5 Benefits of using T3 Medication + Who Should Use It

Many patients on levothyroxine or Synthroid stand to benefit by simply adding a small amount of T3 medication to their regimen. 

T3 is metabolized in the body in a different way than T4 which makes it special.

It's also the strongest and most powerful of all the thyroid medication BUT it must be used correctly.

Learn about the benefits of T3 including which patients should use T3 and why in this post: ​

More...

What is T3 Thyroid Medication?

​T3 thyroid medication is the strongest of all thyroid medication. 

Why?

Because T3 is the active thyroid. 

But most patients with hypothyroidism are not taking T3 thyroid medication.

​How come?

Despite the medication being quite safe if used correctly, many physicians simply aren't comfortable with prescribing it.

As a result, most patients are taking some form of T4 thyroid hormone. 

You know these medications well: levothyroxine, Synthroid and Tirosint

​All of these medications fall into the class of T4 thyroid medications. 

And, unfortunately, they are considered to be weaker when compared to pure T3.

T4 thyroid hormone must be activated in your body through special enzymes.

Thyroid conversion with leptin resistance

When it is activated your body changes its structure and turns T4 into T3.

Once it's in the T3 form it can then get into your cells and activate genetic transcription through its action on nuclear receptors.

But your body can also INACTIVATE T4 by turning it into reverse T3. ​

​And this is one of the reasons that using T3 thyroid hormone is so special. 

Instead of providing you with a medication that your body must activate, you can instead bypass this activation process and provide the body with the direct and active thyroid hormone (T3). ​

Is using T3 actually dangerous as most physicians would have you think?

It turns out that, as long as it is used correctly, there are very few side effects of using T3.

More and more physicians are starting to add T3 to existing doses of T4.

This might come in a combination such as Levothyroxine + Cytomel (usually in small doses).

But T3 can be used much more effectively, and safely, at even higher doses.

In fact, most patients stand to benefit tremendously by adding in a small amount of T3 to their existing dose of T4 - even if it means lowering their current dose of T4.

​T3 can also be safely combined with natural desiccated thyroid hormone (you can read case studies here). 

​But the question remains:

Who should consider using T3? ​

  • Bottom line: T3 is the strongest form of thyroid hormone and can be prescribed by your doctor. Certain patients stand to benefit by adding doses of T3 to their existing T4 dose. Unlike T4 thyroid hormone, T3 does not require activation to exert its effects in the body. 

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When to use T3 thyroid medication

​Determining if you would benefit from T3 thyroid hormone is not as difficult as you might think. 

As a general rule of thumb:

The more medical conditions you have, the more excess body fat you have, the more medications you are on, the more inflammation in your body... the more likely you are to benefit from T3.

Why?

Because all of these conditions create an environment ​inside of your body that favors the production of reverse T3 over T3. 

That means you are in a state of thyroid resistance.

In a nutshell, your body is basically blocking the action of thyroid hormone at the cellular level, this can occur even though you have "enough" thyroid hormone floating around in your bloodstream. 

When it comes to thyroid hormone we really don't care how much is floating around in your blood, we really only care if thyroid hormone is getting inside your cells and turning on your genes.

Patients who benefit from cytomel

But we don't have a great way to test for this, so instead, we use surrogate markers such as reverse T3 and sex hormone binding globulin.

Most patients who ​stand to benefit from using T3 thyroid hormone fall into one or more of the following categories: 

While this list isn't exhaustive, it does include the majority of patients who might benefit from the addition of T3. 

It's also important to consider T3 therapy (either in addition to your current dose of T4 or NDT) if you are having any issues or remaining symptomatic despite taking thyroid medication. 

This might manifest as intolerance or sensitivity to thyroid medication, or an inability to absorb your thyroid medication. 

Benefits of Using T3 Thyroid Medication:

Because of the unique way that T3 is utilized in the body when compared to T4 it comes with several benefits that we should talk about. 

These benefits have to do with the fact that this medication does NOT require an activation step in the body, which means that it is active once it is absorbed. ​

#1. More Weight Loss

Another VERY important aspect of T3 is its ability to influence weight loss.

​So does T3 help with weight loss?

The answer yes a resounding yes! 

In fact, this effect is much more pronounced than T4 and/or NDT.

Why does T3 help with weight loss more than T4? 

​T3 has a greater action on the factors that influence your metabolism than T4 does. 

Studies have shown that patients taking suppressive doses of T4 thyroid hormone, resulting in a low or "suppressed" TSH still have a lower metabolism than what would be expected (1).

Obviously, a low metabolism would result in an inability to lose weight and this might explain why so many hypothyroid patients have issues with weight loss despite taking thyroid hormone. 

In addition, other studies have shown that patients with "normal" TSH levels tend to have lower levels of both free T3 and free T4 (2) compared to age-matched controls. 

This reduction in thyroid levels may help explain the difference in weight among hypothyroid patients and euthyroid patients. 

Basically, your free T3 and free T4 levels seem to matter much more than your TSH when determining how you will feel taking thyroid medication. 

And lastly, other studies have indeed confirmed that patients who take T3 thyroid hormone over T4 show that they have more weight loss (3) and a higher metabolism WITHOUT negative side effects. 

This doesn't necessarily mean that everyone will benefit in this way from T3 but it does mean that using T3 should be a serious option for patients who are not tolerating T4 only thyroid medication (or NDT).

#2. Higher Basal Metabolic Rate

​Another benefit of T3 medication is that it increases (or normalizes) your basal metabolic rate. 

Hypothyroid patients are very susceptible to having a lower than normal metabolism for a variety of reasons.

First:

Having low thyroid itself changes your metabolism and will lower it. This is one of the main reasons that weight gain is a symptom of hypothyroidism. ​

Second: ​

The second reason is also very common and more sinister than the first.

Because hypothyroid patients tend to gain weight these same patients usually undergo calorie-restricted weight loss programs to try and lose weight. 

Unfortunately, calorie restriction actually makes the problem even worse by further lowering the metabolism (4).

The combination of low thyroid hormone plus metabolic damage from calorie restriction results in a metabolism that is usually in the range of 1,200 to 1,500 calories burned per day.

This is why many hypothyroid patients have difficulty with weight loss and why Doctors look at you like you're crazy when you tell them that you're eating 1,000 calories per day and still not losing weight.

The benefit ​of using T3 is that it can help heal your metabolism and increase your basal metabolic rate through its influence on your mitochondria. 

#3. ​Reduction in Hypothyroid Symptoms

​Another benefit of using T3 is that many of your true hypothyroid symptoms will likely improve or be reduced dramatically. 

I'm talking about hair loss, fatigue, weight gain, brain fog, etc.

These symptoms are all indicative of low tissue levels of thyroid hormone and many of these symptoms persist even while taking thyroid medication like T4.

But once you start taking T3 thyroid hormone your body is able to take up the T3 and use it at the cellular level.

This results in greater tissue levels of thyroid hormone in your skeletal muscle (increasing metabolism and energy), your hair follicles (reducing hair loss), ​and your brain tissue (reducing depression and brain fog).

While it is true that other factors like nutrient deficiencies may contribute to your symptoms, it's easier to distinguish the cause of these issues when you start taking T3. ​

#4. ​Higher Body Temperature

Through its influence on energy production in your mitochondria, T3 can actually help to increase or normalize your body temperature. 

Your total body temperature is a reflection of the amount of energy you are producing and the amount of energy you are burning. 

Many patients walk around with very low body temperatures (in the 95-96 degree range) as a consequence of hypothyroidism. 

This low body temperature is almost always associated with a slower metabolism and a low basal metabolic rate.

T3 thyroid hormone helps improve your body temperature in several ways:

First:

It directly mediates energy production in your mitochondria (this helps boost your metabolism). ​

Second: 

T3 helps the body burn fat tissue and activate brown fat to further increase metabolism and increase fat burn (5).

The addition of T3 helps to normalize these processes and can increase your body temperature to normal levels (and help increase your metabolism in the process). 

#5. ​Improvement in Other Hormone Imbalances

​One of the main reasons that thyroid patients DON'T get better when starting thyroid hormone is due to its effects on other hormones in your body. 

Hypothyroidism helps potentiate two very important hormone imbalances:

Insulin resistance and leptin resistance.

​Unfortunately, using T4 thyroid hormone can help reduce the symptoms of hypothyroidism but it won't necessarily treat these hormone imbalances if they are present. 

That is where T3 comes in handy.

T3 has been shown to help reduce insulin resistance (6) (which will help with weight loss and help normalize blood sugar).

Leptin resistance and hypothyroidism

T3 has also been shown to help reduce leptin resistance (7).

This is very important because there are currently very few treatments that can help lower leptin levels.

If you aren't aware, leptin resistance creates an environment in your body which makes weight loss almost impossible unless it is reversed. ​

NDT vs pure T3​

What about natural desiccated thyroid hormone?

NDT is another form of thyroid hormone replacement and NDT does contain some amount of T3 in it.

1 grain of NDT contains about 38 mcg of T4 thyroid hormone and 9mcg of T3 thyroid hormone.

It also contains some other less biologically active thyroid hormones like T2.

NDT is another great thyroid hormone replacement medication but just like T4 medication, it does fall short in certain circumstances. 

​Because NDT is mostly T4 (about 80%) it is still subject to reverse T3 conversion and might cause issues in some patients. 

In addition, certain patients may need temporary supraphysiologic doses of T3 for short periods of time to wash out the reverse T3 and reset the system.

Using higher doses of T3 during this time period or using the combination of T3 and NDT together can help overcome this issue.

It's best to consider NDT as another potentially helpful medication, but it shouldn't be considered the "best" thyroid medication. 

SR T3 vs IR T3

T3 medication comes in two varieties: 

  • Immediate release T3 <--- Including medications like Cytomel and Liothyronine
  • Sustained released T3 <--- This is a compounded medication of liothyronine (usually bound to methylcellulose)

It's important to realize that these medications are the same in that they both contain T3 thyroid medication. 

How they differ is in how quickly they are absorbed into your body.

Immediate release T3 is absorbed rapidly into the body and peaks in the serum within 2-3 hours usually. 

In patients who are sensitive to T3, they may develop heart palpitations or a jittery sensation around this time. 

These side effects occur as a result of this rapid absorption and the sensitivity of cardiac myocytes to T3. 

Thyroid adrenal reset complex 400 x 350

In your heart, T3 has a direct action on the calcium channels which causes the heart to pump harder and faster (which may lead to heart palpitations).

This is compared to other systems in the body where T3 has to directly interact with the nucleus and results in changes to genetic transcription (this process often takes weeks).

​If you fall into this "sensitive" category and you are experiencing these side effects of IR T3 (heart palpitations, etc.) then in most cases simply switching from cytomel to SR T3 is enough to fix the problem. 

In SR T3 formulations of T3 medication, the T3 is bound to a glue-like substance (usually methylcellulose) which delays the absorption. 

This allows your body to slowly absorb T3 throughout the day and will limit the "flood" of T3 that is seen 2-3 hours after taking IR T3. ​

Whenever possible my general preference is to use IR T3 over SR T3, but that isn't always possible.

Another limiting factor that should be considered is that Cytomel and generic liothyronine both contain inactive fillers. 

In some cases, patients may react to these inactive ingredients necessitating a switch from IR T3 to SR T3.

​In most cases (probably approaching 70% of patients), however, patients tolerate IR formulations of T3 such as Cytomel and Liothyronine quite well. 

Side effects of T3 to watch out for

The side effects of T3 come from taking too much of the medication or from the inactive ingredients. 

As long as you dose the medication correctly and use the proper type of T3 medication (IR vs SR T3) there are generally very few issues.

Occasionally patients may present with the following symptoms when taking T3: ​

  • Heart palpitations
  • Jittery sensation
  • Increased anxiety
  • Hot flashes or feelings of being warm or too hot
  • Temporary increase in hair loss
  • Headaches

These would be considered less serious side effects of taking T3. 

If you experience any further side effects not listed here it's best to consult with your prescribing physician. 

I do want to focus on a couple of these side effects for a moment...

​First is the hair loss. 

T3 can absolutely cause a significant but temporary increase in hair loss.

This is worth mentioning because hair IS a symptom of hypothyroidism and this side effect may be confused with worsening symptoms when in reality the opposite is true.

Remember that this hair loss is temporary and usually subsides within 2-3 months.

The next is headaches.

Unfortunately, some patients experience headaches when starting T3.

If this happens to you the best option is to consider switching to SR T3.

Back to you

T3 thyroid medication is quite powerful and safe if used correctly.

Using T3 comes with special benefits due to how the body metabolizes and uses thyroid hormone.

In some cases, patients may require T3 in addition to their current thyroid medication (like T4 or NDT). 

Most patients who stand to benefit from T3 are patients who have not felt better on other thyroid medications or patients with extreme weight loss resistance.

Use the outline above to determine if T3 might be helpful for you.

Now I want to hear from you:

​Is T3 helping you with weight loss?

Is it helping you increase your body temperature or reduce the symptoms of hypothyroidism?

Why or why not?

Leave your comments below! ​

References (Click to Expand)

This post was most recently updated on February 15th, 2019

Dr. Westin Childs

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

149 thoughts on “5 Benefits of using T3 Medication + Who Should Use It”

  1. I’m currently taking 25mcg of Cytomel along with 50mcg of Unithroid. I had my thyroid taken out last March due to cancer. I started on 100mcg or Synthroid. I then switched to Unithroid due to cost. Since then I’ve had muscle or joint or whatever pain all over my body. My Dr. is working with me to try Cytomel. I think it’s working, not sure. My Pain is hard to deal with. Whats going on? Am I still very hypo? or is the pain from taking too much medicine? The weird thing is, I felt great right after my surgery and when I wasn’t on anyting. Why?

    • Laurie a Goetzinger

      I’m like you thyroidectomy for cancer and suffer severe body pains ever since I started synthyroid and cytomel and no one can tell me why and Endocrinologist offer no solutions either.

      Grace

      • I also had my thyroid removed due to cancer and felt awful on Synthroid and Cytomel (achey and flu-ish – I could barely get out of bed). Both medications have a significant amount of inactive fillers and dyes, to which some people react poorly. Once I switched to Tirosint (T4 with very minimal fillers) and compounded T3, the joint aches and flu-ish feelings completely went away. I would say that you are having some kind of reaction to the filler/dyes in the meds. I would find a endo that will switch you to the other meds.

  2. What about the anxiety or nervousness? I have been struggling with this since starting just 5mcg of cytomel about three months ago. I have cut into half and take with meals and it seems to do better, but sometimes I have that “internal trembling” when I try to up the dose back to 5mcg. I have rechecked my labs and things are looking much better, my FT3 is finally up to 3.0 (from 2.2) and rT3 is down from 20 to 15. I am now having some return of fatigue (initially had sooo much better energy, I could get out of bed!) though and believe I may need to up the dose but don’t want the anxiety. My MD doesn’t compound it but would you think a SR type might be better? I might have to seek out another provider to follow me but it may be worth it. Your thoughts? Thanks again for all of your valuable information.

  3. My doctor has agreed To raise my cytomel to 50mcg it has not helped my weight loss and I still think it is too low of a dose. I have had no side effects either.

    • Hi April,

      Rarely does changing your thyroid dosing (even adding T3) lead to weight loss by itself. If you read my case studies you will have a better idea of what I’m talking about.

  4. Cytomel is shown to increase blood glucose. If I’m trying to control my BG (high end of normal), then wouldn’t the cytomel be doing more harm than good? Am currently on 5mcg of cytomel and Levo. I’m thinking of discontinuing the cytomel because of borderline high BG, now I’m not so sure. Diet and exercise are optimal, including HIIT and paleo.

    • Hi Cheri,

      I think you are confused as to how T3 works in your body with glucose and insulin levels. I suggest reading more on the topic, you can also find relevant information on my blog.

      • Thanks for your response, but I find it both uninformative and dismissive. I have spent many hours perusing your blog and find no relevant information regarding the fact that cytomel is shown to raise blood glucose. An important fact if one is trying to lose weight. It’s your blog, so you can certainly respond any way you see fit, but I would have appreciated a link or some actual information addressing the issue of cytomel and blood sugar. That you choose not to provide that and rather berate my lack of knowledge makes me wonder if perhaps the makers of cytomel are offering you some consideration. Thank you.

        • Hi Cheri,

          My comment wasn’t mean to be dismissive, it was meant to guide you into re-evaluating your current understanding of cytomel as it relates to insulin and glucose.

          Just due to sheer volume to questions and emails I get on a daily basis it is impossible for me to adequately respond to every question/request. This leaves me with the option to try and answer some questions and not others, or to simply ignore them all – I choose the former.

          I also do not get kickbacks from the makers of cytomel, I write about what I find interesting and what I think will be helpful.

    • Hi, I’m currently taking 75 mcg’s of Levo and 25 mcg’s of Cytomel. I feel better without hot flashes anymore but feel lazy. I divide the dose of 25 mcg of Cytomel in half; morning and afternoon. I have cut my afternoon dose in half. Is this okay that I feel lazy? Thanks so much for you insight.

  5. I would love to see what the test numbers should be for people who are already medicated, especially with NDT. I think I need more T3, but don’t know how to interpret my recent test results except to say everything is borderline near the bottom of the ranges except for the TSH, which is officially low, and the reverse T3 = 15. I’d like to be at least mid-range on my free T4 and free T3. Is that a reasonable goal?

  6. I started taking 5mcg of cytomel once a day about a month ago, and then increased to twice a day about a week ago. I have not seen/felt any positive effects of the medication yet. About how long does it take to start noticing a difference? I’m on 75 mcg of levothyroxine and cannot shed 5-10 lbs or get rid of other pesky hypo symptoms (extreme fatigue, hair loss, joint pain, etc). Thank you! I have gained a wealth of knowledge from your podcasts!

  7. Hello,

    Firstly, I wanted to thank you for the wealth of information you’ve given! I bought your program, and an going to start it this week. I am currently on Levoxyl and Cytomel once a day, but my doctor wants n to start doubling my cytomel and take it twice a day. My question is can Levoxyl and Cytomel be taken at the same time for the morning dose? And what time is day is best for the second side of Cytomel? I asked my doctor but he did really seem to think it mattered. Also, I purchased b12 injections from you and I was wondering what the shelf life is on those?

    Thank you so much!

    • Hi Ashley,

      In terms of taking your T3 and T4 there is no “best” time to take them, what matters is finding a schedule that fits your personal schedule and that doesn’t result in heart palpitations, etc.

      The B12 will last up to 120 days if refrigerated.

  8. I’ve been on Levythyroxine for about 10 years. I finally talked my endocrinologist into giving me T3 (Cytomel). My starting blood tests showed Free T4 at 1.2 ng/dL, T3 at 76 ng/dL and a TSH of 1.14 uIu/mL. After six weeks my T3 levels went up from 76 ng/dL to 101 ng/dL. After another six weeks my T3 levels are back down to 77 ng/dL. My TSH is down to 0.78uIu/mL and my T4 is down to 1.1ng/dL. The weight is not coming off despite my best efforts. Why would the T3 number go up again when I’m following the prescribed instructions. I’m taking half of a 5MCG tablet in the morning and the other half at 2PM. When I asked my doctor about it she said “The cytomel is not reflective on the T3. The change in TSH reflects the addition of cytomel and it is mostly for you symptomatically.” I’m frustrated and confused as it’s the opposite of what I’ve been reading.

    • Hi Eleanor,

      Your total T3 and free T3 should both go up if you are taking appropriate amounts of T3 for your body.

  9. Life changing!!!

    Sustained Release T3 has been amazing for me after 8+ Years on Thyroxine T4 only treatment.

    The only reason I found out about T3 was doing my own research & finding help from people like yourself willing to share your knowledge.

    So THANK YOU!
    Founder of Hashimoto’s Heroes from Australia

    • This is exactly what I experienced. I am so happy with finally given the right medication with only T-4 for 10 years. People should do the research and find a doctor who reads the latest research and goes to newest symposiums. My doctor was great but she didn’t know about the latest research and was scared of giving me T-3. I seriously took a turn for the better with T-3 meds and feel significantly better. Best decision of my life to change doctors!

  10. I have had Hashimotos for almost twenty years…what a rollercoaster ride! I was taking Synthroid for a long time and I was very sick. I had a nodule that was core biopsied and ultrasonically guided. A blood vessel was nicked and I developed a blood clot in my thyroid-it was difficult to swallow. I had a hysterectomy shortly after and was anemic roo. They were afraid that I had a blood cancer because my red blood cells were immature. I was napping daily and could hardly wake up at times. I was 34 years old and falling a part. Even long after my biopsy, I had a tightness in my neck and felt choked, mostly in the middle of the night. My doctor chalked it up to nerves until I went to the ER and was diagnosed with hypothyroidism. Years later not feeling well, I decided to talk my dr into letting me try Armour…Yikes! I had heart palpations and I tried to work through them for a year. My dr said I was probably sensitive to the other hormones in it. I am now taking Levo and a generic form of Cytomel. I am gluten free and so are the meds. It has made a big difference. My fingers and feet don’t feel as swollen as they used to be. No more heart palpations. My Tsh goes up and down at times, but this is so much better. I also have cleaned up my diet and try to eat real foods as much as possible. It has not been an easy journey but I have seen light at the end of the tunnel. One day at a time is my motto.

  11. My medication made me gain weight. I started out with a functional doctor who had me on NDT. I put weight on. I then went to an Endocrinologist who took me off the NDT, put me on Levo and continued to gain weight but not as quickly. He then added t3 and I continued to lose hair and gain weight. I got fed up and went off of everything. My energy levels seem ok but I can not shed this weight which really frustrates me since I eat so healthy! Any suggestions?

  12. Hi- I started synthroid (on 50 mcg) about a year ago, but couldn’t lose weight, hair loss etc.., just added low dose of cytomel (5mcg) last week in hopes that hair loss will stop, help with weight loss. Any idea how long it will be until I know if this new combination of t4/t3 is right for me?

  13. Hello
    I had to have my Thyroid removed and I also had a quite large goiter removed. Has this all done on 3/1/2017. I am on Synthroid 125mg and I feel like crap.Exhausted ALL the time, hair loss.I am jittery all the time and very cranky.Headaches every morning. Now, I am losing weight because I had gastric bypass surgery in Dec 2016.I have lost 85 lbs so far,With the gastric Bypass Surgery am I making enough enzymes to activate the Snythroid? Should I be taking the T3? I am so confused by all this thyroid info.

    Lynn

  14. Dr. Child’s, I was on 20 mcg if T3 for a month. My rT3 went down from 16 to 2. My vertigo and hair loss totally disappeared! My TSH went up to 35(!) from 0.045. My antibodies went down from 38 to 26. T3 and T4 dropped down dramatically.
    I am dealing with Hashimoto for 30 years and never my TSH was 35. Can you explain to me what’s going on?
    Irina

    • How long were you on cytomel that your symptoms disappeared? I’m on day 16 of adding cytomel to my synthroid regime. Just curious? TIA

  15. I’m taking 120mg armour and recently had lab results of total T3 297 and 5.3 free T3, sex hormone binding globulin of 50, and TSH with reflex to FT4 is 1.62 so dr said to leave things the same. A couple of years ago she was letting me try cytomel and I was feeling so great, better than I had in all the years of taking thryoid supplements, and was losing weight so easily. But she stopped prescribing it because the T3 was too high and she felt it was dangerous. SO have not felt good for a long while again. Lots of fatigue and pain in my body but then I also have fibromyalgia and chronic fatigue and diabetes. I want to try cytomel again but since she is not comfortable with prescribing it I thought if I knew what dose of the armour or even levothyroxine would be correct with which dose of cytomel, she is usually pretty open to working with me and might let me try it if I had the information to give her. Another doctor had mentioned that it sounds like the T3 is just not getting converted or into the cells or something, yet it shows too high in lab tests. Please help me, I don’t feel I have ever gotten this problem addressed and hope that you can offer some information from the lab results I have given. Thank you. I will also try to share the article with my doctor, as well as read it again myself.

  16. I have been taking T 3 liothyronine 7.5 mcg 12 hours apart for the last year. I cycle up dose daily until temp reaches 97.6 and then wean down slowly. I feel better overall but still cannot lose weight very well. I was at my highest weight in Jan and started your fasting protocol and lost a few pounds. I am have now plateaued. I am not sure what hat else to do. During a fasting day recently my body temp went to o 33 c.

    • Hi Valerie,

      You will have to break through the plateau, once you do that you should be able to continue with the fasting again for more weight loss. Most people reach 2-4 plateau’s during their weight loss journey.

  17. Hello Dr. Child’s,

    Help! I am currently taking 320mcg of T3 liothyronine ( from Germany) a day (160 x 2) along with 600mg of Lopressor after having been diagnosed with Hashimotos and thyroid hormone resistance after 4 years of being on t4 thyroxine and 3 miscarriages. I gained over 60 pounds since being diagnosed. I am insulin resistant, not sure of leptin resistance. While I have had some relief from my hypothyroid symptoms, I have in fact gained weight rather than lost while being on T3. I still have a huge amount of water retention. Each time we raised the dose I would feel better for a few days and depuff, but then everything would return to hypothyroid.
    I have tried to call your office to see if I can schedule a Skype consult with you, as I live in Kuwait and am desperate for help with my weight ( 260pounds now from 180) . Please, is there a way I can schedule a consult over the phone or Skype with you ASAP. I am truly desperate and have lost so much from being misdiagnosed over and over, and can’t understand why T3 hasn’t worked completely for me. Thanks very much.

  18. I am hyperthyroid and feel bad, my muscles are weak, I have brain fog and it is a struggle to live my life. What happens if I take cytamel for example?
    Sorry, I am Danish so my english can be wrong.

  19. I am on 100 mg of T3 a day and people are saying it is why I have insulin resistance , is this true? all T4 goes to ReverseT3 because of the insulin and leptin resistance

  20. where can you purchase SR T3 please as I would like to try instead of the liothyronine which causes heart flutters and stomach pain. can I get this anywhere online as I know my GP wont be happy to change anything. They only keep the liothyronine as its been prescribed for a number of years. thanks

  21. Hello Dr. Child’s,

    Help! I am currently taking 320mcg of T3 liothyronine ( from Germany) a day (160 x 2) along with 600mg of Lopressor after having been diagnosed with Hashimotos and thyroid hormone resistance after 4 years of being on t4 thyroxine and 3 miscarriages. I gained over 60 pounds since being diagnosed. I am insulin resistant, not sure of leptin resistance. While I have had some relief from my hypothyroid symptoms, I have in fact gained weight rather than lost while being on T3. I still have a huge amount of water retention. Each time we raised the dose I would feel better for a few days and depuff, but then everything would return to hypothyroid.
    I have tried to call your office to see if I can schedule a Skype consult with you, as I live in Kuwait and am desperate for help with my weight ( 260pounds now from 180) . Please, is there a way I can schedule a consult over the phone or Skype with you ASAP. I am truly desperate and have lost so much from being misdiagnosed over and over, and can’t understand why T3 hasn’t worked completely for me. Thanks very much.

  22. Hello dr. Childs;
    Thank you for writing this information I’m sure it will help lots of people.
    I am super frustrated I have been taking 150 mg NDt for almost two years and my dr.added 60 mg of T3 in addition but my temperature is still 36.2 which is up from 35.8 but I’m still not losing weight even though I have a 90% Paleo lifestyle. I have no thyroid due to thyroid cancer and I have had a hysterectomy. I’m 57 years old and frustrated can you give me any advice?

  23. Hi Dr. Childs. Adding liothyronine 10 mcg for two months to my .88 mcg Levo actually resulted in hyperthyroid symptoms. So the ir t3 was reduced to 5 mcg. But it definitely took care of my conversion problem. Still working out some other issues, but wanted to stop by and thank you for the valuable info. It has benefited many.

  24. 80% of my thyroid removed 2009 my dr said my tsh levels were normal despite being almost in a coma after 3 years. I am covered in mucin (unpinchable fat) I started self treating with NDT 2015 i developed RT3 and went T3 only under a sympathetic endo since June 2016 i started slowly and built up to 75mcg cynomel and recently increased to 100mcg i still have chronic pain in my feet, heels, ankles and knees.For 4 months on NDT this pain went completely.
    I gained 6 stone in 2 years after operation, having been previously fit, strong and slim. I ran with the army 4 nights a week. I became exercise resistant and i still am, if i do more than average day, work, dog walking, occasional swimming and gentle gardening i am floored for weeks, i have been unable despite many attempts to get back to real exercise that makes me feel good.
    I lost 2 stone last year after changing to T3 only but still obese at 15 stone, i dont feel back to myself, i still struggle with pain, aching joints, weak muscles, lack motivation and sometimes chronic fatigue.
    Lots of my symptoms have gone sleeping for 20 hours straight most days,shocking IBS and digestive issues, hair loss, hand co ordination, walking was painful and lack of balance. 14 day periods, internal cysts and lumps all went on NDT. Brain fog, difficulty talking, swallowing, the list was endless.
    I am a million times better than i was over 2 years ago but i am still what i would consider a very ill person. Unable to plan events ahead as never know if i will cope that day, high stress levels despite working from home and resting a lot, anxiety which started before the operation.
    I would like to lose the other 4 stone i gained, get back to exercise, get stronger, fitter, be excited by life.
    best regards
    Nicky

  25. Hi, thank you for all your helpful info.
    In the uk T3 is not easily available.
    There is a supplement by Biotics research called GTA-FORTE 11
    I would love to know what you think of this.
    Each capsule supplies porcine glandular concentrate 20 mg, zinc 10 mg, selenium 26 mcg, copper 0.25 mg, rubidium 5 mcg, in an organic vegetable culture base containing antioxidant enzymes superoxide dismutase (SOD) and catalase (20 mcg each).
    At present I am on 75 of levo.
    I have been taking the GTA for the last month. One capsule in morning with food .It’s fine apart from more hair falling out !!! And memory seems not too good.
    Taking it with levo. Wonder wether to cut down on it and take 2 capsules of GTA.
    It was recommended by a nutritionalist.
    Thank you.

  26. I stopped taking my thyroid natural compound for two months then had a lot of blood test done. My tests results: tsh 64.500
    Ft4. 0.5
    Ft3 1.9
    ReverseT3. 6.8
    I don’t know how to judge these. Looks as though it is just the tsh which needs to be adjusted. I have just been told I have Hashimotos. I have started taking 75 synthyriod. My hair is still thinned out and I get headaches. What to do? Thank you.

  27. I love this article! Thanks. One of the best ones I have found to help me prepare for meeting a new doctor later today – just refreshing my memory reading again. I lost my thyroid two years ago to cancer, and have had undiagnosed hashimoto’s & coeliac disease for many years. I’ll find the right balance of hormones for me & it is this sort of work that helps. T4 has helped & T3 will help more. Thanks again.

  28. T3 caused my blood pressure to go up way to high… I managed 11 weeks on very low dose, each attempt to increase caused further blood pressure rises, then had to go back to NDT and blood pressure dropped to 120/70 within two days.

    • Hi Linda,

      T3 definitely can increase blood pressure and heart rate based on how it alters calcium channels in the cardiac tissues.

  29. Wow! What a thorough article…..the best I’ve read.
    My Endocrinologist added T3 Liothyronine to my T4 back in 2014.
    At the moment I have been visiting my husband in hospital for 9days and would not have coped with the strain and worry,the walking concerned in the daily visiting trips without my T3.It was like a tonic reading your article…..Thank you very much x

  30. After 22 years of suffering on Synthroid, T3 has changed my life. I’ve had to fight for every increase in dose but am now taking 17.5 mcg daily and am finally able to function and take off some weight. I’ve been told it doesn’t matter if you take T3 with food. Is this true? I take all thyroid first thing in the morning and wait an hour to eat.

  31. I have been taking T3 (self medicating ) for a year. On T4 my HR dropped to 40s and I became very ill. I stopped taking it. On T3 I began to feel better but it took a long time. I lost some weight and many symptoms improved. I am able to live a life now, my HR is in the 80s. However I am beginning to get short of breath again as with T4 and have palpitations and HR erratic for the last month or so. I take 47 mcg of T3. My legs are very swollen. I feel I am undermedicating but dare not increase the dose. Do you have any ideas please?

    • Hi Sue,

      You should have your heart evaluated and have your thyroid blood levels evaluated as well.

  32. Hello. Very interesting article, thank you very much! I live in France and after much research on my part and some negotiation with my endo he has put me on a medication called Euthyral which contains 100mcg T4 and 20mcg T3. I had previously been on 100mcg T4 only. The tablets are only available here in this one dosage which I found a little too much, (I was aware of my heart beating more strongly), so I break them and take 3/4 of a tablet each day. I feel much better! More of my research came across the RT3 problem. My endo told me it was something that couldn’t be tested for but I chose not to argue. Of course I had the classic weight gain around the waist and was using a version of the 5:2 diet that extends periods between eating each day. Having a family makes the standard 5:2 too difficult to manage. However I think that the periods when I was feeling hungry were perhaps causing an increase in RT3 and the weight wasn’t moving after an initial success of about 3 lbs so now I snack on nuts or cheese to prevent this. Weight is finally creeping down.

  33. Please help me. I have decreased my thyroid oroxine meducation from 150 every day to 3 days 150 4 days 100. Although I’ve been watching my diet very closely I am putting on weight weekly this is very depressing and frustrating.
    If I ask the Dr for T3 will it help me ?
    I also have a small heart pill for affribulation and blood pressure.

  34. I work out at the gym regularly and lift weight. The problem with taking t3 is that it reduces my strength and makes me feel weak even at only 5 mcg.

  35. My new doctor took me of Iodine and zing. Didn’t give me RT3 test.
    Told me to take t3 an hour before my test.
    I know I should leave but I need a doctor!
    I live in Huntington Beach Ca. Any doctor you know in Orange county?

      • Dear Dr. Child,

        Last night I wrote more details about my Doctor, it disappeared. Its actually important to know when to take the medications on
        the day of lab.
        My doctor claims that since t3 has a short life I cant stop taking
        it 12-19 hours before the test as it will not be accurate.
        I didn’t want to go against him and took 5 mcg (instead of 10 mcg}
        Of course the results are not accurate. Even though my T3 was high 4.3 and t4 0.1 he raised my T3.
        I had RAI,cant convert T4 to T3 has colon inflammation,High Rt3 and more.
        I cant understand his act.Do you have an explanation to that?

  36. Hi I live in Dallas tsh is normal but dr wants to put me on 25mg levothyroxine. I have nodules on both sides of thyroid gland.
    Should I request for NDTS and T3 or only go fir T3.
    Since I am on a clean slate just do t want to come tai ate my system with different things.
    I will also be doing a 7 day colon cleanse and 10 day Li er flush before I start any MEDS. What fo you think
    Also could you recommend a like minded dr in Dallas . I would like a second opinion as my dr was quite dismissive of me.

    • Hi Titi,

      Unfortunately I don’t have anyone to refer you to in that area. I’m sure there are other physicians I just don’t know them personally.

  37. Hi I had a total thyroidectomy in February 2016. I am taking 2 grains of armour thyroid. These are my latest lab results: TSH .04 .28-4.1, FT4.74 .61-1.64, TOTAL T3 107 87-178, FT3 3.1 2.3-4.2, RT3 18 8-25. I’m not feeling well. In this case would you slowly add in t3 medication or would you lower my NDT and add t3 to lower reverse t3?
    Thanks

    • Hi Chrissy,

      It’s hard to say without knowing exactly what symptoms you are experiencing. For instance, you can not feel well if your dose is too high or too low, so you need to tease out which it is. Labs don’t always tell this story very well.

  38. Sibo,candida kreusi, leaky gut and hypo symptoms, ALL OF THEM. High cortiosl and high RT3. Dr has me on T3 and WP thyroid, treating for sibo and candida. Still so very overweight and swollen. Face and hands are so swollen. Can you please take on just one more patient ? 🙂 Miracles happen everyday. SOmething is missing and I know you can find it. I want to enjoy my family and my life again. You are so knowledgeable and I feel like this would be easy for you to detect. Been like this for 8 years now.
    Thanks so much

  39. After showing my NP your site I finally got some lab results that seem to explain why I feel low energy and have joint pain. I had my thyroid removed 15 years ago and have taken levothyroxine since then. My TSH has always been very low since, around .1. Doctors do not like this and always want to lower my dose to where I feel terrible (headaches & depression result). My Free T3 is now 3.0 (2.3-4.2)which seems real normal BUT thanks to you, for the first time in 15 years I have learned that my Reverse T3 is 34 (8-25) and so I now know the reason for my chronic fatigue and joint inflammation. Also, I have TPO antibodies of 62 (<9 is normal). I have now switched to NDT and feel basically no changes after two weeks. Zero heart reactions, actually my headaches and sleep issues did go away. But I think I will need a more T3 concentrated thyroid replacement to "flush" my Reverse T3 levels. What would you recommend? I have no weight issues, I'm 53, weight 129, 5'4" and otherwise super healthy vegan. Also, is it possible that the high Reverse T3 is what gives me a low TSH, even though my Free T3, Free T4, and Total T3 are all normal?

    • Hi Dr. Childs,

      Very useful information on thyroid treatment. I have researched hypothyroidism for the last 6 years and, along with two co-authors ended up writing a paper about Diagnosing and Treating Hypothyroidism: A Patient’s Perspective. The paper is written to be easily understood by patients so that they can recognize if they are not being adequately tested and treated. Then the paper provides extensive discussion and scientific evidence that can assure doctors of the benefit of combining clinical treatment with biochemical testing. I see the problem for both of us as being how to get this type of information accepted and utilized by doctors who currently have the “Immaculate TSH Belief” and use “Reference Range Endocrinology”, instead of clinical evaluation and treatment. I have tried to get the AACE/ATA to reconsider their published guidelines, but they are dug in and oppose any changes because they say their recommendations are evidence based. Yet, extensive evaluation of existing scientific evidence would lead to different testing and treatment practices. I have also unsuccessfully tried other avenues as well. Do you have any suggestions for how to get this kind of info accepted by the medical community, so that it could become the standard of care and improve the lives of multiple millions of people both here and abroad with undiagnosed/inadequately treated hypothyroidism? Without such a change, I am afraid we both will end up affecting only a few people at a time, when they happen upon our websites, and this enormous problem will continue essentially unabated.

      Thanks very much.

      • Hi Mel,

        I don’t really see a way to change the standard of care. I know what physicians are like and I can confidently suggest that they really aren’t interested in change. Thyroid disease is low on the radar in terms of importance compared to other diseases such as cancer or heart disease. While it obviously impacts many people, the thing that moves the needle most is mortality – not morbidity. And our current stand of care as it relates to hypothyroidism results mostly in an increase in morbidity, not mortality.

  40. Dr. Childs,

    I understand what you are saying. It is a sad commentary on the state of medical practice, when hypothyroidism is the number one endocrine system problem that very likely affects far more than the 9 % recognized in the NHANES III study, which was based on TSH results only. In addition, undiagnosed and inadequately treated hypothyroidism leads to far more serious and costly ailments, including cardiac conditions.

    Do you think doctors are just unaware of the inadequacy of the current standard of care for hypothyroidism that they were taught in med school? Or do you think that doctors realize the inadequacies of the current standard of care, but are just not going to change, for a variety of reasons? I’d like to think that the majority would consider change if authoritative sources made them aware of a better approach using clinical evaluation combined with biochemical tests. The current AACE/ATA Guidelines for Hypothyroidism do not preclude that approach, but instead emphasize diagnosis and treatment based on TSH and lab reference ranges, which does not work for most people, and which can be discounted with extensive scientific evidence. So I’ll continue to look for ways to get the right info to people and try to change the system.

    Along that line, I’d appreciate your thoughts on how med schools determine what is taught as the standard of care for hypothyroidism, and what medical text(s) are used? I tried to find out about all that from a local Univ., and was rebuffed like it was something I should not be asking about. LOL

    Thanks again.

    • Dear Mel, I’ve been in Thyroid treatment for Grave’s Disease for 20 years now and like you have studied a lot. Here is a question I currently have related to the big TSH testing issue. They lowered my levothyroxine dose, my T4 dropped, my free T3 dropped AND my TSH went down from .3 to .1! Now this is totally contradictory to their theory that when one rises the other falls! Now I find out for the first time that my Reverse T3 is extreme high (34) and I am wondering if this number is what holds my TSH so low when all the others, free T4, free T3 and total T3 are normal and in range. Can either you or Dr. Childs please tell me if a high Reverse T3 will suppress the TSH? It seems for me like that is what is happening.

      • Hi Sheriann,

        Taking thyroid hormone will drop the TSH provided that it is absorbed into the system and gets into the blood stream, this really isn’t up for debate. The debate stems from whether or not this thyroid hormone gets to all tissues equally and whether or not TSH is a good marker for that phenomenon.

        Reverse T3 should not alter your TSH.

    • Hi Mel,

      Doctors might consider changing how they practice if that practice didn’t increase their risk of litigation, but as it stands now there’s very little to gain and potentially a lot to lose if you are practicing in an alternative way. Even though most physicians would likely be willing to change how they practice if they knew a better option existed, they wouldn’t do it because of the reasons listed above.

      I would also point out that at this point I think patient advocacy groups have likely done more harm than good for their cause. Most physicians have now created a defense barrier to those patients who ask for various testing or believe they know more than their physician, this only leads to those physicians digging themselves even deeper into their conventional thought process and creates more resistance. This in turn leads to more advocacy groups and the cycle continues.

      Practicing physicians usually teach the clinical courses in medical school, so the clinical aspect is always whatever the current standard of care is. And medical school is meant to provide a general background to each specialty so the depth of each subject is somewhat limited due to time constraints.

  41. Dr. Childs,

    Thanks for taking up your valuable time answering these questions. I promise this is the last.

    The alternative approach that is recommended in the paper I mentioned is not inconsistent with that of many Integrative doctors, as well as some Holistic and Naturopathic doctors. And you also don’t seem to consistently follow the existing standard of care, or else your patients would not be so pleased with you. After all, two surveys showed that 50% and 75% of hypothyroid patients are not satisfied with their treatment.

    So I fail to see why change would cause concern about litigation. To the contrary it seems to me that continuing with the existing standard of care, which can so easily be proved inadequate, would be a lot greater jeopardy for those doctors, and the organizations to which they belong. Not to speak of all the dissatisfied patients who continue to suffer with hypo symptoms and related other maladies that result longer term from inadequate treatment.

    Thanks again.

  42. Hi Dr. Childs,

    In what doses do you recommend t3 medications? Also, in about what amount of time will results or no results be seen to see if the medication is effective?

    Thanks!!

    • Hi Natalie,

      I don’t really go into detail about T3 dosing in these posts but I do have a video about how to do it properly in my weight loss guide.

  43. I don’t where to post this question. My son has requested that I receive a Dtap shot. His first child is due any day and that’s what his physican is recommending. I have Hashimotos and Hypothyroidism. Will that shot compromise my health? What are your thoughts on this?

  44. I am a 48 year old female and I had my thryroid removed due to a large (non cancerous)goiter. I have struggled with my weight ever since. I am currently at 180 lbs and am 5′. My physician has had me on Levothyroxine 137mg and 6 months ago lowered my dosage to 125mg based solely on my lab results. I have gained 15-20 lbs in the past 6 months alone. I have told him that I continue to have weight gain, hair loss, fatigue & am cold all the time. I just had my blood drawn again(my results were: TSH .5210 Free T3 2.16 Free T4 1.39) I & have an appointment to see my doctor on June 23rd. I would really like my physician to work with me, but wanted to go armed with as much knowledge as possible when I see him. I copied your “How to Know if you need T3 thyroid medication”-anything else I should ask for or say? Any suggestions from you would be most helpful!

  45. I had a Total Thyroidectomy in May 2017 due to Graves. I am currently on Tirosint only. My TSH is still suppressed (slightly) and in an effort to bring it up, my Endocrinologist keeps wanting to lower my Tirosint dose. This is causing my T3 to drop (I feel best w/ it in the mid-3’s). Currently, it is at 2.7 (T4 1.51). I want to add T3, my endocrinologist refuses. She suggests NDT, which I do not want to take (bad previous experience and increase in antibodies). I have a functional medicine doctor willing to prescribe it…my question: Can you take Cytomel/T3 on alternating days? I’ve taken it before and the effects of 5mcg/daily were pretty strong (for me) but I also had a thyroid + active Graves + Hashimotos (fluctuating). Without a thyroid — Will there be benefits to adding it a few days a week only since it is so short-acting?

  46. I had my doctor switch me to the Nature-throid a few months ago and I have slowly increased it and now I am on 81.25. Over the last couple of months I have been experiencing heart palpitations, sudden sweating, flush, nausea. I have had levels checked and I now have high tsh, high t3 and still low t4. My doctor wants to switch me back to synthroid but I’m not sure thats going to fix my issues. Any guidance you can offer is appreciated as she is not formula with Nature-throid. Thanks

  47. I want to try T3 with my Levothyroxine because My T4 levels are on the higher normal range but my T3 is barely in the nornal range therefore I am not converting well. I am on 100mcg Levo and have bought Tiromel T3. How much should I supplement with the T3 without elevating my T4 any further? I am particularly interested for weight loss and brain fog relief which had only occurred since being on Levo only for quite some time. Often I feel like I am wading through treacle with my head and body. I used to be very fit and slim. It’s an uphill battle with no support from my GP (I am UK based). Any advice re dosage advice would be greatly appreciated.

  48. Hello,

    How long is the treatment with T3 medication? Can it be done in cycles? I am concerned that if I take T3 hormone, my body will stop producing T4 or convert T4 to T3 on it’s own. My RT3 is 22, what would be an ideal marker to stop using T3 to lower RT3?
    My TSH, Free T4 is “normal” and T3 is half of minimum nomral range. Thank you kindly, Yuliya

  49. I have just started on T3 medication – a month this Saturday. Previously I have been on Levothyroxine since total thyroidectomy in Dec 2011.
    I have noticed the palpitations, flushes. How long does it take to flush out the reverse T3 & when will I notice weight loss?
    I gave my Dr links to your articles & he agreed to give me a go on the T3.
    I am currently on 60mcg of Liothyronine – I started with 2omcg then went to 40mcg & now 60mcg. Is that a normal dose to be on? I read some where that T3 is 4-5 times more potent than T4 medication thus 20mcg of T3 medication = 80-100mcg of T4, is that correct?

    • Hi Barbara,

      T3 is much more powerful than T4 but the relative power that it has both in terms of its cellular action and influence on pituitary function varies from individual to individual. With T3 it’s best to start low and titrate slow and follow both resting heart rate and labs as you do it. The amount of time it takes to improve symptoms varies from individual to individual as well. But you shouldn’t have palpitations or flushes while taking it – that’s usually an indication you may be taking too much.

  50. Hi, Dr. Westin, I had total thyroidectomy 6 years ago and use 75 mcg Levothyroxine along with 10 mcg Liothyronine. Though the lab numbers looked good, I have suffered with chronic muscle pain ever since my thyroid was removed. When I stop doing something as simple as taking a walk, my muscles ache all over as if they are unable to rest. I have recently switched to Armour with the hope of curing this. My dose has been slowly increased to 105 mg. The muscle problem has improved dramatically since I increased the dose from 90mg to 105 mg a few weeks ago, but I feel jittery. I won’t have my blood work tested for another two months. Should I assume the dose is too high and kick the dose down and suffer through the muscle aches, or should I give it more time? I feel like I am between a rock and a hard place – too much medication, or too little. Will the jitters go away eventually? I also suffer with very low cortisol which is also being treated. I welcome any suggestions from you as I am tired of feeling miserable. Tks, Karen

    • Hi Karen,

      In these cases you usually need to address adrenal issues to allow you to use the T3. That is likely what you are currently dealing with. With low cortisol you will probably need to use the combination of both glandulars and adaptogens.

  51. Good afternoon, my question is where can I find a dosage chart for my physician to follow. He’s more of a mainstream doctor, but with my persistence, he’s willing to prescribe the SRT3 for me, if I can provide some resources for him to follow. I’m very appreciative of his willingness to do this, and I’m proactive in my care, I just don’t know where to find this information. Any suggestions and insight would be greatly appreciated. Thank you.

    • Hi Jen,

      The information you are looking for doesn’t really exist because the amount that each person needs is highly variable. The dose that your body needs depends on how much inflammation is present, how well you are converting T4 to T3, the presence of other hormone imbalances, etc. Each of these will alter the amount that you may need.

  52. Hi! I have been taking NDT for a while (self medicating) in the hope of levelling my T4 and T3. Previous to this, I was clinically prescribed 100mcg of Levo by my doctor and my T4 has been in the upper level of normal range, but my T3 has been barely in the normal range and therefore, I am not converting very well. My Dr however, states that no change in meds is needed although I have felt unwell and have been putting on weight, hence experimenting with NDT myself. I have been aiming for around 2 grains for 100mcg Levo equivalent. I reached 1 1/2 grains but have been getting increased brain fog and headaches during the day, and palpatations and increased restlessness at night. Today, I have reverted back to Levo and the restlessness and headache has subsided. Do you think it is best to add say 5mcg of T3 to my Levo to help with conversion? I don’t want to just revert back to how I was with just Levo. I am taking all the recommended supplements plus Berberine for possible yeast. I am taking action as recommended by yourself to heal possible reverse T3. I am 48 and live in the UK. I cannot access T3 from my doctor so I am trying to improve my health myself. I would be grateful if you let me know whether I would still benefit from a little T3 to improve my hypo systems. Thank you.

  53. I was able to convince my doctor here in NZ to look at changing my medication to T3 from Levothyroxine. I had a total thyroidectomy in Nov 2011.
    Initially I lost a lot of weight whilst on high doses of T4 but as the medication dosage came down the weight increased.
    I started taking T3 on August 26th this year (2months). I started on 20mcg and gradually raised it to 60mcg. After my recent blood test the doctor said my T3 level as high and to go down to 50mcg.
    At this stage I have not had any weight loss; My temperature is much better in my extremities. I used to get very cold fingers.
    Because this is a new thing for my doctor & I, what is a good dosage for weight loss to start happening?
    A year before I had the thyroidectomy I had a total hysterectomy due to cancer of the uterus & have been told of the obesity – cancer links, so I do want to lose weight for my health’s sake.

  54. Thank you for such a great article!!! I wish I could find an endocrinologist as open-minded as you! Despite being treated with levothyroxine for over a decade with no success by multiple endo’s, no one would even consider testing for Hashimoto’s or adding T3! Finally, my psychiatrist was willing to read the research I provided supporting the use of T3 for Treatment-Resistant-Depression and prescribed it to me. It’s not a complete cure-all (although nothing has been yet), it has helped.

  55. I purchased your program and have a few questions for you about T3 supplementation and some other tools you mention in your program.

    [Background: I’m 42 yo. My leptin, insulin, reverse T3 (at 27), A1c (at 5.3%), and weight are all out of whack. But my TSH and T4 are okay. So, I have a reverse T3 issue. My resting temp is typically 97.8 +/- 0.2 degrees F] I have the following questions about Cytomel:

    1. Can I take <10 mg phentermine per day while taking 25 mcg Cytomel (spread over 4 doses, 6.25 x 4)? Or is that too much for cardic system?

    2. Can I do intermittent fasting while taking Cytomel? The water fasts would last between 16 and 42 hours. Or, do I need to be eating while taking Cytomel, OR is fasting not good for high rT3 people?

    3. Is taking Cytomel on an empty stomach or with food best?

    4. When I get my rT3 re-tested (only rT3), I assume I do NOT need to stop taking the Cytomel before the blood draw?

    Thanks a ton~Alicia

  56. Hi! I am considering switching to NDT instead of my prescribed Levothyroxine. I do not convert T3 ideally so want to add some T3. I also have increased allergies on the synthetic meds. Would you consider Porcine gland NDT superior to Borvine? I have heard that pig hormone is more equal to human. Would you agree? I’d be grateful of your thoughts on this.

  57. I am on 50mcg of Levothyroxine and I am still have symptoms, my doctor said that my levels are in the normal range. She also said that I should be feeling better but I am not.

  58. Hi Dr. Childs,
    Can you tell me the best time(s) during the day/night to take Synthroid and Liothyronine, whether to take them together or separate; with or without water and/or food? I now need to continue to take .075 of Synthroid with a glass of water in early a.m. before breakfast. But I am confused how to include my new daily regiman of 2 and 1/2 mcg’s of Liothyronine. Also, then when do I take my multivitamin? Thank you so much!!!!
    Debbie

  59. Hi! I was on NDT (up to 2 grains) and my numbers worsened including my RT3. I was taken off the NDT and put on Levo (100mcg) and Liothyronine (5mcg). My question is about the dosing of the T3. I’ve seen higher (a lot higher like in the 100s) for the T3 yet I’m on just 5mcg. Can you explain a bit about the dosing of T3? Also, since going off the NDT, although I feel less stimulated (I was antsy on the 2 grains while my RT3 went up!), my energy has been not so great. My November labs (TSH .747, FT4 .96, RT3 14.7, FT3 2.6) Two labs back my TSH was in a better place but it’s not going to the other side. It’s been a journey trying to treat my hypo diagnosis from last February : (

    • Cont. I had been on the levo and lio for 12 days and my hair started falling out again in the shower and I had horrible constipation (not to mention energy level deflation and overall feeling like I couldn’t do anything). I stopped taking the Levo and asked my doc to put me back on the NDT which had stopped the hair loss, provided me a bump in energy, warmed me up, and regulated my digestion. So until I can get my Rx of NDT I’m not taking anything and I’m freezing all the time, my voice is extremely horse (I can’t clear my throat), and of course I’m a little sluggish thankfully though, I’m no longer constipated! I can’t wait to find the right combination of treatment!

  60. Hi Dr. Childs,

    Just a quick note to say THANK YOU for putting all of this valuable information out there. I read your blog posts often and they have helped tremendously as I continue on my journey back to health.

    Best Wishes, Happy Holidays & Many Thanks,

    Rebecca

  61. I recently starting taking 5 mcg sustained release T3 in the morning as my T3 was at the lowest normal level 2.3. My reverse T3 is 24 so there’s obvious conversion issues. I’ve been on it 2 weeks now and I’m ok until about 1:30 then I’m exhausted the rest of the day and achy. How long does the SR T3 normally take to work or is the dose simply too low? Can I take SR twice per day? Thanks:)

  62. Hi Dr. Childs,

    I started on Liothyronine about 5 weeks ago – 12.5mcg once daily. I have asked my doctor about multi-dosing and she said to take it all in the morning one hour before anything else. Is T3 most effective when the doses are divided? Thank you for your help.

  63. Dear Dr. Childs,

    I’ve been on thryroid meds for 50 years. My thyroid, by ultra sound, is has shrunk to almost nothing. The last 20 years I’ve been on 100mg synthroid. Three years ago, a doctor added compounded T3, 21 am and 30 pm. I felt fine but my tsh is 0.1. And t4 high, but within range. Another doctor said I must get off the T3 or loose my bone density (they test fine), etc. I went off the morning dose. Still TSH .01. I tried going off the pm and became bloated and sluggish in 2 weeks. I know this is not an exact science, but I felt good before, even with these numbers. Only negative since taking, is that my blood pressure went from 110/60 to 110/70. Any advice helpful. I am in a dr. maze. Otherwise, vegetarian, 60 years, strong and athletic.

  64. Hi,

    I was diagnosed with fibromyalgia in 2007, which was accompanied by a 55-lb weight gain that will not shift regardless of how few calories I consume. I recently discovered information regarding the use of T3 for euthryroid fibromyalgia. I have been using it for around 5 weeks at 75 mcg daily and feel much better, with almost all of my pain and fatigue gone and weight loss of around 8 lb, and I am now in the process of withdrawing from the morphine I have been prescribed for the past 10 years! However, I have one concern – I am a bit confused as to whether I can continue using it indefinitely, as all of the studies involving use in euthyroid fibromyalgia patients seemed to be short term, and people seem to use it cyclically. Could you advise me as to whether it is safe to take this dosage indefinitely for fibromyalgia, please? With many thanks.

  65. my t4 and t3 are low. I am taking 13mcg daily of Tirosint which is fine. I am also advised to take t3 (still fatigued, weight gain, foggy) but now that i have increased my tirosint from 13mcg Every Other Day to 13mcgs daily, i can no longer tolerate Cytomel (t3) even at 2mcgs! I tried compounded t3, SR at 5mcgs and also had chest tightness and shallow breathing. How can I increase my t3 without taking medication? my integrative medicine doc is at a loss here…..and my t3 is quite low.

  66. I had graves disease and my thyroid was oblitarated. Ive been on synthroid for some time (12 yrs). My doctor hates it that I’ve done research on the meds and refuses to discuss any medications. One year my tests are off and she lowers my meds the next year the meds need to go up then the next lowered. How do I find a doctor to help.

  67. I am a 53 year old menopausel woman and have been taking 90 MG of Armour Thyrouid for several years. I am struggling with weight gain as well as body aches and muscle stiffness on a daily basis.

    My recent labs showed: TSH – .33, T4 free – .95 and T3 – 136. (My labs from two years ago showed a TSH level of 1.6.)

    My doctor does not think that I need to change my dosage of Armour Thyroid. Would you agree?

  68. Hi Dr. Childs. Thank you for all you do to educate us. Wonderful article..! At what point should a doctor stop increasing Naturethroid and start adding T3? There are doctors that go as high as 8 grains instead of just adding a T3 medication. I gained 55 lbs and I have not lost any weight on 2 grains of Naturethroid, in addition to taking progesterone pills and testosterone creams. And by taking such high doses of Naturethroid, are we not creating too much T4 and therefore, it may be converting to rt3? When someone such as myself cannot lose any weight, would you suspect that this person appears to have an issue converting T4 to T3? Thank you!

  69. Hi Westin,
    Great article! I am hoping you have some insight for me:
    I have had a heck of a time getting my body straightened out! I have been on T3 only (Cytomel) for about 9 months now, I’m taking 125mcg per day, split into 5 doses, prescribed by my endocrinologist. The reason I persuaded my doctors to switch me to T3, from NDT, was because I was feeling increasingly more hypothyroid and my weight was increasing, despite my extremely physical lifestyle (I run a farm and do over 4 hours of physical labor, plus an active home life, 365 days a year). I’m very healthy, don’t eat takeout or junk, lots of whole foods; I restrict wheat and sugar – in fact, right now I’m gluten, sugar, and dairy free. I also restrict how much I eat, otherwise, I gain weight like crazy.
    Anyway, I have never felt better on the T3, some days I’m actually worse (more hypothyroid). I don’t get any indication of it working. I can’t tell if I’ve missed a dose or not, I feel the exact same. I can take 50 MCG all at once and not have any racing heart or jitters – it doesn’t seem to affect me at all! What’s worse, I can’t lose weight! I’ve steadily gained almost 40 pounds over the last 3 years. I thought the T3 would help, but it hasn’t (I figured I was thyroid resistant). My only success comes from restricting my carbs completely, eating only 1000 calories, and adding an hour or 2 of intense gym sessions each day, on top of my active life! As you can imagine, this is not sustainable.
    I’m completely miserable and the weight and lack of losing ability have made me depressed.
    I don’t know if I should try increasing my dose or if I should try Wilson’s Temperature Protocol? Do you have any suggestions? Have you ever heard of this before?
    Thank you so much!

  70. I have Graves. Had RAI 27years ago. Doctors put me on t4 only meds. Have had chronic fatigue since

    Have never felt good on t4. Feel best when TSH around .75 or.90.

    Recently have seen an RT3 ratio of 7. Seem to not tolerate t3 added to t4. The first day is great, almost euphoric with depression easing and energy increasing. But have a subtly increasing and persistent neck and back tension too. By about day 3 or 4 I have to discontinue the t3 because it is too uncomfortable to continue.

    I really want to take t3 alongside t4 because it drastically improves mood and energy.

  71. Hi,

    I have been hypothyroid for the last 17 years diagnosed and probably undiagnosed for a year or two. I bought some T3 myself and starting taking it alongside my T4 dose and I had slightly reduced my T4 dose to accommodate the T3, however whilst I felt really good, aches and pains had all but disappeared, good energy levels, I found after a few months on it that I had gained over 2 lbs in weight. That doesn’t sound like a lot, but I am already overweight as it is. Have you got any ideas why I would have gained yet more weight whilst taking T3 plus the T4? Since I stopped the T3, after about a week, or so, I had lost the 2 lbs.

    Thanks,
    Jill

  72. If I already have anxiety, hair loss and insomnia but have low T3 levels, why would I take a drug that causes those same symptoms…please walk me through this thought process as I’m confused and don’t want to make these issues worse. My thyroid hair loss is most troublesome and I do not want to make it worse!

    • Hi Mel,

      I think you are confusing potential side effects with absolute side effects. Hormones, if used correctly, should not cause negative side effects, but if used in excess, may lead to the symptoms I described here.

  73. Hello,

    I started taking T3 about 3 months back, and have seen great results. I was having trouble with fatigue, low temp, being able to use the restroom.
    I have not increased my dosage, and as of last week I am feeling extra tired, insomnia, having trouble staying asleep, and heart palpitations. Does my body no longer need the T3? Is it healthy to stop taking it? And if I stop, will my old side effects come back?

  74. Hi,

    Thank you for providing such current information. I’ve been taking synthroid for 20 years and just started adding t3 a year ago…improvement in energy levels, initial weight loss of about 12 pounds…but now noticing a much higher body fat content, less strength, crepey type skin, back to previous fatigue level. Is this a normal side effect?

  75. Hi Dr Childs, thanks so much for your articles. Some feed back for you. I’ve been taking T3 Liothyronine for nearly 9 months now. I currently take 1 x 50 mcg tablet a day and after a low T4 blood test, I am now on 100mcg of T4 Levothyroxine medication a day.
    I have not at this stage had any noticeable weight loss.
    When I first had the total thyroidectomy (due to cancer), I was on a very high dose of T4 medication and initially lost a lot of weight, but due to side effects, the dose was reduced and weight started coming back on. I was hoping that I would lose weight by now having started on the T3. I walk for an hour every day, eat sensibly and yet the weight is still an issue.

  76. Can t3 only cause weight gain? Even small amounts? I recently started t3 only and have gained 3 pounds with no diet changes at all. Is it normal to gain on t3? Is it temporary? I worked hard the past year to lose 30 lbs my main reason for going in t3 only was low free t3 normal free t4 and TSH my rt3 was only slightly high in the range. Symptoms mainly were fatigue, no libido, dry breaking hair loss, just to name a few. I’ve only been in 2.5mcg t3 about 5 days I’ve read some gain weight in t3 only is this true?

    • Hi Tina,

      Yes, I’ve seen a small handful of people gain weight when taking T3. I’m not clear as to why it happens but I’ve seen it before.

  77. [email protected]
    Oh if you experience t3 side effects, how soon would it take for them to appear normally? Like the excessive hair loss? Would I have experienced it in just 5 days or would it take longer to happen? I know 2.5mcg is a low dose but I’m starting slowly and monitoring.

    • Hi Tina,

      Some side effects can be experienced immediately after taking your first dose such as heart palpitations. Hair loss can take a few days to weeks to kick in in some cases.

  78. Hi Dr. Childs, Based on what I’ve read and watched on the internet your mastery of this topic is quite superior. Question: Why is SHBG a surrogate marker for T3 getting into the cell? Best, Dr. Ippolito

    • Hi Dr. Ippolito,

      Because SHBG only increases in the presence of estrogen and thyroid hormone. So, if estrogen is normal then you can make the assumption that changes to your thyroid may influence SHBG.

  79. Hi Dr.Childs, I have Hashimoto’s with 3/4 of my thyroid gland removed some 24 years ago. So I have barely any thyroid gland, if any ( due to have an ultrasound soon to find out if there is any left(!) My Reverse T3 has beenfound to be very high so my doctor has suggested I take a T3 supplement. I have recently been given T3 capsules in addition to lowering my thyroxine dose from 100 mcg per day (plus 50 mcg on Tuesday and 50 mcg on Thursday) which is a total of 114mcg per week.My dr. Has instructed me to drop my thyroxine dose to 100mcg per day. I tried it for a month and was so tired I was falling asleep @5pm every day-whilst driving home from work! I have felt fine until my thyroxine dose was dropped. Now I am exhausted just about all the time. Taking T3 has made no difference to my energy levels or weight…in fact I feel no benefit at all. I am not due tosee my doctor til Dec 18 & am struggling.
    What do you think I should do?

  80. Hello, I am on 25mg OD for Depression and Fatigue. I have no other side effects other than being intensely hot. It’s winter in Canada and I can still wear a T-shirt outside. My mood has improved but that could be because of my antidepressants kicking in. Can I stop the Cytomel without worsening of depressive symptoms?

    • Hi Natalie,

      I can’t give you medical advice but it does seem as if your medication may be too high. I would get your labs rechecked to confirm before making any changes to your medication.

  81. Hi Dr. Childs, Thank you so much for all your information and wisdom. After having an endometrial ablation, I’ve had nothing but thyroid issues and hot flashes, otherwise NEVER ANY health issues. It took me a few years to find someone to help me. A holistic dr put me on Iodoral 12.5mg 2 a day. I felt FANTASTIC by the next day, and 4 weeks later my hair stopped falling out. Now I see a dr who understands Iodine and is on board with holistic practices. He tested my ReverseT3 which was 33.5. He put me on cytomel 25mcg not mg. 2 a day. 3 weeks later hair loss and heart palps. He told me if palps started to definitely slowly lower dosage. That definitely helped but the hair loss is still bad and its been 5 months now. For 1 month I’ve been only taking 1/2 a tab. Could it be that the Iodine alone with fix my Reverse T3? I felt fantastic on Iodine only and lost a couple pounds without even trying, plus the hair loss stopped. Thank you! Laura

    • Hi Laura,

      It’s certainly possible that iodine could help, but I’ve personally never seen it happen in that way. But it doesn’t mean that it won’t help at all.

  82. Dr. Childs,

    Does this mean that high rT3 levels can be reversed?

    I am currently on a reduced dose of NDT + 25 mcg of T3. My doctor is clueless when it comes to things like rT3 dominance so I simply decided to follow your protocol while being supervised by my doctor (I requested to have rT3 levels tested and sure, they were too high according to your protocol, and I have previously been diagnosed with insulin resistance). I have put on an alarming amount of weight in the past six months and no supplements (such as berberine or cinnamon) seem to make a difference. Every time I raised my NDT, I seemed to gain another pound.

    I have felt great improvement in the five weeks since adding T3 to a reduced dose of NDT, but in one way I find synthetic t3 impractical: I have to multi dose it to avoid feeling jittery, whereas I can take NDT once daily and feel fine. So synthetic T3 seems to affect me differently than the T3 in NDT in that the former seems much more potent and fast-acting.

    So, even though adding T3 to NDT has made a world of difference to me, it would be great if I could go back on NDT only once I’ve cleared excess rT3.

    Is it common for your patients in the same situation to be able to go back on NDT only?

    • Hi Catherine,

      Yes, reverse T3 levels can be reversed provided you find and eliminate the cause of the high rT3, to begin with. It’s common for people to go on NDT/T4 afterward, as long as they fix that problem. If they don’t then they will just find themselves with high rT3 again.

  83. Hi Dr. Childs,

    I have hypothyroidism and Hashimoto’s disease. I was taking Synthroid but I started getting an itchy rash and stopped taking it. I am not sure what to do. What I can take. I need something but do not want to take something that will cause other issues.

  84. Hi Dr. Childs, Thank-you so much for giving this incredibly helpful information.
    As a result of reading your blogs a year or two ago, I was able to give my doctor links to your website and information about T3 medication.
    My endocrinologist was not keen (old school) but my GP was willing to give it a go!
    I started at 20mcg, increased to 50mcg then to 100mcg T3 Liothyronine. I also take 100mcg of Levothyroxine.
    I have started to lose weight and feeling great with lots more energy. The only side effects I’ve noticed is I get warmer at night and some times when standing still for a while I get shaky legs!
    My GP is happy with my blood levels and is happy for me to continue on the two dosages!
    Taking T3 has helped me kick start losing weight again and has improved the quality of my life!
    Do you have a good supplier of T3? Here in NZ, it costs a lot of money – $160 for a three month supply! I’d love to get it cheaper?

  85. I don’t know that I have any problems with my thyroid…I was tested once with the standard testing and I was negative for any issues. Having said that, I’m just curious, would there be any potential ill effects to a person taking T3 who was not Hypothyroid? What if someone was overweight and having trouble shedding the pounds? Is that a viable reason to take T3? Would it cause problems with one’s thyroid, where before there was none? I know this isn’t exactly in line with the questions on here, but please answer to the best of your ability. Thank you.

    • Hi Jenn,

      You shouldn’t use T3 if you don’t have a problem for the same reason that you shouldn’t use steroids for muscle growth. Exogenous hormones suppress your hypothalamic/pituitary function and may lead to suppression long-term depending on the use.

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