I think I was trying to convey the idea that in order to achieve higher t3 levels by increasing t3 doses, sometimes we need to reduce sources of t4 such as levothyroxine and even Armour (which contains both t4 and t3). I agree with your idea that if you want to see how you feel by upping your t3 levels by increasing your Cytomel I would advise reducing the Armour dose. Please let me know if you need further instruction or how the change works out for you.

Best,

Dr. P.

Great article and so true! I am a testiment to augmenting T4 with T3. However I have a question. I think I remember you telling me once that T4 can block T3 absorption and/or efficacy. Am I remembering that correctly? And if so, to what degree?

I’m still constantly tweaking my Armour and Cytomel ratio for the best balance and often wonder if I should ease up on the Armour and instead take more Cytomel to more effectively address my low T3 count. What do you think?

Thanks and thanks for being my doctor!!!

Kimberly Bain

You know I can’t recommend medical therapy in this forum. I can make some general comments, however.

There is debate among endocrinologists about what level of TSH indicates a clinical degree of thyroid deficiency, but there is no doubt that a TSH of 9 is abnormally high. Since elevated TSH amost always indicates that the pituitary gland is releasing excessive TSH in response to thyroid hormone deficiency, unless there is a pituitary tumor (exceedingly rare), replacement therapy with thyroid hormone is indicated.

Thyroid hormone replacement therapy in the U.S. usually consists of taking a pure t4 product such as Synthroid or levothyroxine (generic t4). On this website you will notice extensive posting about treating hypothyroidism with alternative forms of thyroid hormone replacement, particularly desiccated thyroid products such as Armour Thyroid. An appropriate concern in a situation like yours is whether to take t4 only or to use desiccated thyroid or t4 plus t3 therapy.

If you are like most people in this country being treated with t4, you will wonder why someone might need alternative forms of thyroid hormone replacement. In the past year or so researchers have discovered that a portion of the population lacks the ability to normally metabolize t4 into the highly biologically active t3. This means that affected individuals may continue to experience symptoms of thyroid hormone deficiency when treated with conventional t4 therapy [http://www.metabolism.com/2009/11/07/breakthrough-discovery-thyroid-hormone-therapy-part-2/ ]. How does a person know if they won’t respond to t4? The simpliest approach is to try t4 and see how you feel. Then you and your doctor can decide whether you are a t4 responder or not.

You may be aware that Armour Thyroid and similar products are in very short supply in the U.S. Even if some advocates of desiccated thyroid therapy for hypothyroidism argue that only desiccated thyroid can result in a full return to normal, in my opinion the present shortage makes t4 therapy the clear initial choice. If symptoms of hypothyroidism persist even after a full course of t4 has been tried, then you may be forced to join the ranks of those struggling with the pharma industry to get desiccated thyroid products.

Please discuss these ideas with your own physician.

Let us know how you do.

The disclaimer and terms of service of metabolism.com applies to all my posts on this website.

Do I need to take only Levothyroxine

Hi, I am a mother of two, my oldest daughter Peyton(3yrs) , was put on synthroid 75, the bloodwork they take from the hospital when she was born came back high, so we took her back a week later for more bloodwork, it came back good, and over the years her bloodwork has came back good. But now, my daughter Dana’s(23 days old) bloodwork from the hospital came back high, so she’s on the synthroid now. they’re doctor wants to take Peyton off and test her to see if she can be taken off, if so, she thinks Dana does not need it either. They’re doctor said something, like I have something that is blocking their thyroid, because it’s just their first bloodwork that comes back high. Can I just have your point of view?

You may have noticed a few articles at metabolism.com describing how many people with hypothyroidism taking replacement therapy feel best when receiving extra amounts of t3, either as combination Cytomel and levothyroxine (Synthroid, Levoxyl etc), or in the natural product dessicated thyroid (Armour etc).

We are all born with a certain set of genes which determine everything about our physical selves. Our genes are constant throughout our lives. You may have the genetic makeup which requires t3 replacement but only by doing a genetic analysis would you be able to know that. An easier way is to ask your doctor if it is reasonable to try adding t3 to your Synthroid. Reducing your Synthroid dose may be necessary to accommodate the addition of the t3. After that you can see if the combination is better than Synthroid alone. Due to the acute shortage of Armour it is hard to recommend trying that, as you see on metabolism.com all the turmoil people are going through to get it.

As you know, only you and your doctor can decide what is appropriate therapy for you. My comments are for educational purposes only.

Keep us posted and good luck.

Your story is not that uncommon. Many of the members here at metabolism.com share similar experiences.

As you know I cannot offer medical advice in this blog. But I can share some educational thoughts with you.

As I understand it, you are on 50 mcg of Cytomel daily and off Synthroid. Cytomel is relatively short acting and needs to be divided into two if not more doses daily, for best results. Personally I have had better results with combination t4 (eg Synthroid) plus Cytomel as the Synthroid supplies a background of thyroid hormone while the Cytomel supplies the “booster” effect.

If it weren’t for the Armour crisis, I would usually advise people in your situation to try dessicated thyroid since of all the choices it has offered the best clinical response at the best price. If you are interested you might ask you doctor if Armour or similar is a possible choice for you, then you will have to join everyone else in the struggle to obtain it.

Good luck and keep us posted.

Gary Pepper, M.D. , editor-in-chief, Metabolism.com