Liothyronine User Guide: Dosage, Weight Loss, Side Effects & More
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Liothyronine User Guide: Dosage, Weight Loss, Side Effects & More

Liothyronine is a special type of prescription grade thyroid hormone, it's also the most powerful thyroid medication that exists. 

People taking liothyronine (especially over traditional medications such as levothyroxine) report significant improvements in their hypothyroid symptoms and quality of life. 

These benefits range from weight loss to reduced rates of depression and more. 

Learn who should consider using liothyronine and how to use it properly with this complete guide: 

More...

What is Liothyronine & Benefits of Using it to Treat Hypothyroidism

Liothyronine is a T3 only thyroid medication and hormone used to treat patients who suffer from hypothyroidism, low thyroid function or a sluggish thyroid. 

It is a hormone - pure and simple. 

It is also the generic version of the brand name medication Cytomel (also used to treat hypothyroidism). 

Then why don't more doctors prescribe it?

In order to understand how T3 works we need to take a step into some very basic thyroid physiology...

Liothyronine therapy increases serum levels of T3 when compared to T4 only thyroid medication

Liothyronine otherwise known as T3 is one of the two main thyroid hormones floating around in your blood. 

Since you're hear you probably already know the importance of proper thyroid function in the body, but just in case you can read more about why it's important to have normal thyroid function here. 

T3 is the sister hormone to T4 but they differ in one very important aspect. 

T4 is an inert or inactive hormone by itself and in order for it to become "activated" it must be slightly altered

Once it is altered it is changed into T3 - the active thyroid hormone. 

T3 activates genetic transcription at the cellular level

T4 can therefore be thought of as a reservoir hormone that your body can draw from to activate thyroid hormone as the need arises. 

The fact that T3 is ACTIVE while T4 is INACTIVE is very important and is why T3 is considered to be MUCH more powerful than T4

And this is one of the reasons that it's not as commonly prescribed when compared to other thyroid medications. 

Liothyronine is felt to be "too strong" or "difficult to control dosing" or "too dangerous" when compared to T4 only medications such as Synthroid, Levothyroxine and Tirosint. 

Just because T3 is stronger (about 3-4x stronger than T4 medications like Synthroid) doesn't mean that it is dangerous. 

If used properly liothyronine can be added safely and effectively to patients with hypothyroidism and generally they experience significant improvement. 

Who Should Consider Using T3 Medication

Not everyone who has thyroid disease necessarily needs to use liothyronine in order to feel better. 

Patients who tend to require T3 medications are those who suffer from more serious medical conditions such as systemic inflammation, hormone resistance syndromes such as leptin resistance and insulin resistance and those with treatment resistant weight gain. 

Another subset of thyroid patients who may benefit from the use of T3 are those who suffer from low T3 syndrome and other thyroid lab tests which may indicate poor peripheral thyroid conversion

Other patients who are taking T4 only medications such as levothyroxine but who still remain symptomatic may also find relief with small amounts of T3 used in conjunction with their current thyroid medication. 

With these ideas in mind I've compiled a list of patients who may consider the use of T3 in their treatment: 

  • Patients with low serum levels of free T3 and total T3
  • Patients with high levels of reverse T3
  • People who have a "normal" TSH but still remain symptomatic despite taking thyroid medication
  • Those who suffer from leptin resistance and insulin resistance
  • People with treatment resistant weight loss
  • Patients with treatment resistant depression and treatment resistant bi-polar disease

This is not an all inclusive list, but it is a great starting tool. 

When it comes to feeling better starting T3 is only the beginning, more important is the dose that you use.

T3 conversion booster 400 x 350

Liothyronine Dosage Guide

Liothyronine can be used in 2 different ways:

#1. Used in conjunction with other thyroid medications, especially T4 only thyroid medications like Synthroid

This is probably the most common way that liothyronine is used nowadays and luckily this sort of therapy is becoming more and more common especially as providers become more comfortable with T3 as a medication. 

Or...

#2. Used by itself.

Using T3 by itself is much less common when compared to combining T3 with other thyroid medications. 

Much of this has to do with the current "standard of care" which states that physicians should always use T4 thyroid medication over T3 alternatives. 

Liothyronine therapy is comparable to levothyroxine in lowering the TSH

But just because this is the "standard" doesn't mean it doesn't have utility for certain patients. 

Some patients, especially those with very difficult to treat weight loss and hormone imbalances such as leptin resistance, may benefit tremendously from the use of T3 by itself. 

T3 only therapy can be used temporarily to try and "restart" or "kick start" the body back into action or it can be taken long term as well. 

As long as T3 is used in the correct dosages there shouldn't be any long term consequences with its use. 

So what is a safe and effective "dose" for liothyronine?

The answer is not as straightforward as you might think but we can use liothyronine doses to help sort it out. 

Liothyronine comes in the following standard dosages:

  • 5mcg
  • 25mcg
  • 50mcg 

Even though there are 25 and 50mcg doses you will rarely find a provider willing to prescribe a dose that high. 

Instead most people end up with a dose somewhere between 5mcg and 20 mcg per day. 

Is there a specific magic dose to look for?

This is where things can get tricky. 

The answer is no. 

Your goal with using Liothyronine (or any other thyroid medication) is to find the amount that you need to reduce your symptoms without causing long term issues

This range is typically somewhere between 5mcg and 20 mcg but it may be higher for some individuals. 

Splitting the Dose Throughout the Day

Liothyronine is different from other thyroid medications because it is active but also because it has a very short half-life. 

The half-life of a medication is a term used to describe how long it "lasts" in your bloodstream before half of the total amount is metabolized. 

Liothyronine has a half-life on the order of 24 hours while levothyroxine has a half-life on the order of 5-7 days

This means Liothyronine isn't in your system longer than a few days. 

With this in mind some patients may do better by "splitting" their dosing throughout the day. 

For most patients this means taking half of their dose in the morning (with their other thyroid medication) and then the other half later in the afternoon around noon. 

And this makes sense when you consider how the body normally uses hormones. 

Hormones are constantly secreted by functioning glands throughout the day based on the demand of the body. 

No matter how hard we try we will never be able to exactly replicate the dosing schedule that the body uses naturally, but we can get close by taking the hormone at several points throughout the day. 

Obviously we don't want to take something like 1mcg every hour, but taking 5mcg every 4-6 hours may be a better and more realistic approach. 

Some patients do considerably well with this approach while others may be fine taking all of their T3 in the morning. 

Using Liothyronine for Weight Loss

Liothyronine may cause weight loss but it should not be used as a weight loss medication. 

The use of liothyronine for weight loss in individuals who don't have thyroid dysfunction may cause unwanted side effects. 

Having said that liothyronine may help with weight loss in patients who have hypothyroidism. 

Some patients taking T4 only thyroid medication may suffer from low T3 syndrome or other problems that interfere with the normal conversion of T4 to T3. 

This may lead to lower than normal serum T3 levels which show up on blood tests

Patients who fall into this category generally have a normal TSH, low T3 and normal to mid range T4 levels

The addition of T3 to T4 medication such as levothyroxine may help in people who fit this criteria. 

T3 may cause weight loss over T4 medications because of how it interacts with fat cells and other hormones in the body. 

T3 directly influences mitochondrial energy production and increases thermogenesis and fat burning potential. 

If you have low T3 (even if your other thyroid lab studies are "within range") you may be missing out on these important benefits of T3 in your body. 

Bottom line?

Liothyronine can help with weight loss but it should not be used as a weight loss medication. 

Using Liothyronine to Treat Depression

Liothyronine can also be used to treat depression.

Depression is an obvious and well known side effect of hypothyroidism - meaning low thyroid levels in the body. 

But what's interesting is that T3 or liothyronine can be added to antidepressants even in patients with normal thyroid status and still improve mood and cognitive function. 

Unlike weight loss where you shouldn't use T3 unless you are hypothyroid, small doses of liothyronine can be effective in helping treat depression. 

Some studies have shown that the use of T3 in combination with SSRI's (common antidepressants) enhance the effect of these antidepressants. 

The exact mechanism as to how this helps is not well established, but one of the prevailing theories is that some patients with depression may have subclinical levels (or undetected) of thyroid dysfunction that don't show up on standard lab tests and may therefore manifest as depressive symptoms. 

The idea is that upon replacing the small deficiency of thyroid hormone the brain has sufficient thyroid hormone and the depression "lifts" or is treated.

Beyond this, T3 has also been shown to directly increase serotoninergic neurotransmission by altering receptor sensitivity to serotonin and also by increasing synaptic concentrations of serotonin. 

Why is this important?

The most important factor is that SSRI's or conventional antidepressants are only successful in treating depression in about 50% of the cases. 

This leaves a huge majority of patients symptomatic even after taking certain medications. 

The concurrent use of T3 to existing SSRI's and other antidepressants may therefore be a viable option for many patients who are considered "treatment resistant"

But what about patients already on thyroid medication but still suffering from depression?

I've mentioned previously that T3 is the active thyroid hormone in the body and it seems that the total amount of T3 in brain tissue may influence depressive symptoms (as well as other factors). 

Switching from T4 thyroid medication such as levothyroxine to liothyronine, or simply adding some T3 to their existing T4 medication, has been shown to improve mood and neuropsychological function

One study showed that when patients switched from taking T4 medication to T3 medication they showed an improve mood, an increase in sex hormone binding globulin (likely indicating better thyroid absorption and function) and a slightly higher pulse rate. 

Patients in this study took T4 medication for a set time period and were then converted to T3 thyroid medication, at a rate of 50mcg of T4 to 12.5mcg of T3. 

The studies conclusion was that the there may be something specific to T3 that occurs in the brain tissue which may influence mood and cognition, and this benefit may not be achieved with the use of T4 medication alone. 

Bottom line?

If you are suffering from depression, whether that is from thyroid dysfunction or not, it may be worth considering a trial of T3 therapy or liothyronine as an alternative or complementary treatment to your existing treatment. 

What to Expect when starting T3 medication

Because liothyronine is more powerful than levothyroxine (and other T4 medications) it's important to talk about expectations when starting the medication. 

Some people believe that upon starting this medication that they will immediately lose weight and start feeling better - this is not necessarily the case. 

While it is true that many people who take liothyronine do experience an improvement in their symptoms, in order to get to this level you need to understand some basic rules. 

For starters:

The dose necessary for optimal results will vary based on the individual and you must take some thoughtful time and consideration to get there. 

While dosing make sure that you follow the proper labs: TSH, free t3, total t3 and SHBG (sex hormone binding globulin). 

Monitoring lab tests, in addition to your symptoms, will help you get to your optimal dosing. 

Second:

When using liothyronine remember the idea of "low and slow" as it relates to titration. 

Because this medication is powerful you always want to start a low dose and titrate up to higher doses in a slow and controlled manner. 

This means incremental increases in the medication every few weeks with periodic checks of serum lab tests. 

Along this same vein is the idea of sensitivity of certain patients to T3: 

Some people tend to be very sensitive to T3 medications. These are patients who may experience jittery sensations or anxiety upon starting even a low dose. 

Sensitive patients tend to require much lower doses than those who are non-sensitive. 

Patients who tend to be sensitive usually know who they are - these are patients who tend to "react" to over the counter supplements and other medications. 

But it's important to identify yourself as either a "sensitive" or a "non-sensitive" patient because of its influence on dosing. 

Non-sensitive patients tend to tolerate moderate to higher doses just fine and are much easier to obtain the correct dosing. 

Following these guidelines will help you find your optimal dose and help you on your way to feeling better. 

Beyond these guidelines there are also other considerations that should be taken into account when starting liothyronine. 

Hair Loss

The first is the potential for hair loss

Liothyronine, as well as cytomel, may cause a temporary increase in hair loss among certain individuals. 

The good news is that this side effect is almost always temporary (except a few minority) and tends to subside within 3-6 months. 

The bad news is that many patients who suffer from hypothyroidism already experience some degree of hair loss due to the condition itself (along with many other potential factors that you can read more about here). 

Extra hair loss which may be associated with starting liothyronine use may therefore be very disturbing to many patients, and rightfully so. 

If you fall into this camp it's important to realize that this side effect is a temporary and well known side effect of T3 use. 

Provided you can stick out the side effect for 3-6 months your hair loss will generally stop and then begin to regrow, even at a rate which was better than starting the medication. 

It is not well understood why hair loss begins in the first place but it may be due to the influence of thyroid hormone on hair follicles themselves. 

It's also important to realize that hair loss is a well known side effect of nutrient deficiencies such as iron, biotin, B vitamins and choline

It's possible that replacing thyroid hormone with T3 may temporarily exacerbate these deficiencies and lead to an increase in hair loss temporarily. 

Other Side Effects

In general, liothyronine is well tolerated provided you dose in a "low and slow" manner. 

Side effects from this medication tend to occur only when the dose is too high for the individual or for patients who tend to be sensitive. 

With that in mind the negative side effects of liothyronine use tend to mimic those of hyperthyroidism. 

You can see a list of side effects of using liothyronine below along with the potential cause: 

  • Jittery sensation (usually dose dependent and from taking too much)
  • Rapid heart rate (an indication you may be taking too much)
  • Nausea (may be secondary to taking the medication on an empty stomach)
  • Hair loss (usually subsides over 3-6 months and is temporary)
  • Stomach pain (may subside when taking medication with a meal)
  • Sensitivity to heat (an indication your dose may be too high)
  • Anxiety (another indication your dose may be too high)

If you experience any of these side effects you should refer to your prescribing Doctor for further recommendations. 

Some patients are also concerned about TSH suppression with the use of liothyronine. 

This side effect is only seen when dosing tends to be on the higher side and it can be avoided by following thyroid lab testing. 

Studies have shown that substituting T3 in place of T4 in pituitary-equivalent dosages (based on the TSH) results in reduced body weight, better cellular thyroid action on lipid metabolism without negative side effects. 

Final Considerations

Liothyronine is a very powerful and strong thyroid medication that is used to treat people who suffer from hypothyroidism. 

This medication differs from other thyroid medications in that it contains the active thyroid hormone T3. 

This medication, therefore, does not need to be "activated" by the body and begins working almost immediately. 

Because of these unique properties T3 can be used either by itself or in conjunction with other thyroid medications and may help treat difficult conditions such as treatment resistant depression and treatment resistant weight loss. 

Dosing should be titrated low and slow and dosing should be individualized while following serum thyroid lab tests. 

Side effects tend to be minimal if the medication is used correctly and if titrated in this way. 

Now I want to hear from you:

Are you using liothyronine?

Has it helped treat your thyroid disease?

What dose are you currently at?

Leave your comments below! 

Westin Childs
 

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

Click Here to Leave a Comment Below 134 comments
Brian - December 5, 2017

Hi Dr. Childs, I have hypothyroidism and am currently taking W P Thyroid which I know is a T4/T3 combo. I suffered a stroke 16 months ago and was put on Lexapro for depression. Could adding T3 to my current regimen give me too much T3?

Thank you!

Reply
    Westin Childs - December 9, 2017

    Hi Brian,

    It’s possible but it’s also important to consider that a stroke may have caused some anatomical or structural damage that predisposed you to depression in which case the T3 may not help.

    Reply
Mike Dodaro - December 5, 2017

I took liothyronine for about three months, starting with 5mcg and titrating up to 20mcg. My T3 didn’t increase at any dosage. I have a history of atrial fibrillation, and the liothyronine seemed to bring it back, so I quit the liothyronine. I’m still interested in finding a way to increase T3, which last tested at 1.6 where it has been for several years. About five years ago, I got fine results with iodine supplementation, but that has not worked lately.

Reply
    Westin Childs - December 9, 2017

    Hi Mike,

    You can look into other factors that may be limiting T4 to T3 conversion such as weight, inflammation, gut health, etc.

    Reply
Lucas - December 6, 2017

What about people that don’t tolerate even a small dosage of T3? Even with 2.5 mcg T3 I get more fatigue whit it. Maybe I am a candidate for success whit T4 only therapy? Whit no medication my TSH is High and Free T4 low, but I never have low free T3, it is always at 70-75 % of the reference range.

Reply
    Westin Childs - December 9, 2017

    Hi Lucas,

    Yes, you may be someone who does well on T4 only medication like Tirosint. Not everyone can tolerate T3, and I have treated many patients who can convert T4 to T3 just fine.

    Reply
Cathy - December 9, 2017

Great article! I am a thyroid cancer warrior who was on T4 only the first year after TT and not doing well so added 5mcg of T3. That helped somewhat but not enough. Ended up with frozen shoulder and fought with that for 2 years and continued to declined in mood, memory and cognitive function as well as increased fatigue, muscle cramps and pain, heart palpitations, etc. Went on antidepressants and worked up to the highest dose for that particular drug with no improvement. Asked the psychiatrist to add a second 5mcg dose of T3 and she agreed. I was better within a couple of weeks. More T3 was what I needed most but I still also take T4 and antidepressants. I tell people T4 keeps me alive but T3 keeps me functional.

Reply
    Westin Childs - December 9, 2017

    Hi Cathy,

    That’s a great way of looking at it and I do agree that T3 tends to be the thing that improves quality of life in most patients. I think there is a huge difference between simply surviving and thriving and the focus should be on thriving and quality of life!

    Thanks for sharing 🙂

    Reply
Lia - December 9, 2017

My doctor prescribed T3 for me after being on Armour thyroid for many years, and recently resulted in high Rt3 blood results. I had Hashimoto’s and stress seems to have had a deleterious effect on my symptoms. Not sleeping at night, eczema, constipation, and other symptoms along with very low body temps.
I started at 5 mg of T3, and went up to 10. But shortly after I started having symptoms of HYPERthyroid. I’m off all T3 and everything until my heart stops pounding for a day. Then I’ll go back on T3, but only at 5mg.
It’s hard to get to the right dose because our lives are constantly changing. But the only thing that doesn’t change with me is my weight. 8 months completely gluten-free, and I went into hyper-thyroid and still the same weight.
At this point, I KNOW that what a determining factor about weight is – genetics. People don’t want to believe it, but look at your family. My lifestyle was totally different- I exercised my entire life, ate organic, never over-ate…. and I ended up the same as my heavy mom who did none of what I did.

Reply
    Westin Childs - December 9, 2017

    Hi Lia,

    With few exceptions (only about 3-4 people) I’ve found a way to help most people lose weight. In most cases thyroid function as a cause of weight gain is very low on the list, meaning there are more important factors that people often miss when assessing their weight.

    Reply
Bonnie Turnbull - December 9, 2017

I have tried WP, Nature-thyroid and synthetic Tirosint and Cytomel when they reformulated Armour Thyroid and, not one of them has helped me feel any better. They say WP is the identical formula as the old Armour Thyroid but, I disagree strongly with that statement. I was on Armour thyroid for 27 years and when I had to switch, I gained 65 lbs in less than 6 months and that is where it has stayed even on a 500 calorie a day vegetarian diet………..why?

Reply
    Westin Childs - December 10, 2017

    Hi Bonnie,

    The reason is most likely due to metabolic damage incurred by severe and prolonged calorie restriction. You can read more about this concept here: https://www.restartmed.com/symptoms-of-not-eating-enough-calories/

    Reply
      Bonnie Turnbull - December 11, 2017

      The only way I could maintain the 65 pound weight gain and not gain anymore was to lower my calorie intake. Only at less than 500 calories a day do I not gain weight. It has stayed at 65 lbs. only on a vegetarian diet of no more than 500 calories a day so, the restriction of calories came as a way to stop gaining weight.

      Reply
        Westin Childs - December 11, 2017

        Hi Bonnie,

        I totally understand and I’m not faulting you for doing so (what you just described happens to many people), I’m just saying that you treated a problem which caused another problem and never treated the original issue which caused the weight gain to begin with. How you got here is not as relevant as how you treat the problem going forward.

        Reply
          Bonnie Turnbull - December 11, 2017

          I know how it started. I was on the original Armour thyroid, 4 grains per day, then they reformulated it. That is when the weight gain started. I have been on WP, Nature-throid and synthetic Cytomel and Tirosint. None of them have done any good. Everyone of they hypothyroid symptoms are there. I was in a motorcycle accident in 2007 and had a severe brain injury, that is pretty much when this all started. I was put on one synthetic pill a day and even in the hospital and rehab, the weight just came on, I am still on 1 pill per day of Cytomel and one pill a day of Tirosint. I have never converted so, I need both T3 and T4. But now I’m on 1/5th the dose I had been on for 27 years and no one thinks thats odd but me.

          Reply
Amanda - December 9, 2017

I’ve recently had a blood test that shows my levels of Reverse T3 are extremely high (105 ng/dl in a range of 10-24; FreeT3 is 4.58 pmol/L (3.10-6.8); my Reverse T3 ratio is 2.84 (15.01 – 75.00). I take 125 mcg of Levothyroxine per day and live in the UK. Would taking pure T3, or NDT, be beneficial for me (if I could find someone to prescribe it?)

Reply
    Westin Childs - December 13, 2017

    Hi Amanda,

    It’s too difficult for me to say if you would or would not do well on T3 just based on this information alone. I generally spend at least 60 minutes getting information from patients and use their lab tests to determine how to proceed.

    Reply
Amanda - December 9, 2017

Oops, the message posted before I had finished writing, or ticked the boxes to make sure I don’t miss any follow-up comments. I was going to ask where you are based and if you do consultations and prescriptions for people who live in the UK? Thanks so much for your information.

Reply
    Westin Childs - December 13, 2017

    I’m not accepting anymore patients at this time but do have a few options for coaching and lab analysis for those who have a physician willing to work with them but aren’t sure how to get started.

    Reply
      Barbara - December 13, 2017

      Hi Dr Child wrote ” have a few options for coaching and lab analysis for those who have a physician willing to work with them but aren’t sure how to get started”, I live in NZ and my doctor is in that category, what are the options you have available?
      My doctor graciously is giving it a go for me having T3 Liothyronine, but is very cautious about it.

      Reply
Anna - December 10, 2017

Hi Dr. Child’s, when I started supplements g with synthetic 25mg 2 years ago, I started feeling a bit better and my blood tests normalized, but now they’ve reverted. My doctor prescribed a higher dose 50mg and to see a specialist whom I can discuss the specialty tests you talk about. How do you determine if a patient needs amto increase the dose or just change to t3+t4 combo? My doctor said typically people reach their optimal dose when the thyroid level stabilizes and symptoms go away, and they stay there vs requiring to continuously increase the dose, which was my other concern.

Reply
    Westin Childs - December 13, 2017

    Hi Anna,

    It’s not unusual for the total amount of thyroid hormone that someone needs throughout their life to change based on their circumstances. It makes sense, for instance, that you would need more thyroid hormone during times of intense stress or during changes in hormones such as menopause.

    Reply
Dorothy - December 10, 2017

Dr Child’s, have taken thyroid replacement levo since 2000,:this summer tried some thyroid 60 grains ( I thought I’d switch)after two weeks felt it I wasn’t on high enough dose tired, water retention, tired so I went back on Tyrosint 112 mcg. But I feel I needed T3 and I tried taking a 1/2 of natural dessicated thyroid 30 grn a a couple hours after taking Tyrosint and I felt very well for about one week; Almost ” normal”. I stopped because I don’t know a doc who would Rx this regimen for me. I could probably have taken less than 30 grain and it probably would have helped. Cytomel made me feel ill, ( I tried it a long time ago for a few days) can’t take that. Comments ?

Reply
    Westin Childs - December 13, 2017

    Hi Dorothy,

    The amount that each person needs is unique to that individual and can take trial and error to figure it out. Not everyone does well on T3 either in the pure T3 only form or with NDT, some people have no issues with T4 to T3 conversion and do quite well on T4 only. Unfortunately there’s no lab test to determine this you just have to figure it out over time.

    Reply
JJ - December 10, 2017

Dr.Childs I take 100-125 mcgs of T3 all at once , never get a rush or speedy feeling just feel normal . Does that mean my body has serious issues to be able to tolerate that much at once? Still no weight loss FT3 is 3.9-4.0 top of range.

Reply
    Westin Childs - December 13, 2017

    Hi JJ,

    I would take that to mean that you probably have some other issue that is driving your weight gain and is probably unrelated to your thyroid!

    Reply
Dhi - December 10, 2017

Hello!
I am definitely of the super sensitive to medications camp and intolerant to most. I never did well on any of the T4 options, they always caused my TSH to drop way too low and Armour caused an anaphylactic type reaction. I also tried a time release cytomel a number of years ago which was fine for a while but then made me too hyper.

I’ve been taking a generic Liothyronine alone since approximately May 2016. I have done best with the generic brand Perrigo, it seems to have less fillers or at least I don’t react to it like other generic brands.

My doctor had me start with 2.5mcg two times a day. I had many of the jittery symptoms but they seemed to taper off after a couple of weeks. Later she had me increase the dose to 2.5mcg three times a day which is where I am now.

Prior to beginning T3 only, I began developing a goiter which got quite large and palpations which got pretty severe, culminating in a non-sustained tachycardia event, hospital stay and angiogram which happily showed very normal. I was then put on a very low dose of atenolol which I took at night bc it made me so sleepy.

Now, two years after that event, the goiter has shrunk to 1/5 it’s size (along with regular acupuncture, occasional progesterone and other supps), the palpitations are reduced to a couple a month, I’m off the atenolol and am losing the added 50lbs. My early morning temperature however is still in the 96.6 range.

Question:
how important is it to take the T3 at the exact same time every day? I’ve been pretty loose about it and still often forget a dose or two or skip it if I’m feeling jittery or extra stressed. Wondering if i would feel better being more exact?

Reply
    Westin Childs - December 11, 2017

    Hi Dhi,

    It’s always best to take your medication at the same time of day to prevent unwanted or unexpected serum high/lows of thyroid hormone.

    Reply
Nancy D. - December 10, 2017

Hi Dr Child’s
I have hypothyroidism. It took me 6 years to convince my PCP to change me from Levothyroxine 150 mcg to Liothyronine 5 mcg tot rated over several weeks to 3 tabs a day and reduced my Levothyroxine to 112 mcg per day with it. I feel so much better but still have inflammation and no weight loss so far. Prior to the med change you ordered my labs and found that I am now Hashimotos and I have since had food sensitivity testing done and am trying to adjust my diet. Any help with Hashimoto diet would be appreciated. Thank you

Reply
Cheryl - December 10, 2017

Hi there, I have hypothyroidism I’m currently taking natural desicated thyroid hormone can I take t3 med you are taking about with my current medication? I can’t loose weight I’ve tryed everything. I’ve done the dutch test and went on hcg for 3 mo be a use I was low in testosterone and high in estrogen I feel fantastic now clear headed foggy headedness gone mood is great but THE WEIGHT ugh won’t budge still.

Reply
    Westin Childs - December 11, 2017

    Hi Cheryl,

    Switching up thyroid hormone rarely leads to significant weight loss by itself. Most hypothyroid patients have other important and significant hormone imbalances that impede weight loss. You can learn more about my approach to weight loss here: https://www.restartmed.com/hormone-mastery/

    Reply
Sarah - December 10, 2017

Thank you for addressing this in such a balanced way! Some people bemoan the cookie cutter way that conventional medicine treats hypothyroidism and then get so passionate about their alternative solution (which may work for some or even most people) that they inadvertently slip into the same mistake of assuming it will work across the board for everyone. After being diagnosed, I read a lot on certain sites about how essential it was to avoid T4 only meds. I even saw a Dr. who happened to be willing to prescribe Armour. Well, after two years of trying to titrate slowly and every dose increase causing anxiety and palpitations, I ended up at a cardiologist with irregular heart beats constantly 24/7. He referred me to an endocrinologist who was the first one to mention to me it may be that I couldnt get the T4 i needed without getting too much T3. I reluctantly switched to Synthroid, and low and behold, palpitations disappeared, along with all of my hypothyroid symptoms other than 15 stubborn pounds. (but as you mentioned, there are many causes for stubborn weight- cant always blame the thyroid). I did, after reading your resources, start taking trace minerals to make sure i get sufficient zinc and selenium and noticed and increase in energy with that. And I have begun taking myo-inositol. Too early to tell if that is helping my thyroid, but it sure is helping my mood, and monthly hormonal symptoms! Again- so thankful that there are a Dr.’s like you that are helping point people to treatments that will work for their individual situation and that acknowledge that each of our situations are complex and unique and involve many factors.

Reply
    Westin Childs - December 11, 2017

    Hi Sarah,

    Glad you found it helpful! I certainly agree with you that some patients simply do amazing on T4 only medication.

    Reply
Jay - December 10, 2017

Great info! I was on T4 only for years and never felt good, horrible actually. Finally found a Dr. to add T3 and I had a light bulb moment when I felt many changes in a positive way. (although the first 2 weeks were rough to adjust to at just 5mcg, night sweats and heart palps but I stuck it out)
I then took it to the next level and got on WPThyroid. I am at 2grains daily and my labs are pretty good but I don’t feel 100%. I can’t seem to raise things without the serious jitters. My main concern is although the brain fog, body temp, depression etc have all gotten significantly better, I have lost zero pounds despite a strict healthy GF diet and exercise.
Would you recommend I try adding 5mcg Liothyronine with the 2grains of WP and stick out the jitters for a week or so? I’m also considering trying just Liothyronine alone at around 15-20mcg because I’m almost out of WP and RLC Labs has still failed to produce more since the shortage this year.

Reply
    Westin Childs - December 13, 2017

    Hi Jay,

    If you haven’t noticed a change in your weight with the changes to your thyroid hormone (within a few weeks of starting) it means your weight is probably caused by some other issue. I would spend time looking for that problem as opposed to min/maxing thyroid function in the mean time.

    Reply
JV - December 10, 2017

I recently started taking T3 two to three times per day in addition to my morning NP thyroid dose. I find that it helps tremendously with mood and energy. I previously used it in combination with Synthroid, but stopped when my endocrinologist became concerned that my TSH was suppressed. I personally didn’t see a problem with a TSH near zero; to me it seems the better I supplement the less my own thyroid has to work! I definitely missed the T3 when I stopped taking it; major afternoon slumps. So far it hasn’t helped with weight loss, but if it keeps my energy up activity and meal prep should be easier to tackle.

Reply
    Westin Childs - December 10, 2017

    Hi JV,

    Glad it’s working to improve your energy! If it hasn’t helped with weight loss at this point it’s not likely to in the future, this means that your weight is probably secondary to some other reason.

    Reply
Jan Cuellar - December 10, 2017

Hi Dr, I’m a soon to be 72 year old, I have been on thyroid med for 40+ years. I was on senthroid for a lot of years and other then weight gain I did really great then it just stopped working, My Dr put me on nature thyroid about a year ago, my numbers go up and down, I go high, he drops it to 97.5 then after 3 mnths it goes way down and he rises it to 113.75. It changes every three mnths, I feel horrible, I’m losing my hair. I hurt every where and am so tired all the time. Any suggestions?

Reply
    Westin Childs - December 13, 2017

    Hi Jan,

    Perhaps your next best step would be to find someone more knowledgeable to help manage your thyroid dose. That may be easier than attempting to force a different treatment out of your current physician.

    Reply
Karen - December 10, 2017

I was diagnosed with Fibromyalgia in 2011. One of my symptoms was chronic fatigue. There were days I could hardly get out of bed. I found a Fibromyalgia doctor in California who helped me a great deal. He started me on T3. (I had been taking T4 for at least 20 years.) The T3 medication made me a little jittery so we changed to a more extended release formula. (This was done at a compounding pharmacy). We started with low doses and slowly increased the dose. The T3 medicine along with natural supplements and a change in diet, gave me a better quality of life. I started losing weight, only 1-2 pounds a month. Unfortunately we moved from California to Arizona and I haven’t been able to find a functional medicine doctor. My normal health care provided did tests on my thyroid and said I need to take only 1/4th of my dose of T3 a day. Gradually, I started getting more and more fatigued. I had trouble keeping my eyes open and would be in bed for 16 hours a day. My doctor ordered new tests and they came back perfect. But I wasn’t perfect. The only thing I changed was that medicine. Reluctantly, the doctor agreed that I could work back up to a 3/4 dose. I am pretty much back to normal, however the weight loss stopped. I really believe in T3.

Reply
    Westin Childs - December 10, 2017

    Hi Karen,

    I’ve seen many cases similar to yours in that the use of T3 can dramatically reduce the symptoms of both chronic pain and chronic fatigue. I’m glad it’s working well for you!

    Reply
Wendy - December 10, 2017

Dr. Child’s

I was diagnosed with graves disease and Hashimoto’s. I had my thyroid killed. This was about three years ago. I have since been diagnosed with celiac, I also have inflammation some joint pain and pre-diabetes. I have also gained a significant amount of weight in the last couple years that I cannot get off. I can’t lose 1 pound! I initially started with Synthroid, then I was switched to Tirosint, and I am now on Armour Thyroid. I thought I was feeling better on the Armour Thyroid, at least I feel more normal mentally, but physically I am not better. I have anxiety, I feel like my heart is pounding sometimes, I have heat intolerance I am hot all the time. Whenever my TSH kids into a normal range my T3 goes out of normal. It doesn’t matter what medication I’ve been on that has been the case it’s like a seesaw effect. I’ve read a lot of your articles and it’s like you were talking to me directly with all the symptoms that you talk about. Can you give me any recommendations as to what I might take that could help me to feel better? I’m only on 90mg of armor thyroid. I started out at 120 mg and went back into the hyper thyroid situation.

Reply
    Westin Childs - December 13, 2017

    Hi Wendy,

    There’s no easy way for me to give you that information without first getting a lot of information about your symptoms, thyroid lab tests, other hormone tests, etc.

    Reply
Michelle - December 10, 2017

This was a great read. I had my thyroid removed 1 1/2 yrs ago. I have been taking this for about the past 6 months and it has made things much better! I take 75mg of synthyroid and 10 mg of Liothyronine in the morning and 10 mg more in the afternoon. This has really helped me feel much better. I still have not been able to loose weight, but life is crazy and I am a stress eater. But I am feel much better with this added to my synthroid!

Reply
    Westin Childs - December 10, 2017

    Hi Michelle,

    Glad it’s working well for you and thanks for sharing your story.

    Reply
Christine Andersen - December 10, 2017

I just this past week started on extended release compounded T3 at 2.5 mg once in the morning due to my sensitivity to meds probably due to my HASHIMOTOS. How long should I wait to begin to increase the dose. It has been 5 days so far and my doctor wants to see me in 4 weeks to reevaluate but shouldnt it be increased soonercthan that or not? Id love your opinion as im not very confident right now.Thank you

Reply
    Westin Childs - December 13, 2017

    Hi Christine,

    It’s best to work that kind of information out with your current physician because there are a lot of factors involved and dosing/titration can be complex.

    Reply
Beth - December 10, 2017

Hi Dr. Childs,
I appreciate your information and have been using your articles to help educate my providers and to hopefully help them to help me find thyroid hormone medication/dose that will work for me. I had a thyroidectomy in July 2016 due to thyroid cancer and have struggled to find a medication that works for me. I’ve tried many. I’ve also gained nearly 20lbs (at the time of my thyroidectomy I weighed 120lbs….I’m 5’2”) and it seems that no matter what I do (I eat gf diet and moderate exercise), I keep gaining pretty steadily. I weigh more today than I’ve ever weighed in my life…nearly 140lbs. During the summer and fall, On 112 mcg of Tirosint + 10 mcg of Liothyronine, my reverse T3 was 26 ng/dL and free T3 2.97pg/mL (my reverse T3 on 125 mcg Tirosint + 10mcg T3 was 29ng/dL and on 137 mcg Tirosint + 10mcg T3 reverse T3 was 30nd/dLl). I had tried Naturethroid feb-may 2017 97.5mg up to 113.75 mg and my reverse T3 went down to 6.1 ng/dL, but my free T3 was down to 1.09pg/mL….and that was when I really started gaining weight. They put me on Tirosint + 10 mcg T3 and my free T3 and T4 labs normalized a bit (closer to optimal but not quite), but my reverse T3 went really high (mentioned earlier)….so in November (last month), they put me back on Naturethroid 81.25mg + 10 mcg T3 (last time I was on Naturethroid I did not take T3) + we started low dose Naltrexone. The rational was that Naturethroid, so far, has been the only medication that showed a normal reverse T3….so if we try Naturethroid + T3 this time, maybe that will help the reverse T3 normalize, and my free T3 and T4 will hopefully be better with added T3 medication. (And the low dose naltrexone will hopefully help underlying inflammation.) I hate the feeling that I keep gaining weight no matter what I do….I have not had my leptin tested (provider said they don’t offer that), or other hormones….should I have sex hormones tested and check for insulin and leptin resistance (can I do that if provider won’t??). Are we on the right track? If my reverse T3 is down at next blood draw, should I up my Naturethroid until weight/constipation/low mood symptoms begin to lessen? Would I maybe start seeing weight loss (of course with continued exercise and clean diet) if I upped my Naturethroid alone or would higher T3 make more sense, or increase both?

Reply
    Westin Childs - December 15, 2017

    Hi Beth,

    It’s best to consult with your physician regarding the dosing of thyroid medication because there are many factors that you need to consider, especially when T3 is involved. It’s difficult for me to give advice over text simply due to all of these complexities.

    Reply
Anna - December 10, 2017

Hello! I have Hashimoto’s Thyroiditis and am currently taking 88mcg of Tirosint and 15mcg of Cytomel, two in the morning and one in the afternoon. I just recently lowered both of these meds due to my labs. I was taking 100mcg of Tirosint and 20mcg of Cytomel.
Free T3: 4.5
Free T4: 1.19
TSH: 0.01
TPO: 124.30
Thyroglobulin: 1.8
Thyroglobulin tumor marker: 23
I felt much better after the doctor added the Cytomel. Not 100% but better. Then my doctor decided to close the doors to his office so I was left without a doctor. My psychiatrist has been prescribing my thyroid meds while I searched for a new doctor. Months went by with no new doctor nor lab tests. This is when I started feeling bad again and when I decided it was time to check my labs and I’m so glad I did. I see a new Endocrinologist on Dec 13th for further testing. I’ve been having anxiety/panic attacks since lowering both meds. Any advice for me?

Reply
    Westin Childs - December 13, 2017

    Hi Anna,

    Thyroid dosing can be tricky and it requires a lot of information (including symptomatic history and laboratory data) to get right.

    It certainly sounds like you are heading in the right direction but the best thing you can do is search out a local physician to help guide you the rest of the way there.

    Reply
Peter L - December 10, 2017

Dr Childs, you could perhaps also mention that one reason some people may not tolerate T4 is that their bodies use it to make so much Reverse T3 (RT3) that not only does this mean a limited production of real T3, but also the RT3 blocks T3 receptors, so that the small amount of T3 available, doesn’t do its job.
I’ve read about a theory that RT3 originated as the body’s defence in conditions of famine, in order to slow down the metabolism. Interesting, but who knows?

Reply
    Westin Childs - December 10, 2017

    Hi Peter,

    Great point and it’s something I’ve explained in great length in this post for those who want more information: https://www.restartmed.com/reverse-t3/

    It’s my belief that reverse T3 is simply a mechanism which the body can use to help regulate the powerful conversion of thyroid hormones. Your body may increase reverse T3 in times of severe illness, severe stress, severe inflammation, severe starvation, etc. to help conserve energy for tissues that may need it more. The main problem with thyroid conversion occurs when we use caloric restriction as a means to help with weight loss which can increase reverse T3 levels and set the physiology off in the wrong direction thus making weight loss more difficult long term.

    Reply
      Bonnie Turnbull - June 6, 2018

      I have a reverse t3 in the 30’s and I have had to cut calories just to stop gaining weight. I have, so far, put on 64 pounds so, cutting calories is all I can do. The endocrinologist doesn’t even run a rT3, I had to go outside of my health insurance provider to find this out. So, calorie restriction is all that had slowed down the weight gain, not stop it completely but, slow it down. If I didn’t cut calories down to under 1,000 calories a day, I’d be up in the 80 lb. weight gain.

      Reply
Laura VR - December 10, 2017

Dr. Childs. I’ve been suffering from Hashimotos, hypothyroidism for 15 years. Armour worked for me before menopause but not after. I gained 30lbs on it after menopause with no dietary changes. Levothyroxine was poison to my system. I had the worst stomach pain, nausea and anxiety from it. I am now taking only Liothyronine based upon your advice. I feel great better than I have in many years and I have begun to lose the weight I gained, down 6 lbs so far. Thank you so much!

Reply
    Westin Childs - December 10, 2017

    Hi Laura,

    Glad it’s working well for you and thanks for sharing your story!

    Reply
Maggie - December 10, 2017

I have normal TSH AND T4 but low T3 my body temp stays around 35.6 to 36 deg. I am retaining a lot of water and have severe colon distention and gas and water in the colon it is as if the food is stagnating (fermenting) in my gut. Could this be linked?

Reply
Geevike - December 10, 2017

Hi Dr. Childs,
I am grateful to you as I learn so much from reading your posts and article. I had subclinical hypothyroidism and was given Levothyroxin to start with. It was really bad for me and I felt depressed, insomniac, and even gained weight. I already had problem losing weight. After reading your posts, I insisted that I be checked for reverse T3. It turned out to be high but my primary physician did not know what to deal with it and sent me to an endocrinologist. The endocrinologist did not want to deal with rT3 either. Then I went to a integrative medicine doctor who put me on slow release T3, which I get from a compounding pharmacy. This doctor also put me on Adrenal supplements, Trulicity and a whole bunch of vitamin and mineral supplements. I am doing much better with these combination of treatment. It was like a day and night before and after the treatment. But I still feel sluggish/sleepy in the afternoons. I ahve noticed weight loss but it has been very slow. I hope to improve these conditions. Thank you very much for all your educational posts that are far ahead-of-time “standard of care” practices.

Reply
    Westin Childs - December 10, 2017

    Hi Geevike,

    No problem and glad you find them helpful! 🙂

    Reply
Michele - December 10, 2017

Hello, I have been on Levyroxine (75 mcg) and Liothyronin (25 mcg,split dose twice a day) for 6 months. I feel major improvement in my energy level, depression, and brain fog; however, my weight has not budged. I do also still suffer from bloating and constipation. I was wondering your thoughts of possible low estrogen levels and/or gluten sensitivity?

Reply
Irene - December 10, 2017

Hi.
I am on cytomel 10 mcg in the an and 5 mcg in the pm. This dose works great to help manage my symptoms. However, I have developed chronic nasal congestion since starting this med which is rather annoying. I was thinking about trying to decrease my cytomel and add the thyrovanz back in to try and find a balance between symptom relief, decreased side effects, etc, but not sure how to titrate these meds. My Dr reluctantly prescribed the cytomel and doesn’t want to give me any guidance regarding adding thyrovanz. I did start taking thyrovanz before I switched to cytomel with some results, but cytomel works better. Is there some kind of dosing guideline or recommendation you can make when using cytomel and thyrovanz together?

Reply
    Westin Childs - December 10, 2017

    Hi Irene,

    The short answer is that there really isn’t a dosing guideline but you can use the combination of thyroid lab tests and symptoms to help guide you. I do discuss this briefly in this blog post.

    Reply
Val - December 10, 2017

I am 56 years old femaleand at 50 I was started on t3 liothyronine 15 mcg time release. I thought I was doing better so I weaned off. I then realized that was not a good idea. So I was put on levothyroxine t4 and I gained 50 pounds in a few short months. I stopped taking it and asked to be put back on liothyronine. I was put on 5 mcg for a while and then went up to 15mcg. I am not able to release the weight. It has been a year since I switched back. I have never been this weight even when I was pregnant. I was also the same weight maybe up and down by 5 pounds. Not sure why this is happening. Do I need to increase the dose. Have I messed up my metabolism. I eat healthy small meals.

Reply
Leila - December 10, 2017

Hello,
What lab test for thyroid function do you recommended when a full thyroidectomy due to nodule has been performed? How do I determine if T3 is a good therapy for me after complete thyroidectomy? Are there different considerations in treatment (diet, supplements, medications) when hypothyroidism is due to complete thyroidectomy?
When reading information, I am confused if it relates to me because I don’t have a thyroid.
Thanks in advance for your help.
Leila

Reply
    Westin Childs - December 10, 2017

    Hi Leila,

    This article is about weight loss after thyroidectomy but it discusses many of your questions about thyroid medication if you don’t have a thyroid: https://www.restartmed.com/weight-loss-thyroidectomy/

    The short version is that not much changes with the exception that you are 100% reliant upon thyroid medication for the rest of your life.

    Reply
Josslyn - December 10, 2017

If you are post-thyroidectomy, and taking synthroid, is there any way to organically, with food and herbs/minerals to put the transfer of t4s to t3s?

Reply
Dara - December 10, 2017

Hi Dr Childs,
I take 2.5mcg three times a day and it’s been pretty good tho I often have super off days.
Is it important to be exacting with taking the liothyronine at the same time each day? I sometimes forget or can’t get to the meds right when the alarm goes off.
Thank you

Reply
    Westin Childs - December 11, 2017

    Hi Dara,

    It’s generally best to take your medication at the same time of day to prevent serum highs/lows in thyroid hormone.

    Reply
Barbara - December 10, 2017

Thank-you for this information on Liothyronine. I live in NZ – had a total thryroidectomy (due to cancer)in December 2011 – I was put onto Levothyroxine high levels and lost a lot of weight. When I started having side effects of jitteryness, heart palpitations etc i was put on lower doses and the weight came back on.
My current doctor has kindly allowed me to try the T3 medication liothyronine only after i presented him with links to your articles.
I started out on 10mcg then slowly worked up to 60mcg, however he wants me on 50 mcg. On 60mcg I have more energy – i am just starting on having one 50mcg tablet a day.
I have been on the medication since September but have not had any weight loss – I am concerned about not having the weight loss now that I am on T3 – I know that there is a strong link between obesity and weightloss.
Given that I had the dramatic weight loss when initially using high levels of T4, should I try and go back onto that or what can I do to enhance the effectiveness of the T3 medication – or could the manufacturers of it be giving me tablets that are not effective – i am buying the T3 medication from a Pharmaceutical compounding company in Auckland?
Having no thyroid means I am in the hypothyroid category and the weight issues go back a long way – i have had a history of yo-yo dieting – however now am on a very healthy diet – is there any foods I should definitely avoid?

Reply
    Westin Childs - December 15, 2017

    Hi Barbara,

    I think the best way to find out what foods you should be eating and/or avoiding is by testing for it through delayed IgG serum testing or through the elimination diet (both can be effective).

    Reply
Karen - December 11, 2017

Hi, I live most of the year in Mexico and I am able to buy liothyronine over the counter. I went to the pharmacy at Walmart and asked for cynomel (cytomel in US) I was given triyotex capsules 75 mcg. I had read online that individuals that had ordered cynomel online received triyotex instead of the usual cynomel (some kind of shortage of cytomel in Mexico). I have read that the strength of the triyotex, 75 mcg., is weak and actually equivalent to 25 mcg. of cytomel. It comes in a capsule and am at a loss as to how to dose this. I take one capsule and my a.m. temp. has gone up to 98.1 from 97.4 and my heart rate is in the 70’s but I feel like crap and don’t know how to proceed with this product. Any suggestions. I am an RN and the local expat MD’S are not familiar with using t3. Thank you.

Reply
    Westin Childs - December 13, 2017

    Hi Karen,

    I do know that some people try to dose T3 by themselves but I honestly think this can be potentially dangerous (some people can probably get away with it but others require close monitoring).

    It’s far safer and far more effective to find a physician local to you to help dose your medication and check labs, etc.

    Reply
Cheryl - December 12, 2017

Good morning, enjoy reading your information you so freely give. Original eltroxin
has been discontinued and has been replaced with eltroxin new formulation (seems to have many fillers)and information insert has many more cautions.Any comments on it?
Thank you.

Reply
    Westin Childs - December 12, 2017

    Hi Cheryl,

    I don’t have any comments on the new formulation of Eltroxin but you might find better results using a medication such as Tirosint which has few fillers/dyes, etc.

    Reply
      Cheryl - December 13, 2017

      thank you, i will persevere for a few weeks and take it from there.
      regards

      Reply
JJ - December 12, 2017

Dr.Childs I take 100-125 mcgs of T3 all at once , never get a rush or speedy feeling just feel normal . Does that mean my body has serious issues to be able to tolerate that much at once? Still no weight loss FT3 is 3.9-4.0 top of range

Reply
    Westin Childs - December 12, 2017

    Hi JJ,

    It’s possible but it also might be an absorption issue meaning a large amount may be passing through your GI tract instead of being absorbed systemically. You also might be getting a poor source of medication (if it’s from a international pharmacy or something like that).

    Reply
Annie - December 13, 2017

Hi

Im on cytomel only. It has been a wonder and was the magic to get my health back after 25 years of feeling crap.
After a slow intruduction and adjustments I settled on a fixed dose Ive had for 7 years now: 100 mcg a day of T3. No T4 at all.
I have my life back!!

Reply
    Westin Childs - December 13, 2017

    Hi Annie,

    Thanks for sharing your story and glad it’s working well for you!

    Reply
Pepa - December 13, 2017

Dear Dr.Childs, could you answer also my question? I have Hashimoto’s and for more than 10 years I am on only T4 therapy. I don’t feel well and I am looking for some other ways to improve – diet changes, joga, homeopathy – everithing with low success. This year I decided to add T3 and started with low dose, then increased a little, but thought that it is not helping me much – only a little more energy. Then I stopped taking T3 and after that weight gain started. I normally don’t have problems with weight, but now gaining several kg per 1 month is strange for me. Is it normal reaction to gain weight after stopping T3?

Reply
    Westin Childs - December 13, 2017

    Hi Pepa,

    It’s very rare but some people do gain weight when using T3. You’ll need to figure out if it’s coincidence that you gained weight while starting T3 or if it’s actually caused by the T3 itself.

    Reply
      Pepa - December 14, 2017

      Excuse me, but I said that I started to gain weight after stopping T3.And that was my question – is it normal reaction?

      Reply
        Westin Childs - December 14, 2017

        I gotcha, that is fairly normal but certainly doesn’t happen to everyone.

        Reply
Marce - December 14, 2017

Hello Dr, I used 2 years ago Armour and was terrible, I gain weight, gut problems etc.
I used synthetic T3 with synthoid and works perfect but my Dr change me few months ago only to Synthroid 125.
I want to go again with T3 and T4 but Im not sure the doses that will be perfect to use T3 and T4 combo if 125 works good(T3 in the lab levels are low) I’m depressed, gain weight and very tired.
Thank you

Reply
    Westin Childs - December 14, 2017

    Hi Marce,

    Thanks for sharing your experience! I think armour thyroid is fine but some other formulations of NDT may be easier absorbed and utilized by the body such as WP thyroid or naturethroid. Some patients who don’t do well on armour for instance do well on these other medications.

    Reply
Kathy - December 14, 2017

Dr. Childs,

I have mild hashimotos and endometriosis. I have started taking thyroid medicine before my pregnancy . It’s almost 3 years now still could not figure out the optimal dose and thyroid medicine. After delivery I became hyper. After 4 months again hypo. Tried synthroid, levo, armour. I felt irritation, agitation, anger, uncontrollable rage sometime while I was taking them. Finally kind of settled in naturethroid. But it’s unavailable now. It’s been 3 months since I got my last naturethriod refill. So switched to armour 60 mg . Feel terrible and having all the issues again. Is there a link between thyroid medicines and mood? Armour has both t3 and t4 right then why do I feel mood issues ? Can I ask my doctor to add t3 in addition to armour ? Really frusted with trying different medicine. Still am having all the symptoms. Do you think it will help ?Thanks .

Reply
    Westin Childs - December 15, 2017

    Hi Kathy,

    There is definitely (potentially) a link between thyroid medication and your mood. Suppose you are taking a thyroid medication in which you are not absorbing or utilizing properly after ingestion, in this scenario it’s certainly possible that it may alter your mood.

    Reply
Lucy - December 14, 2017

Hi Dr.Childs,

For three months I had insomnia (for the first time in my life) due to anxiety which snowballed. I have never had thyroid issues before, but about two months ago I became symptomatic. My doctor tested my thyroid and all was within range except for my rt3. I had never heard of this and have found your blog to be the most useful, understandable and hopeful of all resources. I was started on liothyronine (after advocating for it) one week ago. Is it effective immediately or does it take awhile to get into one’s system. Thank you for all your helpful information.

Reply
    Westin Childs - December 14, 2017

    Hi Lucy,

    Great question! It takes about 4-6 weeks for most people to notice the benefits but some people realize them within days of starting liothyronine. Keep us updated and good luck!

    Reply
Kate - December 20, 2017

Have to just say first how much I love your site, always such great information. In the UK it is impossible to get Liothyronine on prescription. I am an admin with ITT Campaign fighting this. It would be wonderful to have your support.
I have high RT3 and high cortisol. 34 in waking…
Did very badly onT4 only, felt fab on NDT(self medicated) for a year but now I’m struggling again. Am I right in thinking I should be T3 only or can I just add T3 to a smaller NDT dose? Thanks.
I’d ask my Dr but he didn’t even know what RT3 was and thought T4 was the active hormone

Reply
Lynn - January 1, 2018

Hi Dr Child’s,
I have had hashimotos for 3 1/2 years. It was diagnosed but left untreated because I was also diagnosed with depression and Endo wanted to do a wait and see approach. After a year passed by I finally started on supplements like magnesium, selenium, vit D, amongst many others. Another year went by and I started on levothyroxine at 25 mcg. On that for six months along with cytomel of 5mcg twice a day. Then went up to 50- then 75 and now 100. I am still not losing weight actually am gaining as I gained 10lbs in the last 2 months. I have over the 3 1/2 years went from 140lbs to 210 lbs. I have gone gluten, dairy and soy free. My energy is still low and nap usually along with 8 hours of sleep. My TSH was 1.313 and Free T4 was 1.06.

Reply
    Westin Childs - January 1, 2018

    Hi Lynn,

    The best thing you can do is get a complete thyroid panel to help get you started. You’ll want to check TSH, free t3, total t3, reverse t3, free t4, sex hormone binding globulin and thyroid antibodies. From there you will be able to get an idea if you are converting well and what is going on with your antibodies based on your dietary changes.

    Reply
Shannon Glass - January 14, 2018

Dr Childs,

I had my thyroid ablated 12 years ago and have never been the same. I can increase my t4 and somehow my body levels it back off. I take Tirosint and cytomel but feel best when backing off the t4 and increasing the t3 so that my t3 is out just out of the reference range but then my doc gets scared and lowers my dose so we increase my t4 since it still has wiggle room and I end up feeling bad again. Any thoughts?

Reply
    Barbara - January 14, 2018

    Hi Dr Childs, Thank-you so much for all you do to help us with the information on T3 & T4 etc.
    I had a TT in 2011 and was on Levothyroxine until late last year. I was titrated up to 6omcg daily but my Dr didn’t want me on that level as T3 level were high. They were: Free T4:<1.9 pmol/L ( 7.0-16.0 ) L

    TSH:<0.01 mU/L ( 0.3-5.0 ) L

    FT3:10.3 pmol/L ( 3.6-6.5 ) H ,
    So Dr wants me on lower dose of 50mcg – I find though my energy levels are better when I am on the 60mcg daily dose. My Dr is new with this so is cautious about it, what can I do?

    Reply
Kate - January 16, 2018

Hi Dr Childs,
Firstly I would like to say how much I enjoy your blogs and that that are always full of fantastic information.

I am hypothyroid, left undiagnosed for 30 years. I was on T4 only for several
Years which made me v unwell. I switched to NDT which worked amazingly for a tear and gave me my life back but then I was back to hypo symptoms after a year.
I have self tested as no help with GP here. My RT3 is high as is my cortisol. I have recently switched to T3 only but I am wondering how much an average dose would normally be. I am taking 25mcg amandpm and feel fine no hyper symptoms.
Should I increase or is 50mcg daily a good amount?
Also any ideas on how to reduce cortisol? I am not stressed particularly and am at a loss of what to do to reduce.

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Mackenzie - February 6, 2018

Hi Dr. Childs,

I have been on 50mcg of T3 for 2 years but I am still symptomatic. I have gained 20lbs in the past couple of months, low energy and lots of hair loss. My FT3 is in range, but my TSH and RT4 are low and antibodies are a little elevated. Sex hormone binding globulin is normal. I cannot lose weight for the life of me. Any clue as to what might be happening? I have Hashimoto’s. Do you suggest a compounded t4/t3 mixture? I have no idea what’s going on but I feel like a medical mystery at this point. Thank you for your input.

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Caryl - February 14, 2018

Dear Dr. Childs, You cite a study and says that the half-life of T-3 is a few hours. I’m sorry but that is not correct. I looked at that study and it said the peak blood level was a few hours but the half life was about 22 hours. Also The Davis Drug guide I have, though a few years old, says po half life is 24-72 hours while duration is 72 hours. I have seen this recommendation for several (2-3) daily doses a couple of places, but when I found a holistic doctor (DO) who would prescribe me 50 mcg daily, I brought that up, but he said once daily was good going from the half life from his drug book similar to the Davis one. Does the peak blood level make more difference than the half life? Are the books wrong from your clinical experience? What other reasons for a sustained dose or spaced dose is there?
Thanks

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    Westin Childs - February 14, 2018

    Hi Caryl,

    The half life is around 24 hours and it reaches peak serum concentration 3-4 hours after ingestion. The non genomic effects of T3 are felt with the rise in serum levels while the genomic effects take weeks to kick in. If I said something different in the article I will go through and edit it.

    Reply
Marcella - February 19, 2018

I take T3 75mcg SR twice a day, early at about 4am and then at 3 pm for lifelong major depression, not responsive to any of a long list of different types of antidepressants. On this my blood pressure and pulse rate are normal, no side effects. I have had insulin resistance as well and inability to lose weight even on 500 cal. diet while morbidly obese. I do very badly on T4 only, and not well on T4-T3 combo. I have been able to lose about 100 lbs. now on very low carb diet with intermittent fasting, combined with a weekly cheat meal, which seems to loosen up the resistance.

Reply
    Westin Childs - February 19, 2018

    Hi Marcella,

    Thanks for sharing and glad it’s working for you!

    Reply
theresa - March 4, 2018

Dr. Child’s

I am having a very difficult time trying to figure out the right dosage and it seems no doctor has a clue as to what to do.

I had a parathyroidectomy (two glands removed that were overactive), and my thyroid must have been an issue before as the surgeons say that parathyroid surgery can cause what may have been hidden in the thyroid to come to surface. My t4 went VERY low after surgery, my TSH low but within clinical range and my t3 rt3 ratio was poor. I started treating with t4 first, compounded, and then added t3. Since treatment my voice has changed, but all the hypothyroid symptoms have not improved at all. My T4 is now subclinical but low, and my TSH is now super super low. My ratio of t3 and rt3 are ok now. I stopped t3 thinking its why I am not getting well, and my voice seems to be improving but I am exhausted, with worsened hair loss (already thinning badly) and mood changes. What do I do? Am I still undertreated?

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colleen - March 24, 2018

Great article! I just found out my reverse T3 is quite high. I’m taking 3.5 grains of compounded armour. I had what was called thyroid resistance 20 years ago or so when I discovered Dr. Lowe (SO excited to see you know all about him!) and was on Cytomel exclusively for about 5 years. I was taking 75 mcg at the time, and I’d like to go back to Cytomel to clear out this reverse T3. I see this guide doesn’t recommend anything that high really. Do you think that’s too high if that’s all I’m taking? I’m going to talk to my naturopath next week, and I bought your diet guide as well. I think my issue is adrenal fatigue which I’m treating, though I think I’ll switch to your products and recommendations.

Reply
    Westin Childs - March 26, 2018

    Hi Colleen,

    High doses of T3 do benefit some individuals, but I find it’s best to use them only temporarily during weight loss or to fix certain issues in the body. Using supraphysiologic doses of T3 may be harmful if used for years, but short-term (6-12 months) that kind of dosing probably won’t cause long-term issues.

    Reply
      colleen - March 28, 2018

      Thanks so much! I will see what she recommends then. Maybe I will try the lower dose and titer up. This explains a 15 pound weight gain I can’t seem to get rid of. I’m going to follow your excellent diet guide I purchased.

      Reply
      colleen - March 28, 2018

      One more quick question. Can I follow the adrenal diet plus fast 2 successive days a week as your guide details for weight loss? Or can I not actually try to lose weight for several months?

      Reply
        Westin Childs - March 29, 2018

        Hi Colleen,

        You should be fine to go ahead with the fasting right away 🙂 Most patients do it this way and they do very well. Keep us updated on your progress!

        Reply
          colleen - March 29, 2018

          Awesome, thanks so much! I’m excited to start. Your protocol makes a lot of sense.

          Reply
Vicki - April 18, 2018

Hello,

I have been taking T3(compounded sublingual) for 8 yrs and used to take my full dose in the am and then if lab work was due I would wait to take my next dose after labs were done( approx. 24 hrs later). I now split my dose 1/2 am and 1/2 pm and have not any issues with questioning my lab work. I run above the FT3 range in order to be symptom-free ( around 7 pg/mL range 2.0-4.4). I recently had labs done and it had been approx. 12 hrs since my last T3 dose and my result represented none to very little T3 in my system at 0.4 pg/mL. I have been feeling symptomatic. I am now trying to determine if my latest batch of T3 was not made correctly or if I had my labs drawn at the wrong time in relation to when my last dose was taken. Long story short when should labs be drawn in relation to the last dose taken?

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Chris - May 2, 2018

Good morning!

I know I’m late to the game, but after being on Armour for years and doing well on it my new doctor switched me to Levoxyl, which was a miserable experience. My numbers were “perfect,” but I was still experiencing all the symptoms – sensitivity to cold, fatigue, fogginess, hair loss, etc.

I finally convinced her to look at other options and she said she would do both Armour and Levoxyl, but the pharmacy gave me a combination pill of levothyroxine and liothyronine and when I requested a refill she promptly called me and said she never Rx’d it and has never even heard of the combination pill before.

I have to admit, I’m a little disappointed since for the past month while I have been on it it’s the closest to human I have felt in years – so it’s frustrating that she’s not willing to continue it due to her lack of experience with the product.

Chris

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Patty - May 14, 2018

I need help sorting out my lab results. 2 years ago a doctor put me on Armour because my reverse T3 ration was 7.35 I got severe headaches from the Armour and stopped it and went to a different doctor. He put me on Liothyronine only because of lab results and symptoms. I have been on Liothyronine for a year taking 15mcg/day. My symptoms had improved but my last 2 lab results showed my T4 levels were low (4.0 and now 3.7). My doctor said I shouldn’t be concerned by that but of course, I am since I am now gaining weight again with no change in my diet and even an increase in my exercising. He didn’t do a reverse T3 test the last few times but the latest labs were T3 – 126 and TSH 1.460 and T4 3.7. My doctor is not an endocrinologist but I couldn’t find one that actually looked at Reverse T3 ratios. They look at my TSH and say I am fine but I know something is not right with my thyroid processing. Any insight you can give me would be greatly appreciated.

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Jade - May 19, 2018

5/19/18 Dr. Childs: It seems to me that using T3 only is hush-hush and not discussed enough. There are Hashimoto’s and Hypo-T patients that are doing extremely well on T3 only, Dr. Childs so why are doctors not talking about this with their respective patients? I am on T3 only (was on Levothyroxine for 261/2yrs. and felt like I wanted to die the entire time) and I feel so great on T3 only, only have been on T3 only for a couple of weeks. After I initiated T3 only, I began to wake up like I have been in a coma (mentally) for over 2 decades. Why do doctors keep T3 only information away from their patients? There’s a book out – Recovering With T3 by Paul Robinson, I have this book. Drs. should read this book. Many patients are living far healthier and happier lives on T3 only, and this is one of the biggest secrets and cover-ups in our medical history. Jade.

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    Westin Childs - May 19, 2018

    Hi Jade,

    It is mostly kept hush-hush because it’s not the standard of care which means that Doctors who use it put themselves (and their license) at risk. In addition, not everyone needs T3 only, I would say only a small percentage of hypothyroid patients actually benefit from T3 only when you consider that millions of people suffer from hypothyroidism in the US.

    Reply
      Jade - June 16, 2018

      Dr. Childs, The standard of care needs to be constantly evolving and keeping up with the hundreds of thousands (if not more) of patients that are utilzing T3 only and are doing very well on it. A grand majority of Hypothyroid patients, Dr. Childs are not able to convert T4 to T3, therefore are in need of T3 only. I am appalled and so very disappointed that the standard of care for those of us who simply do not convert well, are not given the option of T3 only as the standard of care for us who cannot convert. I am bewildered and so frustrated with our medical community about this. We patients need to educate one another since the medical field will not, Sir. There are several good FB groups now that are educating the masses and there is an amazing book out by Paul Robinson ‘Recovering With T3’ and again there are probably now in the low millions of people who are asking and receiving T3 only from their doctors. The medical community needs to keep up with how wonderful T3 only works for so many patients and the numbers are exponentially increasing daily. To witness this for yourself, just simply go on T3 Support on FB and see for yourself, Sir. The medical community needs to be taught in pre-med to educate their patients about the benefits of T3 only, instead of saying it will only help a small percentage, Sir. Jade.

      Reply
Kate - May 21, 2018

Okay so, long ago I was put on a Nortriptyline. Supposedly they checked my thyroid before prescribing it, but the Doc couldn’t remember receiving my results and assumed they were normal. After that Wellbutrin was added, then after a few more years Celexa was added. I should probably mention that each one of these meds was added by a different psychiatrist because the first shuffled me to another when she moved her practice, the second told me to my face that it was my fault that I didn’t have a man and I should be out pounding pavement to find a guy instead of sitting in her office crying. I found another, he left the city without even telling me. I finally got a different one that seems to actually care. He redid the thyroid test (because he’s actually intelligent and received and checked the results.) He’s the one that put me on Liothyronine, which I’ve been on for a couple years now. I have actually gained weight in that time. I don’t remember which, or what combo of drugs eliminated my appetite. I have to force myself to eat things and even now I eat like one meal a day. In the time I’ve been on it I’ve gained at least 20 lbs. I’m 30 yo, 5’8″ and currently weigh nearly 200 lbs.. 🙁

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Charlotte - May 27, 2018

Hi Dr. Childs,

What are the Optimal labs ranges when on T3 only?
I have searched the site and can’t seem to find them.

(I am desperately trying to find them before my doctor’s appointment on Tuesday.)

Thank you.

Reply
    Westin Childs - May 28, 2018

    Hi Charlotte,

    I don’t have that information posted publicly, but it’s something I’ll add to the list of potential future posts.

    Reply
jj1 - June 1, 2018

Hi Dr. Childs, My naturopath started me on 5 mcg Liothryonine several months ago and told me to take it with a bit of fat, like cream in my coffee. So, I put a little ghee in hot lemon water. Should I stop doing this?

Thank you!

Reply
    Westin Childs - June 6, 2018

    Hi Jj1,

    That’s not necessarily how I use it but if it’s working for you then I don’t really see a reason to change it.

    Reply
Geri - June 8, 2018

Dr. Childs, thank you for this article – I found it very informative and thankfully written in layman’s language. I’ve had Hypothyroidism since 1980 after diagnosed Graves Disease-Thyrotoxicosis. 80% of my Thyroid gland was removed and I have been on Synthriod regimen since then. However, my Endocrinologist has today began Liothyronine to address non-responsiveness to Synthroid therapy. I feel hopeful that this may be the answer but the jury is still out in this regard.

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    Westin Childs - June 8, 2018

    Hi Geri,

    Glad you found it helpful! T3 is definitely a great medication but it doesn’t solve all problems. I do hope it works out for you though! Keep us updated on your progress.

    Reply
Sue Smith - June 10, 2018

Hi Dr. Child’s. Finding a doctor who is knowledgeable regarding all components of thyroid is extremely difficult. In April I saw a bio-identical hormone replacement doctor who prescribed me 30 mcgs of liothyronine in conjunction with T4. After doing my research I was finding that this wasn’t the correct treatment for my issue. So I found a naturopathic doctor who was knowledgeable about Wilson’s Syndrome and understood the correct treatment for that. He immediately switched me to T3 only due to me improperly converting T4 to T3. Instead I converted T4 directly to reverse T3, thus causing me to be symptomatic. I stopped T4 about 21 days ago. I am now just finally feeling better, have lost some weight, have energy for the first time in forever, and have a general sense of happiness. I’m very grateful for finding the right help. This medication is truly a lifesaver. Thank you for your knowledge and for spreading the word about the benefits of this medication.
Suzanne Smith

Reply
    Westin Childs - June 11, 2018

    Hi Suzanne,

    Thanks for sharing your story and glad you found it helpful!

    Reply
Jade - June 16, 2018

Dr. Childs, I was on various forms of T4 for 26 1/2 yrs. and experienced extreme brain fog, weight gain, and depression, and actually wanted to die. Over a month ago, I stumbled upon a blog by Paul Robinson (who takes 60 mcg. T3 only per day (he wrote a book ‘Recovering With T3’. I ID with Paul in that he lost nearly everything before he realized his body could not convert T4 to T3 (my issue as well). Over a month ago, I started T3 only and slowly but steadily have increased my dosage to 50mcg. 25mcg. @ 5:30 a.m. and my second dose of 25mcg. @ 8:30 a.m. I feel as good as I did when I was nineteen; the brain fog, depression, and now I’m working on the weight loss issues. (T4 used to make me feel horrible and also have a ravenous appetite throughout the day, but not T3 only). My question for you is why do you state the following: “This range is typically somewhere between 5mcg and 20 mcg but it may be higher for some individuals.” Most people are on higher doses of T3 only without adverse residual affects, why do you say “most people” for your statement is misleading as I’ve researched and found that most people are on higher doses, Dr. Childs. I wish you would research this yourself and then update your T3 only article. Wishing you well. Jade.

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Rita Dalton - August 5, 2018

Hi Dr Childs,

I am heterozygous for DIO2 gene (discovered through private testing). I have never felt well on T4 only. I have been hypothyroid for about 20 years, but only diagnosed 6 years ago (I know this from accessing my blood test results). I started a trial of T3 in January, initially 20mcgs daily. I tried to use it a couple of ways, splitting it into 2 doses and taking it at night with Levothyroxine 100mcgs (reduced from 150mcgs when T3 was introduced). I initially felt well for a few weeks, less tired, although no weight loss, despite eating healthily). After a few weeks the tiredness and the feeling down returned. My endo told me that I could increase my dose to 30mcgs, which I have done. This has done nothing for the tiredness but has increased my appetite and therefore my weight too. I don’t see my endo until October, so I’m unsure what to do. I’ve tried reducing back to 20mcgs with 100mcgs levo, but it has made no difference, still tired, down and overweight. Can you offer a suggestion please?

Thank you.

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Sidney Kahn - September 6, 2018

My TSH is low (.019) but T4 and T3 are normal; I have hypothyroidism and I am taking Levothyroxine 112 mcg (have been on for many years, starting off low) and Liothyronine 5 mcg. I have been on Liothyronine for over six months, but nothing changed; my doctor keeps my meds at the same levels. What would you suggest? Sidney

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    Westin Childs - September 7, 2018

    Hi Sidney,

    You’ll want to look at your lab tests with the optimal ranges in mind (compared to the normal reference range). You can read more about this idea here: https://www.restartmed.com/normal-thyroid-levels/

    Reply
Pauline Powlesland - September 13, 2018

Dear Dr Childs

I have been taking 125mcg of Levothyroxine and 20mcg of Liothyronine. I had a test which showed I do not need Liothyronine anymore; but I am worried that without it, that my body will not convert T4 to T3, as I have had problems in the past. Should I continue to use the Liothyronine? I am not losing any weight, but I do have jitters.

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    Westin Childs - September 14, 2018

    Hi Pauline,

    T3 doesn’t help with T4 to T3 conversion but it does directly provide your body with T3 so it bypasses the conversion process. It is, however, not a good sign if you feel jittery while taking it and may be a sign you need to slightly reduce your dose.

    Reply

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