 Results (40 yrs old)
    TSH: 3.350 TSH: 3.2
    Thyroxine (T4): 8.0 Thyroxine: 7.5
    T3 Uptake: 32 T3 Uptake: 29
    Free Thyroxine Index: 2.6 Free Thyroxine Index: 2.2
    T4 (Free, Direct): 1.19 T4 (Free, Direct): 1.26
    Reverse T3: 20.5 Reverse T3: 33.0
    Triiodothyronine (Free, Serum): 3.0 Triiodothyronine (Free,Serum): 2.9

    2015 Thyroid Antibodies Tests:
    Thyroid Peroxidase (TPO): 34
    Thyroglobulin Antibody: <1.0

    I need you advice on what you think is going on here. What you believe my situation is since you seem to be very knowledgable and the doctors may not always have a clear of what is going on. I was treated for mental illness and bi-polar disorder and and accidentally overdosed on psychiatric medications when the doctor handed me a hand written note instructing me to take 8mg of a psychiatric medication, when the highest dose anyone was supposed to take was 3mg. Anything over 3mg was an overdose amount. I do not know why he told me to take 8mg. Medical negligence I guess. Sick of doctors, sick of being misdiagnosed. I have been having nerve pain, heart palpitations & pain, joint pain, back pain,(vertebrates crack a lot and shift, I was in 3 car accidents and was diagnosed with slipped discs), insomnia, low libido, small nerve twitching in arms and legs after sex, dry skin, memory issues, brain fog, itching.

    I would like to get all of these symptoms resolved once and for all. I have been living with them for quite some time I think(I got so used to it, I didn't realize anything was wrong, I think it just became normal, I have a high pain tolerance, might be why). I need to know from someone who knows what they are talking about what dose of cytomel is recommended so I know what dose to ask for when I see a doctor. Do you have any advice or recommendations for me after looking at my test results?

  76. Hi
    does cytomel have a short half life? if I were to experience palpitations due to cytomel how soon after taking my dose would that be
    like if i took cytomel at 7am..the racing heart I experience at 6pm will be due to cytomel or will it have already left my body? I hope I am making sense..
    Kind Regards and Thank You for this post

  77. I persuaded my GP to subscribe T3 (liothyronine 5mcg.) 2 two months later my tsh went from 1.21 to .35
    She told me to cut the dosage in half.
    I had a TT one yr ago and am currently taking 125mcg Levothyroxine.
    Does the T3 lower tsh?

    • Hi Laura,

      Yes, all forms of thyroid hormone replacement will lower TSH. T3 happens to be about 3x more potent than T4 at lowering the TSH.

  78. What are your thoughts on taking cytomel, synthroid, iron and hormone replacement? Is it best to separate all these with a 4 hour window? I’m tending to get up at 5:00 am just to take the cytomel. I feel like drugs run my life schedule.
    Hashimotos
    I’m currently on 10 mcg of cytomel .075mg synthriod in the morning then 5 mcg of cytomel at lunch
    I’ve recently lowered my T4 after reading your blog I have halfed it and thought I should possibly quarter it? I’m still feeling tired and weighty.

  79. I go to a functional doc and was told my thyroid was under active. I was given the smallest dose possible of naturethroid and after a week had hyper symptoms… Racing heart, etc. Would I probably not be able to tolerate T3 either? It’s so frustrating!

  80. Hi! 2012 DX: non Hodgkins lymphoma, had Chemo treatment then developed thyroiditis! Was on low dose of levothroxin for 5 years! Last 2 years developed all the symptoms of hypothyroid with 40 lb weight gain past 2 years, along with cold sweats, extreme fatigue, brain fog, leg cramps! Cold sensitivity ect! Dr checked my tsh level is was 78.9. Rechecked after 6 weeks of 37.5 of levothyroxin. Tsh down to only 64. Saw internal medicine he checked t3 and 4. Said both were low. T3 was 40. I’m now on levo at 75 mcg and started me on liothyronine at 5 mcg! I have been in remission for past 5 years. Took Ritoxin IV for 2 years after done with Chemo last dose of Rituxin was 2 years ago. My question is. Have you ever known a tsh to go that high?
    ,

  81. On Cytomel only, Free T4, is very low. Do I need to add T4? I’m having terrible muscle cramps and spasms around rib cage and across shoulders.

    • Hi Terry,

      That would depend on a number of factors and would depend on the individual but not something that I would regularly recommend anyone do (especially now without physician oversight).

  82. I am on levothyroxine 0.2 mcg for the past 20 years. Back in 2001 I went on the depo-provera shot for a year. I noticed I started gaining weight. I stopped the depo and have never been able to get the weight off.
    I had my blood work done
    My TSH is 0.03 mlU/L
    FREE T4 is 21 pmol/L
    FREE T4 is 4.3 pmol/L
    FSH is 23.6 IU/L
    RT3 is 23 ng/DL

    My dr started me on cytomel 5 mcg the first few days I felt good then I started getting tired ,ankles swelling so he uped me to 10 mcg. Then to 25mcg.
    After taking the 25mcg I started having breathing problems ,headaches ,on edge, sleepy ankles swelling ,brain fog and sweats weakness. My basal temp before cytomel was 95.7 after medication 97.7.
    Even when I’m sweating profusely my internal temp is 96.7 at times .
    Because of my symptoms he told me to stop the t3 until I get my strength back up.
    What I want to know is how do I find out my adrenals are working . I just want to feel better , I’m 47 and feel like I’m 90. I have no energy I just want to sleep.
    Do you have any suggestions to help me get my life back.
    I would love to hear your opinion if there’s any help for me . Thanks

    • Hi Wendy,

      You can test your serum cortisol and then look further if necessary by evaluating your urinary/salivary levels. You can read more about that here: https://www.restartmed.com/cortisol-test/

      There’s always hope, it will just take the right approach to get things back in order. Your situation may also be complicated by peri-menopause/menopausal changes to your sex hormones just given your age.

  83. Hi I started taking cytomel last September 30, 2017 2 50 mcg a day so that’s one in the morning and one in the evening. I’ve noticed that the effect on me is that my hands were shaking and on my 3rd day nothing has been changing or in short i don’t see results. So i asked the pharmacist who sold me the drug, why isn’t the product working on me. He also said that i don’t need to go on a diet and i can eat whatever i want incase i crave. But still im on a healthy lifestyle so every morning i run and watch over what i eat and still i don’t drop off my weight still at 59-60 kg. So last tuesday October 3, 2017 he told me to increase my dosage on 4 50 mcg a day so 2 in the morning and 2 on the evening and still it’s already sunday October 8, 2017 and nothing is happening. I don’t see any results at all which i really feel bad because i need to shape up right away for this position that i am applying for. I seek your help on what to do and how is the proper intake of cytomel. The only positive results i see is that my sleeping condition is okay and i have more energy but weight loss doesn’t show any results. Or would this take time to clense and fix my metabolism? I hope you can help me. Thank you!

    • Hi Paris,

      Cytomel isn’t a weight loss medication in the sense that it will directly cause weight loss. It will only help with weight loss if you have hypothyroidism, meaning your thyroid was low to begin with. If you take excessively high doses of cytomel but your thyroid is fine then it really won’t help with weight loss. I discuss how to use cytomel and, more importantly, how to combine it with other therapies to help with weight loss in my guide: https://www.restartmed.com/hormone-mastery/

      • Thank you for answering and i’ve seen the link that you pinned in this comment section. So by chance when you said my thyroid is fine so I don’t need to take cytomel? Or is it fine if i take it for weight loss? Can you also advise me how to use it properly with how many amount of tablets i should take a day. Thank you so much!

  84. I have forced my dr to remove me from synthyroid because i couldn’t function on it at all gained tons of weight almost went bald and could never stay awake. I have tried a few natural ones. Armour i didn’t do well on at all. Then i was kinda okay on nature thyroid but it went on national back order. So now i’m on NP thyroid and having a hard time adjusting. The pain, fatigue, joint and muscle pain is really bad and the insomnia is horrible. and at the last appt this week found where i had been stable with weight I have recently gained 10 lbs in the last few weeks. I feel I could benefit from this on a low dose. I find resistance from specialists because they don’t even want me on NDT. How do i get them to try and add cytomel to my day? this last dr only wanted to test my TSH and I made him put in t4and T3 and he argued with me on rt3. but thats all they test me for each time. I need help. I want to feel normal again or as close as possible.

  85. Hi Dr. Childs, my tsh has been taken 5 times in the last few years, usually around 1.5-3. Having pcos and insulin resistance, I had a lot of problems losing weight. Taking phentermine with low titrating doses of topirmate was the only way I could lose the weight, the lowest my tsh has been has been while being on those meds and losing weight (1.5 tsh), after stopping those meds I was able to keep my weight the same around 145 for a few months while I tried to get pregnant, my tsh was about 1.5, t3 140-152, t4 7.6-10, free t3 2.94-3.1, free t4 1.08, reverse t3 20.3-30.3, insulin 5.5-8 (on metaformin), sex hormone binding globulin 80.9, cortisol 31, tpo 11, drvvt 33, vitamin d 30. Anyway, right after they did my first frozen embryo transfer, they took another tsh (right after implantation about 5 days later I think and my tsh went from 1.5 to 3.66, which my RE promptly put me on synthroid 50mcg. I miscarried a few days later. I stayed on the synthroid as we are going to do another FET this month, the first tsh level at baseline before any estrogen was added was .89. My hair last month was falling out at an alarming rate (when it spiked to the 3.66), it has slowed since the synthroid or maybe just because of the miscarriage, but it still falling out every time I run my fingers through it. And I have gained 10 pounds in just a couple weeks after starting it. Do you think because of my reverse t3 being elevated and having pcos and being on metaformin I should ask to start on 5mcg of cytomel with the synthroid? I can’t help but think that it may have made my tsh come down, but with the sudden weight gain so quickly, maybe I am more prone to making reverse t3 than t3. I’ll have to get another set of labs to be sure. Any input would be greatly appreciated.

  86. Hello. Thank you for providing this information on your site!

    My TDEE, based on meticulous food/activity logging (weighing/measuring food eaten daily for years) is typically around 60% of what it should be according to various methods of prediction. I am currently exclusively breastfeeding my baby, but I have seen no weight loss despite eating the same amount of calories on average as I did prepregnancy; it appears my body simply downregulates.

    My temperature hits lows of 96.3 on any cool day (below 70 degrees), and is generally around 97 on the warmest days. This is with taking 1.5 grains of Nature-throid daily. I find I cannot increase above this level without having episodes of tachycardia (113 resting) and/or hypertension (blood pressure rises above normal levels for a few hours, usually resulting in a migraine).

    I’ve had issues with low body temperature & very slow metabolism my whole life, though I am doing much better now than around 10 years ago, when I was gaining weight on anything over 800-1000 calories per day intake.

    I have Type II diabetes, but I am currently controlling my blood glucose levels with diet/exercise; I controlled them during pregnancy & before with the addition of Metformin, which I started in 2015 due to an increase in fasting glucose levels despite postprandials continuing to be normal. I am typically around 5.5 A1c, but I have not had my fasting insulin tested.

    I am thinking I would do better on T3 only medication. I tried Synthroid and it was like taking nothing; I was literally bedridden on it.

    Do you know of any contraindications for taking Cytomel while breastfeeding? I would appreciate any feedback on my situation. I am having great difficulty losing weight. I averaged 9 pounds a year weight loss since 2009 (started NDT in 2013), but this requires doing a minimum of 90 minutes per day on my arc trainer & having an average calorie deficit of 1000+ daily (that is with the adjusted lower metabolism).

    I still have around 70 pounds to go. I love exercise, but I just don’t have the time to do more. Eating less never leads to weight loss for me.

    Thank you!

  87. My thyroid/related medical history history is complex but here are highlights. I am the only non obese member of a family with a history of both obesity and a hereditary lipid disorder (familial hyperlipoproteinemia dxed 20 yrs ago by head of Johns Hopkins Lipid Cllinic). I am also the only immediate family member not taking statins (even though my lipids are slightly elevated – I refused) and without rhabdomyalysis. One brother is even developing kidney problems (from which our father died).

    I’ve been taking Synthroid since I was 25 when testing at the student health center revealed very very low thyroid levels (they didn’t want to test me because I was controlling my symptoms “to the naked eye” – moisterizers, extreme dieting which minimized my sudden weight gain to “only ” 20 lbs., etc. In fact when my thyroid results came back so low, they had me retested – certain it was a lab error)

    For years I took Synthroid 2 mg /daily periodically tested for Hashimoto’s (negatiive) which was gradually reduced to 125 mcg. I only take the brand because I believe the dosage is more reliable. Suffering from depression, much slowed metabolism, extreme cold sensitivity, and hypersomnia (average 12 hrs sleep/night – or more) I decided to request T3 supplementaion a year ago.

    I am presently taking 112mcg Synthroid (before adding T3 125 mcg) and 10 mg Cytomel, simultaneous.
    Here are my present concerns:

    First, I improved dramatically with T3 – morale improved, sleep down to ~ 8 hrs/night (MOSTLY! Confused by varariability), less cold intolerance (Raynaud’s still a problem) and higher energy level (though not where I’d like it). My appetite increased a great deal too, though, causing weight gain ( 🙁 )but I think/hope it’s due to a relapse of my “carbophilia” which I’m now struggling to control with slow success. (I know I messed up my insulin metabolism – has happened before.)

    Note: I am 71.

    Second, I have slight Atrial Fibrilllation (need cardiac work up to confirm) – on medical todo list is Holter Monitor test. In any case, I want to be careful with T3 on this account.

    Three (and this is the main area of confusion), I’m taking pains to separate the following medicines by several hours because I was told they “compete for absorption”: estradiol and progesterone (OKed for extradordinary reasons via cost/benefit analysis), iron (I’ve had anemia dating from same testing period when hypothyroid was identified; i.e., age 25), and calcium to help main marginal bone density . Actually, I hardly ever get to the calcium because the med timing is already so complicated to keep on top of (horrible enough to try to take both thyroid hormones first thing in the day, least of all, before any food comsumption. There’s a limit to how much I can live my life around scheduling medicines much less managing other medical issues! E.g., had T4-pelvis spinal fusion last year, breast cancer the year before – now OK after surgery) and a few oddds and ends.

    However, a mainstay of your recommendations to regulate T3 is to divide the dose or take it in slow release form.

    HOW AM I SUPPOSED TO MANAGE THIS? Surely, I’m not the only woman taking these meds!

    Help!

    PS I live in a “medically underserved ” area – at present no endocrinologist and only one ENT. Travelling to nearest acceptable medical center is bankrupting me financially in $ and time.

  88. Pt II

    Many apologies for multiple typos! Hope you can decipher previous message.

    Decided to add, that I have high consumption of dairy products so am not worried about often missing calcium dose.

    Also, I have not been tested for “reverse T3” or Leptin resistance but hope I can persuade endocrinology PA to order them (she’s been taking over for former endocrinology who is on indefinite medical leave. Don’t know how much discretion she has though (adjusting the Cytomel has been very complicated, involving lab errors and a few “mysteries”)

    Lastly, I have decided to request ENSAM (selegeline patch) to treat my depression. I have high hopes despite long history of TRD (Treatment Resistant Depression) as one MAO-inhibitor depression (NARDIL) worked brilliant though no other AD did. Unfortunately, a common side effect – extreme orthostatic hypotension landed me in hospital for long stay so had to discinue.

    Hopefully, though less effective, the ENSAM will help and since it’s delivered in a patch, it will not require the same dietary restrictions (note, my problem was HYPO-tension, NOT hypertension – the infamous tryamine reaction.)

    HOWEVER, how might it interact with the thyroid, T3 especially?

    Many thanks for your extremely educational page! Endocrinology certainly requires a Sherlock Holmes!

  89. Morning

    Thank you for all your detailed information.

    I am in the UK and have been using t3 for hashimotos for the last 3 years. I have a question…..is it impossible for t3 to convert to rt3?

    When I started t3, I lost about 14lbs with no effort at all, no dieting the weight just fell off, then with no change to dose or diet after about 8 weeks the weight went back on. I feel better on t3 so have stuck with it but cannot shift the weight I take 25mcg of cytomel 3 x a day.

    My body temperature is still quite low around 36 degrees.

    Would be very interested in your opinion.

    Regards and thanks

    Kim

  90. Hello , your site is wonderful . I’ve studied most everything I’ve read from you prior to seeing yours . But I’m still stuck at this weight . Can’t budge a pound. I noticed the weight gain after I switched from armor to Synthroid . Not my choice . My insurance stopped due to a divorce . I then had spine surgery adding to my weight from the steroids . I haven’t taken them in 8 months and I’m not on any pain lkillers either . I hated those !
    I felt the synthroid was not doing anything . I started t3 only been a week but no weight loss yet . Is it to soon ? I do feel 100 % better on it ! I can think clear ! I sleep better than I have in years! Real sleep ! I see positive results just no weight loss . Should I up it you think? I take 25 mg . I’m 5’9 220 . Which is insane ! I’ve alwats been 170 ! I can’t stand myself ! I’ve used progesterone cream too . To balance estrogen dom. I’ve used DIM also . I hardly eat anything ! I never drink soda ! I eat organic . I never drink milk . I don’t eat fried foods . I watch what I eat !i should be so thin . I even work out . What’s going on . I detox a lot . I take zinc and minerals too . I tried ox bile and other herbs . Amino acids . Nothings working . My sex drive is killer! But it always was lol I’m 51 years old . Help !

  91. Why is everything marked up to the point only the the rich can afford it. I’m on SSI and that’s way out of my reach. I would love to try this I’ve put on 35 lbs in 4 months and am in pain most of the time. I’ve been to 3 different Doctors for pain and and even a Thyroid Doc and still no help.

  92. Goo day Dr. Westin Childs!

    I am also an MD, and I am currently studying for my licensure examination. I am quite well-informed as to effects of T3 in the body, both its desired effects and some adverse effects. And reading your article here added up to the knowledge that I already have, so thank you for that.

    I am a 29-year old Asian male; height of 183 cm, weight of approximately 220 lbs (110 kg), with a sedentary to light activity lifestyle. My diet includes lots of carbohydrates in it, considering that the South East Asian diet comprises of lots of carbohydrates in it. Although I try to cut down on my CHO intake; given my age, it is truly difficult to loose weight just by adjusting and modifying my diet alone. I also had MD friends before who took some pills during our med school. They claimed to have had increased focus and insomnia (they were able to study for longer periods of time), palpitations, and tachycardia. I therefore suspected that the pills they were taking had some thyroid hormone in it.

    I know that it is not advisable to take thyroid hormone, in this case Liothyronine (Cytomel), because of the possible harmful effects, especially I do not have hypothyroidism. But some of its side effects like increased focus and insomia might help me in studying for the licensure exam since it is imperative for me to do a lot of reading, and I may also benefit from its weight-losing effect. Perhaps I will only be using it for around 4 to 5 months. I am planning to start on the lowest dose, then monitor my vitals as what you recommended, and titrate Cytomel carefully depending on my symptoms (if ever I develop one). I plan to do a one-week daily monitoring for a baseline of my vitals prior to starting Cytomel. What do you think of this, Dr. Childs?

  93. Hi Dr, Child’s,

    I have high reverse t3 due to prolonged stress. I am having hypo symptoms and under the care of a functional med doctor. She wanted to start me on NP thyroid but I shared that the T4 in the rx may create more reverse t3. I have never been on thyroid mess because my thyroid has always been in the normal range. My stress has substantially reduced. I asked her to consider a t3 only med and she said she would prescribe liothyronine. Is there any chance my reverse t3 can go away without medication? Thanks for all your work and knowledge on this topic.

  94. Hello, Very useful site, thank you. I’m a 51 year old active, healthy woman. After years of trying to lose weight thru diet and exercise, a nutritionist said she thought I wasn’t eating enough and sent me to get a Metabolic test. It showed I needed only 800 calories a day to function, 25% less than the average woman my age. My GP said I could talk to Endocrinologist who put me on 5mg of Cytomel in addition to the 125 of Synthroid I have taken since I was 15. I lost a pound a week for 8 weeks, but now it’s started going back up. Endo doc said new labs were ideal, but I’m thinking of increasing to a second Cytomel per day, 6 hours or so after my morning Cytomel because I have very bad insomnia.
    I am so tired of the self-loathing of being overweight despite my best efforts. Any suggestions would be helpful. My HMO seems to be based on me leading the way thru inquiry and research.
    Thanks very much!

  95. Dr. Childs,
    After years on Levothyroxine, my doctor just prescribed the combo including liothronine. I was on 150 MGC of levothyroxine. He now prescribed 100 MCG of levothyroxine with 5 MCG of Liothyronine. That seems like a large decrease of the levothyroxine. Is that the right ratio when I was originally on 150?

    • Hi Tiffany,

      There isn’t a set “established” guidelines for conversion but a helpful place to start is to consider that T3 is approximately 3-4x more potent than T4.

  96. What about those of us who had their thyroud removed due to thyroid cancer or other issues…?
    I’m now tagged with fibromyalgia, arthritis, chronic fatigue, (anxiety, ptsd, dealt with that most my adult life but, it’s heightened since my total thyroidectomy). I had to fight hard for t3 meds. Currently 100 mcg tirosibt, 30 mcg cytomel a day. I notice a huge difference. It took me close to 2 years to get to that dose- doc playing god or fear of medical malpractice because my tsh numbers (suppressed due to thyca)..
    I’d like to do more t3 therapy and cut farther back on my t4.
    So….
    For a person with no thyroid, will we produce enough t4 if we are on higher doses of t3 and lower t4?
    I’d love more info for us with no thyroid.

  97. Fabulous info. Thanks very much. Hope I find a doctor who,will give me t3. Tasmania, Australia is difficult to find open minded doctors.

  98. I have a nodual (0.63×0.73 cm) on my thyroid and have been slowly gaining more weight even with exercise and low cal diet. I would like to try a low dose 5mcg of C3 to see if this would help. Any thoughts on this?

  99. Hi Dr Childs,
    .I started on T3 Jan 8 along with 105 mg NDT. Raised T3 by 5mcg every five days and quickly found I needed to reduce NDT to 60 mg. currently on 69 NDT and 30 mcg T3. No weight loss. Feel more “alert” if that makes sense. Tried to increase to 30 mcg T3 and it appears to be too much. I am still on 25 mg cortef trying to heal my adrenal glands. So maybe weight loss is not achievable until I am off cortef?

  100. Hello and thanks
    I have hypothyroidism as well as chronic pain etc I am on 75mcg of Levothyroxine and 10 mcg of Cytomel. I eat well but over the past years I’ve gain 40 to 50 pounds
    And watch my diet well as well as am active. Nothing works to lose weight and thought about raising t3 and maybe lowering Levothyroxine.i give up? Will raising T3 to say 25 to 30 mcg and keeping Levothyroxine same or ? I’m gonna talk to my doc but would love your input before I talk to him so I’m more knowledgeable. I learned a lot from your site now I need to put into action! Thanks again
    Ken

  101. Dear Dr. Childs;

    I have been struggling and gaining weight since I was given floxie antibiotics to save my life. I am now trying t3 sr compounded in addition to compounded t4/t3 with the t3 at 1 mcg to 100mcg t4. All my labs and my symptoms scream I need more t3 but, my body can’t take more of either t3 or t4. I get such bad heart palps and can’t walk up the slightest hill w/o stopping every few feet. My doctor after 3 years of trying every med and possibility says I am hopeless and has taken away my hope of losing weight and getting better. Can you explain better how to tritate up. I am now kinda self medicating doing adding 5 mcg of sr t3 every three days. And, somewhat tolerating that. Will I be able to go higher and how. My doctor just shrugs his shoulders when I say what else can we try. Do you have any suggestions I can give to him? Or a way to not scare myself. I also have tried every form and type of probiotic, and fermented food. I know my absorbtion is a problem. But, that too seems hopeless. Before my antibiotic nightmare I was on 200 armour. I can’t take naturthroid or any of the ready made thyroid meds. Compounded is all I can tolerate. Thank you for any suggestions and help.

  102. Hi Dr. Childs,
    I noted in your post (nice post btw, thank you) that you referenced RT3 > 15 was problematic and likely cause for medicating. My RT3 is 13.2 ng/dL and FT3 2.1 pg/mL, yet my naturopath just diagnosed me with RT3 disorder and wants me on lyothyronine…I’m all about feeling better, but am also concerned because this particular practitioner diagnoses most of his patients with thyroid disorders, by his own admission. Are these numbers truly problematic? Besides some unpleasant symptoms I’d love to solve for, I’m a healthy 32 year old athlete. Medicating for life is a serious prospect…thanks for any thoughts, truly.

  103. I have been on synthetic 112s. Dr added 5mcg caramel to start off just in the morning for now. I could not handle even a fourth of pill. Had rapid heartbeat and anxiety. Went to an 8th of a pill, which I can handle. Heart rate is 78 texting and temps went up to 98.6. Most of my intense aches and pains sent away and I have a sense of well being. This is week 3 on it and I want to increase. I notice some aching and energy decrease. If I increase, will my temps go too high? I am always sensitive to meds. My iron levels are good. Waiting on rf3 test next month. I feel I need the t3. My ft3 levels have always been low normal. Any thoughts? Do I just need more time?

  104. Dr. Childs, When i was first diagnosed with hyperthyorid 15 years ago my Dr. put me on Synthroid and cytomel. I lost some weight and i felt great. But 4 years ago he took me off every thing and put me on just Armour. Ever since that time i have put on almost 20 pounds, have been feeling out of it, and my labs have been up and down. An integrated doctor got me off Armour and put me on .75mg Synthroid (later changed to Levothyroxin) and .10 mcg Cytomel. When my insurance didn’t want to cover cytomel I started taking the Liothyronine and I got very sick from it so I went back to cytomel. Today, a year later I decided to try the generic again by taking 05 mcg of cytomel and 05 mcg of the generic form to ease into it. Do you think mixing the two forms of Cytomel is OK to do until my body gets used to it? I hope I don’t get sick again!

  105. Hello Dr.
    I’m on .75 mcg of levoxyl. Added in 10mg cytomel a few months with little change to weight (5’2″, 122 lbs, but this reflects a recent 5 pound weight increase I can’t lose). Increase cytomel to 15mg and my T3 levels were elevated (4.5) so my cytomel was reduced back to 10 mcg.

    Would I benefit from reducing my levoxl and increasing the cytomel again? thank you.

  106. For healthy people that cycle T3 (bodybuilders). how long should you be on and off T3 so in order not to damage your own natural thyroid glands.

  107. I have read on another website that NDT can make some people irritable and angry. I feel this is how it affects me, but my N.D. thinks NDT is the best treatment for most people. I was on SR T3 and felt more positive with more energy, but he told me that SR T3 is very dangerous and I could end up in the hospital. So I’m back to being depressed, angry and irritable on WP Thyroid. Am I only imagining this?

  108. Dr. Childs,

    Thank you for your informative articles. I had a full removal of my thyroid 2 years ago and was on Levothryoxine 112. My weight was at 110-115 then. My thryoid levels were low so my doctor switched me to 125 mg Levo and my weight has increased to 140. I have been 100-115 my whole life. I am really trying to figure out what the best route to go is to go back to my normal weight or at least get my medication to cause weight loss and not weight gain. Please guide me. Thank you

  109. I am currently on 150mcg of Levothyroxine, had thyroid cancer, so had surgery to remove my thyroid when I was 32. Now will be 62 in a month. Never even heard of Cytomel till a couple days ago while looking through facebook. I am probably about 60 lbs overweight have tried many different diets, lose weight and of course always comes back! Do you think adding Cytomel would be an option at my age to finally lose the unwanted weight? At my last cholesterol blood test LDL somewhat high 138, low tolerance to cold, don’t sleep well a lot of nights. And at what dosage should I start?

  110. Reading through all the articles and posts from everyone I would like to find a doctor that would listen to me. I have all the symptoms but seem to fall into their mile wide “guidelines”. I have tried everything to lose weight, my last resort has been to join a Crossfit program…Intense workout…I joined in January and to this day have not lost a pound and I watch what I eat…healthy eating! Where/whom in my area can I go to that can help me without costing a fortune. I know the T3 would be very helpful if I could just get someone to listen. Or is it something I can order online? Thank you

    • Hi Calista,

      Unfortunately, each therapy and dose should be individualized to the patient. I can only give guidelines to help with the process, but I figure guidelines are better than nothing! At this time I don’t know of a way to get this type of treatment without paying out of pocket, just the reality of the situation right now. Insurance doesn’t pay for these types of services which is a big part of the problem. I suspect that within 10 years or so this will be more mainstream, but currently, and for the foreseeable future, it doesn’t seem to be the case.

      You can try to find physicians to help you with this resource: https://www.restartmed.com/thyroid-doctor/

  111. Hi- My 18 yr old daughter has gut imbalances that led to leaky gut & Hashimotos. Her T H S is normal with low out of range T3 & low in range T4. She has hypothyroid symptoms- weight gain, constipation, cold hands/feet, mood swings. She started on 30 mg of Armour & it took her T3 to 3.1. The Endo reluctantly raised her to 45 mg Armour. Leptin number is 17. Fasting insulin is 11. Checking on the 8 a.m Cortisol, not sure it has been run. Some Candida overgrowth & probable gut bacteria being treated holistically. What type of Dr will treat this- I live in Northern NJ? I need to get her to someone who understands this! Thanks for your help.

  112. Dear Dr. Childs,
    I had TT due to Graves Disease in 2011. After 2 years of horror, I found a doctor who prescribed t3. I am on 150 ug t4 plus 25 ug t3 spread in 5 portions over 24 hrs. My free t4 and t3 are in the upper thirds and my TSH 0.0x for 4 yrs now. Do I have to watch out for bone loss? Or does this only apply to t4 overdoses?
    Thank you very much!

  113. Hello Dr. Childs,
    I have been on a medication roller coaster! I’m currently on 25 Synthroid,15 cytomel. And other medications for adverse reactions to Femara, 60 mg cymbalta, testosterone, progesterone, and a host of supplements. I’ve gained 30lbs in the last 6 yrs. My Dr has recommended increasing the Cytomel to 20, then 25 and so on till I reach my goal of energy and weight loss. The hair loss is depressing!
    I am currently taking 25 cytomel and I am feeling very fatigued. I’m sleeping 9 to 10 hours a night. Help!
    Lynn

  114. Hello. My 19-year-old daughter is really a mess. She plays college bball and has gained 10# over the last year…when she actually should be losing weight due to her training level and calorie intake. Her FT3 is 2.3, T3 88, T4 7.8 and FT4 is 1.1 and RT3 is 17.4. Her ferritin is horribly low-8.1, but her iron is “okay” but could be higher-41. Now that she isn’t exercising in the past 5 days due to the low ferritin, she has gained 2 pounds! I hate to think what her weight would be if she wasn’t an athlete. For the past 5 months, her average caloric intake is about 1300-1500 per day. I told her it is not enough on the days she has 2 hours of bball practice. She also sweats profusely while exercising..always has. Her other symptoms over the last few months are that her hands and feet are very cold, she has become increasingly tired-which is not like her, she has swelling in her ankles/lower calves. We have an appt tomorrow w/a functional doctor, so I’m hoping I’ll be listened to instead of ignored. She was also low on Vitamin D and her iron saturation was flagged low at 12. I have started her on Vit D w/K2, Vitamin C, Super B, and Iron. Her energy has improved over the last 2 days but something has to be going on w/this weight gain. Her caloric intake is low…but she does eat-just a lot of low-calorie foods such as fruit, chicken, turkey, yogurt. She did drastically cut her red meat intake over the last 5 mos., so that might be why her ferritin fell so much. I would greatly appreciate your opinion. Her antibodies were both negative for Hashi/etc. Bilirubin was 0.3, so not flagged low..but on the lower end of normal range. RBC was 3.9, also in the lower end of the range. WBC 8.5 on the range of 3.8-10.8, so that seems okay. Hemoglobin 12 on a range of 11.7-15.5. Ultrasound of thyroid was normal-both normal, equal size and no nodules. Thank you!

  115. When adding T3 to your current thyroid medication would you only go by basal temps and heart rate to determine if you are taking enough? or would you also take into account the lab ranges that are provided on blood tests? Can you go outside of the FT3/FT4 lab ranges and still be ok as long as your BBT and heart rate is in the normal range?

  116. Thanks, Dr. Childs for providing all your knowledge and information online. It is a shame that all physicians do not take the same approach to care as you have….anyway.
    I am still struggling with hypothyroid issues and unable to lose weight even though I am on Cytomel 5mcg and compounded NatureThryoid 19mg/4.5. My doctor would not alter any of my medication with my recent April 2018 results. I am under enormous stress in needing to move my business location in the next 6 months. 6 months ago revT3 was 11 on same meds. Could stress be the cause of increase revT3? Also I am on several other supplements…12.5mg iodine, designs for health metabolic synergy
    TSH=1.87
    T3free=3.2
    T4free=1.4
    Total T4=6.1
    RevT3=22
    H1cAB=5.5
    I am thinking I could have insulin resistance, leptin resistance or both.
    Testosterone total=23
    Testosterone free=2.1
    Testosterone Bioavail=4.2
    Will your product Thryoid conversion booster help??? what about the Adrenal reset supplement??? Maybe I need those two plus the Berberine 500+?
    Looking for a solution.
    thanks

    • Hi Yvonne,

      It sounds like you are on the right track! Yes, those supplements would probably benefit you given your situation. At the very least, given that you are under stress, you should be on an adrenal supplement.

  117. Hello doc,
    I take 300 mcg of levothyroxine and 50mcg of Cytomel. I have excessive sweating, especially at night. My hands sometimes are shaking and I have headaches. My family doctor wants to increase the Cytomel to 75mcg. Will this make my symptoms worse with adding more cytomel?

    • Hi Debra,

      You wouldn’t want to start cytomel unless you know that you need it, so you will want to check your free T3 and total T3 first. If they are not optimal then it would be reasonable to add it.

      Hope this helps!

  118. Hello Dr Childs,

    Thank you in advance for sharing your knowledge. I was diagnosed in 2015 with graves after 9 months of high dose prednisone for a viral joint infection. I had the physical symptoms, but the Endo did not check my TSI antibodies. I was on 10mg methimemazole for five months before labs we’re checked. I went hypo with a TSH of 11.9. I stopped methimemazole and did nothing for a year. In April of 2017 my labs we checked again and my TSH was 55.2 and my TPO antibodies were 1378. I was diagnosed with Hashimoto thyroiditis with benign nodules and started on 50mcg of levo. I am now on 100mcg of levo and am due for labs in a weeks. That will be the six week mark of increase to 100mcg from 75mcg. My labs on the 50mcg starting dose this March was TSH 3.89 FT4-1.3 and FT3-2.77.I started 75mcg 3 months ago and my labs were still not normal for Hashimoto my TSH was 2.66 (.7-5.2) FT4 was 1.5 (.9-1.7) FT3 was 2.89 (2.57-4.43) reverse T3 was 20. I asked for Cytomel, but I am the opposite of the nomal weight gain. I’m 5’9 and my weight has dropped from 123 to 105pd. I eat and and can’t gain any weight. This has made my doctor reluctant to prescribe Cytomel, so they increased my levo to 100mcg and will recheck labs next week. My heart rate runs high, but has done that well before I had thyroid problems. During work it runs about 110 to 120 and resting is between 70 and 80. What are your thoughts on cytomel for me. I have fibromyalgia but that’s a wimp compared to this thyroid stuff. I’ve continued to work full time, but I am alway exhausted. I have Raynauds and dry eye disease (narrow angle glaucoma) dry nose and mouth. I just want some energy and 20pds back on me, I’ve read that low FT3 can cause stomach acid and make it hard for my body to absorb nutrients. Your knowledge would be greatly appreciated. Thank you,

  119. [email protected] Hi, I have read your article a couple of times and I am wondering where it is best to get the tests done. It is all so complicated and takes a lot of understanding and I’m not sure my general gp would have the knowledge or the time to look into it properly. Could you recommend the best place to go for tests please.

  120. Hi Dr. Childs,

    I have been following your blogs with interest since discovering that I have a low thyroid issue. My doctor has prescribed Cytomel for me at 25mcg taking half in the morning and a half in the evening.
    After one month on Cytomel, I have lost 5 pounds and feel that I have more energy and less brain fog.
    At my recheck, my doctor then prescribed Victoza to help with my weight loss. I just started this today at .6 and have my next visit scheduled for next week. I am looking forward to seeing how this hormone therapy works for me and even more so after reading your blogs. (I had tried different diets in the past with poor results).

    Thank you for your blogs as it really helped clarify what my doctor was doing and why. They are well written and really help the average person to understand what is going on with their bodies and why hormone therapy is important. (also helped because I was a little nervous to start all of this).
    I was searching the internet for answers and yours explained it the best! Thank you!

  121. I had thyroid gland removed due to multi-nodular goiter that was not cancerous 2015. I tried levothyroixine but felt terrible. I finally found a doctor willing to prescribe natural dessicated thyroid med (currently I’m taking 60 mg) and after 6 weeks am experiencing improvement, which of your supplements would help me?

    • Hi Kathy,

      If you are just getting started then Thyroid Adrenal Reset Complex + T3 Conversion Booster will probably be your best bet! From there you can determine if you need probiotics and so on.

  122. I have been taking Synthroid for 9 months without much change in my hypothyroid symptoms. I have permanent liver damage. After questioning my GP about the possibility of my damaged liver not converting the T4 to T3 properly, he put me on Cytomel.

    My period has been delayed for 12 days now and I am trying to figure out why the cytomel has affected me this way.

    I would appreciate any thoughts or topics I should research. Thank you.

    • Hi Sheri,

      It’s fairly normal for T3 medication to do that, I believe it has to do with the regulation of the cycle that occurs with more potent T3 doses.

  123. Hello Dr. Westin Childs,

    I was diagnosed with Hypothyroid disease in 2005. I started on Synthroid and did not feel well. I have been on Armour Thyroid for over 12 years now. My dose is 30mg (1/2 GR) and 15mg (1/4 GR) 2x per day. My thyroid levels of free T3 and free T4 are usually in the normal range and my TSH is always very low. However, I have struggled with losing weight and with a lack of energy and other low thyroid symptoms for quite a while. I spoke to my endocrinologist who agreed to try me on Levothyroxine 125 mg once every morning and Generic Cytomel 5 mg 1/2 BID. His reasoning is that using this two in combination he can adjust my T3 and T4 dosage whereas with the Armour thyroid they are both in one pill so you cannot adjust them separately. Do you think this will help me? It’s kind of scary since I have been on Armour for so long. Armour has taken away many of my hypothyroid symptoms except for the weight, brain fog, and lack of energy. My energy seems to come in spurts.. I have good days and bad days. I have also returned to a gluten free diet as I believe I have a gluten sensitivity. I was tested and do not have an allergy to gluten but was told that I could still have a sensitivity to it which can cause inflammation and bloating.
    I would appreciate any thoughts you have.
    Thank you,
    Ms. Carolyn

    • Hi Carolyn,

      It’s reasonable to use T4 + T3 medications in place of NDT for the reasons your endo listed. Titration and dose really depend on the individual.

  124. Dear Dr. Childs I have left 2 other comments but cannot find them on this blog. I have them on the series of thyroid videos. How can I find the comments I left so I can read if they’ve been answered? I have to decide whether I want to take 5 mcg of Cytomel because the D.O. I’ve been seeing changed her mind about giving me both NP Thyroid and Cytomel. I see everyone leaving their lab numbers here, but didn’t know if I was supposed to pay a fee to do that? I did purchase the 97.00 membership but I need help faster than exercising is going to help me, diet and exercise take time. I do eat organic and not much but I don’t lose the weight and started on this lab testing but there are so many different doctors telling me I am not thyroid yet I feel bad and don’t know if I should take the cytomel or not. I was told to either take it on an empty stomach or with food but be consistent if I take it. I don’t want to lose my hair! I don’t want my facial collagen to collapse if I need to go off of it like when I was on 60 mg NP Thyroid for only 2 days! It may seem hard to believe but there are no knowledgeable doctors where I live and if there are, they don’t accept insurance. Much thanks for all you do. This comment section keeps moving when I move it up to submit.

  125. Hi
    I have listened to all your podcasts and they are brilliant. I am 38 extremely active and have been trying medication for hypothyroidism for a year. I don’t ink my doctor wanted to give me any. I have steadily been gaining 20 lbs over 2 years. Am terrified..will this end. .how can I stop this? I’m not sure if it is more thyroid or metabolic adaptation. Do you have suggestions? My last TSH was low… if this is the case shouldn’t I be losing weight, with low calories, exercise and my t3 and free t3 in normal? Thank you! I’m terrified.

    • Hi Nikki,

      Having a low TSH does not mean you are hyperthyroid (contrary to what you’ve been told and what most physicians think). There is a difference between lowering your TSH due to thyroid medication and having a low TSH due to endogenous hyperthyroidism. The best thing you can do is try to optimize your lab tests within these ranges: https://www.restartmed.com/normal-thyroid-levels/

  126. I am currently on 88 levothyroxine and 10 cytomel. I have recently started having horrible headaches and gaining weight. My tsh is extremely low while t4 is normal but going down and t3 is now optimal. Reverse t3 is optimal as well. Still no relief of fatigue and other symptoms. Any suggestions?

    • Hi Natasha,

      It may not be your dose but the medications you are using. You may find more relief with cleaner medications such as Tirosint. In addition, it’s possible that your weight gain is unrelated to your thyroid if your thyroid has been optimized. I would look into those things first.

  127. Hello Doctor, I have been on generic Cytomel off and on because it makes me sick to my stomach. I didn’t notice any good or bad affect on my weight but it was on 5 mg. to my 75 mg Synthroid, so I couldn’t give it much time. However, I did get very nauseated taking the medication in the afternoon. I don’t take at night b/c of the other meds that can be rough on my system as well (Fish oil and magnesium). I also take Metformin 500 in afternoon. Do you have any suggestions on why it is making me nauseated and how to avoid such? None of the other symptoms listed concern me, just nausea. Thanks!

  128. Best concise write-up about the connection between nutrition hypothyroidism! Thank you so much.
    I am reading in many places that high cholesterol always points to hypothyroidism. I am 78 yrs old. My cholesterol has been slowly rising since menopause. Does that mean that my hypothyroidism actually started at that point?
    THANKS

    • Hi Magda,

      I’m glad you enjoyed it! High cholesterol certainly doesn’t always indicate thyroid disease but it is a common cause of high cholesterol. But many other factors can both cause and contribute to high cholesterol.

  129. Hello, I have enjoyed reading your blog about Cytomel. I currently take Synthroid and could stand to lose a few pounds as well. As a powerlifter, the only concern I have is some warnings I have seen about the medication causing a loss in muscle mass. Is this a true side effect and if so can taking testosterone combat the effects. I also do HRT 200mg per week of testosterone. I am curious because reading your blog made it seem like something my body may need but I read don’t want to give up muscle mass.

    • Hi Jayme,

      A decline in muscle mass would only be seen if you were using too much and putting your body into a hyperthyroid or catabolic state.

  130. Hi Dr Childs

    Sorry, I realise I’m a bit late to comment. I’ve been reading a lot of your articles and find it really helpful, thank you so much. I’ve been on T4 for more than a decade now but I’m still tired, foggy and I can’t shift any weight even though I’ve been following a strict 1600 calorie keto diet for the last 18 months.

    My TSH is in range but I still think its high at 3.69

    I just wanted to ask, if I’ve been taking 100mcg of T4 and I want to consider adding 20-25 T3, should I reduce my T4 by a quarter or half or simply add the T3?

    Thanks again,
    Heidi

    • Hi Heidi,

      Each person responds differently to T3 so, unfortunately, there is no “standard” to apply in this situation.

  131. Hi Dr. Westin Childs

    I’m currently on T3 due to hypothyroidism.
    But I do not know why I’m gaining a tremendous amount of weight.
    Is there any scientific reasoning to the cause of this?

  132. I am currently on both T4 and T3 hormones after a total thyroidectomy in 2009. I recently started running but suffer from extremely high heart-rates. I ran a 10K this past weekend and went way over my max heart rate at 189 bpm. I need some advice and help, please. Will my heart rate lower the fitter I get? I struggle to breathe under these circumstances Any help or advice welcome.

    • Hi Chrisna,

      I would take a look at your thyroid labs to make sure that you aren’t taking too much thyroid hormone as tachycardia is a symptom of taking excessive thyroid medication. And if your heart rate is caused by your thyroid medication then getting more fit will not reduce it.

  133. Dear Dr. Childs,

    Yet another very interesting article! I just love your articles and find the advice you give great.
    I just read in another one of your articles that you can add T3 to NDT in patients with insulin and leptin resistance. In your example you added 25 mcg of T3 in a slow titration to an existing dose of 3 grains of NDT daily. How do you usually add T3 to NDT, when the patient is already used to getting some T3 from the NDT? Do you add higher doses of T3 from the beginning, or do you start low and go slow in that case as well?

    • Hi Catherine,

      I don’t have any articles right now about how to dose thyroid medication, but I will consider writing about them in the future. There’s a liability that comes with information such as that so I’ve mostly avoided it.

  134. Hello Dr. Childs,
    Thank you so very much for all your time, work and information; I find it fascinating and very helpful!

    I am 42-year-old female, initially diagnosed with hypothyroidism in 2012 (midway into my 2nd pregnancy). I believe I induced some degree of my thyroid disorder due to excessive exercise and dieting from 2007 – 2010. At one point I weighed 118# which at 5’7″ is low. In 2012 I was started on levothyroxine and felt ok, I never had any significant symptoms except cold intolerance and fatigue (which I attributed to pregnancy). I did have a low resting HR (40-44) but attributed that to lots of cardio.

    After some basic research, I decided to switch to Armour thyroid and felt somewhat better. I also went on to have 2 further pregnancies with no complications. I eat an extremely clean, low carb diet and exercise 3-5x/week but not excessively as before.

    Jan 2019 – body temp 96.8, RHR 60
    TSH 3, FT4 0.81, FT3 5.3, RT3 19 – on armour 90mg/day – wt 135#

    Feb 2019 – started cytomel 25mcg x1 week, then increased to 50mcg/day

    March 2019 – bod temp 97, RHR 64 – wt 139#
    TSH 0.13, T4 0.69, RT3 – 10 – FT3 still pending, vit D – 34

    I am wondering in cytomel is not the drug for me, I do not feel significantly improved and my weight is climbing despite a clean diet and exercise program.

  135. I’ve been on a T4/T3 combo for 20+ years – my Free T3 is low (under 2) and my RT3 is around 20. My TSH bounces all over the place and Free T4 is normal. My body temperature is a steady 96.4 degrees and my resting heart rate is around 50.
    My blood pressure is consistently around 90/60. I’m on 180g of Armour (I can’t take NP, it makes my gums bleed) My old doc missed 2 labs in a row with an abnormal thyroid so I recently changed docs and have asked him about supplementing T3 and he’s open to it, especially with my Free T3 being so low. He had me try an OTC supplement and it did nothing, so I see him tomorrow and will ask for a stronger prescription. I’ve been under extreme stress over the past 9 months and have gained 30 lbs after a car accident has left me sedentary. I’m very conscious about the food I eat and consume between 1200 and 1350 calories a day, which shouldn’t cause weight gain. I’m 5’9″ and 190 lbs (now – I was 162 at the time of the car accident). I don’t eat any grains, sugar, or carbs in general other than certain vegetables which I cook thoroughly. The rest of my food intake is primarily protein, with a minimal amount of fat (around 60g of fat per day) In your opinion, would the addition of T3 be a good option for me?

    • Hi Reese,

      It would probably be easier to alter your dose of T4/T3 (unless you are taking NDT) than adding T3 to your existing regimen. It’s also never a good idea to restrict your calories if you have thyroid disease because it will always result in worsening thyroid function and metabolic damage and the inability to lose weight (which appears to already be the case).

  136. Had a poorly differentiated thyroid cancer removed about 2 years ago. Recent sonogram–NO CANCER. Seeing a doctor at U. of Va. and taking alternating doses of 125 mcg and 113 mcg levothyroxin. I have asked for a T3 and free T3. He says that is in the tissue. Feel like I need T3 added. I tire easily and have trouble remembering as well as sleeping. I am 89 years young, very active, no medical problems. NO ONE HAS EVER COME
    CLOSE TO GUESSING MY AGE. Read another article just like yours by a pharmacist who has done intensive research and she agrees with you about possibly needing both T4 and T3. Thinking about taking your advice on my own and adding T3–checking temp and heart rate. I don’t feel as well as I should–BUT I DO FEEL OK
    I am eating less, but find it easy to add weight–195-200 lbs at 5ft 10in. I take my med at 11:30 PM to avoid Ca and food in AM. Best time to take T3? Will start with 10 mcg daily and go to 20 mcg in 2 weeks. Your thoughts? Any harm trying?

    • Hi James,

      The risk of using T3 is quite low compared to the potential benefits, but I wouldn’t say there is zero risk. Just make sure to dose based on your labs and symptoms and you should be good to go. I typically have people take T3 at night and T4 in the morning, it’s just something I think that works best for most people.

  137. Dr. Childs,

    First of all, thank you for your wonderful articles and advice!

    I am currently desperate enough to self-diagnose and self-treat. Not recommended, I know, but what do you do if you cannot find a doctor to listen to you? (I’m in Europe where doctors like you are few and far between)

    I spent ten years on levothyroxine only, taking as much as 200 mcg daily without much improvement (I was diagnosed with Hashimoto’s in 2001). In 2012, I found a doctor working with NDT. I started on Armour and was later switched to Erfa when the former was out of stock.

    I did well on Erfa until last year when I was put on short-term cortisone treatment for autoimmune encephalitis. I was put on 1 g of methylprednisolone IV for five days, then went on 100 mcg of Solupred for a week, decreased it to 80 mg the second week and then decreased it by 20 mg every week until I had weaned off it completely.

    I felt much more hungry while on cortisone, with terrible carb cravings, and put on ca 10 lbs while on it. But told myself I’d be able to lose that fairly easily once I had weaned off it (after all, I had managed to lose 60 lbs on Erfa).

    But it turned out not to be so easy. When the cravings wouldn’t go away my family doctor ordered labs which showed fasting insulin and blood sugar levels close to the upper normal limit. My family doctor suggested I try Metformin although not technically diabetic, but as a preventive measure. However, having read about Berberine being as effective as Metformin in this regard, I decided to try it first. But it did nothing for me. Neither did alpha lipoid acid, cinnamon, or gymnema sylvestre.

    Recently, my family doctor suggested I go off NDT and back on T4 only as my cravings suggested I was overmedicated, along with a suppressed TSH (my family doctor, unlike the alternative doctor who prescribes NDT does only test the TSH, not the free Ts). My TSH, on 3 grains of Erfa, was <0.01 so my family doctor concluded I was hyperthyroid.

    However, since going back on T4 only, things have gotten much worse. I now feel hungry all the time, and even wake up during the night from my stomach growling. I literally eat for two and keep gaining weight, a couple of lbs a week. I now weigh 220 pounds (5.8ft) and look and feel terrible (bloated, puffy face, abdominal fat making me look like I was four months' pregnant…).

    I have been wondering for quite some time if I have leptin resistance in addition to insulin resistance, since going on T4 only (and a higher dose of T4 than I was getting on NDT, now on 150 mcg of T4 daily vs 114 mcg daily on NDT) only made my cravings worse. Normally, if I suffered from drug-induced hyperthyroidism on NDT, I'd imagine I'd feel better on T4 only. BTW, the dose of 150 mcg was calculated based on the following formula: 1.6 mcg of T4 per kilogram of body weight.

    I have read that you have successfully treated many patients with leptin resistance. I am planning to raise this with my alternative physician to see if I can get him to prescribe T3. I doubt he has ever heard of leptin resistance, but he is open-minded and unconventional and, unlike most doctors, doesn't pay attention to my TSH but rather goes by my FTs, mainly my FT3 levels, when on NDT.

    What I wanted to know is: is there an average dose of T3 required in order for patients to successfully recover from leptin resistance? I realize everyone is different, but would you say most people require 5, 10, 25, or closer to 50 mcg of T3 daily (just to give me an idea)?

    Also, do you recommend patients go off T4 completely, or just reduce their daily dose of T4?

    I really hope to get this doctor on board, but the better prepared I am, the more likely I am to succeed, which is why any input from you would be most welcome.

    Catherine

  138. Hi
    I gained 4 stone thanks to the menopause and am very unhappy about this. I have read about how the bodybuilders lose weight and flab by using T3 and clenbuterol. Would you recommend this, it seems as though clenbuterol is a taboo word? Thanks, Tracey

    • Hi Tracey,

      No, I would not recommend using T3 unless you need it because you have hypothyroidism or low thyroid function. Using hormones unnecessarily is an easy way to cause harm to your endocrine system.

  139. Hello- thanks so much for this information. I started on 25mcg of Levothyroxine about 6 months ago even though my levels were “normal” I had symptoms of hypothyroidism…hair loss, fatigue, puffy face, dry skin but I’ve gained 10 pounds in the last 6 months and developed debilitating fatigue. My doctor wants to add 10 mcg dose of t3- but I’m thinking I should just go on a thyroid support supplement and get off of any prescribed meds. Any thoughts? Feeling miserable.

    • Hi Dr. Westin. Thanks for all of the information. I have just purchased your weight loss program. I am 55, multiple autoimmune issues as well as Hashimoto’s, diabetic, insulin and Leptin resistant. I now believe I am also thyroid resistant. I have been keto for a year with much success. I have 15 -20 lbs to go. Many of my labs are either still too low (vit D, b-12, DHEA, progesterone, testosterone, estradiol) or too high (homocysteine, reverse t-3,). I have been on Levoxyl and Cytomel for many many years and recently my dr increased my Cytomel dose. It is my glucose and especially by fasting glucose (over as high as 140’s) and my fasting insulin (14.5) that has me heavier than I should be and has me most concerned. I have tried metformin before and I currently take LDN at 4.5 mg. I will be asking my dr TOMORROW for Victoza to add with my metformin and LDN, and I will ask to increase my LDN to 13.5. I will also seek to add b-12 shots weekly. I am also buying your recommended supplements. I feel like I am close to cracking the code. But I am tired too. I have been at this for a very long time.

  140. So I’ve finally lost back to 102 but I think it’s mostly due to the Cytomel as I haven’t changed my clean lower-carb organic diet in years.
    However, when I tested my thyroid they said I had low
    TSH .006
    Low
    T4 Free Direct. 25
    And wanted to see my T3 a little higher
    3.0
    So they increased my T3 to 50 mcg
    But put me back on T4 75 mcg
    Hair started falling out and feeling tired again so we are cutting the 75 in half.
    My question is, does it matter if TSH and T4 numbers are low if I was feeling better just taking the T3?
    I don’t like the symptoms associated with the Synthroid.
    If you could just guide me with the knowledge of why I need higher T4 numbers or TSH I’d appreciate it.
    My RT3 did fall from 29 to 5.2 and my TPO was 21 (0-34) which they didn’t think indicated Hashimoto.
    Getting retested this week so any guidance will help.

    Thank you!

  141. Hello,
    I am 68 yrs old living with Hashimoto’s for at least 20 years, maybe longer.
    Presently I take 125mcg of Tirosint. Weight is a big problem for me as over the 20+ yrs it has become nearly impossible to take off weight no matter what I do. It is now affecting the rest of my body. Would I benefit from taking Cytomel & how can I convince my doctor to prescribe it if it might be helpful to me.
    Rosemarie

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