Hypothyroid? Will You Benefit From T3 (Cytomel)?


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Over 20 years ago endocrinologists had experience with hormone compound pills containing both T4 and T3. Those physicians who had the opportunity to use these compounds know that patients frequently seem to do better with them than with the more traditional T4 (Synthroid, L-thyroxine, Levoxyl etc.). For various reasons most companies stopped producing combination thyroid hormone pills two decades ago.

Why does combination therapy with T4 and T3 appear to provide more benefits than either hormone alone? The reason was clarified in an article published in The New England Journal of Medicine summarized in this news report;

NEW YORK, Feb 10 (Reuters Health) — Patients with hypothyroidism show greater improvements in mood and brain function if they receive treatment with two types of thyroid hormones instead of one, according to a report in the February 11th issue of The New England Journal of Medicine.

Hypothyroidism, where the gland has ceased to function or has been removed, is usually treated with daily doses of thyroxine hormone. But the researchers found that substituting another thyroid hormone, triiodothyronine, for some of the thyroxine dose led to improvements in mood and in neuropsychological functioning.

“There are two thyroid hormones, thyroxine and triiodothyronine,” Dr. Robertas Bunevicius, of Kaunas Medical University in Lithuania, and colleagues explain in their paper.

“Not all tissues that need thyroid hormone are equally able to convert thyroxine to triiodothyronine, the active form of the hormone,” the researchers write. “Nevertheless, most patients with hypothyroidism (reduced thyroid function) are treated only with thyroxine.”

To determine whether patients would benefit from receiving triiodothyronine as well, Bunevicius’ team studied 31 women and 2 men who lacked a functioning thyroid and were dependent on thyroxine.

The research team divided the study into two 5-week sessions. During one session, each patient took his or her usual dose of thyroxine. During the other session, the researchers replaced 50 micrograms (mcg) of the thyroxine dose with 12.5 mcg of triiodothyronine.

On 6 of 17 measures of mood and cognition — a catchall term that refers to language, learning and memory — the patients scored better after receiving thyroxine plus triiodothyronine than after receiving thyroxine monotherapy.

No score was better after monotherapy than after combination treatment, the study group determined. The authors also detected biochemical evidence that “thyroid hormone action was greater after treatment with thyroxine plus triiodothyronine.” But in an editorial, Dr. Anthony D. Toft, of the Royal Infirmary, Edinburgh, Scotland, recommends that physicians should not use thyroxine and triiodothyronine in combination until the study findings are confirmed by additional research.

Toft notes that “most, if not all, of the currently available combined preparations of thyroid hormones contain an excess of triiodothyronine as compared with thyroxine.” Besides, he argues, the majority of patients taking thyroxine “have no complaints about their medication.”

SOURCE: The New England Journal of Medicine 1999;340:424-429, 469-470.

I have used Cytomel (T3) in treating hypothyroidism for over 18 years and I am still surprised and gratified at just how well it works. For those complaining of persistent fatigue, muscle pain, constipation, or weight gain, despite blood tests showing normal levels of thyroid hormone, combining T3 with T4 therapy appears to boost the thyroid hormone action. Combining the two hormones can actually avoid the sometimes frankly negative aspects of simply increasing the level of T4. If you or someone you know has similar problems with thyroid hormone replacement I suggest consulting with an expert health care professional such as an endocrinologist about adding T3 supplementation.

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    Please, where can I find you for a consultation? I am in the New York area and would love to finally see a good doctor….

  • Seshaya

    Of course, what a great site and informative posts, I will add backlink – bookmark this site? Regards, Reader.

  • Gary Pepper M.D.

    Thank you Seshaya. We take pride in providing quality thyroid and other metabolism and nutrition related information.

    Dr. Pepper.

    • Dr.Pepper,
      My TSH level is over 3,500, for real. My Dr. did not beleive it either. She had it tested at the Mayo Clinic twice. She will still not change me off of synthroid,although it appears to do absolutely nothing for me. Any suggestions?

      • Gary Pepper M.D.

        Hi Mary

        A TSH of this level is indeed unusual particularly if you are already taking thyroid hormone. A very rare cause of high TSH levels that don’t come done on thyroid hormone treatment is an abnormality of the pituitary causing it to produce a defective form of TSH or excessive amounts of normal TSH. Another possibility is an inborn defect in the way your body responds to thyroid hormone. If your thyroid levels have been normal in the past then inborn errors of metabolism are not the cause (since you would have this problem your whole life.)

        It would be helpful to know the levels of T4, T3 and free T4 to figure this out. Have you been to an endocrinologist yet? Sounds like a good idea.

        Let us know what happens please

        Dr. P

  • I had a partial thyroidectomy in 1991 and 2 years later started feeling really bad. I began taking 0.075 of Synthroid and have been taking it ever since. I have had my TSH checked at my doctor and it is 2.022 now. I feel really bad, I have a new demanding job and find myself falling asleep during meetings and even while talking to people. I am not depressed and am actually very happy with my life, but something is wrong. My doctor is checking a complete thyroid profile, but I wonder if I would benefit from adding Cytomel to my Synthroid?

  • Kay

    I too am having the same problem after being diagnosed with hypothyroidism about 4 weeks ago. I am on .25 mcg of Levothyroxine and am experiencing severe fatigue and weight gain as well as feeling all around “sluggish”. I, too, am at a job where I need my mental facilities intact. I find myself falling asleep at 9:00 in the morning after being at work for an hour. I have a call into my physician about adding Cytomel to my Levothyroxine.

  • Darlene

    I have been on synthroid for Hashimotos thyroiditis for over 10 years. I am on 300MCG. l have experienced severe fatigue and chronic joint pain for most of my life. I also experience bouts of depression. Four weeks ago I was placed on 5mg of Cytomel along with the 300mcg of synthroid. I am happy to say that my fatigue is almost gone, I have lost weight, my depression is gone and my joint pain is almost gone. I have never felt better in my life. I feel better than when I was teenager. I am now 37 years old and feel like life is starting over for me.

  • Lora Tate

    I would be interested in trying this Cytomel. I am trying to go back to school and the mental faculties have increased a little since I started on Synthroid 88mg, but I still feel the depression and still need naps each day. I have improved in that I am not sleeping all day and all night. How long should I wait before trying this Cytomel? I am a new patient of yours and have wasted five years trying to get someone to even listen about my thyroid, that I don’t want to wait any longer than I must to feel good again. I didn’t even know that muscle aches were part of the symptons, but I do have them.

  • Darla

    I went from 112 lbs to 180 lbs before I had my thyroid removed in February of 2003. I have been on Armour for 4 years now. In the past 16 months I have gone from 130 lbs to 170 lbs. Doctor says my labs are very good and shouldn’t be changed. I am extremely active and eat very healthy. I am currently taking care of our 5 acres and house by myself as my husband works out of county during the week. I have horses to ride, lawn to mow weekly, chickens, weedwacking of the 5 acres with a push weedwacker that I have to do 2 times a year. This alone takes about 2 weeks each time at 6 hours a day. I run or exercise daily. I eat a ton of fruits and raw/steamed veggies some chicken and drink water and coffee only. I don’t like sodas. So, with all of this information, would cytomel help me? Will it give me energy so I don’t have to take a nap by noon, cure the muscle fatigue and keep me from being so cold also? Any help with this would be great…….I am not a lazy person, nor do I sit around watching tv and eating junk food as doctors have accused me of this in the past.

  • Suzann

    Hey Darla, I just had to respond to your post. I’ve been gaining about 10-15 lbs every year with no explanation for the past several years. I am very active as well. I was so sick of being accused of overeating and being lazy. Not every person who has a weight problem is lazy…pleazzzzz! After getting numerous “normal” thyroid blood tests, but all the textbook symptoms of HYPO I finally found a doctor willing to listen to me and take my seriously. I went in with all my research on how my body may be showing the thyroid hormone in my blood stream, it may not be getting to my tissue and organs. She did some research of her own and to my immense surprise put me on 5mcg of cytomel. I have been on this since this past Thursday and already my face is no longer swollen and puffy and my hands and feet are warm for the first time in over 6 years. I highly recommend cytomel and can’t wait to see what the next symptom to disappear is. Good luck and never be afraid to show your doctor your research and that you may know a thing or two about your own body!!!

  • Darla

    Suzann, Where did you find the information about the medication being in the blood but not the tissues and organs? I have done extensive research and have not seen anything about the medication getting into tissues. I would love to get rid of some 50lbs of excess weight. My doctor last suggested going to see nutritionist in order to get a diet to help me lose weight. Any information would help. Thanks for responding.

  • Suzann

    I have seen a nutritionist before….what a great education I got. Lost 30lbs…but it came back slowly. I still recommend it though. The information I told you about came from a book a friend of mine gave me. I believe every person who even think they might have a thyroid problem should read this book. “The Thyroid Diet” by Mary J. Shamon – http://www.thyroid-info.com. These days we need to be our own doctors. I believe everyone should seek professional medical help, but before you go educate yourself, be your own advocate. I did and I got results. Mary states in her book, “be persistent, but unemotional…..show the doctor articles about thyroid disease that reflect your symptoms”. She goes on to say you need to fully explain your symptoms. Don’t just say I have gained weight…..tell the doctor I only intake 1500 (or whatever your intake is) calories a day and I am still gaining weight. Or I sleep 10 hours every night and by dinnertime I am exhausted. I stress this enough to everyone. My last endo told me my problem is not endocrine related….no??? then why am I feeling better on T3 replacement? Get this book….it will change your life!

    • donna williams

      darla and suzann,

      please contact dr. david clark. the place for answers, out of dallas. I had those same issues and some even worse. He tested me and after 25 years of no doctors being actul medical detectives, he found that I had hashimotos and has changed my life for the better and is no beginning to treat my husband as well. We live in oklahoma and he treat us long distance. check him out. he will save your life.

  • Lee

    Dear Doctor Pepper
    I have been on thyroxine for the last 13 years, since I was 23. I’ve been steady at 150mcg of Levothyroxine now for about 10 years. Recently I’ve been feeling really sluggish and suffering with brain fog. Went for a routine blood test and the results came back that I need to adjust to a higher dose, so now taking 200mcg daily. Do you think that I would benefit from trying cytomel along with my Levothyroxine? What would you recommend as a dosage of each taking into account that I’m currently on 200mcg of the Levothroxine.
    I really look forward to your response on the matter and can hopefully get the treatment I need.

  • Dr. G. Pepper


    As you know I cannot provide medical advice electronically. But in general your story seems pretty familiar. If you search metabolism.com you will find many other people who have stories similar to yours, and responded well to the addition of Cytomel. Sometimes the dose of t4 (Synthroid) needs to be reduced when adding Cytomel to avoid side-effects of excess thyroid levels.

    Other people with hypothyroidism have used Armour thyroid to great advantage under circumstances similar to yours. Armour contains t3 and t4 in a single tablet making it convenient and cost effective.

    Fatigue is a common problem and can arise from numerous, nonthyroid abnormalities, some as simple as not sleeping well. Be sure to discuss your symptoms with your doctor to be sure all possibilities are explored before making any assumptions about the cause and treatment of this type of problem.

    Hope this helps.

  • Debbie

    I have Hashimotos and thyroid problems for 5 years. I was on 112 mcg synthroid for a long time, then went hyper but still hypo symptoms. One doc said lower it to 100mcg ANOTHER SAID i HAD TO RAISE IT TO 125MCG. After searching and searching I found a Internal Medicine doc who heard me and put me on 100 mcg synthroid and added 10mcg Cytomel, for the first time in years I feel normal plus I had a extra 15 Ibs I could not lose no matter what. I have lost 7 lbs in two weeks. (I have just started my third week) I started out with 5 mcg cytomel and now I am up to 10. I am not freezing anymore the joint pains are gone and memory is back, and the puffy sagging eyes lids have vanished, what can I say I love it.

  • Frances Gross

    I had RAI do to graves disease and now I am hyporthyroid. I have been faithfully following weight watchers and exercising daily, twice a day. I do aerobics and resistance training.
    I have not lost one pound and I am sooooooooooo discouraged. I take Levothyroxine 127 it was 125, 150 ,137 and I am sure when I go back it will be something different. Does not matter though. I am still not losing weight. Nor, can I find a doctor that will prescribe the cytomel. I live in the Chicago area south suburbs. Does any one know a doctor in this area that will prescribe cytomel. My doctor just will not do it. More than the weight, my bones hurt and my joints pop. I can’t remember stuff. My feet are always freezing. I actually had to quit my 23 year well paying job in this economey because of my lact of focus, concentration, depression etc. I really need a doctor that will listen to me and help me. It sounds like from what I have read that the cytomel will work for me.

  • susan caruso

    Hello Frances,

    I see Dr. Mark Stolar at Northwestern Internists on the Northwestern medical campus in downtown Chicago. He was the only doc who would give me Armour. Now, since Armour is not available, he has me on a combo of Synthroid 1x per day and Cytomel 2 x per day.

    Hope this helps.

  • i was wondering if you could give me a name of an Endocrinologist in the St. Louis or Cape Girardeau that would talk to me about Cytomel..I have been on Levoxly for 7 years now, I have gained 30 pounds the last 2 years..I feel very jittery, anxiuos, and overwhelmed at times. i have been reading about Cytomel and I feel I may benefit from that, but my current physician will not prescribe it for me. I have discussed with her my concerns with my syptoms with her, but she said it is my age.
    I have Health Link insurance hopefully i can get a doc that accepts the insurance.

  • peaches

    Hi Tonya!

    I live in the Cape area and couldn’t find a doctor at all to listen to me in Cape or St. Louis. Finally after 4 years of feeling physically and emotionally ruined by doctors telling me that I had nothing wrong with my thyroid (even when presented with two ultrasounds confirming Hashimoto’s) I found a doctor in St. Louis who seems to be concerned with how I am feeling along with the bloodwork. Remember normal labs are not necessarily normal for everyone as a whole. We are all individuals and should be treated that way. I am currrently taking 100mcg. of levothyroxine daily and my new doctor just added 5 mcg. of cytomel. I haven’t started it yet but tomorrow will be the first day. I am so excited and hopeful that it will help. I was always around 115lbs. until this all started now I am at 155lbs and have gotten as high as 162. Her name is Dr. Naseer in St. Louis. You can search her on the web. I too had a lot of your symptoms along with hair loss, constipation muscle aches, flushing episodes in the middle of the night preventing good sleep, then exhausted during the day. I have also had muscle tremors and low body temperature. The anxiety was so bad I thought I was going mad. It sounds like you’re a local gal. Good luck to you and email me if you wish. It is kinda nice to have someone to talk to who understands your situation.

  • Laurie

    I am so sick and tired of telling my story over and over again but decided to share it on this website in hopes of some sort of resolution. About 5 years ago, my thyroid quit and I gained 70 pounds. I worked out before and after this occurred, so that was not an issue. When they FINALLY figured out what was wrong, I had hopes the taking and getting my thyroid levels right, eating right and working out I would get back to normal. Well that was not the case at all. I actually became rather obsessed with working out and was working out about 3 hours a day, eating less than 1200 calories a day only to lose about 4 pounds over a year period. Then I quit, ate whatever I wanted, and nothing happened. I didn’t gain any weight back. I started up again about 6 months later and was jogging and walking 3 times per week. I did lose about 20 pounds but gained it all back. I am now at an all time high. I am ready to start working out again, regardless of any results but want to talk to my Dr. about Cytomel. I have pretty much given up and don’t think I will ever get back to my normal self. I am in good spirits and have decided to just accept myself for what I am….I don’t think it is fair and I don’t like that I have to be so overweight while I was normal all my life. It is just not fair I just can not believe that this can not be fixed. Its so frustrating. I am not a saint, I do indulge from time to time, but only on the weekends. My mother who is about 100 pounds eats twice or more than I do, doesn’t do a thing and maintains. Every one I know maintains their weight with a little fluxuation. I just don’t understand how a person can gain 70 pounds and there is nothing I can do about it. Sometimes I think I need to quit work and go to a fat farm for 6 months and only work out 24-7. Nothing works. I need help and guidance.

  • Frances

    My problem is I cannot find a doctor that will prescribe T3. I live in the southern suburbs of Chicago. Any suggestions?. I have so far been to 3 endocrinologist and one internal medicine doctor. I don’t work any more because of problems with depression, concentration and memory loss. I can not afford to keep paying for these doctor visits and repeated blood test for nothing. And, I can’t afford to keep buying bigger and bigger clothes. I am miserable.

  • Frances

    I just read a post that gave me a doctors name. THANK YOU SUSAN.Let me call the doctor right now.!

  • laura

    Hi France! I am experiencing the same issues! I live in suburbs too, and can’t find a good endo! I have been to 9 over the last 11 years!!! i ahve gained 60 lbs and it sucks! Can u forward me the list that susan gave you? u mentioned u found a dr, through her……
    greatly appreciated!!!!

  • Donna

    I too need the name of an endo doctor in the Detroit, MI metro area that will treat with T3 and T4.

  • Rachel

    Does anyone know of a doctor in Orlando, Florida who perscribes cymotel for a low t3?

  • Frances

    Hi Susan!

    Thank You soooooooooooooooooo much for your suggestion. I went to Dr. Stolar a week ago and he put me on Armour. What a blessing to have a doctor that will finally listen to me. I was able to find armour but I really had to search around for it si we will see how that goes. . I do not fear because the doctor is willing to try other combos such as your cytomel and synthroid. Susan, Susan, Susan, I cannot thank you enough for all your help. You were a God send in the REAL sense.

  • Frances


    The doctor’s name is Dr. Mark Stolar. He works out of a downtown office. You can thank Susan for the referral in advance. You will not be disapointed.

  • Anybody out there know of a Doctor in the Richmond, VA area to get T3? I have been on T4 for 15 years and in the last 6-8 months everything is haywire again and my doctor just wants to keep upping the T4–she says she hasn’t read any evidence in medical reports that T3 works. T4 is not working-tired, swelling, joints ache, feel awful, etc. and the doctor just won’t listen–it’s like it was in the beginning all over!! I need help and would like to try T3 but my doctor just will not listen.

    • Heather

      Dr. Adrienne Clamp in MCCLEAN VA

  • Frances


    You are going to have to find another doctor. Once your doctor’s mind set is the way it is, there is no changing it. Trust me. I went to 4 or 5 endo’s before I finally found one that would give me the t4/t3 combo and it took years. I would still be looking if it had not been for the referral I got from this sight. There is one website I found that listed doctors that would prescribe T3/T/4. It is a nationwide registry. . . . I am going to see if I can find that registry and come back here and post it for you. Maybe that will help.

  • Frances


    I think you will be able to find your doctor through this registry ;


    I wish you the best. I feel like a new person since I switch and I have only been on the new meds for 2 weeks! I retired from my job because of my condition and now I feel great and my mind is clear. I could have kept working if I had been on the right meds.

  • AMAZED!! My doctor 3 days ago added 25mcg of Crytomel to my T4!! I didn’t feel anything the first day or night but the last 2 nights I slept hard thru the night and felt better first thing in the morning. I know it’s too early to tell long term but so far I am impressed! I am taking 5mcg twice a day for the first week, 5mcg three times a day for the 2nd week, and four 5mcg four times a day for the third week and then I will take 12.5 mcg twice a day going forward. I am also on .137 of t4 which she did not change right now–she is going to re-do my bloodwork in 6 weeks. My last TSH is at 1, but my T4 is 13–she feels I am not converting T4 to T3 anymore and need some T3–is this what other people have experienced? If you have normal TSH but high T4 (my T4 has tripled in the last 8 months-going up) you need to add T3? T3 is low also.

  • In case anyone lives in the richmond, va area- my pcp is Dr. Sara Breeden–she is a great doctor, she listens. She was just very slow on the T3 idea but she did some research and decided it was ok.

  • Joan

    I myself have gained over 150 lbs. in the last several years. Was diagnosed in 2005, have yet to loose one ounce taking Levothyroxin 118mg. I have done a lot of research and read books about Hypothyroidism. Yes, like a lot of women I have been told to “quit eating pasta,” “workout more.” Among other things, I have taked diet pills and starved myself while doing hours of excercise to no avail. I have asked my physician for Cytomel and hope she responds favorably. At this point I can not work, I am being treated for Depression, elavated testosterone levels, high cholesterol/triglicerides, high blood pressure, type II diabetes, etc. I have never been this big in my life. I am in pain from my muscles and joints daily. Oh, they want to give me lortabs! I do not want any more meds to treat the symptoms I am suffering. I want the one thing that will take care of my main problem and in the future relieve me of some issues upon weight loss. My endocrinologist just said everything in “moderation.” That was supposed to help me lose weight….Why do they not try what the patient wants to do, we do pay them for their services, why blow us off all the time??? Best of luck to all of you.

  • Ok it’s been 5 days–I have lost 2 lbs and am feeling alittle better. Hopefully after a month or so I will feel like a new person!! I haven’t changed anything but added the Crytomel–I am going to start walking again–knees, ankles, joints feel better and I am not as tired at night so I am going to start slow and work up to walking an hour a day.

  • Hi Joan. You hadn’t really mentioned what your average daily intake is but basic advice is to eat at least planned meals and 2-3 snacks per day made up of WHOLE UNPROCESSED food with an emphasis on plant based foods. Targeted supplementation also may help you get the insulin resistance, diabetes, elevated blood lipids, blood pressure and depression under control… As always,
    Consider having an individualized consultation!

    Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N
    In regards to this reply please read the our terms of service at:http://www.metabolism.com/legal_disclaimer/

  • Terra

    YES, I had suffered for 20 years like the rest of you have by being misdiagnosed by unknowing Endocrinologists who are falsely taught in school that T4 is the answer. They have been led to believe that T4 does convert to T3 and in most cases it does NOT!!!!
    There is an amazing doctor named John Lowe (drlowe.com).He has done over 25 years of intensive research on the thyroid and his book is called The Metabolic treatment of Fibromyalgia. It is pricey but here is the good news…he does telelphone consultations. So no matter where you live this man is availabe to talk to. He is incredible and so is his research. Please please contact him or go to the library for the book. He got me off the T4 and we are now playing with the T3 doeses to get it just right. In his years of updated and modern research he proves that blood work (lab results) are what doctors have been taught to rely on but it is NOT going to give them the answers they need. Instead It is patient symptoms that they need to be watching and assessing.. Please ladies check out his website and read everything you can it. This man has REALLY doen hiss homework. I am getting better everday and beleive me I wwas super sick for a very long time due to the thyroid being grossly misdagnosed. the T4 recommendation was wrong and then when they( (physican assistant) finally figured out to add a little T3 the amount was so tiny it didn’t make any difference anyways. I even had a col-rectal surgeon tell me that my colon needed to be taken out because years and years of chronic constipation eventually led to my colon shutting down totally a year. it was hell. (but the real problem was the metabolism which is directly assciated with the Thyroid!!) Thanks to Dr. Lowe and his dedication to research in this area, my colon is working and I am on the right path to feeling better. Bless you gals and all the best. You have all suffered long enough!!

    gal in Denver

  • Jan LLoyd

    How long does it take for cytomel to work. I have been taking it for a week now and all I seem to get is a rise in body temp about an hour after I have taken it. I may be a little less brain fogged too.

  • cindy

    Seven weeks feel almost normal and am down eleven pounds and best of all have energy and am sleeping better

  • I have recently been put on synthroid and not getting the results I planned on getting. I have been doing lots of reading and research and have only recently run across all the buzz on cytomel. I’m not sure that my endo will prescribe it. Where can I get it, from a representable supplier? Thank you for your help.

  • cytomel is by prescription only. I would not be buying on the internet as you can’t be sure of what you are getting. synthroid and/or cytomel takes a while to start working 4-8 weeks-and if you just started synthroid, you should be on a low dose and after 4-6 weeks your doctor will do bloodwork to check your levels and adjust synthroid as needed. I was on synthroid for over 15 years before cytomel was added but wish it had been from the start. Hopefully your doctor ran tsh, free t4 and free t3. For me to feel my best I need my tsh at .2 to .5 and the free t4 & t3 in the upper range of normal but everyone is different–hopefully your doctor will listen to how you feel not just the numbers. Good luck.

  • ann

    after yrs on synthroid alone cytomel was added at my request 3 wks ago.first thing noted my fingernails are no longer flaking,sliting and breaking,they are HARD for the first time in ten yrs.my hair loss has decreased,i have lost a half pound,i’m dreaming again,i feel so much more alive!!!

  • cindie

    Where has cytomel been all these years for me? S/P thyroidectomy 8 yrs ago – taken synthroid since. Never felt well – ever. Fatique, swelling, brain fog, no labido, hyper/hypo flucts… Just started Cytomel after a visit to new endo dr and the world is clearer and many of my probs are notibly better. Don’t think Synthroid is right for my body at all, all this time of suffering and undertreatment is so sad because I know now that it can be better and that others are suffering needlessly too.

  • Frances

    I could not agree with you more

  • Ann Johnson

    I had my thyroid removed on may 12, 2010 and came home with no problems at all!!! However, it is now July 24 and I feel so bad, I am constipated and have some type of brain for and confusion and have to take a nap every day of the week around 11:00am. I have alwys been very active and do not like to sit around, I have always had so many things on my plate and now I wish I had nothing to to at all but sit and stare at the wall…I don’t want to talk to people or go places as I have gone from 150 lbs to 180 in less than12 months…I just got the results back from my blood test today and for the first time I have some hope…Cytomel is the drug Dr Turner prescribed to me and I am on my way to Walgreens to pick it up. I will start taking it with my thyroid medicine tomorrow (I take mine at 4:00 am)…
    Oh, my cholestrol was 163 and I eat very healthy and did I say I work out an hour and a half with a trainer every day of the week monday thru Friday and an hour on Sunday. I own two companies that I started fron nothing and have 6 office staff and about 8 sales people!!! I have an Inn I rent out to people by the day or the week and am very fussy about how it looks. I AM NOT LAZY, I AM VERY CREATIVE althought right now I feel like I just want to take a nap and don’t really want to even think about writing out my grocery list. I want feel better and finally be my normal size and not get up to 400 bs as I felt that is where I was headded. Thank you for every post I kept saying, that is me , that is me oh, and that is me too…

  • Ann, be sure to let us know how you do on the Cytomel. You didn’t mention what you had been before trying the Cytomel. It is truly amazing how our hormonal health can affect how we think, feel and function. I feel so bad for people that feel this way but never identify, or have any help identifying, the underlying problem/cause. Remember your “favorite you… full of energy and creativity” and crawl, walk or run back to being that person! Good Luck!

  • Ann Johnson

    I had Graves Disease it took a while to diagnose. While I had Graves I changed everything about me…I went to a Nutritionist, I hired someone to cook meals for me, I got rid of my TV and did not watch for 9 months to not have stress in my life, I went on hikes everyday, changed Dr’s twice. I was one of those people that did not loose weight from having Graves Disease. But I was not fat, for my size I was good at 150 lbs.
    I did not want to have my thyroid taken out however, I no longer have a craving for sweets at all…since the surgery and have not had refined sugar since the end of May. I eat a balanced diet, protein and good carbs beans, spinich,brussel sprouts, and pumpernickle bread, fruit, blueberries, Almond milk NO regular skim milk as I understand that can interfeer with the medicine.
    that being said, I feel so lisless and began taking a B-12 shots every Friday for some type of energy or mood stimulater. My friend said (that gave me the shot)…my mother went to see Dr. Turner in Columbia Tennessee and he did a series of blood work and she has lost 25 lbs and isbeing her normal self! He also did that to the neighbor across the street…I called the neighbor across the street and it was the same story, THYROID issues and now a new person!!
    I am on 112MG ofLevothyroxine once daily and Liothyronine 25MCG once daily and i take them between 3:30 and 4am. Not feeling good but have only take for three days. Dr Turner says it may be 4 to 6 weeks so I am hopeful.

  • Ann Johnson

    I am feeling so much better it is August 22, I am down 3 lbs and feel like doing a few things now…am hopeful I will be back to my old self in a couple of weeks. However last nignt and yesterday I have been experiencing heart palpatations, don’t know what’s up with that. Has anyone experienced that too. So last night i only took half of the Liothyronine. I have e-miled the Dr. to inform him.

  • Vanessa Lindgren

    I have a slow thyroid also. I have not found any information on this anywhere so I am asking you. My entire body sometimes feels like it’s onfire – like hot flashes all over with burning. It’s different from a low estrogen hot flash.

    I know an overactive thyroid can cause this but can my slow thyroid also cause this odd symptom? Also, do you believe that a slow thyroid is the root of fibromyalgia?
    My heat question is desperate! Please answer as soon as you can.
    Thank you so much.

  • Ann Johnson

    I so understand your desperation, however I don’t have an answer for your question. My Dr. is David Turner in Columbia, TN at Core Physican he is wonderful! he will do extensive blood work on you and find your problems. I feel so much better, however I know it is me that has to make the first step to wellness. If possible give him a call.

  • Rossergrl

    I have been on thyroid meeds since Jan 2010 started on synthroid and based on blood work over the past several monkths have gone from 25mcg to 112mcg. I was switched to armor 11/2 grain and had a horrible time with muscle aches and pains and hair loss etc so i am baack on synthroid. I feel ok but know I can feel better is cytomel known to be mor effective alone with t4 vs a t4 t3 combination? My doctor is also checking to see if my adrenals may be the culprit as well. Thank you…

  • My thoughts on all of this–your thyroid makes T4 and T3 so if you are hypo why would you not need both? The trick is in how much to take of each which will take a long time. Be patient and experiment until you feel your best. I feel better than I have in 20 years with the T3 added to the T4. good luck to everyone but don’t give up and don’t feel bad for very long before going to the doctors and FORCING them to listen to you–don’t accept feeling bad.

  • Donna

    Does anyone know of a Dr. who will effectively treat thyroid problems and be willing to prescribe T3 in the central New York area? I live in Ithaca and am afraid that I will die of a heart attack from weight gain before someone finally gets it right. I’ve been playing with synthroid now for two years with my Dr. who will not prescribe Cytomel, and continue to gain, despite a healthy diet and 60 – 75 minutes of exercise five days a week. HELP!

  • To all: T3 is not just for weight loss!! Yes you will probally lose a few pounds after taking it for a few weeks but it will stop. You have to also eat right and you need some activity–try walking. The T3 for me made me feel alive and better than I had in 20 years when added to the T4 and I did lose about 15 pounds over two months but it slowed down and the ONLY way to keep it going was to walk 3-4 times a week. T3 is not for everybody but for the people on only T4 that is not working, this added to it could solve alot of your problems. The only side effect I have is the Whole body flushing but now I take the T3 in smaller doses 2 to 3 times a day and it is less severe. I take .125 of T4 and 20 mcg of T3 (10am, 5 lunch, 5 dinner) and it works.

    • Linda Skipper

      to Vicki Batzer,
      What endocrinologist do you go to in Los Angeles? I am looking for a new doctor who will prescribe T3 and they are hard to find. I live in L.A.

  • vicki batzer

    I just saw one of the top Endocrinologists in Los Angeles and he told me that my T3 was low and my T4 was high;. He is calling my pharmacy on Monday to put the RX in for this. I have been on replacement for over 30 years and literally starve myself and work out diligently, but plateaued at a certain weight. I have seen eleven endocrinologists. One of them told me I had adrenal hyperplasia, pituitary problems etc. This, now, is not the case. I have been on the wrong medication all of these years, meaning, not a complete program of replacement. T4 does NOT convert into T3. That’s a myth. I don’t know why people have to pay good money, wait in doctors waiting rooms for hours and get bad advice. On top of that, there is no dignity in being told that you are overeating and being lazy. One doctor said to me, when I was only l5, “look at you, you’re getting fat”. I had just had my thyroid out less than a year prior to that comment. Prior to that thyroidectomy I was average weight for my height. i recommend Molly Shannon’s book and website to everyone with thyroid issues. She is well informed and very helpful to all of us who suffer with this problem which effects virtually every aspect of our lives. Weight, skin, sexuality,
    depression, work life, social life, moodiness, ability to think clearly etc. For a little organ that looks like a butterfly, it packs a powerful punch when you do not have one or it is not functioning properly.

    • Linda Skipper

      Please tell me the name of the top L.A. endocrinologist as I am desperately looking for a new one and live in L.A. Thank you. Email: LINDAUTHR@AOL.COM.

  • Cate

    Cindy, did you start on 20 mcg of T3, or did you work up to it? Also, did you have any side effects at the beginning?

  • Cindy

    Cate, I think I started on 5mcg twice a day then went to 10mcg twice a day and then added 1 more 5mcg in the early evening for a total of 25mcg. then took 12.5 twice a day (broke the pill in half) then it was reduced to 20mcg. I take 10mcg first thing, 5mcg lunch and 5mcg early evening. this is in addition to the .125 of levothyroidixe I take first thing in the morning. I have been on the combo over 6 months and still feel great. The only side effect I have is the hot flushes from the t3 but I can live with that. It was a gradual increase every 4 weeks. My doctor also runs blood work to check my levels. Do you know what your thyroid levels are and I mean all of them? tsh, t3, t4 and free t3 and free t4? They all make a difference in how you feel. It is a time consuming job but feeling good at the end is the goal, Good luck and make sure you have a great doctor. I saw a primary care that is open but it took awhile for her to get on board!!!

  • Cate

    Hi Cate, thanks for your answer. I just got my first Cytomel script for 25. I will be dividing it 4 ways and building up to it like: 6.25 in the morning, 6.25 in the evening for a week and adding on until I go up to 25? My doctor just told me to divide it by half but from what I have read, I think it will be too much. I am on 75 of Synthroid. She will be testing next set of labs in 4-5 wks. My last labs were when I was on just Synthroid but that PCP wasn’t openminded to Cytomel or potentially Armour.

    Where are your ft3 and Ft4 now?

    Also, so you never had any kind of palpitations? And I don’t want you to think I think of Cytomel as a weight loss drug. But as someone who has been working with a nutritionist and a personal trainer for months with basically no results (he ended up saying get your thyroids checked. There is something wrong), I was curious to read from your old posts that you lost some weight initially. How quickly did that start and how much total?

    I am aware that I won’t lose all my weight this way, I just hope that Cytomel will “level” the playing field if you will so that my hard work will pay off (I work out2 hrs a day and am on 1500 cals a day). Thank you!

  • Cate

    Oops I meant thank you Cindy! The above post was for Cindy…not cate, myself! Typo…sorry.

  • Hi Cindy, I’ve try every hormone pill that my doctor could prescribe me and nothing went well. Actually the only thing that got me was some 10 kg on me. Although I have some hormone problems that affects my body, the pills doesn’t do their job.

  • Nataliy

    Dear Dr. Pepper,
    I have Hashimotos , and I am currently taking Erfa thyroid 3.5 grains/day.
    After taking it for about one year, my labs are looking great, but I still feel very tired, bloated, listless, sleepy, unmotivated and hungry all the time…
    I am thinking that Erfa just does not work for me, despite my good lab results..
    Reading on Cytomel, I see some good results , as far as how people feel on it…
    I would like to know if I can take Cytomel alone without any Erfa thyroid or Synthroid?
    I would sincerely appreciate your input on this issue,
    Thank you,
    Nataliy C.

  • Zafer B

    I have been feeling bad for the past 8 year always from morning till late afternoon or evening. I was put on many different anti-depressant medicine and non of them relieved my symptoms. 3 years ago i was diagnosed with hypo I have been on 50mg levoxyl for the past 2 years and i still have the same symptoms. From reading these posts I am going to give cytomel a try. Looks like many people benefit from the combo. If this works I will start a web page dedicated to this topic to help others. I also have elevated normal high cortisol which may also be playing a role.

  • Sarah

    I was diagnosed with hypothyroidism in my early twenties and Synthroid did not help. I did not know at the time that many of my symptoms were due to hypothyroidism. After changing to my long time physician, I told her of my original diagnosis some years back. She did only the TSH and told me I was no longer hypothyroid! So for some 15 years after being in her care and continuing to feel crummy, then for the last 8 steadily gaining weight and feeling worse, I was not on any medication. I begged her for Cytomel several years back and was denied…she said she didn’t treat with that. When I finally was deemed hypo by her, she put me on the smallest dose of levothyroxine. It did not help. I finally went to see a shrink and he put me on 25 mcg of Cytomel. For the first time in my post pubescent life, I feel like living. My dose was upped to 50, and I felt even better but my thyroid levels were off, so we are now working on that and I am back to 25 mcg per day. If you can’t get Cytomel from your regular physician, you might get a psychiatrist to prescribe it. It changed my life and I finally feel alive. I’ve since switched primary physician because she wouldn’t listen to me, and she didn’t like that I was on Cytomel. I don’t know what it is about this medication that regular physicians don’t like and make them refuse to treat with it, especially when so many can benefit from it. I’ve lost only 12 lbs since being on it, but I gained nearly 35 unnecessarily while not being properly treated and was told to eat less and exercise more…I only ate about 1500 calories a day and walked my dog 2 miles each day, so I don’t feel it had anything to do with my diet!

  • Faith

    I too have been fighting hypothyroidism for many years. Family doctors are pretty much clueless and Endo’s are an absolute joke! I have been on Synthroid, Levo (generic Synthroid), and the natural dessicated thyroid Armour which has both the T3 and T4 combined. I still haven’t found the right combination of either of them. However, I am a very determined person and during my many hours of online research trying to educate myself because I can’t seem to find a GOOD thyroid doctor, I came across a website called “Stop The Thyroid Madness” This website is awesome and the founder also has a book out that you can purchase as well. It really helped open my eyes to a lot of things including how low cortisol, B12, iron, and vitamin D can play a huge roll in how well you respond to your thyroid medications. To all of you out there keep fighting the fight, you know your body better then any so called “Specialist” does that you pay good money to see, but yet can’t seem to get any answers. Good Luck and God Bless…..

  • Mal

    I have been hypo since May 2010, rarely hits the Male, anyhow settled on 100mcg of Levothyroxine also 10mg Amitryptiline for crippling headaches. The pain can be so bad it effects the way I talk, so conversations can be a bit difficult, also I nearly faint when someone talks too much, it’s like my brain can’t process enough information anymore, wheather this is a contributory factor to being hypo is to be ascertained.

  • Thank you. I read everything and will pursue finding a doctor here in L.A. who would prescrive CI wrote an incorrect last name. It should be as in my last message…m a r t e l

  • Cindy

    Hi Dr Pepper,

    I’ve been treating with you for quite a few years now. I’ve recently gone through a difficult time and ended becoming hypo and having some frightening and uncomfortable symptoms. I’m getting back on track now, but recently came across a pretty interesting article that I thought I would share with you: http://www.mbschachter.com/hypothyroidism.htm

  • Lesley

    I have been trying to help my sister who has graves Disease find a Dr in Syracuse NY that will prescribe T3. From everything I read, It seems like it helps immensly.She is HYPO and having emotional problems and her current Dr is not helpful. HELP

  • kathy iftody

    I am 50 years old and have NHL (non-hodgkins Lymphoma) since 2006 and am not in remission but for the most part after months of chemo therapy i feel okay. However after i finished treatments for the second i developed Hasimoto’s disease and have gained 30 pounds. My height is 5 8 1/2 AND i use to be around 140-145. I am okay with the weight but would like to be a little less especially since i spin 3 times a week and eat very healthy. I also have lyphadema (where the lypnodes hold water)so i am battling 3 autoimmune diseases. My life is full and i am blessed, i have a wonderful supportive and loving husband, 2 wonderful teenage children and many fabulous friends. I am on Cytomel 25 MCG two times a day and feel good except for the weight, i sleep great, have lots of engery. My joints do not hurt any longer, my only concern would be the weight gain. I heard that if you mix taking cytomel with sythroid it can give you better result.

    • Dr. G. Pepper

      Are you taking Cytomel only? That seems like an unusual therapy since most people start on T4 (Synthroid, Levothyroxine) first to treat hypothyroidism then have Cytomel added to that, if their thyroid symptoms persist. Anyway, if you are on Cytomel only and want to add some T4 to your treatment, my thought is that Armour thyroid would be very convenient since it has both T3 and T4 in one tablet. This way instead of taking Synthroid and Cytomel separately you can get both hormones in one pill. Why not ask your doctor what they think about that solution?

      Good luck and keep us posted.

      (this is not medical therapy or advice. Only your own doctor can provide that.)

  • Suzi

    Hi Dr. Pepper,

    I was diagnosed hypothyroid 2 years ago and given levothyroxine. On diagnosis I had lots of symptoms and my BP was 175/115 despite my whole family having low BP. After some months on T4 I did feel an improvement in a lot of ways and my BP got better. Then after a year, things started going wrong, as if my body didn’t like T4.

    I tried reducing my dose of T4 back down to 75µg but went hypo. But each time I increased above 75µg my BP increased again, then on 112µg it became a serious problem, especially the diastolic. I still had fatigue, constipation, red eyes, swollen legs and so on.

    About 3 weeks ago I started on 10µg T3 and reduced my T4 from 112 to 75µg and pretty much immediately felt clearer headed and more energy, the constipation went etc….. My BP has gone down by an average of 20, which I know because I check it regularly myself. I’m doing a 24-hour BP monitor this week too, because my doctor put me on Amlopidine 6 weeks ago after being shocked by the monitor results from then while on 112µg T4 (only took Amlopidine for 2 weeks after terrible side-effects incl. overwhelming fatigue and massively swollen legs).

    So, it looks as though my body goes weird on T4 tablets when the dose is above 75µg, but if I stuck to that dose I’d be really hypothyroid. The T3 has changed my life completely!!

    Now I’m wondering what the ideal balance T4 / T3 tablets would be? Is that possible to say or does it depend on each individual body and genetics? My typical BP now is around 120/ 95; it goes down after eating, and gets worse when I’m hungry or tired. The T3 reduced my BP so much more than the Amlopidine did, and on T3 I feel great whereas on Amlopidine I felt half dead. I’d like to get my BP back to before I got hypo, so that’d be 110/70.

    All I need to do now is find my ideal dose of T4 and T3, could you possibly advise me on that? If I started 20µg T3 instead of 10µg, would you advise a reduction in T4 from 75µg? ( I’ll be doing a TSH, fT3 and fT4 test in about 5 weeks’ time, maybe I should wait till then?).

    Thank you so much!

  • Dr. G. Pepper

    Thanks for sharing your story with us. Some people hate it when I say this, but you are a fascinating case. I have never encountered anyone who had this type of beneficial BP response to T3. This type of individual response is what makes treating thyroid disease so challenging.

    In the past year or two new insights have been gained into the various ways people can metabolize thyroid hormone. According to researchers this can result in certain groups of people that need more T3 than what is considered normal. It is possible you are a “t3” requiring individual.

    As far as how much of t3 you need, it is a bit like trying to find the most comfortable shoe size. Each person has an ideal fit. The right amount of thyroid hormone and the ratio of t4 to t3 can be determined by adjusting the dosage, checking your levels and taking a careful history. Hopefully, you and your doctor can figure out the recipe that is best for you.

    Hope it works out!

    This information is for educational purposes only and is not intended as medical advise.

  • Suzi

    Hi Dr Pepper, Thanks for your interesting reply. All I can think of now is that the T4 was converting into something other than fT3 (maybe rT3?) and that was causing my high BP, so when I reduced the T4 from 112 down to 75µg the BP went down. The addition of the T3 made me feel so much better, and I really believe taking a small dose of that can be life changing, but maybe it wasn’t directly responsible for my improvement in BP. The metabolising differences between people you mentioned sounds fascinating, but it must make things incredibly complicated for doctors! I was talking to my osteopath yesterday who said her blood indicated she didn’t need any thyroid meds, but in fact she does, and takes 50µg T4 and 12.5µg T3 which she worked out according to how she felt – she’s now fine but before had all the typical hypothyroid symptoms. I wonder when tests will be developed that can see thyroid levels in the organs and cells rather than just the blood, because the blood tests don’t seem to work very well. Anyway, thanks again, and yes I think my doctor is good – I feel well looked after and even if it takes some more months I think I’ll find the right dose combination. Regards, Suzi

  • Kat

    Lesley in Syracuse: I am not in Syracuse, but in the Buffalo area and know of a fantastic doctor that may be able to help your sister. I know what it feels like to be desperate, so it may be worth the drive for her. Do a search for the Sedona Holistic Center. I am working with Dr. Ron S. who has me on Armour Thyroid and Cytomel. He is the first doctor that has been of any help to me. He takes his time to dig into a case, and is conservative with medicines, but will prescibe it if he feels it is appropriate. I wish you luck.

  • Elina

    Hi, I would like help finding a dr. in the Los Angeles area that is open to prescribing T3. Can anyone help me with this?

  • Mary

    Does anyone know a Dr. in the Cleveland, OH area who would consider prescribing Cytomel? Is there some risk to Cytomel? I don’t understand why an endocrinologist won’t entertain the idea that something else might be beneficial to a patient.

  • Lisa

    I have found this thread most interesting.
    I was diagnosed with Hypothyroidism in Dec 2010. My doctor prescribed Levoth, but I didn’t really notice a change. So, he put me on Cytomel, but only 5 mg. 2 times a day. I again didn’t notice any change and now am on 25 mg 2 times per day. It’s only been a week, so I’m waiting patiently as the weight was really the biggest problem for me.
    I gained 15 lbs in 5 months and couldn’t figure out why as I am extremely active and eat very healthily. I hope to post some amazing results as time goes on.

  • Vickie Craighead

    I have had my thyroid removed. I had Hashimotos a goiter and a suspicious biospy. That was two years ago and my doctor is still changing the level of Synthroid every time I visit.
    I am tired, depressed, have trouble sleeping, and have difficulty thinking, (i’m and accountant) I have tried to mention trying something else and my doctor will not speak with me about it. I would love to find a doctor who would treat me and not just the test scores. I am in Roanoke, Va. If anyone knows a doctor in my area who will listen to my symptoms and treat them. I would love to know. I know Synthroid is not giving me everything I need.

  • Jordan

    Mary, I have been dealing with hypothyroidism since i was 16 and a senior in high school. I have been to a dozen doctors that have told me that i am stressed and have taken blood from me. it actually took about 3 years for a doctor to even entertain the idea of a thyroid problem because i am so young. I went to a hormone type of doctor and she perscribed me t4 hormones from a compounding pharmacy. Her practice wasnt covered by insurance so my parents were paying 500 dollars 2x a month for a check up and 70 dollars every month for this hormone..which wasnt doing much for me. My mom began working as a paralegal at Metro hospital about a year ago and she has been doing a lot of research on the doctors there. I saw one doctor named Dr. Konn. He was good but i was not very hopeful that he would perscribe me anything. He ordered a thyroid unltrasound and some blood work and he did not seem very worried about it. I am now 21 so i have been learning about the signs and symptoms of my body for about 5 years now. My s/s have gotten so bad in the last 2 months to the point where i have gained 16 lbs, I am depressed, foggy, and tired ALL of the time which makes it very hard to work and go to nursing school. My mom did more research in the past week and found a dr named Dr. Kuentz(sp?), a colleague of my mom said she loved him. He is at the brooklyn branch of metro on Memphis right off of fulton. I went to see him for the first time today and i had to hold back my tears while i was begging for him to do something to help me-i have become overly frustrated/ exhausted with trying to find someone to listen to me. He prescribed me cytomel 10 mcg which i am picking up from drug mart tomorrow! let me know if you need any more info!

  • Hi, Im 24 and have had hypothyroid disease since I was 20. Other than having that I also suffer from twelve other conditions including, Intracranial hypertension, Fibromyalgia, Narcolepsy, CEBV, Sphincter of Oddi Dysfunction, CSF leak, and others. My whole life I had problems with fatigue, joint pains, and headaches. But, no doctor believed me. At 20, I went from 120lbs to 180lbs in less than 3 months. My neck swelled and I became very pale. I went to the doctor for the first time in over 3 years, I didnt want to go after all of the horrible times I had experienced before seeing doctors but did anyway. It was at 20 that I started being treated for Hypothyroid disease. It was at 20 that the domino effect of diagnosis after diagnosis has been taking place and still has yet to end. For the last two years I have spent most of my time in doctor offices, surgery rooms, and hospital beds. Even after finding the answers, (or atleast some of them), being on dozens of medications, having four surgeries, numerous procedures, and top notch docs, I have yet to feel even an ounce like I did four years ago. But, I came across this page, it gives me a small glimpse of hope that there is a possibility of maybe feeling that “ounce” better. I just want that small chance, that small possibility of maybe feeling somewhat “normal” again. I just want a glimmer of hope, and reading all these posts do that for me.

  • Also, forgot to add… My thyroid levels are normal when Im on the meds. But I know that something is up because I had nodules a year ago. I understand that I have a lot of other health conditions that cause my symptoms. But, I truly feel my thyroid is a huge part of my problems. I wish my endo could see this too. Reading all these posts do help me a lot to push further on this issue. Thank you Dr. Pepper for posting this site and information.

  • Michelle

    OMG! Maybe I’m not crazy after all!
    I’m 47 in December and can’t remember the last time I felt good or even okay. Same thing – doctors repeating same tests, thinking I’m exaggerating, sent to Psychiatrist…Over the past 6 years or so, major stress, low immune (sick all the time), worsening depression, borderline diabetes, high blood pressure, peri-menopause. Got to the point that I’m sooo exhausted. Don’t want to do anything. Lab diagnosis finally showed up hypothyroidism so doctor put me on Synthroid – I was so happy that I cried. Devastation set in after 6 months as this was not the miracle I thought it would be.

    Started taking my temperature 3 to 4 x a day as suggested to me by a naturopath I had seen but couldn’t afford to keep going to. Again, measurements taken 3 x daily for a week averaged to 97.0. Talked to doctor about Wilson’s Temperature Syndrome; she did not believe in it and sent me for more blood tests which came back normal.

    FINALLY (after 20 years at same doctor’s office) was lucky enough to be accepted under the care of a physician who hadn’t heard of WTS but had heard about the T4 not converting into the T3 (you all know the fault in the system)… so right then and there wrote me a prescription for Cytomel and told me to stop the synthroid. As the WTS website recommends sustained T3, I’m taking half the dose every 12 hours.

    I started today and feel like a kid on Christmas Eve a million times over! I am so hopeful that this can get to the root of so many ailments. So many that I feel that I’m not even living my life, that I’m just here putting in everything I have just to get through the day.

    With the lack of memory and concentration I have right now, I hope I remember to come back to this site and update you all!

  • Has anyone else had cardiac problems with cymotel? Racing, pounding heart, trouble breathing? Only on 5 mcg. Scared to move up. Also on prednsisone. Copuld that be causeing the problem Help. Have heart stents and lung issues. Trying to fugre out if its cymotl or prednisone causing these issues. Any advice would help me know what to do. Almosat anyone should be able to take cymotel. Donan

  • Julie

    For those who cannot find a doctor who will prescribe Cytomel/T3, I finally found one by calling a nearby Compounding Pharmacy and asking for names of doctors who prescribe it. I went to visit her earlier this week, and this morning, I took my first dose of T3 after years of just taking Synthroid/Levothyroxine. I am so excited and optimistic – hope I feel better soon! Just look online or in your phone book for a compounding pharmacy, and then go from there. Good luck!

  • Shannon

    does anyone have the name of a doctor who will consider cytomel combo therapy for me in the South Jersey or Bucks County, Pennsylvania area? I have been suffering with joint pain & fogginess terribly since my 1st pregnancy which started up a hypothyroid issue that hasn’t resolved itself. My stomach is so bloated and I have increasing weight gain. NO workouts will help and 3 failed diets so far. I’m echausted, frustrated & embarrassed to be seen this way. Its not ‘me’. I am currently taking 50 mcg per day of levothyroxine. Any names of good docs would be wonderful.

  • Fr. JC Maximilian

    Is there a way of finding a doctor who might be willing to prescribe Cytomel in NJ (especially the Barnegat or Trenton area). I had my thyroid removed due to cancer 7 years ago. I have been on 250mcg of Synthroid since. I put on over a 100 lbs since having my thyroid removed — 60 in the first year. I asked my endocrinologist and he will not consider it, says that my blood tests are good. I still also have fatigue.

  • Leslie Denoff-Sanders

    My name is Leslie, and I am an American lady living in London, England. First, I want to thank you, Dr. P, for Metabolic.com, and the thread here. I apologize in advance for the verbosity and length of this post, yet I believe all my own experiences may benefit or help someone else. I was brought up in Beverly Hills, Calif, and when I was around 20, I had been dx with a Goiter. I was lucky in that my endocrinologist sent me to a Dr. Edwin Peter Gabor, an Oncologist/Endocrinologist, due to lympadenopathy. I had a FNA, which was sent to Davis, and the Pathologists were split. Half saw atypical cells, and half did not. Because at that time I was asymptomatic, except for swelling at the Goiter site, and the lymphadenopathy, Dr. Gabor decided to do a biopsy of a Rt. Axillary lymph node, which was normal. That was in 1981. I was put on Synthroid, to try to shrink the Goiter, but it made me toxic, as my labs had been normal. Thus, it was basically forgotten for many years, as I didn’t experience any problems. Bear with me, as the next bit IS germain! In ’76, I’d fractured my C6 vertebrae in a car accident, and was put on 100 mg Demerol IM for the year that I spent in Cedar Sinai Hospital. As a result, I became addicted, and remained on Percocet until 1984, when I got clean and sober. (never did drink alcohol) In ’85 I went back to school to become a doctor. I got my pre-med BSSci, but ended up in Law School instead in ’92. In ’95, I moved here to England. I was 10 yrs clean. I had moved here because my fianceé was British, and a lot of other reasons. Within a year, my health began to decline, and I felt tired and in pain all the time. My G.P here would not listen to me, due to my prior history of opiate addiction, and by the 2nd year here, I was feeling awful. I relapsed in ’97, and the opiates I took were the only way I was able to function with the pain and exhaustion, however, emotionally, I was miserable, as I adored sobriety. I began a search for a doctor who would listen to me, and take the symptoms seriously, and detox me from the opiates. Cut a VERY long story shorter, in 2010, in Oct, I was sent to an endocrinologist who discovered that I was so Thyrotoxic, that he had never seen lab values as high, which were, at the time, 43. He also felt that the Goiter had grown considerably. He put me on 20 mg of Carbimazole, and in Dec 2010, I developed Neutropenia Sepsis, which was nearly fatal. Before I was discharged from the hospital, it was decided that because I now had medically intractable Thyrotoxicosis, I would undergo a Subtotal Thyroidectomy 6 wks from then. In Feb 2011, I had the surgery, despite concerns over thyroid storm during surgery. The op went well, and I went home 4 days post op. I began losing my hair almost immediately. My hair has always been waist length, straight, healthy and, my pride and joy. I was beside myself with shock and grief, but aside from that, I felt better than I had in years. After 40 % of my hair falling out within 2 wks post-op, I was put on 25 mg of Levothyroxine. It slowed the hair falling out, but my levels on labs showed that I was still quite Hypothyroid. I was advised to increase to 50mg, yet every time I did so, I felt toxic. CONTINUED ON PAGE 2.

  • Leslie Denoff-Sanders

    PAGE 2. By March, I began to feel really terrible. Oh, I was also put on Adecal D, a calcium replacement. Having detoxed from the opiates while in the hospital in Dec, I was now happily 3 months clean and sober again, and starting to think about wanting to pick up my life again, and I desperately wanted to return, yet again, to school, and finish my Medical School path, and gain my M.D. However, I was feeling physically awful, total fatigue, awful hot flashes with huge amounts of sweating. These flashes made me feel sick all over, like I was unable to stand or move. They lasted about 10 mins, and occured 4 or 5 times a day. I noticed by June, that my mental accuity was decreasing, and I was unable to remember simple words when I needed them. Words that I’d known since my pre-med days, and some, even more basic. This development made me really concerned, and that, along with the now almost totally disabling exhaustion, had me at a real point of dispair. I was unable to increase my dosage of Levothyroxine, and did not have any ideas of how I would ever function in Med School, or in fact, daily life. By chance, a week ago, my husband saw a t.v program about a young girl who suffers from Stevens-Kline Syndrome, and her consultant had put her on Cytomel. My husband pointed out to me that many of the symptoms this girl had, were similar to mine, and, that Cytomel was, in fact, a T3 replacement drug. I typed Cytomel into Google, and again, by chance, (nothing is, in my opinion!) Dr. Pepper’s name, along with the Metabolic.com site, came up. I had an appointment with my surgeon last Wednesday, and told him how I felt, and showed him the info on Cytomel on Google, along with Dr. P’s info. He gave me an Rx for Liothyronine, 10mcg, as Cytomel itself is not used in the U.K. So, I began to take the Liothyronine on Friday, just 3 days ago, along with my Levothyrox. I have no way to know if it is simply the idea that the Liothyronine can make a big difference, but within 3 hours, I felt an improvement in the crippling tiredness. I spent the entire night, until 10 a.m the next morning, cleaning my house! I hope that this drug really CAN change things for the better. I am coming close to a year of sobriety, and am wishing to start school in September, and go forward in my life. I plan to move back to Beverly Hills after I finish my Medical degree, and I pray that this drug can assist me in regaining my life. For anyone in the L.A area, Dr. Paul Rudnick, my original endocrinologist, may still be in practice, and is worth a call. Dr. Gabor, I believe, is semi retired, but may still consult. He’s also in Beverly Hills, and is great. Anyone in the U.K, my surgeon is Mr. Thomas, at St. Helier Hospital, Rose Hill, Surrey. He is absolutely amazing, both as a surgeon, and as a human being. He listens. Please, do NOT give up. You MUST be assertive in your contact with physicians, but also proactive in your own care. Finally, thank you again, Dr. Barry Pepper. I would not have had the info I required, had it not been for this site, and all your hard work. I will let you know how it goes. God Bless. LDS

  • Leslie Denoff-Sanders

    Sorry about the multiple posts. I forgot to mention that since the surgery in Feb, I have gained around 10 lbs. Because I had been so Thyrotoxic, I was about 5 lbs underweight pre op. My weight has never been an issue, and since high school, I’ve been exactly the same weight, which is 105, and for 5’7, I’ve been happy with that. However, I now have gained the extra 5 or so pounds, over what I’d wanted to gain post op, and I only eat about 900 cal per day. That’s an estimate, but i’ve been Vegan for 25 yrs, and have a good idea of food values. The extra weight, while not a huge amount, is quite uncomfortable, and looks awful on me. I’m hoping it will go, once my metabolism is at a proper level. I would, however, warn against anyone viewing Liothyronine as a weight loss drug, per se. I evaluate my weight gain within the totality of my hypothyroid symptomology. Good luck to everyone. Thank you for being patient with my story. LDS

  • Leslie Denoff-Sanders

    My apologies to Dr. Pepper. I mistakenly wrote your first name as Barry. Perfect example, though, of the memory issue. Sorry about that. I do know that it is ‘G’ Pepper. Thanks! L

  • Carey

    Buckle up, this is gonna be a long ride… 7 yrs ago I had pre eclampsia while pregnant. About 6 months after I had my son, I started having anxiety and panic attacks. These have worsened through the years and major depression and panic attacks have become an issue. I had been feeling so tired and just “bad” for so long, I didn’t even realize how bad I felt. 3 yrs ago I had a lot of blood tests done and found out I had hypothyroidism. That explained a lot. I was immediately put on levothyroxine and felt GREAT 2 wks later. However after those 2 wks, I began to feel bad again. My doc told me I needed an antidepressant. Needless to say, nothing helped. 2 yrs ago I switched docs. She put me on synthroid brand at 25 mcg. Had some minor improvements in numbers but symptoms didn’t improve. I also developed palpitations. Went to an endo who told me just to take the synthroid and quit whining. I never went back. I have talked to my GP regularly about all of my issues (forunately I see her often, as I am her nurse) and have tried several SSRIs with no improvement. I am desperate for help, so I search for answers almost daily. Last night I read about cytomel and approached my GP about it as my symptoms, depression and weight gain are substantial. She is leary about the cytomel, but open-minded and drew some new labs including t3 and b12 for the first time. I am waiting impatiently for results and wondering…will my t3 level be such to warrant taking cytomel? Can I try it with normal t3 level? I really feel like this is my last hope. I can’t stand feeling like this anymore and I can’t stand watching my family suffer because of my issues. Can this medication work for me???

  • Zach

    Hi everyone. From what I can gather, most posters here are women, well I’m a guy with similar problems. I thought my story might be useful so that men don’t think it’s a women only problem. I gained a hypothyroid diagnosis at the age of 25 due to Hashimodo’s. There was no direct cause, it runs heavily in my family. For a year, or two, maybe even three (it’s hard to tell due to widespread symptoms), I was feeling nervous, bad memory, attention problems, sleep problems, low appetite, and easily fatigued from a normal 8 hour work day. I assumed my lifestyle choices were causing these symptoms so didn’t go to the doctor for years.

    Finally when I was diagnosed I was put on levothyroxine. The very first day I took it I felt IMMENSLY better. However, months down the road the symptoms gradually built up again. Every time my dose was raised, I would feel better for about 2 days, but the symptoms would gradually return. My endo decided to drop my T4 dosage and put me on a combo T4/T3 (T4 was dropped by 50 mcg and one quarter of the drop was added in as T3, so 12.5 mcg of T3). This is the first day I’ve tried it, and instantly the morning of starting on T4/T3 my body aches have almost disappeared and I am feeling much less sleepy at my desk during work.

  • Donna

    Dr Pepper,

    I was diagnosed with Hashimotos 5 years ago. I’m a patient in your office and previously my old dr had me on 75mg of the compounding T3 only. I moved and had to leave her so then when I came there a year ago the dr put me on .075mcg Synthroid (T4) and 5mg of Cytomel. Since then my weight has gone up 20 lbs in one year and I feel terrible. I was just in and am concerned as there was no adjustment even after the bloodwork shows my T3 was way below range, I think it was like .04. I found this page and started reading only to find it is part of your practice. I am concerned as if I was on 75mg of T3 why would I would I be put on Synthroid when I was never on T4 and have a huge reduction of the T3 to what is almost like nothing to my body?

    • Dr. G. Pepper

      Hi Donna

      Thanks for your question. I would not want to try to second guess what your doctor is trying to do but I can add a few comments here. I think you were on 75 mcg (Note: microgram, not milligram. A milligram is 1000 times more than a milligram and T3 is given in micrograms). It is somewhat unusual to be on T3 treatment only since T3 is cleared from the blood in hours while it takes days to clear T4, meaning that T3 when used alone it usually is given twice or three times a day. That is probably why your doctor added T4. If you don’t feel like you think you should on the new combination you should let your doctor know. Maybe he or she will make your Cytomel (t3) dose twice a day. Armour thyroid would be another solution. I’m sure your doctor will be willing to help.

      Gary Pepper, M.D.

  • Mel

    I had a partial thyroidectomy in September 2010 for a suspicious thyroid nodule. Turned out to be non-cancerous, thank goodness. The pathology did mention Hashimoto’s Thyroiditis. Shortly after the surgery, in January 2011 I started to have some fatigue and my TSH was drawn. It was 4.99. My doctor put me on 50 mcg of Levothyroxine. Within 2 weeks of taking the medication, I was in the emergency room with shortness of breath, chest pain, anxiety, nausea, hot flashes and dizziness. I was taken off the medication and my thyroid levels were checked every three months and continued to be in the “normal” range. I felt pretty normal without being on any medication until the beginning of this month (August 2011). I started to have tingling of my extremities and of my lips off and on. The tingling feeling would move around, sometimes on the left side of my body and sometimes only on the right or just in my lips. I went back to my family doctor and she ran my thyroid labs as well as Vitamin B12 levels. My Vitamin B12 was normal, my T3 total was 88 and my T4 Free was .99 but my TSH was 8.45. It was just normal two months ago when it was drawn, so I was pretty surprised to see the rise in levels that quickly. I was really reluctant to try the Levothyroxine again due to my issues I had had with it earlier in the year, but my doctor thought I’d be okay this time. I went ahead and started it August 17th. We started out with half a tablet this time, thinking this would help. So, my dose was 25 mcg. By August 26th, I was having the heart palpitations, nausea, anxiety to the point that I couldn’t even function. The tingling in my extremities went away within the first day of taking the Levothyroxine, but that was the only benefit I had experienced. My doctor had me stop the medicine again (only was able to take it 10 days this time). I had some Ativan that was given to me from the last time I was in the emergency room from back in January. I never needed to use it because I’m normally not an anxious person. I had just stored it in the medicine cabinet. Good thing I did, otherwise I would have had to go to the emergency room again. I have had to take Ativan for the last 4 days to help to counteract with the medicine that is still in my system. I lead a very busy life with working full time and taking care of two young children by myself because my husband is out working most evenings. I feel completely helpless at this point. What are my options? I have only tried Levothyroxine because that is the only medication that my family doctor usually prescribes. She said it has the least amount of side effects and mostly anyone can take it. I guess I’m one of the few that can’t, right? I am awaiting a referral to an endocrinologist, but I want to go to my appointment with some knowledge and most importantly, hope! I feel like this has taken up my entire life. I’m supposed to be enjoying my kids and going out and having fun like other 32 year old people, but it is impossible when I’m feeling like this. If I definitely need to be medicated for thyroid, I just hope I can find something that doesn’t make me feel like I’m going to have a panic/heart attack!!! Anyone have any advice? Do you think Cytomel could help me?

  • vcraighead

    I need to find an endocrinologist who will prescribe Cytomel. I had my thyroid removed and I have felt depressed, fatigued, can’t lose weight and I have trouble concentrating. My doctor would not discuss anything but synthroid. I spoke with his assistant at my last visit and explained that I was having trouble concentrating and getting my office work done. (I am an accountant). She asked if I had ever gone anywhere and then couldn’t remember how to get home. No, I do not have Alzimeirs or dementia. I have not felt like ME since I had my thyroid removed.

  • Jill

    Hi, I just have some comments…I had my thyroid removed 17 years ago….I was 40 years old when that happen…I never weighed more than 115lbs all my life..Within one month after the removal of my thyroid I gained nearly 30 pounds in that one month…I only weighed around 100lbs right before because I had Graves Disease…I then gradually gained about 10 or 15 more pounds…I’ve somewhat maintained that all these years with a gradual gain of maybe 10 or 15 more pounds through the years…Mainly the last 3 years has the last pounds come on…The only thing I’ve ever been on was .112 mcg of Synthroid or Levothyroxine…I’ve never been able to budge a pound unless I just starved…I’m not an over eater, and I eat healthy…I work out with an ab workout, cardio, walking or pilates…I’ve always said I’d like to weigh more like 130lbs and I’d be just right for my age…I’m 55…Recently I’ve been having throat problems….I was sent to an ENT for that…He of course ran allergie tests, but also he did a T3 and T4 which most Md’s as we know only ever do the TSH…I had recently had my yearly heath check up with my Md and of course the TSH was normal…Well I learned something new from the ENT…He explained to me that you can have hypo problems when the TSH is normal but your T3 is low or even on the low side of normal…He also told me that some people after their thyroid has been removed don’t do the conversion of the T4 to T3 very well….He felt like if I had a boost with my T3 (it was low) it would help with my weight and energy…It was kind of funny because this to me was all accidental finding I didn’t expect an ENT to know so much about the thyroid, although hypo thyroid can also cause us to have raspiness in our throat and cause cold like symptoms and other things…He was covering all bases…He didn’t talk about the Cytomel but he did put me on Armour…He said it was T3/T4…I’ve only taken it now for about 4 days, so we’ll see….He’s the first doctor other than an Endo that really knew what he was talking about and really listened….

  • Kristi

    How come after I do the research no drwants to add a T3 to my medication????? I have been on thyroid meds for 10 years and im 35. I had radiactive iodine and still had to have my thyroid removed. I had a gastric bypass 6 years ago and I exercise all of the time. You would think I wouldnt have to worry about weight. I am cosntanly tired, been fighting hoarseness, contsitpation and muscle fatigue and no one listens to me. I know my body!!! My dr increased my level fromm 200mcg to 250mcg 3 weeks ago and I still feel like crap. How can I go about getting some help before I am severely overweight again or so damn tired I drag in the dirt.

  • Stacy

    Kristi- keep looking for a dr, that will prescribe cytomel- ask the secretary when calling to make an appointment. Thats what I did. My appointment is October 11th, and I am keeping my fingers and toes crossed that this dr. will listen to my symptoms and give cytomel a chance. I was taking cytomel .5 mcg and synthroid 50 mcg. for 2 months but that dr. passed away-and my new dr. does not believe in using cytomel with synthroid. I just kept searching for endos until I heard them say “Yes” to using cytomel. I know EXACTLY how you feel- the weight issue is BEYOND frustrating. I gained 65 pounds in the past year and a half. I weighed 125 to 130 my whole life ( I am 48) and this weight gain has turned me into a recluse- I do not like to be seen in public this way! I am praying that cytomel will be the answer that I have been looking for- I am NOT looking for a “free ride” as far as weight loss is concerned- I just want to be on fair playing ground with the same metabolism as a “normal” person without hypothyroidism. I wish you the best of luck.

  • Kirsten

    Does anyone know of a doctor in Minnesota that will prescribe Cytomel and is a excellent reference overall for the treatment of hypothryoid? I need to find a doctor who treats me like an individual taking into account my symptoms. I have had hypothyroid since 2001 and have been on Snythroid. I’ve never felt like my “normal self” I’ve gathered my medical records and have put together my own comprehensive view of my health to show a doctor who is willing to listen. Its disappointing that I have felt rushed by doctors and lumped into the average thyroid treatment. I’m going to push ahead until i find a doctor who will take the time to care for ME. Come on isn’t that why they went into medicine?! To care for the individual..ugh its so frustrating.

  • Lisa

    I am going through all of the same problems as all of you, simply cannot convince my doctors to give me Cytomel. I am going to order it out of country, Canada, and try it without my Doctor. Anything is better than feeling like crap.

  • Dana M.

    I was diagnosed as hypo a few years ago and my doctor just added 25 mcg of liothyronine (Cytomel) along with 100 mcg of Synthroid. In the past year I have gained 35+ pounds and it’s been alomost impossible to take it off. Last year I competed in my very first fitness/ figure competion. At 135lbs I came in 2nd place. I play softball and basketball on competitve level teams for the psat 15 years and I run about 3-4 times a week. I eat relatively healthy and have recent gone gluten-free, soy free, and nitrate free. Today is my very first day on the combined T3/T4 thereapy. I steppeed on my scale and it said 174lbs. Im hopeful that not only my weight will decrease but my hair will stopp shedding, dry skin/ scalp, joint pain, hopelessness and depression, and fatigue will all go away. I know patience is the key so I will be patient and wait.

  • Dr. G. Pepper

    Hi Dana

    As you read here, some people are unable to return to normal thyroid equilibrium on t4-treatment alone; this may be due to an inherited form of enzyme defect preventing the normal conversion of the t4 hormone into the more potent t3 hormone; I am happy you found a doctor who will prescribe T3. Sometimes this needs to be given twice daily since t3 is a short acting hormone and the benefit may wear off within 6 to 8 hours. Some people don’t notice this while others definately do.
    Good luck with your treatment. Also remember, thyroid hormone allows you to lose weight normally but doesn’t make weight “melt off”. You still have to do the right things with diet and exercise but at least your efforts should start paying off.
    Good luck.

    Gary Pepper, M.D.
    Editor-in-chief, metabolism.com

  • katherine walker

    My Doctor Prescribed T3 today….(Cytomel). He said to take 5 mg 1x per day. He did not reduce my Synthroid, which is 100MCG. I feel like he should have reduced my Synthroid to 75 or 88 mcg and given me 10 mg Cytomel 2x per day instead. I dont know about how I feel about taking the Cytomel without having a lowered T4 dose, because I had serious hair breakage on the Synthroid and I have heard that taking Cytomel, has the same side-effect, if your thyroid is thrown out of balance. I cannot risk any more hair loss. Hmmm. NOt sure what I should do here….Dr. G can you give me some advice? Thank you!! 🙂 Cheers, KW

  • katherine walker

    PS – My weight is fine.

    My October 9th labs were FT3 (2.5), FT4 (1.57), TSH (1.36)
    My November 2nd labs were FT3 (3.0), FT4 (1.67), TSH (.826)

    …..Do you think 5 mg of Cytomel is enough? Shouldn’t I lower my Synthroid? I know that adding T3 Cytomel makes your TSH go down anyways. I want my FT4 in the mid-range and my FT3 in the mid-to-high range, correct?


  • katherine walker

    Dana – You are still hypo. What are your tests showing….You must be, because that combo would not have you having those side effects. Your Free T3 should be mid-range to high mid-range and your Free T4 should be mid-range and your TSH should be around .5 to 2.0, but it’s how you feel, mostly. Sounds like you need a new doctor!!!

  • Sophia

    Hi Dr. Pepper, I was told I was hypothyroid in 2008. The Doctor I went to back then said it wasn’t serious, so I didn’t take it seriously. This year, in January, I started gaining a pound almost everyday and had trouble breathing. I went to a weight loss clinic. They told me I was hypothyroid and put me on Cytomel. I was afraid to take it because I heard that it supresses the Thyroid. After researching it, I recognized symptoms of hypothyroid that I had back in the late 90s such as hair loss and body aches. I started taking the Cytomel after reading that. After taking it for a while, the lab only offered the generic version and that was crap, so I went to a homepathic doctor. He told me my hypothyroid could be stress related since my dad died in December. He put me on the dessicated thyroid, but it wasn’t as good as the Cytomel. I started having the breathing problems again going up the stairs. I went to a new doctor last week, and he told me that Cytomel was crap and he wants me to take Synthroid instead. Now, I’m very confused. What should I be taking, and how can I find a doctor that will prescribe Cytomel, and what pharmacies carry the real Cytomel? I want to know if the Cytomel is really crap. I read that T3 works well for Perimenopausal women. I’ve started running and eating properly. I was 212 pounds; now I’m 193. I still want to lose more weight. I live in Fort Lauderdale and don’t mind driving to Boyton Beach.

  • katherine walker

    Sophia – Most old-school medical trained doctors usually treat patients with Synthroid (T4) only, by checking your TSH level alone. Some endos do not even look at your Free T3 and Free T4 values in determining the right medication to prescribe. THey just look at the TSH and give you Synthroid T4 and watch your TSH level to see if it improves. This practice has changed in recent years, however, because doctors are realizing the benefits and need for SOME patients to have T3 as well as T4. It depends on the individual and a lot of it is also based on how you feel, as to whether or not a doctor should prescribe T4 alone or a T3/T4 combo. It is very strange to ONLY be prescribed T3, from everything I have read in various books, etc. over the years. I may be wrong, but I have never heard that T3 alone is common.

    Some doctors will prescribe the dissecated (porcine) Armour, which you also took, which is a combo of T3 and T4. If you took that, and it did not help, trying T4 alone (Synthroid) might be a good option for you.

    I have been taking 100mcg of T4 (Synthroid) for over a year, but still have some hypothyroid symptoms, and my T3 should be higher (it’s in the very low end of the range), so I am going to add a little bit of T3 (Cytomel) to my prescription, so I have enough T3 and T4. Some people don’t convert T4 to T3 as well (hence, their need for T3 as well as T4).

    Maybe you are one of those people who only needs T4, and Synthroid will be the best option for you. You really just have to try to see what makes you feel better..sometimes adjusting the dosage, too, ever so slightly, can be the answer.

    Like I said before, I am surprised someone prescribed T3 (Cytomel) alone…That’s is definitely NOT the norm. Also, if you are on the right dose and medication, you should lose weight and it should not be a struggle. Once you get on the right dose, and your TSH, Free T4 and Free T3 are all at good levels (FT4 should be mid-range, FT3 should be mid-range or slightly higher, and FSH should be between .5 and 2)….Of course these ranges are not what you see on the bloodwork results, so you cannot really go by that. Ask most endocrinologists, and they will agree.

    If your levels are good, and you are STILL gaining weight, then it might be something else that is wrong….I’ve read that Cushings Disease may be a culprit if you are gaining weight on thyroid meds, but your levels are still off.

  • katherine walker

    Dr. Pepper: I forgot to ask you…..I am on 100 MCG of Synthroid and my hair has been breaking and brittle from the Synthroid in recent months (and I’m always cold, poor memory, etc). My current TSH is .85, so I am good there….my FT3 is 2.3 and my FT4 is 1.67….I want to get my FT3 up and am going to add some Cytomel to my prescription. My current dr. is very old school, but he will let me add whatever (within reason), becuase he believes it’s all about how you feel. I am VERY Worried about hair breakage if I add the wrong dose of the T3 Cytomel. I was going to start with 5 mcg 1x per day and work up to 10 mcg, but shouldn’t I be REDUCING the dosage amt of the Synthroid, as well, when I add the Cytomel, even if it is only 5 mcg? I know there is a formula, and various dr’s have different “formulas”….Generally I think I should reduce the Synthroid to about 75 mcg and add the 5 mcg Cytomel and increase it slowly to 10 mcg over a month. Would you agree?? How do you determine the right ratio for patients of T3 and T4?? Thanks! 🙂 -Katherine

  • Sophia

    Thanks, Katherine. I will try it.

  • Pat

    November 11, 2011

    Help! Please refer me to an endocrinologist in a surrounding area of Morris County, NJ. I am desperate to find someone who can treat me with T4/T3. I cannot take Armor because of side effects even though it helped raise my T3 to normal. My T3 is low and I have depression, night sweats, hair thinning, etc. My primary doctor agreed to give me T3 but really has no knowledge about dosage, etc. He gave me 25 mcg which I know is too high. I was going to cut it into quarters and start with it once a day. I am on Synthroid 25mcg. Please help me!!! Thank you.

  • Cindy

    Pat, don’t think 25mcg is too much–remember it does not stay in the body and works best if taken in smaller amounts–I take 10mcg in am, 10 at lunch and 5 at dinner–works for me (get your doctor to do 5mcg tablets–they do not cut good–they fall apart). Started this a year ago and still feel great. My levothyroixine was lowered from .137 to .125 after a few months but just know it takes time to adjust both medicines to get to the correct levels to feel your best ,not just what comes out on the reports from bloodwork. It has taken awhile but my doctor now is on board and will adjust based on how I feel. Some levels I need to be at the “lower” end and some at the “higher” end. It took a long time to get it right.

  • Cindy

    Also to all and this is just what I experienced: When you start to take Cytomel T3, your T4 medicine should not be reduced right away–This is not a instant fix–it takes time–and please note–IT DOES NOT WORK FOR EVERYBODY!! Yes, it is worth a try but it takes a long time, patience, and MONEY (doctors office visits, prescriptions, gas, etc) to get to the right combo. I started off on 5 mcg a day for about a week, added 5 more a day the next week, and so on until I got to 25 mcg a day. I was tested at 4 weeks with no reduction in my T4 medicine. After results came back I was lowered on the T4 and went back after another month. Added 5 more T3 and kept the T4 the same and went back after another month. 5-6 months later, we had it where I felt the best and a year later it’s still the same. Just went for a 6 month check up–will let you know if any changes but I don’t expect any. GO WITH HOW YOU FEEL NOT HOW MUCH OF EACH IS GIVEN–Bloodwork levels are a tool and have a range–you will need to play in the ranges–I need to be on the upper end on some and the lower on some.

  • Pat

    I got my primary doctor to rx 5mcg of Cytomel. Today I took one in the am with 25mcg of Synthroid. I need to know when to increase it to 10mcg daily. I still can’t find an endo on board with this I live in NJ. Can anyone help! thanks!

    • Dr. G. Pepper

      Hi Pat;

      The adjustment of your thyroid hormone requires skill and knowledge. Unfortunately there is no cook book approach to adjusting thyroid meds (or most prescription meds). An experienced physician will not only want to see how your thyroid hormone levels change but how your symptoms and physical exam (for example your pulse rate) change with medication adjustment. The ratio of T4 to T3 needs to be individualized as does the absolute amounts of these medications. It is good that you seem to be on the right path to getting adequate treatment for your underactive thyroid, but I am hoping you can find an endocrinologist in NJ who has the expertise you need. Wish I had a specific name for you.

      By the way, my ebook Metabolism.com will be available in a few weeks on this site and I have a chapter on this type of problem.

      Good luck.

      Dr. G. Pepper

  • Teresa

    I am interested in weight loss. I have cancer. And had surgery on the 9th of September of this year. 2011. I feel like such a cow right now. I was always a little overweight. But NOTHING like this. I gained 30 lbs in the last 2 yrs. Scary. And now? I am huge. And terrifed of gaining more weight. I have to go for teh RAI in January 2012. As of today I was told to go off synthroid..and to be begin the cytomel protocol for the Radioactive Idodine Pill. I am praying this will help me lose this weight…i know things will get worse before they get better. But I am wondering..is it
    possible to lose weight…on JUST cytomel??? Since Septemeber..i have been feeling great. I have so far..not gained any weight..or lost any on just the synthroid. (But then again…i haven’t tried). Overwhelming ot get a Cancer Diagnosis.
    But I am hopeful..things will be okay. I just need to know all i can..about Cytomel.

    Thanks and Good Luck to all,


  • Erin

    Hi, I need some advice on being borderline hypothyroid. I am a 26 year old female. As a teenager and young adult, I have suffered from bouts of anxiety and depression. I tried many anti-depressants, which never really worked…they just kept the panic attacks away. About 2 years ago, my hair started falling out (mostly from the front and sides) and my doctor could not figure out why. A dermatologist could not figure out why either…but at that time I was taking topamax (i had migraines everyday for a month and was put on that) and I felt fine until several months after starting the medicine, my hair started falling out for the first time ever and I got horrible acne all over my face. I had to take myself off the medicine and the acne eventually got better, but ever since I have had problems with my hair. In January 2001, I was diagnosed with subclinical hypothyroidism. I went to another doctor for a 2nd opinion and he put me on 50mcg generic levothyroxine. I started to feel better within a week or 2 and my hair loss stopped. However, I started to experience hyper symptoms a few months later– upset stomach, anxiety, feeling hot, etc. and I had to take myself off the medicine because my doctor was out of work for several months due to illness and none of his fill-ins would listen to me. They kept telling me that I had IBS!!! When my doctor came back, he said I could try Armour thyroid. The first day, my face felt warm. The second day, I was in panic mode and could not eat anything, my stomach was upset, I had awful heartburn, and that night I was so scared to fall asleep that I tried to stay awake all night. It felt like my body was on fire…but I had chills at the same time. The next morning, day 3, I threw up after I took the medicine. I also had the worst panic attack ever later that afternoon…with heaviness in the chest and my throat tightened up. Needless to say, I stopped taking it and told my doctor what happened. I had to double my dose of klonopin to get calmed down. I went to see an endocrinologist and I made the mistake of telling her I have anxiety. Everything I said after that went right over her head. She said she didn’t know why I was there because I didn’t have the hypothyroid symptoms, and that she “doesn’t deal with psychological conditions”, that there was no medical reason for my levels to be perfect, and that she would not treat me if my TSH did not go above 10. I got no help from her, just an expensive bill for labwork, and a letter from her that said she was pleased to say that my thyroid was low normal and I tested negative for antibodies. So I carried on for months with no thyroid medicine and I felt awful. I had heartburn, hair loss, sensitivity to cold, was tired, and had muscle and joint pains, especially my jaws. My mouth hurt so bad everyday. I eventually went back to my regular doctor and told him I wanted something done about the thyroid issue. My pulse had gotten slow and I had the brain fog and tingling in one of my feet. He put me on 25mcg brand name Synthroid and the heartburn, pulse rate, jaw pain and tingling in my foot got better, but the hair loss and fatigue is persistent. In fact, I think the hair loss has worsened on synthroid. He increased it a little to 37.5mcg, but I still don’t feel better….in fact, I think it may be too much because I am starting to get some of the upset stomach symptoms again, which I did not have on the lower dose. I am wondering if maybe I only need a small amount of T4, but also T3, like cytomel? Or would that put me into overdrive like the armour did? I do not want to feel the way armour made me feel, but I really need more symptom relief than I am getting from the synthroid. I have no libido, am not motivated, my hair feels dry and is still falling out, but now have the negative side effect of an upset stomach. The last time my labs were checked, my TSH was ‘normal’…in fact I was even told that it was perfect!!! (it was like a 2.something)l, but I felt far less than perfect. I don’t think my free’s have ever been checked. It’s usually just TSH, T4, T3 uptake and free thyroxine index. It’s like I am putting more T4 in, but not getting much benefit from it and also with the increase getting negative effects. I am really struggling with this and do not know what to do. My weight seems to be holding steady at around 160lbs.

    • Dr. G. Pepper

      Hi Erin

      It sounds like you have been through a terrible time. Have you considered that it is possible to have more than one medical condition at the same time? It would be great if all your symptoms could be relieved just by fixing your thyroid but if you have two or even three different medical conditions, it is not likely that one pill will cure them all. I know this sounds discouraging but even if you could feel 50% better that would be something good, don’t you think?

      Although it is impossible for me to offer a diagnosis or medical advice on the internet it sounds like you could have a gastrointestinal as well as a metabolic problem. Have you consulted a gastro (stomach) doctor. If some of your stomach problems were relieved it might be easier to get to the bottom of the metabolic/thyroid issues after that.

      Hope these thoughts help and good luck. Keep us posted with progress.

      Dr. Pepper
      The disclaimer/Terms of Service for use of this website found at the bottom of the homepage apply to all my responses on this forum.

  • Jeanne Wolfe

    I can’t remember for sure, but at one time I seem to remember seeing a caution on a refill of my Cytomel that said “not to be taken with calcium”. Is that true & if so does that mean not taking my calcium with D pill daily? Also what about 1/2 in my coffee?

    • Dr. G. Pepper


      Taking Cytomel with calcium, or even with ordinary food, will decrease the absorption of the medication. Instead of getting the full benefit of your dose of thyroid medication you will only get part and it is impossible to say how much will get into your circulation. It is generally recommended to take any thyroid meds (including Synthroid, Levothyroxine as well as Cytomel) on an empty stomach. Not eating or taking supplements for at least an hour afterward is recommended. Some say wait up to 3 hours but that is not very practical for most people.

      Dr. Pepper
      These comments are for educational purposes only and do not constitute medical advise

  • Marina

    Do you know of a doctor who will prescribe Cytomel in Calgary, Alberta, Canada? I have been on synthroid for 15 years, and feel that adding Cytomel will help me greatly.

    Thank you very kindly,


    • Dr. G. Pepper

      Hi Marina

      Sorry; I don’t know of anyone in that area; Have you tried calling the main hospital in your area and asking for names of near by endocrinologists? Then check with these offices regarding if the doctor is using Cytomel in their practice. It’s a lot of work but is better than just going to a doctor and hoping for the best.

      Good luck with your problem.
      Dr. Pepper

  • Wendy

    I’ve been reading all of the posts and have decided it’s time for me to self-medicate. I’m unemployed, no $$, no medical insurance, 56.5 years old, all of the raging hypothyroid symptoms except I’m post menopausal, no periods, definitely not trying to become pregnant. Out of necessity, not choice, I’ve been going to a free clinic. The physicians volunteer and rotate once/year; patients rarely see the same one twice so there’s no continuity of care. The first Dr. I saw ordered blood work and said if it wasn’t definitive he’d refer me to an endo, free via the state medical board. Awesome…. I thought– until I saw a different doc when I returned. As has become my typical experience he treated me like a neurotic hypochondriac; but, he said since I was convinced I’m hypo it wouldn’t hurt to put me on a low dosage of levo. I’ll take being patronized if it will make me feel better. After a few days I had more energy than I’ve had in nearly a decade but it quickly wore off. A rather significant fact he failed to share with me was that my lab results, I learned months later, indicated I AM hypo. I saw different docs and NP’s on my next few visits. One Dr. planned to increase my levo to 125 but I never saw him again. I’ve seen the same resident the last two times I’ve gone in. He’s worthless. He doesn’t see any problem with the fact I’m gaining 3-5 lbs./month. I’ve gained over 40 lbs. in under five years and it’s been coming on rapidly the last few years. I’m just under 5’4″ and maintained the same weight, 105-109, through my 30’s and 40’s. I feel like I’ve been eaten by an alien composed of lard. I can’t cut back any further than the 500-700 calories/day I’ve been consuming for the last four years desperate to lose weight. I eat a fish fillet or chicken breast each day and have a cup of hot chocolate at bedtime, skim milk. Some days I forget to eat because I have zero appetite. So, Dr. worthless tells me to start running in place to burn calories. Yeah, of course, this is MY fault for being a slovenly couch potato. Isn’t it always! Genius–NOT my knees are both shot! Walking 2-3 miles/day didn’t help budge an ounce so I became fed up and quit. In addition, I live in a bad neighborhood, nearly got mugged while walking my dog on a nearby university campus, so I’m afraid to walk very far from my front door. He refuses to listen and treat my symptoms, he’s treating lab results. I’d MUCH rather take Cytomel prescribed by and under the supervision of a physician but without $$ or insurance and the freedom to choose my own doc I’ll buy it online and treat myself. I’m sick to death of feeling like crap, freezing year round, penciling eyebrows on the outer corners where I used to have them. Also, EGADS, when I first went in my cholesterol was well OVER 300. I had to bring that fact to the Dr’s attention and asked him don’t you think that’s something to be concerned about! So, I’ve begun squirreling away a few bucks here and there and have begun searching online for the best buy I can find for Cytomel that APPEARS to be from a legit source. This resident and I have been battling over this and I can tell he’s going to be yet another poor to mediocre doc who refuses to listen and BLAMES the patient. It isn’t helpful that the clinic manager is an RN who weighs at least 350 lbs. I do not want, in fact I refuse, to become HER.

  • Michele P

    I have a question for Dr. Pepper, off record.
    I’m 30 yrs old and was placed off of synthroid for having a TSH 154.32, placed on Cytomel. With in 30 days my TSH 53.22. I was diagnosed with hyperthyroidism 2002, then diagnosed with Grave Disease 2004. I experienced “all” side-effects, Synthroid wasn’t working, had total thyroidectimy 2006. Still on synthroid, seeing the Dr’s every 30 days. I struggled in college, transcripts are a disater. Finally after the 5th Dr, seeing the confusion in his eyes, he placed me on Cytomel and I’ve never felt better. I’m 90% better in the last 30 days and he is hopeful that my body will be on the right path to sustaining homeostasis.
    My question; since it has been 8 yrs since my original diagnosis, what, “if any”
    damage could happen internally? I feel that I may have been mis-diagnosed. I have spent my entire 20’s workin full-time to pay all
    Medical bills and struggling to obtain a degree.
    My husband and I want to try having children, but am terrified of possible birth defects since my hormone level is dangerously low. Can one sustain a normal life on Cytomel alone?
    I will be asking these questions with my PCP in Jan 2012, but just would like a different opinion, again, these are just questions. I’m aware that you are not my physician and have not seen any of my medical records. But your friendly opinion would be appeasing.
    Thank you,
    Frustrated 30 year old!

    • Dr. G. Pepper


      The situation you describe could be due to a very rare syndrome known as Refetoff Syndrome or thyroid hormone resistance syndrome. If the body cannot “recognize” thyroid hormone, the pituitary will continue to pump out TSH while the thyroid hormone levels climb into the hyperthyroid range, and yet because the body is insensitive to the thyroid hormone the body will experience hypothyroidism and all its complications. This is a situation like someone who is almost blind (insensitive to light). The light has to be extremely bright for them to ‘sense’ the light but even though the light is very strong, they still experience mostly darkness. It is conceivable that someone may be insensitive to T4 (synthroid, levothyroxine) but not T3 (Cytomel) so that T3 will be sensed by the body enabling the person to get back to a normal thyroid status. This would be a variation of the classic syndrome where the insensitivity is to both thyroid hormones.

      Thyroid hormone resistance is usually a genetic (potentially inherited) disease so anyone suspected of having this should see a genetic counselor before undertaking to become pregnant.

      I hope this information is useful. Let us know how things turn out!

      This information is for educational purposes only. Terms of Service of metabolism.com apply to this response as well as any of my responses on this website.

      Dr. Gary Pepper
      Editor in Chief, metabolism.com

  • Kerri

    Help need a doctor that prescribes t3 in Buffalo NY!

  • Sarah

    Dear Dr. Pepper,

    Is there a test that can be done for this genetic resistance? I posted about a year ago and was happy on 50 mcg Cytomel (was hypo but doctor wouldn’t treat with Cytomel, was being treated my psychiatrist). Went down to 25 mcg and my new general practitioner wanted me to add 25, then 50 mcg Synthroid. I added the 25 mcg Synthroid and within a month the hypothyroid symptoms started returning (I was still held at 25 mcg Cytomel). I decided I no longer wanted to feel crummy, after suffering for 40 years pre-Cytomel. In the months since, I have increased up to 75 mcg, in 3 doses 25 mcg, and do not have the hyper symptoms. I have never felt better, my aches are lessened, as is the severity of my hives, and almost all of the weight is gone, even if my body doesn’t look like it lost it all! Since I felt so bad on Synthroid in my 20s and then again the months before my psychiatrist put me on Cytomel, and when I added it back to the mix, I’d like to know if there is a test for this genetic marker. It would be a great defense when talking to any subsequent endocrinologists who don’t understand how I can tolerate such high dose of Cytomel, nor why I do not respond to Synthroid or its derivatives. Do you know of any clinical trials or studies that are open which study the efficacy of T3 only for such patients or maybe for those with high antibodies? I already see all the same signs in my teenage son, which I had in my childhood, and he has tested positive for TPO antibodies. Many thanks.

    • Dr. G. Pepper

      Hi Sarah
      What you describe may be a form of genetic thyroid hormone resistance. Solving this problem in your case, doesn’t require a radical approach (using T3 only) in your case, but I see that getting the medication you need is causing a lot of problems for you and your doctors. In my ebook “Metabolism.com” I have a section on how to talk to your endocrinologist with this very problem in mind (see page 65). Actually diagnosing thyroid hormone resistance can be done in the office but if you want a more in depth look at your genetics or your son’s genetics you could try contacting Dr. Francesco Celi who is at the NIH in Bethesda Maryland who is on the forefront of research in this area.
      Hope this information is helpful.
      Gary Pepper, M.D.
      Editor, Metabolism.com

  • Sarah

    Hi Dr. Pepper,

    This is indeed good news, as I live in VA! I will take note of Dr. Celi, and maybe see if he thinks I should see him/his office or if I can do something in our area. Thank you for your help.


  • Michele P

    Hi Dr. Pepper, this is Michele P.
    I had my follow up with my Primary Dr. After another 30 days of higher Cytomel dosage, my TSH went from 53 to 34. My Dr was looking through his medications booklet and then I shared this website and comment and would like to be tested for Refetoff and thyroid resistance syndrome just to be safe. My Dr immediate became upset, throwing the book onto the counter and slammed his laptop closed, saying he’s not going to listen to a cyberspace Dr, if I don’t want his help then he will refer me to a Endocrinologists. He started to leave and I quickly and politely said, I’m just concerned with my health, I’ve been battling with my thyroid going on 8 yrs now, until just recently you found that my body needed T3. Why wasn’t this checked years prior? I have to research, this is my health and all I’m trying to accomplish is to feel better. I appreciate all that you have done but what else am I suppose to do?
    He then stormed out saying have a nice day, yelled to his asst to refer me I Endo Dr and I’m no longer to be seen again.
    I immediately bursts into tears, I asked for a copy of my lab results, they refused to give me. I then asked to sign a medical release form for copies of “all” my medical records dating back 8 years. The office told me that they only have records dating back 1 1/2 years, I said well I was recently married please check my maiden name. They found my other chart, I asked them to merge both charts together they refused, then when I demanded my records, I’ll pay any fees necessary. Their response, we will have someone look into this and get back to you with-in 2 wks.
    I’ve never been treated so poorly, I have PPO insurance and have always paid my bill on time. Apparently my primary Dr doesn’t like to be questioned, acting like a child shows me that he isn’t practicing medicine to care for his patients.
    I’m upset, confused and don’t know where else to turn, I live in Central California and feel that I should look in San Francisco for a specialist.

  • Carol Drake

    Unfortuneatly I am not surprised. I have been through similiar issues with egocentric endos. I was told by the last endo that all info on the internet are lies, even though the sources I quoted were: Mayo Clinic, New England Journal of Medicine, Brigham Young, Assoc of Endocrinologists, Cleveland Clinic (even though she had worked there) and peer revued journals, etc., etc. I was told there is nothing wrong with me in spite of the fact I have Hashimoto’s and have for 30 yrs, and in the last 3 yrs. have gained 80 lbs. She also said she does not treat weight problems, and should find a “weight doctor”. Also requested Cytomel (t3), but she refused any dosage over 5mcg., which for me is useless. I am also at the end of my rope, and have pretty much become a recluse since I have become so obese. Most of the endos I have seen can’t get past TSH. I live in S. Florida and also do not know where to turn. I am tired of being dismissed and treated like a moron.

  • Dr. G. Pepper

    Hi Michele

    It is a shame you had such a bad experience but don’t let that discourage you. Now that your primary doc has helped you get on Cytomel you can at least start the road to feeling better.

    Severe thyroid hormone resistence as in the Refetoff Syndrome is extremely rare and even a specialist can have a problem diagnosing and treating it. Imagine driving an exotic sports car into your local mechanics shop and asking them to repair it. On top of that, imagine that the mechanic can get sued if he messes up the repair. That’s how your doctor is feeling. You are the exotic sports car.

    It seems like a good idea to take the referral to an endocrinologist. It may take some time before a new doctor gets the full picture of what you are dealing with so be patient and good luck.

    Dr. G. Pepper

  • Michele P

    Thank you Carol Drake for sharing your story. There is so much information on the Internet. I take great precaution with moving forward to a site unless I strongly feel it is an accredited site. I wish you the best of luck in feeling better.

    Dr. Pepper,
    You are a great Endocrinologists, sharing this website with everyone and replying promptly exemplifies your care, experience, and determination to help others. You’ve educated me in the differences between T4 and T3, patients are all different, like shoes, and it takes time to determine the underlying cause.
    I’m being referred back to my original Endocrinologist, last seen 2008, she’s only been practicing for 8 years. Maybe thats a goodthing, she may be apt to really get to the root of my absorption problem. I originally stopped going after my thyroidectomy 2006. After seeing my Primary Dr’s NP for sinus infection, she was confident and assuring that they would be able to monitor my TSH levels, no need to continue with specialist since Graves had gone away after removal of thyroid.
    I hope my Specialist will continue to keep me on phentremine, 2 mos on & 1 month off, so I can refrain from excessive weight gain. I’m 5′ 4 165lbs currently, my primary Dr. says I’m over weight and prescribed phentremine. I am now moving on in search for a new Primary Physician.
    Thanks again, Dr. Pepper.
    I may be calling your practice next if I’m still unable to find the right treatment options.
    I don’t mind taking a trip to Southbeach, it would be an honor.

  • Stephanie

    Hi Dr. Pepper. I have a question for you regarding my tsh that has my endo perplexed. I had caner with a total thyroid removal in Sept. 2011. I had Graves before surgery with a very suppressed tsh. My current lab work shows good numbers but my tsh is still .014. And I have hypo symptoms with a FT4 of 1.5 and Total T3 of 120. He does not want to put me on cytomel with a suppressed TSH. Do you have any idea why my tsh would still be so low? Any insight would be most helpful.

  • Dr. G. Pepper

    Hi Stephanie

    I assume you are not on any thyroid replacement yet (T4 or T3). Was your TSH lower a few months ago? If so, this is my thought….for some reason people with Grave’s disease can have suppressed TSH’s for months after their thyroid gland is removed. You can have very low thyroid levels and still have a low TSH for that reason. It may be some unusually long lag time for the pituitary to start making TSH again. Perhaps run free T4 and free T3 levels and if they are low I would bet that is the answer.
    Keep us posted with your progress.
    Dr. G. Pepper
    Comments for educational purposes only, not medical treatment (you know that ;=)

  • Gina

    To Pat from Morris County–

    Hi Pat, I’m from Morris County also and was not finding good treatment for my hypo. BUT, 5 years ago, I found an incredible endo in Cherry Hill. Its an hour plus drive from Morris County but I figured my quality of life is at stake and what’s a few hours invested in order to potentially feel well. His name is Dr Anthony Jennings and he’s gentle, kind, compassionate and open minded. Feel free to contact me at ginageorge335@gmail.com with any questions, etc.

  • John

    Dr. Pepper,

    Question concerning Reverse T3 – What are your thoughts on it? There is a lot of stuff going around the internet with this. Some doctors don’t believe it’s useful at all, others feels that it completely blocks T4 from converting to T3.

    I have been exhausted and shown many symptoms of thyroid issues for over 6 years now, (29 years old- Male) however all blood work shows I’m in normal range, yet my Reverse T3 always comes back as High, out of range. All other lab work and studies have shown to be normal, as well. I have consistent (unrefreshing-sleep) fatigue.

    I have tried all types of diets, exercise (this is very hard to do) consistent bed times, no drugs/drinking/smoking.

    Recent labs
    TSH – 0.95 (0.40-4.50)
    Free T3 – 3.4 (2.3-4.2)
    Free T4 – 1.3 (0.8-1.8)
    Reverse T3 – 35 (11-32)
    Ferritin was 130 (20-345)
    morning cortisol was 19

    Is it possible that high Reverse T3 is the reason for my symptoms? Would I benefit from something like Cytomel or SR T3 as some have recommened?


    • Gary Pepper M.D.

      Hi John

      First, the easy part of your question. Reverse T3 is formed when the body wants to remove active thyroid hormone from the circulation. During certain conditions the body wants to shut down metabolism so it shunts the thyroid hormone into an inactive product which is reverse T3. This is instead of forming active T3 from T4 which is the normal pathway. Conditions such as starvation, any kind of infection such as the flu, a bad cold, a tooth abscess, even severe emotional stress, can result in higher production of reverse T3. The bottom line is that during stress the body wants to conserve its resources so T3 declines and reverse T3 increases. Therefore, I agree with those who say that reverse T3 doesn’t cause problems, but I would say when reverse T3 is elevated it is a signal of some form of stress in the body.

      Why do you feel so crappy? That is the hard question. Based on the little information you provide I can’t say what the problem is, but I can tell you not to worry specifically about reverse T3 but what is causing the stress in your body that results in more of this hormone to be made.

      Hope that helps.

      Dr. G. Pepper, Editor, Metabolism.com
      Comments are for educational purposes. Only you and your doctor can decide what is appropriate treatment and testing in your case. Terms of service of this website apply.

  • Hi Dr Pepper, I have Hashimotos and my last labs showed very high antibodies in the upper 400’s I think 485 or so. For 4 years I was on Synthroid 125mcg. On 137 mcg I was hyper. I felt horrible and was going bald. My normal Endo said T3 would give me heart palpitations and he would never give it to me. He said T4 converts to T3. I went out of my HMO with Cedars in Beverly Hills CA and went to The Holtorf Group in Torrance CA they specialize in thyroid. Dr Laufer MD not an Endo put me on T3 only from their compounded pharmacy so it is time released. I am up to 87.5 mcg a day. I’m also taking 4.5 mcg of Naltrexone and 100 mg of Progesterone. My hair has almost stopped falling out now I’m only loosing just a little bit instead of handfuls. I’m not gaining but I’m not losing either. I feel better no more PMS . But I think I could feel better. My free T4 is low my free t3 is on the low end of normal and my TSH is 1.85 any thoughts???

    • Gary Pepper M.D.

      Hi Lisa

      Nothing beats success and it seems like you are doing better with Dr. Laufer than with your previous endo. As you can see in my blogs and book, I believe a lot of people benefit from the addition of T3 when traditional T4-only treatment has failed. I favor Armour thyroid for its convenience and cost. I am wary of docs who insist on using compounded pharmacies and of time released T3. I tried time released T3 in the past and was unimpressed and even a little afraid of it due to potential toxicity. Call me a skeptic but some docs are cashing in by having patients use compounded products. What’s wrong with Armour? You might ask at your next visit. I would be curious to hear the response.

      Anyway, sounds like you’re doing better, so good for you.

      Dr. G. Pepper

      • Michelle

        Dear Dr. Pepper,
        My endo said porcine (Armour) is 50% T3 and 50% T4. He says humans are 90% T4 and 10% T3. He will not prescribe Amour based on this. What are your feelings on this?

      • I just sent you a quesion about me being hyper on my labs, but maybe still lacking T3 in my cells. And I wanted to ask you something else too, the 3rd doctor that prescribed me the Armour & T4 told me that Armour is mainly T3 and is why he added T4. Yet I see that another lady’s doctor told her that Armour is 50%T3 and 50%T4, so which one is it? On Synthroid my hair fell out A LOT, so I’m scared of synthetic T4 and want just Armour, do you ever prescribe only Armour to your patients? This 3rd doctor Dr. Freidman says I need extra T4, but I don’t believe this. He said numerous studies show that T3 does not cross the BBB very well. If this is true then why do I feel good on T3 only and I’ve been on it for a few months now? My brain fog was on Synthroid, not T3.
        Thanks, Lisa

      • I’m sorry to keep bugging you, but I forgot to memtion something in regards to reverse T3. You said not to worry about reverse T3, however over the past 2 years I’ve lost 100 pounds and I’m always dieting to keep it off. I’ve also had several cosmetic sugeries back to back to remove excess skin. The constant dieting and numerous back to back surgeries are probably why my reverse T3 was high, I was unable to shed any more weight and I am still a little over weight and need to lose another 15 pounds. The T3 has corrected my reverse T3 problem, which is helping with weight loss, it’s slow going, but at least the scale is moving now. So I feel like correcting my high reverse t3 was the only thing that would have helped boost my shut down metabolism back to being somewhat normal again. In my case reverse T3 mattered. So maybe addressing each persons issues, even when they are high reverse t3, can help certain people like me, the constant dieter who’s metabolism has shut down or someone who’s had mutiple surgeries back to back. Waiting for my metabolism to get back to normal may have never happened on it’s own, because if I stop dieting my weight comes back.
        Thanks, Lisa

      • Dear Dr. Pepper;
        I also wanted to mention that someone brought to my attention an article stating that T3 does in fact cross the blood brain barrier and that my new doctor Dr. Freidman is incorrect when he told me that the brain needs T4, any thoughts, here are the articles:

  • Dear Dr. Pepper;
    I think you’re awesome to respond to all these people, where do you find the time! I just bought your book and look forward to reading it!
    You mentioned not liking time release T3, well guess what… today I went and saw Theodore C. Friedman, M.D., Ph.D. Certified, Internal Medicine, Certified, Endocrinology, Diabetes and Metabolism. Unfortunatley he did not have a high opinion of the Holtorf Group. And he was right on track with you! He prescribed me Armour with additional T4. He said the brain needs T4 and is why he would never prescribe just T3 alone. He added the extra T4, because he said Armour was mostly T3. If I don’t like this combo, then he said I can change to a synthetic T4/T3 combo, but he did mention that I could take the T4 with a time release T3, just so I don’t have to be taking it more than once a day, like I will have to do with the Armour/T4. If I decide to change to a synthetic T4/T3 combo, would you still suggest not taking a time release T3??? I was also taking 2.5 mg of Cortisol and 100 mg of Progesterone, which he told me to stop taking, do you ever recommend those hormones to your clients? I forgot to tell him I am also takng 4.5 mg of Naltrexone at night before bed, so I need to call him and see if I should stop taking that too. Do you ever prescribe low dose Naltrexone? And are you seeing new patients and if so how does someone from out of town go about making an appointment? Thanks again, Lisa

  • Dear Dr. Pepper;
    I forgot to mention, the original doc Dr. Laufer from the Holtorf Group, the one that put me on the T3 only time release, he said it would just be until my reverse T3 was under 200 and then he would switch me over to Armour or to a T3/T4 combo made at thier compounded pharmacy. When I mentioned the reverse T3 to Dr. Freidman he said that in regards to the reverse T3 that Dr. Laufer doesn’t know what he is talking about. He disagrees with all the reverse T3 hype you read about on-line. He said the brain needs T4 and so he never gives just T3 only, would you agree? It might be in your book, but I just bought it and haven’t read it yet sorry.

    • John

      I cannot offer any advice, but I do have a question. I too am in a similar boat with the RT 3 thing. Is it an issue? Is it a REAL issue? My current doctor wants to try me on SRT3 as well to see if bringing down my RT3 helps with my exhaustion. You mentioned that your doctor (Laufer) wanted to see your RT3 numbers under 200. Did you ever get them under that? Did you notice improvement in symptoms as these numbers went down?


      • Hi John, I went from T4 only Synthroid 125 mcg to T3 only, I was started at a low dose of T3 and worked up to where I am now 87.5 mcg. LabCorp is having some sort of issue with my reverse T3 results, they do not have testing materials or something like that, so I am still waiting on those results. But my SHBG is very high I think from the T3 only, which might not be good for you if it messes with your testosterone, so check into it first. My hair finally stopped falling out on the T3 and I can eat more and not gain weight, so I like it FAR better than Synthroid. My new doc wants me to start taking Armour/T4, but I’m not sure I want to give up my T3 yet, it’s very confusing. I’ll post my RT3 results as soon as I have them.

      • John, my reverse T3 is low now it’s 63. For the 1st time in YEARS my hair has stopped falling out. And for the 1st time in a long time my scale is moving again when I diet. I’m happy on T3 only thus far, I’ll let you know how I like Armour after I switch over to it.
        In my particular case I feel the reverse t3 was hindering my metabolism and weight loss, not sure if it had anything to do with my hair falling out, or if that was just caused by being on Synthroid. What I do know for sure is I hate Synthroid and I like T3.

    • Dear Dr. Pepper;
      I also wanted to mention that someone brought to my attention an article stating that T3 does in fact cross the blood brain barrier and that my new doctor Dr. Freidman is incorrect when he told me that the brain needs T4, any thoughts, here are the articles:

      • Linda S.

        I live in the Los Angeles area and have been struggling with Hashimoto’s hypothyroid for 10 years. I have during that time had a lot of trouble with muscle pains and cramping in my legs and feet and not feeling well. I would like to know whether Dr. Friedman helped you or if you have found any other MD that has helped you. I have also been to the Holtorff Group and saw Holtorff himself. Currently, I am looking for a new doctor, as mine wants to cut down on my time-release T3, which is the only thyroid medicine that has ever done me any good. He is afraid it will harm my bone density. I am now on Tirosint (a T4 newer medicine) and compounded time-release T3. I have failed at Armour, Synthroid, Westhroid, and Cytomel and have bad side effects from them. Would love a doctor recommendation.

  • Michele P

    Dr. Pepper,
    After my appointment with my Endo Dr., I’m continuing Cytomel (liothyronine) 5mcg twice daily and Levothyroxine 75 mcg daily.
    Endo says that I should’ve never been taken off of Synthroid entirely, the Cytomel needed to be added. She was perplex to my Primary Dr’s treatment method.
    She assures me that I do not need to worry about thyroid resistance or Refetoff Syndrome at this time. I’m to have labs taken in 6 wks.
    I let her be aware that my husband and I have been trying to conceive since August. My Primary Dr says that I should not worry with low tsh levels.. My Endo says to refrain from trying to conceive until my Tsh is at least 2.0. She says once she gives me the “go”, I will have to stop Cytomel prior to pregnancy and while breast feeding. There hasn’t been any confirmed cases where a baby has successfully been healthy while the mother is on Cytomel.
    I’m thankful to finally be in the care of a Dr who is properly educating me, my husband and I are using caution and will wait to conceive. This could’ve been a terrifying experience if I were pregnant.
    I will keep you posted to my next lab tests.
    Michele P.

    • Gary Pepper M.D.


      Great news! Sounds like you are getting on track with your new doctor. Keep us posted on your progress.

      Dr. P.

  • Jackie

    Dear Dr. Pepper,
    I am 49 years old soon to be 50 year old woman living in FL. I was diagnosed with multi-nodular hypothyroidism in 1998. I was placed on a low dose of Synthroid for approximately a year then told by the Endo that I no longer needed to be on medication because my levels were normal. After years of no visits and three Endo’s later I found someone new. I am still suffering from all of the known symptoms (dry brittle, and thinning hair, brittle nails with deep ridges, no outer eyebrows to speak of, I am always freezing, palpitations, muscle and joint pain, brain fog, tired, no energy. I also have very bad constipation despite eating a very healthy diet, etc….. ). I’m still being told that I don’t need medication, but I’m not feeling any better. Actually I feel worst; my current Endo has been running test after test and I go back for another ultrasound next week and my latest lab results. Last year she’s mentioned maybe putting me on a low dose of Synthroid to see if my symptoms improve, but nothing yet. I plan on asking her to give me something because doing nothing is not helping; I am going to ask her to try Cytomel as well. In 07/2011 my TSH = 0.50, TSH BLD = 0.66, T4 FREE = 1.1, T3 = 179, CORTISOL = 1.9, FSH = 55.8; I don’t know how to interrupt these results, but it seems as if my T3 and cortisol is very high. Any advice you can offer in how to approach my Endo or questions I should be asking would be greatly appreciated.

    • Gary Pepper M.D.


      As you know I can’t offer medical advice on the internet but I can give you some information you might find helpful to use in conversation with your own doctor. When someone has a multinodular goiter (enlarged thyroid) that immediately tells you that the thyroid is not normal. Enlargement of the thyroid implies that the thyroid environment is not normal in some way and that there is a possibility that the “normal” hormone balance of thyroid hormones has been disrupted. In such cases the normal ranges of thyroid hormone may not be as relevant. These issues are covered in my book Metabolism.com

      If you are seeing an endocrinologist they should explain your lab results to you. The cortisol level you posted is actually low if it was drawn first thing in the morning but could be normal in the afternoon or evening. This is due to the natural rhythm cycle of the adrenal gland known as the circadian rhythm.

      I hope this information is useful. Let us know how it goes.

  • Nicky

    Have had Hypothyroidism since age 2. Will turn 50 this year. Have been on Synthroid or Eltroxn all my life. A couple of dosage raises, most recently from
    150 to 175. Very overweight @ 287 despite regular exercise and a very healthy diet. Am now seeing an internal medicine dr. He has ordered blood tests.
    I am going to ask him about Cytomel. I am even contemplating bariatric surgery. I have recently dropped 28 pounds after adjusting from 1500 calories a day to 1200, and upping my exercise regiment.

  • AnalogDog

    Very helpful posts. Had Graves/papillary cancer. Total thyroidectomy 2008. Worked up to Levoxyl 175mcg. Did OK, but nagging little problems becoming worse. To wit:no outer eyebrows, nails tear ridiculously easy, and now I’m getting tendonitis at the drop of a hat.
    Any little thing. Not good when you’re a serious cyclist like I am!
    Come to find that ‘brittle tendons’ like this is OFTEN a sign of low T3. Sure didn’t have this prob. before my thyroidectomy!
    My endo has no clue, won’t supplement with T3. She thinks measuring free T3 is “…worthless, since it’s all over the place, anyway.”
    I’m not somebody who feels ‘awful’ like a lot of folks do on synthetic, but I’ve clearly GOT to find somebody who’ll supplement my Levo. with some Cytomel!

  • lynn

    To anyone living in South Jersey Dr. Fallon in Woodbury N.J. is the man for you!!!!

  • Kay Bryant

    I have been taking Cytomel for years, and now I am showing a low T4 (.63) and a low TSH (.04). Someone told me that taking Cytomel only could cause this. Is this true? I can’t see my doctor for a month and these results concern me.

    • Gary Pepper M.D.

      Hi Kay

      Your friend is correct. Taking T3 only can cause your T4 level to be low particularly if the dose of T3 is high enough to turn off your own thyroid production. That seems to be the case for you since the TSH is low, indicating that the thyroid hormone levels (could be T3 only or any combination of T3 and T4) are above normal.

      I suspect your doctor will want to make an adjustment but that is between you and your doc.

      Dr. P.

  • Valerie

    Dear Dr. Pepper,
    I am reading all of these posts with tears of frustration in my eyes because most seem to have same problems that I have had for the last (omg, it’s actually been…) 3 years since having my thyroid ablated via RIT. My current endocrinologist does not believe me that I eat a very healthy diet, exercise regularly and yet cannot lose weight. I do not feel right – lack of energy, etc. She has come out and said that I am lying to her! I’ve gone in with diet and exercise logs, daily logs about how I feel, etc., but it doesn’t seem to matter to her. I gained about 30 lbs. after the RIT, am experiencing slight hair loss, the energy level is not what it should be (to her, I’m just getting older…), etc., etc. My TSH and T4 counts come back ‘in the normal range’, but is toward the hypo side of things, and she will not test for T3 at all – just refuses. I’ve asked her multiple times about changing the 112 mcg of Synthroid to a combination T4/T3 or to look at other options, because I. just. don’t. feel. right. She refuses still.
    So, I have three questions: 1) I have read that furosemide (the only other medication I am on) will affect T4 binding even if taken an hour after the Synthroid and / or test results. Is this true?
    2) Is it true that there is no need to test for T3 after having the ablation done? Doesn’t seem right to me…
    3) Do you know of an Endocrinologist in Erie, PA or even Cleveland, OH or Pittsburgh, PA areas that will look at the whole patient and not just ‘the numbers’ and be open to prescribing a T4 / T3 combination to see if it is right for me?
    Thanking you ahead for your time and your helpful comments to the people’s posts above!

    • Gary Pepper M.D.

      Hi Valerie

      So sorry to hear about your experience, but it is common to run into an inexperienced doctor, as many others at metabolism.com have posted about. Several generations of endocrinologists never heard of combination T4/T3 treatment let alone something like Armour thyroid (which I tend to prefer). Endocrinologists are taught that taking synthetic T4 such as Synthroid or levothyroxine is the only replacement option which is “scientific” and everything else is quackery. I’d say the pharmaceutical companies which make synthetic T4 have done a great job of brainwashing these doctors. I can sympathize however, with a doctor who will not give their patient a medicine they have never used before. This may be the case with your endocrinologist who has probably never used combination therapy.

      In my book Metabolism.com I offer a script for patients such as yourself, which can be used to try to convince the doctor to be more flexible. Finding a more experienced doctor is likely to be the most practical approach, however. I don’t know of any such docs in your area, unfortunately. Perhaps call the office of the American Academy of Clinical Endocrinologists for a listing of endo’s near you, then call their offices asking if the doctor every employs combination T4 and T3 therapy.

      Your questions; 1. No problem with interpreting thyroid blood tests in someone using furosemide. Furosemide is one of the most commonly used medications so if it caused a problem it would be widely known. 2. For someone without a thyroid such as you after radioactive iodine ablation blood tests will simply show the effect of taking thyroid hormone treatment. While taking synthetic T4, most of the time the T3 level will be low and the T4 will be on the high side. 3. I answered that above

      Good luck and keep us posted.

      Dr. P

  • Dana

    Dr. Pepper, am glad I flound this forum as I am experiencing a lot of the same problems.
    I have always had a hard time losing weight. Several years ago I started gaining uncontrolably. After seeing doctors and endocrinologists who would not help I finally found a natural doctor who prescribed me progesterone for estrogen dominance, and dessicated thyroid even though all my lab work was normal. The weight gain stopped but I have plateaued at 160 for three years no matter what I do.
    I went off of the dessicated thyroid because i was getting heart palpitations and recently went back on to see if it would make a difference with my weight. After 5 weeks there is no weight loss. I run 30km per week and swim and walk. I eat approx 1400 calories per day.
    I am beyond frustrated and don’t know what to do! I want to lose the weight to be in a healthy range.
    Dr. Pepper, in your experience would being on just t3 help? I live in Ontario and there are no blood tests for reverse t3, but I am wondering if years of dieting have forced my body into a type of famine mode? I tried eating more to snap out of it but I just gained weight. I do not lead a stressful life, except for this issue, and all of my adrenal tests and liver function tests are normal. I do not understand why I get to exactly this weight and it just stops.
    Please let me know of any advice you have for people like me. Thanks

  • Amy Albrecht

    HELP!!!!!!!!! I am currently taking 100mcg of time release t3 prescribed by Holtorf medical group. I feel horrible. I have tried t4 alone and do not do well. I asked Dr. Wightman about going on armour and he tells me I will gain weight and not feel well. I am so confused.

    • Michelle

      Hello Amy, I myself after 5-6 years of being on a roller coaster ride by physician assistance I went and found me a new doctor. He will not prescribe Amour – although I thought I did ok on it when I took it. I felt better but not 100%. Today after finding an older gentleman doctor he has me on 100mcg of Levox and .25 of Cytomel (half of a tab of Cytomel). I feel so much better and with exercise have lost 35 lbs since November 2011. If you are not getting the results you are looking for find a new doctor. Take your own health in your own hands. You’ll be glad you did. I have been told by this good doctor that in humans the ratio between T4 and T3 should be 90% T4 and 10% T3. The old physician assistants had my body so wacked out and inverted – back then on 15 mcg of Cytomel and .50 mcg Sythn. My sister is Hypo and she is on .75 mcg of Synth and .25 mcg of Cytomel. My next appt is April 2012 and I will assume I will be lowered to .88 mcg of Levox as I was a tad but highish on my TSH back in Jan 2012. I can tell I am overactive at this time but in a few weeks I am sure he will lower my Levox to .88 mcg.
      Good luck.

  • Elizabeth

    Dr. Pepper,
    My name is Elizabeth and I am looking for guidance. All my life I always been very active and fit doing gymnastics, cheerleading, and going to the gym. However, I have always been bigger and unable to lose weight. Back in 2004 after going through several personal trainers I was advised to get my butt in to a specialist. My trainer said…something is wrong with you; you should be a size 0 with your diet and workout. So off to the endocrinologist I went. I was diagnosed with PCOS. I was told there was not much I could do for the diagnoses (or symptoms). They tried putting me on metformin but I did not do well with it (apparently sensitivity to medication is a symptom of Hashimotos). So I just kept on keeping on. Then early 2005 I got an opportunity to take a family members place for a lap band procedure. I was not sure what it was at that time but I called the Endo. She said that it might help and mentioned something about DHEA processes. However she quickly followed that sentence with but it also may not do a thing for you. So off I went with hope that it might work. I know now that this what a big mistake. Apparently as soon as it was put in (which I did not find out until 7 years later as I just had it removed Jan 2012) I had developed a massive amount of scar tissue between the band and my stomach which had me about 90% blocked. This is why (even without fluid in the band)I was on liquids for 4 months after the band was put in and have always had such a difficult time trying to eat. I wanted to include this portion because I think it is important to know that my body has been in starvation mode for 7 years. Rewind a bit…in 2011 still not being able to lose weight my obgyn tested my thyroid. Another whirlwind and off to the Endo I went again. This time I was diagnosed with Hashimotos. My TSH was only 5.36 but my antibodies Antitthyroglobulin Ab (normal showing as 0-40) was 2069. My Thyroid Peroxidase TPO AB (normal showing 0-34) was 122. I was put on synthroid. My weight went up and so did my blood pressure. As the dose increased so did the blood pressure. Normally I am 110/60. It went all the way up to 158/129. So they gave me a water pill to try and bring it down. I was so frustrated with this endocrinologist that after a few months I decided to walk away to see a neuropath and get a new Endo. With sometime and some supplements my TSH went down to 3.7 which the new Endo said he would consider normal. But here I am 6 months later. I still feel like crap. I am still gaining weight. I am not enjoying taking tons of supplements. I even tried the new big thing “Body by Vi” and gained 10 more pounds. Did research and found out that Hashimotos does not like soy which is what these shakes are made of. Grasping for straws I started another weight loss clinic this week and that is why I am here. Luckily for me the nurse that saw me (before the PA) looked at my chart. She had Graves disease that reversed to Hashis after they killed her thyroid (she went from 89 lbs to 190lbs). She told me that she doubted that the weight loss clinic would benefit me. She also said that the PA wouldn’t understand. Said she felt for me as she went through the same thing. She said her miracle was Cytomel. So I started doing research and here I am. I am supposed to go see my Endo next week for my 6 month blood work check up. After reading about Cytomel I called and asked what the blood work is testing. Sure enough it is only TSH and free T4. I am discouraged yet again and feel like I will never get the help I need. I have tried to fight for my health/life by changing doctors and seeking alternatives. I don’t even know if Cytomel will work for me as I am so sensitive to medication. But at this point I am willing to try anything. I just wish doctors were more educated and willing to help. I feel so hopeless. Is there anything that will/can help me?
    Dr. Pepper…Can you please tell me what you would advise?

    • Gary Pepper M.D.


      By now you may have been seen by your endo. Not drawing a T3 or free T3 level should not be a reason for not prescribing T3 since the problem is more with T3 levels within the cells not in the blood. This was the findings of the Watts Study. These issues are covered in my book available on this website. Let us know what happened with your doctor and if you were able to go on combination therapy.

      Dr. P.

  • Pat

    Dear Dr. Pepper,
    I live in Morris County, NJ and have been to 3 endos without success in finding one who is competent and well informed about t4 ratio to t3. Where are you located??? I would really like to have a consultation with you. I am 67 years old and know that Cytomel can be contraindicated for someone my age. I would prefer taking Armour but I had a problem with loose stools and chest tightness. I would be willing to try it again but am reluctant to do so. Also, I know that the formulation was changed and that cellulose was added as a binder which caused problems with people who previously took it before that. It was recommended that the pills be crushed or chewed and not to take them whole because they would not be absorbed. Can you help???

    • Gary Pepper M.D.

      Hi Pat

      It’s nice that you would think of coming to see me but I imagine we can find someone in the NJ/NY area that can help. I’ll put out some emails to see if I can locate someone nearby.

      Dr. P.

    • lynn

      Dr.Fallon in Woodbury Nj is the bomb!!!!!

  • Melanie

    Hi Dr. Pepper,

    I’ve been on Synthroid 75 and Cytomel 25 for about a year and feel great on it. I’ve also not been able to get pregnant and about to start IVF in a month or so.

    Being on Cytomel of course has suppressed my TSH (0.02 to 0.04) and my reproductive endocrinologist and regular endo are both pushing me to come off of Cytomel. Could it be the reason why I’ve not gotten pregnant? I’m afraid of getting off and feeling horrible again…

    Thank you.

    • Gary Pepper M.D.

      Hi Melanie

      Hyperthyroidism (excess thyroid hormone) is associated with increased risk of spontaneous abortion. This means it is harder to hold a pregnancy if your thyroid levels are high (when your TSH is low). Maybe your doctors can find a way to cut your Cytomel dose without stopping it entirely, but enough to get your TSH into a more normal range. I suspect they are concerned that the sudden rise in T3 levels after taking Cytomel is not the best environment for pregnancy either but you can ask them that question too.

      Good luck and let us know how things go!

      Dr. G. Pepper

      • Melanie

        Thank you – You were right. My reprod. endo and regular endo both advised me to stop Cytomel until I get successfully pregnant and deliver. I am not looking forward to how I will feel with just Synthroid, though… Thank you for your answer!

  • It’s me again, I would like to share an update on my latest Endo appt.
    After having a terrible experience with my primary Dr, I have been under the care of an endocrinologist, the appointment was extensive, almost 2 hrs.
    I continued with the same medication, Synthroid 75 mcg and Cytomel 5 mcg 2 pills 2x daily. After my last labs, Tsh was 34, now Tsh is 16, high testosterone, very low Vitamin D, and moderately high chlorestoral. My T3, T4, LH, and Fsh were all normal.
    My new medications are as follows:
    Synthroid 100mcg, 2,ooo units of Vitamin D, same Cytomel dosage, and watching my diet carefully with increase in exercise.
    I am relieved that my Tsh is on the right path to be within normal range, but am terrified that I may not be able to conceive. My Endo explained the dangers of ingesting Cytomel while trying to conceive, pregnant, or breast feeding. There is high risk that my future child may have mental retardation. Wow, I immediately spoke with my husband and we are taking extreme measures to refrain from becoming pregnant until my Endo and OBGYN give us the green light to try.

    I’m concerned that even though I will have stopped taking Cytomel, could there still be a risk? I am also worried about having high testosterone and am awaiting to have a ovarian ultrasound to eliminate a possible cyst causing the high level.
    Since my original Primary Dr found that the Synthroid wasn’t converting, and added Cytomel, this would allow for future embryo to not receive both t3 and t4 hormones, right?
    So, the risks are still there, and worst case could be birth defects such as mental retardation, fetus could be born without thyroid gland, and etc.
    I understand that Dr’s can’t predict the future, however, should we even try and conceive when the Dr’s say its, ” safe” to try.
    Dr. Pepper have you ever treated a patient where they have taken Cytomel while pregnant? Having a child would be a blessing healthy or with birth effects, I’m scared of the terrible side-effects returning on Synthroid alone, and also trying to keep the baby healthy when I wouldn’t be 100% healthy.

    So many questions, I’m consumed with my condition and the future of having children. Thank goodness my husband is extremely supportive, I’m turning 31 this week and had planned on starting a family at this age. I’m thankful for everything in my life with the exception of graves disease, total thyroidectomy, and hypothyroidism. Im keeping my fingers crossed that my 30’s will be much better than my 20’s. I’m going on year 9 of battling to become healthy and hope of feeling “normal” .

  • Elizabeth

    Update…It went as I thought it might. The Endo thinks I am ridiculous. He firmly said that he has been a doctor for 20 years and there is no protocol for testing T3. He also said there is no reason for compound therpay and there is no science to back any of it up. He said if it worked and made people lose weight and feel better that he would have used it and retired years ago. He pretty much said it is what it is and there is nothing to do about the symptoms. When I told him I just want to feel better and feeling this way sucks he said to me no this is just hypothyroidism. I see people with cancer…that sucks. I said isn’t it the hashimoto’s (auto ammuine disease) that cause the symptoms. He blew everything off and said he would only test my TSH & T4 and rushed me out of his office. This is all so difficult. I feel like I am deteriorating and can’t find doctors to help me.

  • Barbara

    Hi Dr. Pepper,

    Currently I am taking .075 mg Synthroid at 7:30 am along with Cytomel 12.5 mcg at 7:30 am and 12.5 mcg at 2:00 pm. When is the optimal time of day to test my T4 and FT3 levels?


  • Peaches,
    I read your comment and I am going to see Dr. Naseer next week. I am wondering if you still see her and how you are doing?

  • Danielle Lynch

    I need help finding a dr who prescribes T3 in the Bergen/Passaic county area. I have not been able to find any dr willing to help me.

    • Danielle

      Sorry, forgot to put Bergen/Passaic County NJ area.

  • Carla

    I just found this blog and I feel so sorry for all of us who suffer from this terrible disease. No one understands because we look normal. I have Hashimoto’s and thankfully have a very good endo, who placed me on cytomel 5 mcg along with my 88 synthroid years ago and I felt quite a bit better for awhile. Over the last year or two I have begun to feel more and more anxious, wasn’t sleeping well, over the last six months I have developed heart palpitations, anxiety got much worse, fearfulness and confusion have become almost a part of my daily life. Very fearful over EVERYTHING, and that is not me. I can’t seem to make a decision about the smallest things a lot of days and often just go around in circles and then sit and cry, although so far I have managed to keep it together at work. I was putting all of this down to menopause but saw my endo a couple of weeks ago and she said to stop the cytomel and see if that helps. I seem to be a little calmer but am exhausted and my feet are swelling. I have also gained 5 pounds in 2 weeks. I will try to hang in there until I see her again in a few weeks and get bloodwork taken to see where my results are. Sure feels like a case of “damned if you do, damned if you don’t.” Anyone else experience this?