You probably already know that T3 is the single most important thyroid hormone in your body.
If you’ve spent any time researching, then you probably ALSO know that you can take T3 as a medication and that most thyroid medications contain only T4.
But what you may not be aware of is that there are several different TYPES of T3 medications.
And the one we are going to focus on today is known as sustained release T3.
If you have sluggish thyroid function, for any reason, you should be aware of this medication.
Why?
Because using T3 (in any form) bypasses the normal thyroid conversion process and provides your body DIRECTLY with the T3 that it needs to function.
Sustained release T3 (abbreviated as SR T3 in this post and elsewhere on the web) refers to a special type of thyroid medication.
SR T3 is bound to a specific ingredient that delays its absorption in your intestinal tract and provides a slow and steady absorption of T3 throughout the day.
And this delayed absorption matters quite a bit (for some) which is what we will be talking about today.
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Sustained Release T3 vs Immediate Release T3
But first, you should understand the difference between immediate release T3 (referred to as IR T3) and sustained release T3 (SR T3).
Believe it or not, we really don’t have standard nomenclature for the various types of T3 that are available (probably because many doctors are afraid to use either).
For purposes of this article, and just to set the record straight, I’ve split up the types of T3 available into 2 groups:
- Immediate release T3 (includes Cytomel and liothyronine)
- Sustained release T3 (includes sustained release T3 by a compounding pharmacy)
That’s it!
There are really only two groups and 3 types of T3 medications.
Yes, there are other medications that contain T3 in them but here we are talking about PURE T3 or T3-only thyroid medications.
For this discussion, we are going to focus primarily on sustained-release T3 but I want you to at least be aware that there are other types of pure T3 medications.
You can learn more about immediate release T3 (Cytomel and liothyronine) here.
Multi-Dosing T3 Throughout the Day
Many people have the belief that if you want to take T3, in any form, you really need to be taking it multiple times throughout the day.
Even though this idea makes logical sense, I completely disagree with it when it comes to practical application.
The idea goes something like this:
T3 thyroid medications are rapidly absorbed and utilized by the body.
T4, on the other hand, stays in your system for weeks and weeks whereas T3 stays in the body for only hours.
If you want to keep your T3 levels high then you must take smaller doses more frequently throughout the day.
This allows T3 levels to stay high.
All of these statements are true but there’s only one problem:
It doesn’t really matter.
The blood level of your T3 is not important. What we care about is whether or not that T3 is getting into your cells to activate nuclear receptors (1).
And, it turns out, you don’t really need to multi-dose your medication throughout the day to get this stimulation.
BUT… there is one reason you may want to multi-dose throughout the day and that has to do with sensitivity to T3.
Some people, for various reasons, are extremely sensitive to even small doses of T3.
So if they take one large dose per day they may react with anxiety/tremors/jittery sensations, and so on.
These people MAY benefit from multi-dosing.
How does SR T3 fit in?
SR T3 sort of takes this problem away by delaying the absorption of your T3 and normalizing it throughout the day.
So even if you are taking one large dose in the morning, that dose isn’t hitting your system all at once.
Instead, you are getting a slow release throughout the day.
I don’t find it necessary in most cases to multi-dose SR T3 though it may be necessary for IR T3.
How do you get Sustained Release T3?
Sustained release T3 is unique among thyroid medications in that it can only be formulated and produced by a COMPOUNDING pharmacy.
Compounding pharmacies are specialty pharmacies that can combine medications in specific ways, they can place medications in carriers that normal pharmacies can’t, can create cleaner versions of medications, can adjust the dosing of medications, and so on.
Basically, these pharmacies give you MUCH more control over the medications you are taking.
And the only way to get SR T3 is through these types of pharmacies.
The reason is simple:
Immediate-release formulations of T3 such as Cytomel (2) and liothyronine (3) come prepared in terms of their inactive ingredients.
And the only way to delay the absorption of the T3 found in these medications is to put them in a filler which DELAYS the absorption of the medication in your GI tract.
This is typically done with ingredients such as methylcellulose.
Methylcellulose is difficult to break down (4) by your intestinal tract which means that your intestines have a harder time getting to the medication found in the capsules/tablets you are taking.
Who should use Sustained Release T3
I should point out that while I am a fan of SR T3 I typically prefer to use the immediate release version of T3 because I think they are more powerful and easier absorbed.
Having said that, there are still certain types of people who do much better on SR T3 compared to the immediate-release versions.
If you fit into any of these categories then you are likely someone who would benefit from SR T3:
- People who have heart palpitations when taking T3 medications
- People who experience a jittery sensation or anxiety while using IR T3
- People who experience an elevated heart rate or elevated blood pressure when taking IR T3
- People who experience anxiety while using IR T3
- Those people who don’t have a schedule that permits multiple doses of T3 per day
- Patients who do NOT have intestinal issues or absorption issues with other thyroid medications
- People who are interested in weight loss (not specific to SR T3 but it’s still an option)
- People who have experienced abdominal PAIN (or ulcers) with IR T3
- People who get headaches with IR T3
- People who have tried and failed IR T3 for pretty much any reason
I can probably simplify this list by saying that if you have failed IR T3 for any reason you may want to try SR T3.
You would be surprised at how many people tolerate SR T3 compared to those who do not tolerate IR T3.
The reasons can be endless, but I’ve listed several above.
Also, you don’t always need to start with IR T3 before swapping over to SR T3.
It’s perfectly fine and safe to start with SR T3 if that is your preference.
Downsides of using SR T3
There aren’t many downsides to using SR T3 compared to the more immediate release version.
Perhaps the main downside is that in order to get a ‘sustained release’ version of T3 it must be bound to something that is somewhat hard for your intestines to break down.
What this does is act to reduce or slow down absorption in your intestinal tract.
What ends up happening, though, is that certain individuals have a much more difficult time compared to others in breaking down the medication.
The variability in breaking down the binding materials leads to variability in absorption.
What does that mean to you?
It means that it can really be difficult to nail down your dose.
It also means that you can’t really switch from immediate-release T3 to sustained-release T3 in a milligram-to-milligram conversion.
The absorption variability can be as much as 50% in some cases.
Let’s use an example to drive this home:
Let’s say that you are currently using something like 10 mcg of Cytomel or liothyronine.
It’s working well for you but you are experiencing heart palpitations so you want to try and get SR T3.
Can you just switch over from 10 mcg of Cytomel to 10 mcg of SR T3?
Typically not.
Instead, you may need as much as 20mcg of sustained-release T3 to ensure that you are getting the same 10 mcg dose you were getting before.
This is because your intestinal tract may not be able to break down the binding materials that hold onto the T3 ingredient.
Ultimately, you may lose some of that T3 in your stool without it ever being absorbed.
This is probably the single biggest downside.
Another downside has to do with the cost of the medication and the fact that it can only be obtained from a compounding pharmacy.
You will NOT be able to walk into a CVS or Walgreens to get sustained release T3.
Instead, you will need to have the medication specially prepared by a compounding pharmacy which means you may have to do the legwork to FIND that pharmacy as well as a physician who is willing to prescribe SR T3.
These are really only minor downsides, though, when you look at the bigger picture.
SR T3 is far more beneficial than it is harmful and is typically easier to dose compared to the immediate-release version of T3.
Final Thoughts
Sustained release T3 is a great T3-only thyroid medication that provides a ton of benefits for thyroid patients.
I believe that MOST thyroid patients do better when they include some T3 in their thyroid medication regimen.
This doesn’t mean you need to take ONLY T3 (and leave out the T4), though that is an option, instead, you may benefit by ADDING T3 to your existing medications.
You can combine SR T3 with your existing levothyroxine/Synthroid dose to obtain the benefits that T3 thyroid hormone provides.
Now I want to hear from you:
Are you currently using SR T3?
If so, why are you using it? Did you experience problems with IR T3?
If you are using it, what benefits have you noticed? What side effects have you noticed?
If you are considering using it explain why!
Leave your comments or questions below!
Scientific References
#1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC329808/
#2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2002/10379s47lbl.pdf
#3. https://www.greenstonellc.com/sites/default/files/pdfs/MSDS/Liothyronine%20Sodium%20SDS.pdf
#4. https://www.ncbi.nlm.nih.gov/pubmed/30058391
Dr Childs,
Can you please do a dedicated post on Histamines and Estrogen/Progesterone/Testosterone imbalances? It was a big underlying issue for me and looks like very little information out there about what to do!
Thanks!
Hi DSharp,
Sure, I’ll add it to the list of future blog posts.
Glad to hear. I am one who is suffering from hormone imbalances and estrogen dominance. I am on an estradiol .025 transdermal patch, 100 mg oral progesterone. My former endo kept increasing my estradiol patch because of anxiety at night to.05, and then my limbic system went into fight or flight mode. Before handing out HRT, they should be doing hormone labs and cortisol levels. I needed progesterone, not estrogen. They say they won’t run the labs and only go by symptoms. My cortisol was already low and estrogen made it lower putting me in a state of distress. My adrenals suffered. I since have gone hypo and very little amount of synthroid or Cytomel are absorbing. So 6 months later, I am cutting down my estrogen patch and hoping that will help absorption. With limbic system distress, I have GI issues now. My endocrine reserves are very low and cortisol suffers. It has taken me a lot of reading, but mainstream endos are not addressing these issues. They leave you to suffer unnecessarily. Thank you for helping so many who are suffering.
Hi Kathryn,
I’m glad you’ve found the information to be helpful! Thanks for sharing your story and experience.
i am on Synthroid 75mg and t3 5,she put me on the t3 because i was not focusing and not remembering much and just foggy.. all through the day. i am also having a lot of fluid retention ,and weight gain do you have any suggestions.
Hi Wanda,
The first step is to get a complete set of thyroid labs so you can figure out if your symptoms are thyroid related or not.
Hi, Dr. Childs,
I’m taking T3 SR 1.5 mcg twice per day and 25 mcg of Levoxyl once per day. Feel lots of hypo symptoms such as fatigue, hair loss, mild depression, and shortness of breath (not cardiac related, checked out OK). In addition I have heart palps. About 18 months ago I was on 1 grain of Naturethroid, but then that stopped working for me, so my doc is trying me on this regime (about one year now). He says my labs are OK, but they are all on the very low end of the range, except TSH, which is 3.65. Any thoughts? Thank you for doing what you do.
Hi Jamey,
I would take a look at this blog post for more info on converting between thyroid medications: https://www.restartmed.com/thyroid-medication-dosage-chart/
Hello,
I take a SRT3 from Wellness compounding pharmacy in addition to non generic synthroid 125mg and have done this for a good year. I had previously taken the SR T3 under the Wilson program, but had swelling and Achilles heel issues (that disappeared when I stopped)
It has been working really well and I was gradually dropping some weight until this past Christmas- not sure what happened-I made some dietary changes (less sugars, GF) after putting on 4 pounds.
And now my free,T4 and Free T3 are high according to your optimal math equations and TSH is non existent and no weight loss.
So actually not sure–too much of everything?? I’ve got a great PC Dr. who listens and experiments with me but isn’t a thyroid expert.
When taking both T4 and T3, does the T3 stop the conversion of the T4? I am on .125 of T4 and 15mcg of SR T3, and feel a bit hypo (I usually take .137 of T4). I was reading your article about SR T3 and that if a person was to convert from IR T3 to SR T3 that they would most likely need 20mcg of SR T3 if they were taking 10mcg of IR T3. So, in regards to your conversion chart, how much SR T3 would replace 12.5 of T4? I apologize for being a little all over the place, just trying to understand. Thank you
Hello Dr. Childs,
I started Cytomel 5 mcg along with my Synthroid. I want to take them all together early in the morning with plenty of time before breakfast. My question is, if I take the Cytomel that early will the effects last long enough throughout the day? I don’t want or need to multi-dose the Cytomel. I just want to crash later in the day because the T3 has worn off. Thank you!
Hi Monika,
Once daily dosing of Cytomel is usually sufficient for most people but some people do need to multi-dose throughout the day.
Why are doctors prescribing Armour more than anything else recently. Can I raise my Armour to get more T3
Hi Kate,
It’s sort of the hot NDT right now simply because it’s more available than the others.
Hello;
Do you have recommendations since antibodies are the only thing that is high? I am on Armour Thyroid now.
What would you recommend for hypertyrodism with Graves disease.
Hi Dr. Childs,
I am taking Synthroid 125mcg one day and then I take Synthroid 112mcg the next day. I alternate these two doses per my Endroconoligist. I also ordered your Leptin and am taking 1/2 hour after my Synthroid. I see my Endroconoligist Thurs July 2nd for him to check my goiter (not big and has gone down). Should I suggest that he do any certian tests while I am there?
Thank you.
Hello! I was diagnosed with Hashimoto’s in 1990 and put on Synthroid which never worked for me. After some time a very small amount of Cytomel was added without much affect. After 12 years I was diagnosed with Papillary Thyroid Cancer and had a total thyroidectomy in 2002. I developed neuropathy in my feet after my thyroid was removed but when I had to transition off of Synthroid and on Cytomel to get a radioactive test, my feet stopped hurting so I realized it was Synthroid that was hurting me. At this time I sought out the help of a naturopath and shifted away from an endocrinologist. Armour caused neuropathy in my feet again but SR T3 worked like a charm. I have been on it for about 17 years. The problem for me is that if my dose is a little too low, in time (say 3 months) I will be too low and will have trouble with having a BM. On the other hand if my dose is a little too high, again in about 3 months I may experience some heart palpitations. In other words SR T3 seems to act like a ‘runaway train’ and eventually it’ll become too low or too high. Is there a way to stabilize it? I also have had naturopaths tell me how our bodies also benefit from having T4 (I believe I was told the brain benefits from T3 and the stomach or GI tract benefit from T4). But when I have tried to decrease SR T3 and add in T4 (also compounded) I cannot tolerate T4 at all. Do you have any suggestions or comments?
I take 75 mg of np thyroid which has the T3 in it. How do you know if it is enough, I get such muscle weak ness after I tried a t3 booster I had to stop. But I had so much energy, Just not sure what to take anymore, plus started on Zoloft for the depression. Can you just take t3 alone with out the T4 been on this roller coaster for over 20 years, would like some help.
Hi Linda,
Yes, it is possible to take T3 without any T4.
Dear Dr. Childs, I am using T3 – Thybon Hennning from Sanofi, Germany. I dont know if its SR og IR, but this is the only T3 I can use. Liothyronine was no good for me! I use 20 mcg Thybon together with only 45 mg Armour Thyroid. I have used this combination this last year – and I have got my life back! I have celiac disease and other digestion challenges, but this combination got me back on track! But now my doctor will no longer prescribe T3, so I have to get another doctor – again.
I dont know if this new doctor will help me -yet.
In Norway it is sooo difficult to find a good thyroid doctor!
I have said it before; I wish we had doctors like you!!!
Hi Britt,
The Thybon 20 is definitely a type of T3 but I can’t see what the inactive ingredients are so I am assuming it’s probably immediate release T3.
I’m a little confused about the article itself. If we want this, what exactly are we supposed to ask for from a doctor? I have a doctor that would likely prescribe me it but she’s no thyroid specialist so she’s unlikely to know exactly what it is. So it seems like you’d need to have a doctor who knows how to prescribe it?
I’m currently on Armour Thyroid, no Hashimoto’s, and my insurance doesn’t cover it so I haven’t had it in a week, and they only cover NP Thyroid. I’m starting to question on if I need medication anyway. Plus, I had been getting really high heart rates so my PCP started lowering my dose anyway. In my case, no one knows why I need it but my genetics do show a lot of potential for interference with my thyroid. I had been taking it since probably 2011 or so off and in but haven’t been able to keep a steady doctor that I feel really knows how to treat me. Labs are easy enough for me to get, now but interpreting them is still difficult even with all my research.
This ended up being a venting comment, but feeling a little frustrated with not knowing where to go in terms of medication, or even if my thyroid is even a problem.
Hi Jeanine,
Yes, you would probably need to have a doctor who has prescribed it before. This has to be made in a compounding pharmacy which is not a regular pharmacy like a CVS or Walgreens. Most regular doctors do not use these types of pharmacies or even know they exist.
Dr. Childs, been following you for many years and appreciate your information and love the podcasts. Do you do any telephone “appointments” where I could ask you the many questions I have. I am a 65 year old woman, diagnosed at age 18 hypothyroid. I have always struggled with symptoms. I am small, light, and very active, with a solid nutrition plan. I have questions about my labs, and medications which rite now are Synthroid 112, and Liothyronine 25. You may answer here or email me. thanks
Hi Robin,
I do but they are currently all booked out for 3-4 months. I will send out an email to my email list when more slots open up, though!
Was taking 20mg of Cytomel in regular T3 and after much research and reading, I heard that SR T3 would be in my body and released throughout the day and help with my energy level. I have a doctor and a compound pharmacy that had no problem with prescribing it or making it. I do have a question though. I was on 20mg of regular T3 and went to 20mg of SR T3, should that SR T3 been 40mg based on what I just read? If you think so I would like to discuss with my doctor.
Hi Sue,
Yes, most people need more SR T3 when they transition from IR T3.
I switched from .125 mcg Synthroid to Armour a bit more than 2 years ago. My doctor started me on 60mg a day but I was so tired I could hardly move. She then upped it to 75 mg but as I was still tired she upped it again to 90 mg. I felt somewhat better on 90 but still tended to feel tired and to have a body temp of around 96 to 97.4. My doctor referred me to another more experienced doctor and she agreed to increase my Armour doseage to 125 mg and I have been on that dose for about a year. While I generally feel good and run a body temp between 97.5 to 98.6F I am down to 134 pounds from the 144 lbs I weighed when I switched to Armour. As a Type 1 diabetic I follow a fairly strict low carb diet and if anything am more inactive today than when I switched to Armour. Could it be that taking an excessive amount of Armour is causing the weight loss?
Hi Winston,
Yes, it could potentially be from that.
Hi Dr. Childs,
I’ve been on Armour Thyroid for ten years. I was taking it in the morning, now I take it at night. Feel pretty good, but sometimes I wake up at night with shortness of breath. I would like to lose ten pounds, I’m 5’ 5” and weigh 136., And that’s in the past year, normally I weigh 124. I thought this is why I have shortness of breath. My PCP checked me out, no heart issues. Any suggestions? I had a biopsy on my thyroid because I have goiter at my check up in Feb. all good. Also is Armour Thyroid T3 and T4? I take 60 mgs. and have the entire ten years.
Thank you!
Greetings Dr Childs,
My doctor has prescribed both T4 and T3 medication and I am happy with the added benefit of the Cytomel. My question is this….. is the ratio of the two medications of importance? I know that I feel much better after my recent t3 Medication increase but are there limits to the amount of t3 medication one can use daily?
Thanks….
Hi Marjorie,
Yes, I’ve seen a lot of issues when people get to the 150+ mcg dose per day range.
Hi Dr. Childs
I’m taking 21 mcg of SR T3 with 2.5 mcg T4 q 12 hrs. My Free T4 is way below normal. I have used you T3 conversion supplement which required a dose adjustment down.
Do I need to increase the T4 dose in the compound to bring the FT4 into more normal levels since the conversion supplement helped raise my FT3?
And should my T4 be in the normal range when on the compound anyway?
Thank You!
Magda
I was on 75 mcg 2 times per day, it worked really well for me. If I ate more, I didn’t absorb it well :/ some of us need higher dosage because our cells are not receiving all of the medication.
Hi R.,
I am skeptical of the claim that some people truly need T3 doses as high as 150 mcg per day (if that’s what you’re saying). While I have certainly prescribed that dose in the past, due to genetic T3 resistance, I don’t believe it’s common and my concern is that many people are brute forcing higher-than-needed T3 levels because they are missing other more glaring problems. If you are referring to 150 mcg of T4, that’s not as big of a deal, so I may be misunderstanding your comment here.
I tried substained releases T3 but never ciukd absorb it could never get my free T3 above 2.5
Hi Debbie,
Could be dosage issues or absorption issues.
Dr. Childs,
Since I’m euthyroid (but symptomatic with high antibodies) my endocrinologist has only given me 15mg. of levothyroxine and remarked it probably won’t make much of a difference. Well, it hasn’t made a difference and so I asked if I might have a conversion problem and what about some T3?
She said she couldn’t give me any T3 because my levothyroxine dose was too small. I did eventually get her to switch to NP Thyroid because I know there is a small amount of T3 in glandulars. (At 15mg. of NP it still isn’t making much of a difference).
Is this really true that one cannot give someone T3 when they are on such a small dose of T4, because as she says, it will mess up the ratios? I know you can’t read her mind, but what rationale might she have for saying this?
You will probably say that I need to get a full range of testing, but since I’m already taking medicine, she will only get TSH. Do I need to get T3 and RT3 tests? (Really, should I try to find a different endocrinologist?)
Thank you,
Nancy
P.S. If you cannot answer the above questions, I got the results of a nighttime saliva cortisol test, on two successive nights. One was 30 and the other 60 with ‘normal’ being less than 100. Are my results high normal or low normal? What is optimal? Thank you again.
Hi Nancy,
You are right! I will say you need to get a full set of lab tests 🙂 There’s not much you can do without that information.
Hi
I have subclinical hypothyroidism. I’m currently in 20 mg IR Cytomel which seems to balance out my levels. I do have restlessness and some anxiety. I am 70 years old. I see a DO who seems very thorough with thyroid. Am wondering if I should try SR Cytomel? Also I have very low hormone levels including progesterone, estrogen and testosterone. Doc thinks I should try pregnenolone and progesterone. What do you think? I sleep pretty good now but s am taking some homeopathic relaxant which helps with sleep. Thanks for your input. Char
I started on Armour in 1993 with decent success. In 2002 I read about Wilson Syndrome, and shared the book with my D.O. so we could try cycling T3. I don’t know why I was never able to get my thyroid to work on its own again. I’ve always tested negative for Hoshimotos’s. Since I had IBS back then, SR-T3 dosing was all over the place until 2003 when I eliminated gluten and offending foods. I was fine on 15mcg BID for a few years, and then we decided to add a bit of T4 to balance things out (like getting cold and sleepy when the T3 ran out). Over the years, only the T4 has been tweaked as my weight changed or I’ve had symptoms: 50mcg, 75mcg, 100mcg, 125mcg, and now 112mcg. Last year, however, I started keto and dropped 24 pounds. I had to adjust the SR-T3 up to 20mcg BID. I’ve since just been doing LCHF with about 45-70grams of carbs a day (not real keto). My most recent labs were flagged as low in thyroixine (bound I assume since free was low normal), but this was the first time I ever avoided biotin for a few days before testing. My RT3 is only 12.1. (Back in 2002 it was 80.) It has been a constant battle with doctors to get this stuff prescribed, as no one seems to definitely know what tests to order, how to interpret these tests, and to prescribe combos of medications. I’m just a squeaky wheel, so they humor me and order what I ask for. I am curious as to what a normal physiological dose might be for T3 and T4 in a 125 pound female as my thyroid has pretty much been retired for years.
Hi Dr. Childs,
This is Mari Trejo. I have been taking 50 MCG tablet of Levothyroxine for the past 7-10 years, but have not been successful with it. Am taking some supplements to enhance the thyroid medicine with some luck. Now my practitioner order NP Thyroid 15 MG. Could you give me more less an approximate good dose for NP Thyroid. Some years ago, I was taking the original Armour Thyroid, but had very bad experience. Thank you so much.
I am 52 and on HRT. I’ve had crushing, debilitating fatigue and brain fog for a few years. No weight gain. I eat a varied, healthy diet. I exercise, but not too vigorously. I sleep 7-8 hours, generally. I started 5mcg of Liothyronine in Oct 2019. Tried both SR and IR and couldn’t decide which I preferred. Ended up doing SR twice a week and IR the rest of the time (is that okay?). Felt a little better for a few months, but then was just as tired as ever. When I got my labs done 8 months later my Free T3 was even lower and my Free/Rvs ratio worse. So I went up to 10 mcg. That didn’t cut through my fatigue so now I’m up to 15 mcg IR in divided doses. Having dizziness, elevated heart rate and shakiness, so tried a morning dose of 15 mcg SR which felt much better but then I couldn’t sleep because I wasn’t tired enough. Might I be better off with just a thyroid supporting supplement? I’ve been tested for all kinds of things and can’t find an underlying condition.
July 2019
TSH – .69
T3 Total – 84 NG/DL
T4 (thyroxine) – 6.9 UG/DL
Free T4 – 1.04 NG/DL
ESR (sed rate) – 6 mm/Hr.
Ferritin – 71 ng/mL
October 2019
TP antibodies – <1
Free T3/Rvs T3 ratio 1.98
Free T3 250
Reverse T3 126
October 2019 – Began 5mcg Liothyronine
6.1.20
TSH – 0.77
Free T4 – 0.8
Free T3/Rvs T3 ratio 1.88
Free T3 – 220
June 2020 – Began 15mcg Liothyronine
Hello! Thank you for all the information. I want T3…. can you please help me? I live in Canada…
I had a Thyroid removal at 25 yrs old and since then all I do is gain weight…. I used to be an athlete… the worst thing I ever did in my life was agree to have it removed.
Anyways I’m on synthroids 175 mcg…. According to all your explanations, T3 could really help me. A prescription is mandatory? Can we order it from you?
Hi there,
I have had every combination of thyroid meds! Originally, my TSH was normal, and my thyroid was always fine, but my T3 numbers were well under range (T4 slightly). We recently cut out all t4 (have done that before) and went back to all t3. I was taking all Cytomel, but am slowly transitioning to the SRT3 and adjusting. I didn’t want to completely switch over at once, as I’ve read about needing more of the slow release, and my doctor is very conservative in starting at low amounts and adding every 6-8 weeks.
My question is – what is the half-life of the SRT3? Does it release over 24 hours? 12 hours? I’ve read mixed opinions on if it should be taken once a day or twice a day (ever 12 hours) and my doctor doesn’t appear to know for sure.
Nature throid is on recall once again leaving me in a panic as it is the only thyroid med that worked for me. After reading about sustained release T3 from another of Dr. Westin’s blogs, I called my doctor and asked if we could go the compound route. He was very supportive and said that it should work well for me and that it would be wonderful if I got off the recall issues we were having with the Nature throid.
I feel amazing since the switch. No more heart palps or jitters. It was strange at first not having the T3 dump in the morning but it is so nice to just go along on an even keel all day. Only issue I’m having is about 6 pm I start to feel the low thyroid symptoms so after having a blood test done at 6 pm to see where my levels are- we are going to add a low dose around 6:30.
Dr. Childs
I am changing my routine of taking my Synthroid and Liothyronine to see if it might be more affective.
I want to take my .112 Synthroid at night at least one hour after any food or drink, except water, as you suggested in another post. I also take SOD 10 MCG of Liothyronine. If I take this at night it keeps me awake.
My question is can I drink black coffee after taking Liothyronine? Or do I need to wait 30 to 60 minutes?
Thank You
Simone
Hi Simone,
I wouldn’t take coffee with your thyroid medication as it may cause issues. I have outlined in other articles how coffee, in general, can negatively impact thyroid function.
Hi Dr. Childs,
I am a 36 year old woman that was diagnosed with Hashimotos in my mid twenties. I found a great doctor a few years ago that put me on a path to recovery, using many of the modalities you speak of.
I have recently been put on SR T3 since my last couple of labs have shown low levels and also I struggle with low energy and weight loss resistance. I have adrenal fatigue issues and high cortisol for long periods of time with intermittent recovery periods. My TSH and reverse T3 are in range, but I have had high reverse t3 in the past. I’ve been taking Armour the last several years and have worked my way up to a 90mg dose. I tried 120mg, but felt agitated with it.
The doctor agreed to try SR T3 added to my 90mg dosage of armour to see if it would help with my weight and energy issues. So far I’m feeling slightly better and am not experiencing the energy dips. I haven’t been on it long enough to experience weight loss, but I’m hoping it will help.
I have a few questions. The first is, since the SR T3 gets slowly broken down, how does the food in your stomach effect it? I know with armour, it’s not supposed to be taken around a meal…so even if we take SR T3, since it sits in our stomach and intestines, won’t it eventually mix with food and lower the effectiveness?
Secondly, you mentioned that you’re not much of an advocate for spreading SR T3 doses out. So should I just take all the SR T3 I need in the morning? Lately I take one in the AM and one at 2pm. I’ve been sleeping fine. I will most likely be upping the dosage soon.
Lastly, I was on Saxenda, and then Victoza with amazing results about a year and a half ago. Once I dropped the 25lbs I needed to, I remained on a 1.8mg dose for over a year up until my insurance would no longer cover the off label use of Victoza. I have steadily gained back the weight at that dose the last year. I’m now on metformin and not really feeling as good as when I was on Victoza. My insulin is at 6 and I’m slightly insulin resistant. To get to my question, I’m curious if the Victoza effects T3 in a positive way. I’m not sure the relationship between T3, leptin, and insulin. I’m wondering if taking SR T3 will help me shed weight like Victoza did…I’m wondering if they possibly work through similar pathways…like maybe my T3 has been the issue the whole time and Victoza improved it (along with my blood sugar) for awhile? Could be totally unrelated…
Thanks so much for all the info you share. It has really helped with my journey to better health!
Hi Annie,
Yes, it would impact the absorption but that’s kind of the point in using SR T3 🙂 You want to prolong the absorption because then it slows down how much is entering the bloodstream.
Hi Dr Childs
My provider wants to put me on small dose of cytamel and t4 hormone. I have had severe brainfog for the past months that comes and goes. I also have issues with anxiety, memory and just function normally….mental fatigue…could thyroid be causing this, feels like dementia and it scares me.
TSH 1.42 0.3-4.2 uIU/mL
T4, Free 0.95 0.6-1.3 ng/dL
T4, Total 9.7 4.5-11.7 ug/dL
T3, Free 2.9 2.1-4.3 pg/mL
T3, Total 1.13 0.8-2 ng/ml
rt3 17.6
Hi Sasa. Your Free T3 is too low and nowhere near optimal. That can cause brain fog, fatigue, etc. (Total tests are useless by the way.) Your Reverse T3 is also likely high (need range). It shouldn’t be mover than 3 above the lowest level in the range. This is usually caused by low iron and/or adrenal problems. You will have more problems from that high Reverse T3, and it is what is likely causing your Free T3 to be low (since it’s converted to Reverse T3 instead of Free T3). Typical treatment is to lower T4 (or NDT) dose and add T3 to help clear out the Reverse T3 while you treat the cause at the same time. Dr. Childs has an excellent article on this also on his website.
I’ve had Hashimoto’s 25 years by the way and dealt with a high reverse T3 also. How are your ferritin/iron levels? Have you ever done a cortisol saliva test for your adrenals?
With your levels, you could change your diet to see what happens. Eat red meat, raw liver, etc. No grains, soy, dairy, sugar, etc. You may be lacking key nutrients and liver offers a lot of those key nutrients, along with Vit D, k2, and magnesium.
Thanks to you and your valuable information Dr Childs, I have discussed with my functional doctor on my desire to try Tirosint Sol and compounded SR T3. I’ve just started and look forward to positive results to get rid of my symptoms.
One question I have is in regards to drinking coffee; I know with Tirosint Sol it’s okay to drink coffee after taking and I think I can with SR T3 because of it being SR, but I wanted to make sure. I’ve searched and searched and cannot find any answers for this.
Also, I wanted to note that initially by insurance did not cover the Tirosint Sol, but after my doctor contacted to request coverage for the medication, within a few hours I received a call from my insurance company to tell me that it will be covered – a huge savings! Doctor explained other meds weren’t not working and I needed to try the Tirosint Sol.
Hello Dr. Child,
I was just prescribed SR T3 to take along with my synthroid because of weight gain, hair loss, brain fog and hypothyroid symptoms not resolved. My T3 levels are low while my T4 and TSH are ok.
My question is can I take the SR T3 capsule with some food?
I have a problem swallowing caps and taking a piece of food will help to get it down.
I usually take my synthroid first thing in the morning.
Please advise!!
Rosa Bazzani RN BSN
Great article! This might be my problem. My T3 was low (2.5) and I tried regular compounded T3 and got migraines when I took it and I’m already a migraine sufferer. And also after being on it for 3 months my number didn’t even go up so I’m assuming it wasn’t getting into my cells? I want to try again with SR. What do you think!
Hi Gypsy,
It’s hard to say without more information but that’s a reasonable approach!
Hi Dr, Childs,
I’ve been diagnosed with Hashimoto’s and I found a compounding pharmacist to work with who started me on 10mcg of SR T3 two weeks ago. I take it in the morning.
We skipped over trying T4 alone (which is fine because that didn’t work in the past) but we also skipped over trying NDT or T4 first before adding T3 by itself.
My main symptoms have been depression and an energy crash, both of which happen around 3pm every day and last for 3-5 hours. My symptoms have gotten a little better over the last two weeks.
My question is under which circumstances would would add NDT or T4 to my current SR T3 medication and how would we make sure that I am not going hyper then when/if we add that?
Thank you,
Marie
Hi Marie,
Well, you’d only really want to add NDT or T4 to your medication if whatever you are currently taking isn’t working. In terms of preventing hyperthyroidism, you would just keep an eye on your symptoms and your lab tests and adjust medications as necessary.
Hi – I am supposed to be taking 88 mg Levothyroxine in the morning and 16 mg SR T3 twice a day. But I am really struggling to find a time to take the second dose that is at least 2 hours away from food and all other meds and supplements. If I go back to taking the SR T3 only in the morning, should I take 2 of the 16 mg?
Hi Kristen,
Please see this article for more information on converting between thyroid medication and doses: https://www.restartmed.com/thyroid-medication-dosage-chart/
You may have answered this some wheee else so I apologize if it’s a repeat question. I’m on SR T3 2x daily bc I was metabolizing the meds way too quickly and crashing around 3 pm. But I’m still having a hard time with weight loss with being pretty optimal. So my question is can fillers in the compounded meds play a role and what’s your suggestion? I tried a T4/T3 combo with Methocel and gained 15 lbs rapidly. Tirosint is what works best for me as far as T4. Currently using loxoral as excipient but wondering if there is a better option?
There is a ton of information about SRT3 through Dr. Denis WIlson’s Wilson’s Temperature Syndrome Protocol. Dr. Wilson pioneered this type of Thyroid medication in 1988. You can find a medical read from Dr. Wilson on Amazon it’s called “Evidenced Based Approach to Restoring Thyroid Health”. There are thousands of individuals who were put through this protocol so this isn’t some fly by night approach or hocus pocus…it is tried and true. I am seriously considering doing this myself. I have lost most of my hair, and still do not feel well on my T3/T4 Porcine Thyroid medication which is compounded. The Protocol from Dr. Wilson must be followed exactly (times taking med) or it doesn’t work. It is based on low temperatures and getting them back to 98.6. Physician’s can sign up on Dr. Wilson’s website to become part of this Protocol since it’s so hard to find physician’s that understand SRT3. Contact: wilsonsyndrome.com
Hi Susan,
The cyclical dosing of T3 does work for some people but not for others. If you have tried everything else without success then it may be worth a shot.
Hi Dr. Childs,
What if a hypothetical patient uses 45 mcg of SRT3 and still cannot lose the extra 12 pounds of water weight. Assuming all other labs are optimal, would adding Tirosint or NDT to the SRT3 or trying IRT3+Tirosint or NDT instead be a better choice? Did you prefer SRT3 or IRT3 for water weight loss from hypothyroidism for your patients? Thank you. I really do wish there were more doctors like you.
Sincerely,
Alexandra
Hi Alexandra,
If you are not losing weight after optimizing your t3 medications then it would be time to look at other hormone imbalances such as insulin and leptin resistance.
Hi Dr. Childs,
Have you had people complain of itchy skin from Slow release T3?
I have had itching all over since I started 5mcg of compounded slow release T3.
Hi Rosa,
I can’t say that I’ve had. You may be reacting to some inactive ingredient(s) in the medication. You might want to call up the pharmacy and ask them exactly what they are using.
The pharmacy tech said she uses the lyothyronine (T3) and methocell or something like that, which makes the hormone slow release. All in a capsule.
Hi Dr. Childs,
How is it better to take SR T3 along with T4 in the morning?
-together with Levo or separately, if separately at what time distance of time?
-if together, does it not influence the absorption of levothyroxine?
-if separately in what order (first Tirosint then SR t3 or first SR T3 then Tirosint)?
Thank you!
Hi Adrian,
It’s different for each person and it will take some trial and error to figure out what works best for your body.
Hello, I previously read from another article of yours that if you have a high abnormal Reverse T3, a SR T3 is needed to bring that down. I finally found a Dr to prescribe that and now awaiting my new meds. I’m wondering why you didn’t list this as a reason? I’ve been having hypo symptoms for many months (I had RAI in 2017), this has been a very difficult journey. Second question, is 25mcg of Levo equal to 5 mcg of T3? Just trying to figure out my new prescription as I’m going from 125 mcg of Tirosint, 10 mcg of Liothyronine TO 75 mcg of Tirosint and 20 mcg of Liothyronine but in a sustained release form (2.5 mcg x 8/day). Thank you
Hi Erika,
SR T3 is just one of many options available to help reduce reverse T3 levels but is by no means required. There are natural ways to bring down reverse T3 levels but you can also opt to use medication to do it as well. It’s more about preference and severity. For example, here are some natural therapies that can be used: https://www.restartmed.com/increase-free-t3-naturally/
Do you remember what I said specifically in the other article or which article it was? If you can point it out I can take another look at it to make sure it’s accurate.
Hi, hoping I can paste the link properly here – https://www.restartmed.com/reverse-t3/
That is where I read to try SR T3. Hoping you can answer my other question on the ratio – 25mcg of T4 = to 5mcg T3? Also 4 days into my switch from 125mcg of Tirosint to 75 mcg and SR T3 of 20 mcg. Exhausted and not sleeping well as I have to take 4 – 2.5mcg of SR T3 every 12 hours. Any suggestions would be great. Trying to stay awake and lose weight that I’ve been unable to for years. Thx
I have Hashimoto’s, had a thyroidectomy, and RAI for thyroid cancer. I am on Synthroid 200 mcg once daily and an additional 1/2 dose on Sunday and Wednesday.
I have a traditional doctor who will not consider NDT and I haven’t broached the subject of SR-T3 but I am exhausted after two 10-12 hour days. I sleep until nearly noon the next day. I have begun swimming as exercise but about 2-3 hours after a swim I am exhausted and have to nap.
Another tidbit, I was undiagnosed for around 14 years. I am beginning to feel like I did before I was diagnosed. Another factor that I am not sure about is that I had a partial hysterectomy 3 years ago. Could that affect how well my body converts T4?
Hi Jennifer,
Estrogen and thyroid function influence one in an indirect way. I’m unaware of a direct connection between estrogen and thyroid conversion. You may also have more success looking for another more competent doctor: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/
Hell Dr Childs
I have been struggling for over a year with TSH levels swinging from low to high. Finally got a Dr that ordered right labs TSH 4.54 Free T4 1.3 Free T3 2.8 RT3 20 Antibodies <1. Do you think Sustained release T3 sounds like a good option for me? I currently take 112 mcg Synthroid . And if so do you recommend reducing Synthroid dose in conjunction with starting Sustained Release and what dose do you recommend starting with. Thx for your time. Your You Tube Videos are beyond helpful !!!!
Hi Karen,
Unfortunately, I can’t make any personal recommendations or provide you with medical advice but it never hurts to try various thyroid medications if what you are currently using isn’t working for you.
Years ago, after battling Graves Disease and hyperthyroidism for 22 years, I capitulated and had RAI treatment. Subsequently, I now have no thyroid and therefore hypothyroidism. T4 treatment did not seem to work for me – despite high levels in my blood, it was apparently not being metabolised properly. I have since swapped to T3, but found the multiple dosing schedule difficult, especially when my Endochronologist suggested that best practice is to take it in doses overnight to align with circadian rhythms. (I was on 40mcg per day.) I have since switched to 50mcg slow release before bed, but am still suffering brain fog, tiredness, joint pain, and am struggling with weight gain.
I after reading your post, I’m wondering if the dose is too small??
Hi Natasha,
It’s possible, you will want to check your free t3 and total t3 to determine if your dose needs adjusting. You can find more information on these pages:
https://www.restartmed.com/total-t3/
https://www.restartmed.com/free-t3/
https://www.restartmed.com/normal-thyroid-levels/
https://www.restartmed.com/updated-hypothyroid-treatment-guidelines/
Dear Westin,
Thank you for sharing your knowledge.
I would love to try SR T3, since I take 3x daily T3, and experience ‘drops’ – unfortunately in Denmark I can not get prescription for SR T3. For me it is not logical that I can get prescription for T3, but not for SR T3.
Do you have some research on SR T3 I can send to the local endocrinologists, or by chance can you prescribe it to me?
I have found an pharmacy in Germany that produces SR T3, but I need an prescription.
Thanks and love from Copenhagen
Dr Childs. I have been following you for years and really wish you did consults :(. You are AMAZING!
I have a perpetual problem and am wondering if you can help. No doctor can figure it out.
I have lupus (yes inflammation). I healed and have been in 8 years of remission until Covid. I healed through functional medicine and all the things you do to fix Hashimotos etc. Diet, lifestyle, supplements etc.
Anyway, I have high TSH. Through the years we have found I do best on SR T3. But my TSH is still 11. I am exhausted. I am still skinny 129 and 5’8. Everytime I try to go up I swell with edema, can’t breath, get heart issues and high blood pressure and high blood sugar. I also lose my skin elasticity and go from looking 20 to 90. That goes away after I stop the higher dose I am trying to add of SR T3. I have been on 40 mcg for so many years.
I have high 24 hour cortisol urine and blood tests always and always high have high ACTH and low ADH. We can’t ever figure that out.
I can never tolerate t3/t4 combos and have tried them all. T4 alone is horrible for me too. And I can never up T3 which I need desperately to raise TSH. I get bedridden and swollen and can’t breath with heart issues with any adjustment in doses. HELP!
Have you been to a Endocrinologist? Have you done saliva cortisol testing? I would look into adrenal issues with that high cortisol.
Thank you again for the excellent information. I was put on IR T3 with a continuing dose of T4. Initially it was great but unfortunately the only dose available in Australia is 20mcg and I now find taking half (10mcg) increases my heart rate too much and I have had some episodes where strenuos exercise caused severe palpitations. Speaking to a compounding chemist, she recommends starting with 5mcg SR twice a day, increasing to two once or twice a day if necessary. Fingers crossed as it has taken me a lifetime to get this far with treatment – couldn’t have done it without the information you provide – although it took me years to find a doctor with enough knowledge to act on your information. Thank you very much for the invaluable help you provide.
Hi Gayle,
Glad to hear you found the information helpful and it sounds like you are on the right track! A 5mcg titration schedule is pretty reasonable, even if it’s on the conservative side.
Dr, Childs can you refer me to a doctor who is aware of T3 compounded and compounding pharmacies. do you give appointments if so please add me to it.
hello! i was reading through comments, hoping someone shared my experience. last fall (while on 75mcg of tirosint), i started to retain water like crazy. by december i had put on about 8lbs even though i have maintained a very normal/optimal bodyweight my whole life. i added 5mcg of t3, and two weeks later, another 5mcg (taken all at once) and the water weight flushed out within a week and my energy was through the roof (hard time sleeping). three months later, i have started to lose weight (not desirable for me), my gym performance has suffered and feel so tired all the time. i read somewhere (maybe paul robinson’s site) that the rise in metabolism, over time, can cause exhaustion. usually by the afternoon i feel better. anyway, i am think i am going to try splitting the t3 into two doses or the sr t3 to see if i feel less tired.
i guess i’m describing all of this because i am wondering if anyone else had to shift their dosage/dosing after a few months from undesirable side effects of ir/sr t3, and what worked for you. after watching a different video from dr childs, i may also try backing down my tirosint dosage.
Hi Revekah,
It’s not uncommon for thyroid medication dosing to change over the course of one’s life. Having said that, I’m unaware of a general trend of ir/sr T3 not working but others can chime in if they’ve noticed something.
Thank you for the information you provide.
I watched your video, “Supplements That INTERFERE With Levothyroxine (& other thyroid medication)”.
I am trying SRT3 at the moment and wondering whether diet and supplements may be interfering.
Is there any way of adapting diet to suit SRT3?
Hey Dr Childs…quick question about dosing. Never took any kind of t3. Yesterday my PCP wants me to try 25mcg SRTT3.
It wont get here till 3.24 but it sounds like a big dose to begin?
should I try a smaller dose or take half the 25mcg when I get it?
he has never prescribed it before (SRT3) so he is guessing on the correct dosage.
thanks for any help or advice you can offer.
Hi Thomas,
Most dosing falls within the range of 5-25 mcg, so it’s a relatively high starting dose. That isn’t always a problem, though. You’ll just have to give it a go to see how you respond.