Dosing with T3-only (or with low-dose NDT, or the combination of T4/T3)
Note: as with any page on STTM, this is for informational purposes based on what patients have reported in their use of T3-only, or in combination with NDT or in combination with synthetic T4. This information should be shared with your doctor. For clarification, “T3-only” means a pill that only contains the active thyroid hormone 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 your 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 (though patients have seen a shortage of Cynomel in late 2015 onwards). Other worldwide brands include Tertroxin, Linomel, Cyronine, Unipharma, Ti-Tre, Tironina, Tiromel, Trijodthyronin and more. All brands of T3 are synthetic, but seem to work well according to patient reports. You can see most brands and fillers at the bottom part of this page.
Why would someone use synthetic T3-only (liothyronine)?
Though most patients reflect that they get the best results from all five thyroid hormones, which Natural Desiccated Thyroid (NDT) gives, there are some who find it difficult to get NDT, so their next best step is adding synthetic T3 to their synthetic T4 for much better treatment results.
But there are other issues where one might have to be on T3-only by itself, or adding T3 to a greatly lowered dose of NDT like one grain….issues ranging from having high RT3 (reverse T3) due to low iron or a cortisol issue, to having Lyme disease (which promotes RT3), to having a rare deodinase enzyme conversion problem (problems converting T4 to T3).
There are a small minority who even on high doses of NDT, have to add a little T3 to be optimal.
If I want to add synthetic T3 (liothyronine) to my synthetic T4 (thyroxine), how does it work?
As also explained in the graphic below, patients report it works best 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 at 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 (as simply a storage hormone) is taken 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, just like with Natural Desiccated Thyroid, 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? Because over time, patients started to see an increase in RT3, the inactive hormone, if they went above mid-range or higher.
If I want to be on T3-only by itself, how does it work?
If a patient wants to start on T3-only by itself, they usually stop their T4 or NDT for ‘up to’ a week or less, then start the T3. The half-life of T4 is about one week, and that corresponds with the time one will start to feel the return of thyroid symptoms and/or less conversion to T3. That’s where they start introducing T3-only, or right before they start noticing hypo symptoms creeping back in.
General 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. Raising in small amounts seems to work, too, and using labs. This is NOT set in stone, but seems to work best for people, 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 I dose and raise my T3-only, whether used by itself or with T4-only?
Patients report learning the following:
NOTE: When raising T3, patients have also discovered It’s also quite important to do lab work around 50 mcg to gauge one’s progress. Patients 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.
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.
How can I expect to feel using T3-only?
But 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.
Will I always dose 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.
Why did T3-only tablets make me feel worse??
For the same reason being on Natural Desiccated Thyroid makes some feel worse–it’s revealing less-than-optimal iron or a cortisol problem i.e. with either problem (and which are common if you were undiagnosed for awhile, or on T4-only), you’ll need to discover these and get them corrected! See this page. (And no, iron or cortisol labs results have nothing to do with just “being in range”, as this page explains.)
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.
I have high Reverse T3 (RT3) levels. Do I have to be on T3-only to lower it?
T4 can convert to either T3, or the inactive RT3. The latter happens due to having inadequate iron, or a cortisol issue, most of the time. If one finds they are converting to far too much RT3, there seem to be three ways to lower RT3 as successfully reported by patients:
a) If on NDT, lowering to one grain or so has been enough for many to lower RT3, but has for some, and takes a few weeks.
b) Lowering the NDT to one grain, and adding in T3-only for two other doses to counter increased hypothyroid. An example might be one grain in the morning, 5 mcg approx. four hours later, and another 5 mcg four hours after that. Over time, doing labwork helps discern how much T3 one can tolerate, which is why it’s extremely important to be treating the cause of the high RT3.
c) Being on T3-only by itself–a sure fire way to lower high RT3.
What if I had both high RT3 and pooling of T3?
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 is the T3 Circadian Method?
It’s a method of using T3 in the early morning hours (before normal wakeup time) to bring up adrenal function in the morning especially. Read about it here.
What are the temperatures referred to above?
If I’m lowering my high RT3, how long does it take?
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.
***Take the revised STTM book with you to your doctors appointment.