- Cytomel is a potent T3 thyroid medication that can significantly boost metabolism and support weight loss in patients who are genuinely T3-deficient, but it's not appropriate for everyone and requires careful dosing.
- Simply taking Cytomel won't produce weight loss without concurrent attention to diet, exercise, and other metabolic factors, just like any metabolism booster needs lifestyle support to work.
- T3 medication carries risks including heart palpitations, anxiety, and potential thyroid suppression if dosed incorrectly, so this requires working with a provider who understands T3 physiology.
- Some patients see dramatic improvements on T3 while others experience no benefit or side effects, making individual assessment and trial-and-adjust dosing essential to find your optimal dose.
- Cytomel is best considered as part of a comprehensive thyroid optimization plan after you've ruled out other deficiencies and hormonal imbalances that might be the real culprit in your weight struggle.
Cytomel may be one of the most effective thyroid medications on the market.
And because your thyroid plays a role in regulating your metabolism, it also happens to be one of the best for helping with weight loss.
Does that mean that every thyroid patient should be taking it?
No!
But it definitely means that it can and should be considered, especially if you are someone who is doing everything else right and still struggling to lose weight.
Before you run out and start taking it, here’s what you need to know:
How Cytomel Can Help You Lose Weight
Looking at available research on physiology, you can say with some degree of certainty that your thyroid controls about 50-60% of your basal metabolic rate (1) (pinpointing an exact amount is more difficult than you might think).
This is the rate at which you burn calories at rest and is one of the most important values when determining whether or not you will be successful when losing weight (2).
People with a higher metabolism will lose weight faster and more easily compared to someone with a lower metabolism. It’s pretty simple.
Because Cytomel contains the most powerful thyroid hormone, T3, it’s considered stronger when compared to more standard thyroid medications like levothyroxine.
So if you take it instead of levothyroxine, you are providing a much more significant boost to your thyroid and, therefore, your metabolism.
The end result? More weight loss.
But on top of this, thyroid patients who take Cytomel also see a benefit to fluid retention which is another common cause of weight gain among this population.
When you combine the increase in metabolism with a loss in water weight, many thyroid patients do see a drop on the scale when they start taking Cytomel even without diet and exercise.
Understanding how it works is fairly simple. Understanding how to use it safely is slightly more complex.
How To Use Cytomel Safely
Because Cytomel is stronger than T4-only thyroid medications, there are a few extra steps that should be taken if you plan on using it.
As someone with a thyroid problem, you’re probably well familiar with the need for thyroid lab tests which should be assessed regularly if you are taking any sort of thyroid medication.
This recommendation still applies if you are using Cytomel, but on top of the standard tests (TSH and free T4), a few extra are required.
These lab tests include:
These are not lab tests that are generally ordered by most doctors so you will likely need to specifically request them.
But when taking Cytomel, they are important to track to ensure you are never taking more than what would be considered normal or physiologic.
Again, because T3 is so powerful, taking more than you need can lead to problems such as bone loss (3) or even heart problems (4).
Don’t let these symptoms scare you because they are preventable as long as your dose is normal.
On top of these extra lab tests, you’ll also want to keep track of a few other metrics including:
- Your resting heart rate (5) – Your resting heart rate should stay under 70-80 beats per minute when taking Cytomel. If you see it increasing into the 90s or even the low 100s then your dose is too high.
- And your basal body temperature (6) – Your body temperature should never exceed 98.6 degrees. If you see it increasing higher than this then it’s an indication you are pushing yourself into a hyperthyroid state.
You don’t have to keep an eye on your body temperature or resting heart rate, but I do find them to be very helpful especially when you first start taking Cytomel and are trying to optimize your dose.
Once you determine if using Cytomel is right for you the next step is to figure out how much you need.
Cytomel Dosing For Weight Loss
Like any other hormone in the body, Cytomel isn’t going to help unless you are taking enough of it.
The balance that you must strike is finding a dose that is not too high, as to cause unwanted side effects, and not too low, as to cause no benefit at all, but somewhere in between.
For most people, this dose will be somewhere between 5 mcg and 20 mcg per day.
This dosing recommendation is based loosely on the physiologic production of T3 from the healthy thyroid gland which is around 10-25 mcg per day.
By the way, the healthy thyroid gland also produces around 90 to 100 mcg of T4 each day, which will come into play in just a minute so keep this value in mind.
If we start on the basis that we are trying to mimic what the healthy thyroid gland produces, we will automatically minimize the risk of unwanted side effects while maximizing benefits.
This is because we already know that the healthy body can tolerate this dose.
This range of 5 to 20 mcg is just a guideline, though, as there will be people who need more or less.
For perspective, I’ve seen people use as little as 1-2 mcg of T3 per day or as high as 70 mcg per day.
If you do decide to start taking Cytomel then make sure that you start at a low dose and slowly increase your dose (titrate) over time.
For instance:
A typical starting dose may be 5 mcg which then increases by 5 mcg every 10-14 days.
It’s been my experience that this slow increase over time allows for the body to adapt to the T3 thyroid hormone which further minimizes the risk of side effects.
And in the event that side effects do occur, you can always back down on your dose to a dose that previously worked for you.
Bottom line? Cytomel does come with some extra baggage in the form of side effects but the tradeoff is that it’s much more powerful.
Here’s how it compared to some other thyroid medications:
Cytomel vs Synthroid For Weight Loss
โAs far as weight loss is concerned, Cytomel will be superior to levothyroxine and Synthroid in almost every instance.
In terms of magnitude, T3 is roughly 80 to 100 times more potent than T4 which is what levothyroxine contains.
But instead of thinking about which one is better, I think it’s more useful to think of them as a complementary pair.
While it is true that some people do benefit from using only T3, referred to as T3 monotherapy, many people do even better on a combination of T4 and T3.
And it’s this combination of T4 and T3 that I think you will really start to see significant benefits to your health and weight.
In fact, I would say the majority of thyroid patients need some combination of T4, T3, and T2 because this mimics the natural production of thyroid hormone from your thyroid gland.
And if we look at someone with a healthy thyroid gland, we see that their metabolism and weight are both normal.
From a practical standpoint, this looks like taking two different medications at the same time:
Both Cytomel and Synthroid, in this case.
This is the case for Synthroid and levothyroxine but what about NDT?
Cytomel vs NDT For Weight Loss
This one is a little different than the levothyroxine example because NDT formulations, like Armour Thyroid and NP thyroid, come with both T4 and T3 built into them.
NDT contains a static combination of both T4 and T3 to the tune of 38 mcg of T4 and 9 mcg of T3 in each unit (termed a grain).
This ratio puts us pretty close to the 80:20 ratio that was mentioned previously when combining levothyroxine and Cytomel together, so they are very similar.
For this reason, the answer regarding which one is better has more to do with dose and personal preference than anything else.
I’ve found that some people, for whatever reason, do better on Cytomel and some do better on NDT formulations.
If you spend time on social media or the internet in general, you will find groups of people who advocate and evangelize both.
But don’t fall for the hype either way. One is not inherently better than the other even when you start throwing around terms like “natural” or “synthetic”.
The reality is that both can work and both can help you lose weight. Which one you choose is more a matter of preference, tolerance, and trial and error.
The next thing we need to talk about is side effects.
Side Effects
If you are planning on taking Cytomel then you should be aware of its potential to cause side effects.
These side effects tend to be dose-dependent so whether or not you will see good or bad side effects depends on how much you are taking.
The higher your dose the more likely you are to see weight loss but also the more likely you are to experience hyperthyroid symptoms.
For those who start taking it, here are some common side effects that you may see:
- Hair loss
- Heart palpitations
- Increased heart rate
- Increased body temperature, hot flashes, or warm flushes
- Weight loss (most common) weight gain (uncommon but does happen)
- Jittery sensation or increased anxiety
- Headaches
- Loose stool or diarrhea
Let me be clear in stating that these are the negative side effects that may occur only if you are taking more than you need.
If you are taking the exact amount that your body requires, which is always the goal, you should not experience these negative side effects.
Instead, you should experience these positive ones instead:
- Weight loss
- Increased energy
- Decreased hair loss
- Increased cognition and improved memory
- Decreased brain fog
- Improved sleep
Again, whether you experience positive or negative side effects has everything to do with how much you are taking so make sure to spend time optimizing your dose.
Cytomel is definitely one of my personal favorite thyroid medications because it’s far more powerful than alternatives like levothyroxine.
But this power does come with some added responsibility and it will only work if you dose it correctly.
If you can nail down both of these things, though, it will go a long way to helping you effortlessly lose that extra weight caused by low thyroid function.
By the way, if you are a thyroid patient trying to lose weight, make sure to check out this article next.
It walks you through how to use T2 thyroid hormone which, much like T3, is stronger than T4 when it comes to boosting metabolism and most thyroid patients have no idea that it even exists.
Scientific References
#1. https://www.ncbi.nlm.nih.gov/books/NBK500006/
#2. https://www.ncbi.nlm.nih.gov/books/NBK572145/
#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230461/
#4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832836/
#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8558494/
#6. https://pubmed.ncbi.nlm.nih.gov/8808101/
Additional references:
#1. http://www.ncbi.nlm.nih.gov/pubmed/16883675
#2. http://www.ncbi.nlm.nih.gov/pubmed/24692351
#3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205882/
#4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169863/
#5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148220/
#6. https://www.ncbi.nlm.nih.gov/pubmed/402379
#7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451035/
#8. https://www.ncbi.nlm.nih.gov/pubmed/28138133
#9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737508/
#10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318631/
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.
Hey LaTisha,
Yes, most people do better with more T3 after TT – but it really depends on the person.
I could be wrong but I don’t think the conversion of T4 to T3 takes place in the thyroid gland. I believe the liver does this work.
It happens all over the body including in the cells, but much of it occurs in the gut and liver.
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.
Thank you for the kind reply, Dr. Childs!
No problem!
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.
I personally after yrs on t4 and only feeling great the first few months…after that I felt horrible and gained weight. Finally after yrs of talking the dr let me try 5 mg t3. That first pill, I swear, I was a different person and slept for the first time in yrs. Iโm now on 25 nightly or rather when I wake up after going to bed for a few hours. Then I go back to sleep most of the time and sometimes t3 tells me I need to get up instead.
Now my problem is it does UP my appetite so Iโve got to stop giving in and just go to bed hungry. I hope you will be able to take only t3. Ask to try it alone. Start very low with it alone.
It may not be the T3 that is telling you to get up–it could be your brain. When your glucose level drops during sleep, your brain wakes you up, and you suddenly feel wide awake. The brain’s goal is for you to consume food/fluids that will raise glucose levels back to the nice, safe level the brain likes. Once you give the brain what it wants, you will usually fall back asleep fairly easily since melatonin and other sleep hormone levels will still be available depending on what time it is and where you are in your sleep cycle. The next time you find yourself wide awake at 1 a.m., try drinking a small glass of milk or eat a little cheese and a cracker or two.
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.
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.
Hey Lourae,
No problem! Yes, it can take several weeks to months to start noticing the difference.
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.
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.
I am experiencing the same massive hair loss with T3 and all the hypo systems. I can tolerate the smallest dose of nature throid, but it seems to be lowering my Free T3. I originally had normal labs and was suggested thyroid meds, ever since i did synthroid and different brands, my tsh levels have increased and i am now experiencing hypo symptoms with the additional T3 and my free T4 and T3 ranges went to the bottom of the normal range… I HAVE LESS T3. Help! I’m considering getting off NDT to Synthroid(bioidential ??-) so my own thyroid will start producing again, and get off the meds all together. or I can add more T4 to my NDT, so i will not lose anymore hair. Any advice would be great
Hi Donna,
Please see these articles which outline the causes of thyroid hair loss and provide treatment options depending on the cause:
https://www.restartmed.com/thyroid-hair-loss/
https://www.restartmed.com/treatments-for-thyroid-hair-loss/
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.
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.
That won’t be easy but thanks anyway.
Nothing worth doing is ever easy ๐
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.
Wow, what a great comment! Yes, you can safely raise cytomel dose every 3 days or so, 5-10 mcg if the med is well tolerated. I need a very high dose to reach my cells, about 150 mcg per day split in 2 doses. No, I donโt have heart issues and my resting heart rate is between 75-80, which is normal for someone whoโs on T3 only treatment. I canโt live without T3, I feel horrible.. even when eating super healthy 100% of the time. My dose runs out after 3 hours, I wish it lasted longer. I hope you are well.
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.
Do an internet search on “choline inositol hair.”
I experienced the opposite, hair loss when I got of liothyronine. I was mostly meat based for the first year and experienced shedding due to lio, but it stopped shedding after about 6 months or so. My hair was very thick but tangled very easily. You have to pay attention to your diet, the hair loss can also come from poor nutrition (low iron, B12, Vit D, etc.), so itโs important you look at the full picture when trying to understand where the hair loss is coming from. I donโt recommend getting on any thyroid medication if eating poorly, it will only further complicate things. You must change your lifestyle/diet to feel well.
Hi,
Did you ever fix your hair loss? Look up diamataceous earth. It will grow your hair fully back.
Cheers
This question is about DIATOMACEOUS EARTH … how do you use it to promoted hair growth ?????
Regards
How would you introduce T3 with T4? Would you take them both together at the same time? What’s the best protocol? Thanks
Hey MM,
There is no best protocol, it depends on the person, their labs and symptoms.
I was wondering if you have to separate the t3 from t4? I take them both together at night. Iโm hoping this is ok
Hi Toni,
Not necessarily but it’s often better to split them up.
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.
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.
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.
Hi Pamela,
I live in the Netherlands and my doctor gave me exactly the same reaction to my question about Cytomel.I had to do blood tests on my own (tsh- high,ft4-low mid ,ft3-low).I am on 112 mcg of Euthyrox and decided to buy Cytomel on my own,online.Now I need to play doctor and pay for all myself,having paid insurance next to that.So all in your hands or you find knowledgeable doctor.Good luck either way!!
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.
it’s the fillers in the different medications that can give us trouble.
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.
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.
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.
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.
Hey Susan,
Good luck and keep us updated on your progress.
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.
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.
Hey Sarah,
Unfortunately nothing is as strong as cytomel because it is pure T3 hormone.
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.
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.
Thank you .
No problem!
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.
This is me! Did you figure it out?
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.
Eugenia,
I realize your comment is from years ago and you probably won’t see this, but I was able to fix my conversion issue with running. I had high RT3 and low T3 and started going for 1-5 mile runs every few days. The next time my labs were done, my RT3 was low and my T3 was good. One doctor I saw said he’d never seen anything like it before; another said he had a second hypothyroidism patient who had also fixed her RT3 levels with running.
Unfortunately for me, I was bitten by a tick and got Lyme disease and other tick-borne pathogens and haven’t been able to run so my RT3 is back up and my T3 is down. I now have Hashimoto’s too (previously had no antibodies). So I’m looking into Cytomel and I’m considering taking it by itself since Armour seems to do nothing at all for me. I also suspect I have leptin resistance (will request being tested in June when I see my doctor) and I have other symptoms indicating that I’m a good candidate for Cytomel.
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????
Hi Greta,
Dr. Childs is not currently accepting patients, but you can find more information about his weight loss program here: https://www.restartmed.com/hormone-mastery/
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.
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.
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.
Hey Suli,
Rarely is weight loss resistance due solely in part to thyroid medication, for more information check out this video which goes over what causes issues with weight loss in thyroid patients in detail: https://www.restartmed.com/thyroid-video-1/
Hi Suli,
I believe T3-only medication or Cytomel is also the answer for me. I’m curious–how much were you taking when you lost the weight? Were you taking multiple dosages per day?
I hope you found someone to help you MN. I’m in WI and looking for the same!
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.
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??
Hey Kat,
Cortef can cause swelling, but that can happen from cytomel as well.
So, should I cut out the Cortef for now?? My labs showed that my adrenals were adequate…I think I should just stick with the Cytomel?
Thank you.
I forgot to mention, my temperature has been very low 96ish…and never getting much higher than 97.
You will have to discuss those changes with the doctor that prescribed the medications, I can’t provide you with medical advice unless you become my patient.
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.
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!
Hey Amy,
Changing up your cytomel dose will most likely not lead to the weight loss you are looking for.
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!
Hey Lekalo,
I would try to find a knowledgable doctor to discuss this with prior to your surgery.
It seems there are not many knowledgeable doctors out there for thyroid patients!! Itโs ridiculous that so many people are suffering from problems with thyroid and there are hardly any doctors or anyone that can help! Whatโs a person to do??
Hi Deborah,
It’s definitely slim pickings when it comes to thyroid literate doctors but they are out there. You can use this resource to help you find them: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/
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.
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
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.
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.
Same did you figure it out?
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.
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.
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?
Hey Michelle,
Most patients experience some improvement within 4-8 weeks of starting this medication.
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
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.
Hey Jarod,
It’s less about your body weight and more about how your body handles the medication.
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
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
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?
Hey Charlotte,
Yes, those symptoms are not uncommon when changing/switching medications.
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?
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.
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.
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.
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).
Hi Dr. Childs. I know this article is old but Iโm glad I found it! Iโve had Hashimotoโs for 12 years and in September of 2022, I began a period of unexplained anxiety and panic attacks. Blood tests have all come back normal except my ferritin. I lost significant weight due to the anxiety, and we had to lower my meds from 175 mcg Levo to 100 because I was hyper at 0.02. Now Iโm hypo at 8.62, so I started Levo at 150 mcg. Today I saw my doctor but he wants to keep me at 100 mcg Levo and add 5mcg Cytomel. I was feeling extremely tired at 100 mcg and Iโm scared to go back to it. How much of a difference will that combo make? I have to agree with you when you say we have to address our other problems too not just Thyroid. I started back up on iron supplements and it has reduced my anxiety. Iโm also on Selenium, Zinc and Maganesium supplements which have helped me tremendously. I also supplement with Vitamin D and B12 since those two I know for a fact I am deficient in. For so many years I was dependent on levothyroxine to make me feel better even though I am always tired. I can tell you that since supplementing, my body aches have gone away. I also have been gluten free for 12 years and now Iโm cutting out dairy. Iโm seeing the benefits. Hopefully once my TSH is back to normal I will incorporate Cytomel.
Hi Iris,
It’s very difficult to predict how any one person will react to changes in thyroid medication so trial and error is almost always required. I can tell you, though, that a 50mcg drop in your levothyroxine will not be offset by a 5mcg increase in T3, at least not from the perspective of your pituitary gland. If you are intentionally trying to make changes that result in a net drop in your thyroid medication dose then that’s fine to do, but they aren’t equal in terms of their impact on the body.
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
Hey Zenyatta,
The answer to all of your question is yes, depending on the person and situation.
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.
Hey Emily,
It might be related to fillers/additives, etc. and not the T3 thyroid hormone itself.
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.