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.
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:
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.
Instead you bypass this conversion process and allow for more thyroid hormone to enter into target cells and tissues without reverse T3 competition.
This provides an instant burst of thyroid hormone to the body and makes it a MUCH more powerful medication.
This also helps explain why Cytomel and Liothyronine can cause symptoms if used in high doses.
And this also may explain why Doctors in general are not as comfortable prescribing this medication to patients (even though so many benefit from taking it).
This is also why some body builders use T3 medication to boost metabolism and burn fat before competitions.
How Cytomel Causes Weight Loss
In order to understand why Cytomel causes weight loss you need to understand what the thyroid does in the body.
Your thyroid helps control your Metabolism and Basal metabolic rate.
What that means is your thyroid really helps to control your WEIGHT and the amount of fat you are burning on a daily basis.
As many of you know:
Low thyroid hormone = weight gain (one of the primary symptoms of Hypothyroidism)
But why doesn't that weight go away once you start taking Levothyroxine or T4 hormone?
It has to do with the conversion process I mentioned above.
If you give the body T4 hormone and it does NOT turn it into T3 then your cells will NOT get the thyroid hormone they need and your metabolism will STAY low.
You can read this blog post for much more info on this conversion process and how it leads to weight gain.
You can also read this post for more info on why levothyroxine doesn't cause weight loss in many patients.
Cytomel (or other T3 medications) on the other hand DO increase thyroid hormone in the body and thus can help boost metabolism and lead to weight loss.
If that's the case then you are probably asking...
Should you take Cytomel?
Great question, and the answer is not as straight forward as it seems.
If you've been reading this so far you are probably wondering why you AREN'T taking T3 medication already.
Or you're getting ready to go ask your Doctor to prescribe it to you...
Well, hold your horses.
Cytomel and other T3 containing medications aren't the best for everyone, but based on my experience most people tolerate them quite well.
How do you know if you tolerate them?
Most patients who need T3 have one or more of the following:
- High levels of Reverse T3 (> 15)
- History of Leptin resistance (or leptin level > 12)
- History of Diabetes, Pre diabetes or Insulin Resistance
- History of Bipolar disorder or a strong family history of Depression, suicide or other mental health disorders
- History of Fibromyalgia, Chronic fatigue syndrome or Chronic pain syndrome
- Someone who does NOT feel well on T4 only medications (Synthroid, Levothyroxine, Tirosint, etc.)
Basically these conditions all are associated with a higher demand for thyroid hormone or a condition known as tissue level hypothyroidism.
Tissue level hypothyroidism describes a condition where your blood levels of thyroid hormone may appear normal, but your tissues are starving for thyroid hormone.
This may explain why so many hypothyroid patients are unhappy despite getting "treatment" with T4 only medications.
If you believe you have this condition THEN T3 might just be the medication for you.
I've also attached a guide below to help you find which thyroid hormone is the best for YOUR body based on a number of factors:
Please feel free to share or pin this to your wall for later viewing.
Cytomel Dosage and How to Use it Safely
Because Cytomel is stronger than T4 only medications you should use some caution when starting and titration your dose.
I recommend that EVERY patient who is using T3 medication do these two things:
- Monitor their resting heart rate (resting pulse) every morning
- Monitor their basal body temperature each morning
Cytomel and other forms of T3 will directly increase your metabolism thus resulting in a higher body temperature AND it will directly increase your heart rate by acting on cardiac myocytes.
By monitoring these variables you can ensure that you do NOT get too much T3 hormone and tip the balance in favor of hyperthyroid symptoms.
Try to keep your pulse and resting heart rate within these ranges:
- Body temp no higher than 98.6
- Resting heart rate no higher than 80-90 beats per minute while resting (note this is different from your resting heart rate while sleeping)
I recommend using these metrics instead of recommending certain dosages because the variability between individuals is huge.
I have some patients who do great on 5mcg of Cytomel or T3 and some who do well on 100mcg of Cytomel or T3 daily.
Whenever starting Cytomel make sure to start LOW and titrate SLOW.
A typical starting dose may be as low as 5-10mcg with an increase in dose by 5-10mcg every 10-14 days.
More sensitive patients should obviously start out lower and patients who have been on T3 previously can generally tolerate titrating to higher doses more quickly.
Cytomel vs Synthroid
Instead of thinking of Cytomel vs Synthroid I want you to think of them as a complementary pair.
Some people do benefit from Cytomel only (in higher doses), but many people do well on a combination of T4 and T3.
That means adding Cytomel to your current dose of Levothyroxine or Synthroid.
When it comes to power, Cytomel definitely is STRONGER than Levothyroxine.
You are much more likely to get our Doctor to ADD Cytomel to your current dose of T4 than you are to get him/her to switch you to T3 only.
With that in mind it's probably better to focus on the ratio that you need to lose weight and feel better.
For this I recommend shooting for a ratio of 80/20 of T4:T3.
If you were taking 100mcg of T4 you would want to be on around 20mcg of T3.
Simply adding T3 to your existing dose of T4 may improve your overall symptoms by helping to drive down Reverse T3 levels and by directly activating cellular transcription.
Cytomel & T3 vs NDT
I referenced Levothyroxine and Synthroid above because the great majority of patients are on these medications.
But what about natural desiccated thyroid medications?
Is Cytomel better than NDT?
Instead of thinking about which thyroid medication is best you should consider the specific needs of your body.
NDT contains a static combination of both T4 and T3. 1 grain of NDT equals about 38mcg of T4 and 9mcg of T3.
If you calculate out the ratio you will see that NDT still contains the majority of T4 thyroid hormone.
This means that even on higher doses of NDT patients are still susceptible to reverse T3 pooling.
In a general sense the sicker the patient (more medical problems, high blood pressure, cholesterol issues, insulin resistance, etc.), the more likely they are to need higher doses of T3 compared to T4.
So again T3 can compliment patients already using NDT quite well.
The addition of Cytomel and liothyronine to existing doses of NDT provides an additional boost of T3 and skews the ratio of T4 to T3 more in favor of T3.
This allows for less competition at the cellular level between T3 and Reverse T3 which can result in more weight loss and less symptoms.
- Note: If you are adding Cytomel to an existing dose of NDT due to reverse T3 pooling issues you will likely need to decrease your total dose of NDT to reduce serum levels of T4.
Sustained Release T3 (SR T3) vs Immediate Release T3
There are 2 forms and flavors of T3:
- Immediate release: Cytomel and Liothyronine
- Sustained release T3: Compounded and generally bound to methylcellulose
Why would you care about how quickly the T3 is absorbed into your body?
It turns out that immediate forms of T3 are rapidly absorbed and spike serum T3 levels in the body within 1-2 hours after ingestion.
The fact that serum levels are high isn't really the problem, the problem is that some tissues (mostly cardiac tissues) are very sensitive to T3 hormone.
Most thyroid hormone activates cellular response through a nuclear receptor and through changes in genetic transcription (changes in enzymes, DNA, etc.).
But in cardiac tissue T3 has a direct ionotropic and chronotropic effect.
That means in higher doses it can directly cause an increased heart rate and increased force of contraction.
This is often felt as palpitations or an increased sensation of the heart beat.
Generally the sensation of palpitations is more concerning to the patient than it is medically relevant, but obviously too much constant force on the heart is not a good thing either.
This is where SR T3 comes into play...
Patients who are sensitive to T3 or who have a tendency to lean towards heart palpitations tend to do better on sustained release version of T3.
The delayed release allows for more stable serum levels of T3 which means your cardiac tissue doesn't get hit with high doses all at once.
SR T3 can also be used in patients who want fewer inactive ingredients in their medication because compounding pharmacies can control what ingredients they formulate the T3 with (to some degree).
This is helpful for patients who are very sensitive to medications, supplements and generally have adverse reactions to inactive ingredients.
A few things should be noted about SR T3 however:
1. SR T3 can be tougher to digest so isn't necessarily the best choice in patients who have multiple GI issues or difficulty with absorption.
2. Due to digestive issues SR T3 may not be fully absorbed which means that the dose is less efficacious than IR T3 versions. This means that 10mcg of IR T3 will not necessarily equal 10mcg of IR T3 (usually about half or so).
If you are considering changing to SR T3 consider these prior to transferring over.
Cytomel Symptoms & Side Effects
If you are starting T3, Cytomel or SR T3 then there are some side effects you should be watching out for.
Most side effects come from taking too much medication and result in hyperthyroid-like symptoms but the symptoms from cytomel tend to be a little bit different from overt hyperthyroidism.
Most common side effects from taking Cytomel:
- Hair loss (usually goes away after 2-3 months)
- Heart palpitations
- Increased heart rate
- Increased body temperature, hot flashes or warm flashes
- Weight loss (most common) weight gain (uncommon but does happen)
- Jittery sensation or increased anxiety
- Loose stool or diarrhea
These tend to be the most common side effects when starting or increase dosage of Cytomel but are not necessarily common side effects.
When you are replacing thyroid hormone that is deficient in the body you should only have positive side effects from taking the medication.
If you are experiencing negative side effects you are most likely taking too high of a dose or you didn't titrate slow enough.
Occasionally when starting Cytomel or other T3 medications the starting dose can be over stimulating and may temporarily cause some of the symptoms above.
Usually these symptoms will subside, especially when starting out on a low dose, but sometimes nutrient deficiencies and other hormone imbalances can make it difficult to tolerate T3.
Positive side effects of Cytomel:
- Weight loss
- Increased energy
- Decreased hair loss
- Increased cognition and improved memory
- Decreased brain fog
- Improved sleep
When starting T3 you should experience most of these symptoms.
Improving T4 to T3 Conversion with other Thyroid Medications
What if your Doctor isn't willing to prescribe Cytomel? What are you supposed to do?
If you can get your Doctor to test your free T3 levels and show that they are quite low most physicians are willing to add in T3 hormone, but that isn't true of every doctor.
If this just isn't an option for you then you will want to focus on T4 to T3 conversion and do whatever is in your power to increase this conversion process.
If you can't get T3 by simply taking thyroid medication then you can help promote T4 to T3 conversion by altering various factors in your body.
You can read more about how to do this naturally here.
If you can promote T4 to T3 conversion then you will necessarily reduce T4 to reverse T3 conversion.
By reducing T4 substrate and "forcing" your T4 to convert to T3 you are effectively lowering the reservoir of T4 that is capable of converting to reverse T3.
This has a great impact on your body and your symptoms.
The higher your free T3 the more active your thyroid hormone is, the lower your reverse T3 the higher your metabolism will be.
But realize the opposite is also true:
The lower your free T3 and the higher your reverse T3 the slower your metabolism will be and the more likely you will be to experience symptoms of hypothyroidism.
Cytomel Reviews & Case Studies
I've included some Case studies from my practice of patients who have used Cytomel, Liothyronine and T3 to help with weight loss.
You can read them here:
I've found that up to 60% of patients that come to see me need T3 in some form (either Cytomel, Liothyronine or SR T3).
If you are taking some other form of thyroid hormone (levothyroxine, synthroid or even forms of NDT) and you aren't getting improvement in your symptoms or you aren't noticing weight loss then improving your T3 levels might help.
Generally adding T3 or Cytomel isn't enough to cause significant weight loss by itself, but it is almost always required in order for the body to get into "fat burning mode".
As you can see from the case studies above T3 is always PART of the therapy, and in some cases therapy revolves around thyroid dosing, but other therapies are almost always required for 40+ pounds of weight loss.
Wrapping it up
Cytomel is a powerful thyroid medication that can help boost metabolism and lead to lasting weight loss in certain patients.
Having said that, Cytomel is NOT for everyone.
Use the information in this post to help determine if Cytomel would be helpful for your case and remember that each person is unique.
If you decide to try Cytomel out then I recommend starting with a low dose and titrating SLOW.
While using Cytomel make sure to monitor both your resting heart rate and basal body temperature to ensure that you do not over dose yourself.
Now I want to hear from you!
Have you used Cytomel successfully to lose weight? Did it work for you? Why or why not?
Leave a comment below!