Dosing with T3-only (or with low-dose NDT, or the combination of T4/T3)
A healthy thyroid produces five hormones: T4, T3, T2, T1 and calcitonin. T4 is a storage hormone meant to covert to the active T3 thyroid hormone. But a healthy thyroid also gives some direct T3 i.e. it doesn’t force you to live for conversion alone! T3 is the thyroid hormone which gives massive benefits as far as our health, immune function, energy and overall well-being! You can read more about T3 in that very chapter within the revised STTM book.
What are prescription brands of T3 (Liothyronine Sodium)?
Cytomel is well-known in the US and Canada, as is Cynomel in Mexico. But there are also now many other good generics or brands. Other worldwide brands include Tertroxin, Linomel, Cyronine, Unipharma, Ti-Tre, Tironina, Tiromel, Trijodthyronin and more. All brands of T3 are synthetic, but work well according to patient reports as long as one has optimal iron and cortisol levels. You can see most brands and fillers at the bottom part of this page.
Why would someone use synthetic T3-only (liothyronine)?
It used to be that Natural Desiccated Thyroid was the best way to treat with its T4, T3, T2, T1 and calcitonin. But by 2019, most NDT’s went south. You can read about that here.
So today, more patients are moving to treating with both synthetic T4 with synthetic T3. Some are just using T3, multi-dosed. Some still use Armour, but add T3 to it (the rest of the prescription NDT’s are pretty lousy unless you do compounded NDT)
Some patients use T3 because certain issues (low iron, chronic illnesses like Lyme, mold exposure, high cortisol, inflammation to name a few) are pushing RT3 up from their use of T4.
If patients add synthetic T3 (liothyronine) to their synthetic T4 (thyroxine), how does it work? What is optimal?
A lot of patients have reported that it works best for them to dose the T3 three times a day because of its short half-life, such as first thing in the morning, about 4 hours later, and another 4 hours after that. Some might add a small amount like 2.5 mcgat bedtime, but that’s individual–it helps some sleep better; others it keeps awake.
We have noted that it doesn’t matter when the T4 is taken (as simply a storage hormone that will be converting all the time) as it does with T3 (as the active hormone). For convenience sake, the T4 can still be taken once a day in the morning, or at bedtime.
When on the T4/T3 combination, patients have noted that optimal equals a free T3 towards the top part of the range, and a free T4 right around mid-range. Why only around mid-range for free T4 or very slightly above? Because over time, patients started to see an increase in RT3, the inactive hormone, if they went too far above mid-range.
If patients are on T3-only by itself, how does it work? What is optimal?
Generally, if one is not used to being on T3, reported starting doses are 5 mcg in the morning, and another 5 mcg when one’s signs (BP, heartrate, etc) and symptoms (tiredness) dictate it, etc–that’s usually about 4 hours after the first dose. A third dose is added about four hours later. Remember that we have to have the right amount of cortisol to avoid problems when on T3 or when raising it.
Raising in small amounts seems to work, too, and using labs. This is NOT set in stone, but seems to work best for people as they have stated, especially if they are not used to having T3 in their treatment.
Some patients have stopped NDT or the synthetic T4/T3 combo one day, and started on T3-only the next. But it has to be in very small amounts until the T4, and its conversion to T3, falls, before raising too much.
When optimal on nothing more than T3-only, patients report they achieve a free T3 at the very top if not slightly over. Free T4 will naturally be quite low and patients have not found that to be a problem as long as they are multi-dosing.
How do patients avoid problems on T3-only?
One hard-earned lesson is that having a cortisol problem will cause problems/bad reactions with raising. That’s why patients report that it’s imperative to check one’s cortisol levels via saliva testing. The adrenal info page has Discovery Steps, plus a link to a saliva test. Study chapters 5 and 6 in the updated revision Stop the Thyroid Madness book about adrenals.
How have patients dosed or raised their T3-only, whether used by itself or with T4-only?
Patients have reported learning the following, but it’s always up to you in working with your doctor’s guidance. NOTE: patients report problems raising T3 if their cortisol is not optimal!! We always check our cortisol via saliva testing, not blood, then compare to this page.
STTM WEBSITE GRAPHIC T3-only use NOTE: When raising T3, a large body of patients have reported discovering that it’s quite important to do lab work around 40-50 mcg to gauge one’s progress. Patients and their doctors found out the hard way that if they didn’t do labs and kept going up with raises, some had overdosed! For information on using T3-only with the Circadian Method to raise morning low cortisol (as proven by saliva testing, NOT blood), go here.
What if someone states that T3 may be too stimulative for some people, as if they should avoid it. Is that true?
It’s true that for some who are elderly, or for those with heart issues, they may need to start much lower and raise in low amounts, not necessarily avoid it, our experiences have noted. Hopefully they are working with a knowledgeable doctor. But the problem with the above statement for everyone else is it fails to explain that reactions to T3 for most are due to what it’s “revealing” i.e. inadequate iron levels or a cortisol issue. This page explains. P.S. You might want to be careful with what that advocate states and compare it with solid patient experiences and wisdom as outlined on Stop the Thyroid Madness.
Why a bedtime dose?
Patients first heard about this with the late Dr. John C. Lowe. Turns out that your body can have its greatest need for T3 during the time you are asleep! But not everyone can tolerate T3 at bedtime, so they have to experiment.
What about cutting up tablets?
You’ll need a quality pill cutter. But some T3-only breaks easily by itself, or with dry teeth.
How have patients felt when using T3-only?
Usually pretty good, say patients, especially as you find your unique optimal dose! 🙂
But it’s important to make sure you don’t have inadequate iron or adrenal issues as you are raising T3 in search of that optimal amount. i.e. many end up with pooling problems (T3 going high in the blood and not to the cells) as they raise, or just never getting rid of hypo problems.
T3-only is a rougher treatment, say some patients, since you need to dose it about three times a day, and since it has a short half life. So working towards getting on natural desiccated thyroid has been a goal, since NDT gives back what your own thyroid would be giving: T4, T3, T2, T1 and calcitonin. In the meantime, T3-only by itself, or in combination with Synthetic T4, can help a lot, say patient reports.
Have patients always dosed 3 times a day?
Not necessarily. When some have been on T3 long enough, they might even be able to dose twice a day, but three times is common, say patients.
Why did T3-only tablets make some state they feel worse??
It‘s revealing a cortisol problem most of the time. See this page.
What about slow-release T3?
Yes, there are some who swear by it. But others say it’s a problem. You can’t give yourself exactly what you need, when you need it, because it’s “slowly” releasing. Second, it runs out too fast, say some, later. So it’s up to you.
If patients have found high Reverse T3 (RT3), do they have to be on T3-only to lower it?
Most of the time, yes. Or at least mostly T3 and very low T4.
What if a patient had both high RT3 and pooling of T3, the latter due to a cortisol problem?
There are some patients whose low iron and/or cortisol issues causes both problems–RT3 going up, plus T3 going far too high for awhile called pooling. Patients report the same protocol above–greatly lowering NDT to one grain which can lower the RT3 over time. But caution is important if one adds in T3 as a second and third dose until the reason for the high pooling is discovered and treated.
What are the temperatures referred to above?
How long has it taken patients to lower high RT3?
It generally takes 8-12 weeks for the RT3 to fully fall, patients have noticed, and anywhere during that lowering process, patients report suddenly feeling a little hyper as the T3 comes up and is better able to reach good cellular levels (which the excess RT3 prevented). But we found that it’s crucial to be treating the causes for the high RT3 or pooling in the first place.
***If you need info with you, take your copy of the revised STTM book with you and you can refresh in the waiting room!.
As with any page on STTM, this is copyrighted info. It’s based on what patients have reported in their use of dosing with T3-only, or in combination with NDT or in combination with synthetic T4, and is for informational purposes and is not meant to be seen as personal medical advice. Read the Disclaimer. For clarification, “T3-only” means a pill that only contains the active thyroid hormone T3.