Advanced T3 Dosing & Treatment Guide

Do you need pure T3?

Who needs T3:

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▪ Pretty much every thyroid patient (considerations given to sensitive patients)

▪ Patients with Insulin resistance & leptin resistance

▪ Patients with very low temperatures

▪ Patients with metabolic damage (low resting energy expenditure)

▪ Patients with a history of recurrent yo-yo dieting

▪ Patients failing therapy on NDT and/or T4 therapy

Starting T3 Titrating T3 Starting Doses:

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▪ Sensitive patients:

- Start at 5mcg of Liothyronine/Cytomel

- Titrate by 5mcg every 10-14 days

- Monitor heart rate/body temp

- Stop at 25 mcg or with symptoms

▪ Normal patients:

- Start with 12.5mcg (½ tablet) x10 days, 25mcg (1 tablet) x10 days, 37.5mcg (1.5 tablets) x10 days

- Stay at 37.5mcg x1 month

Symptoms to watch out for

Symptoms during your titration:

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▪ Symptoms you may be getting “too much”

- Heart palpitations, internal jittery sensation, increased anxiety, feeling “flushed”

▪ When to stop your titration:

- With heart palpitations that don’t go away, or changes in your breathing

▪ Symptoms don’t necessarily mean you need to stop titration, instead slow it down

▪ Dealing with heart palpitations or jittery sensation

▪ Back off and treat adrenals for 3-6 months

Thyroid Lab tests on T3 - What’s normal

Labs on T3:

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▪ Labs aren’t very helpful when you are on T3 only thyroid medication

▪ The best indicators are your total T3, reverse T3 and sex hormone binding globulin

▪ Don’t forget your symptoms are multifactorial▪ Total T3: should be at the very TOP of the reference range▪ Sex hormone binding globulin should NOT be elevated▪ Reverse T3 should be as low as possible▪ Put less attention on free T3, TSH & T4▪ When your dose is accurate you will have more energy and

your weight will start to drop

IR T3 vs SR T3

Symptoms indicating you need T3:

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▪ Put preference on IR T3 which is usually superior to SR T3

▪ Switch to SR T3 if you experience palpitations or rapid heart rate

▪ If using SR T3 you may need higher dose

▪ Don’t use SR T3 with intestinal issues/SIBO/low stomach acid

▪ 25mcg of IR T3 equals about 40-50mcg of SR T3 (usually)

Average Dosing needed

T3 dosing:

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▪ Most patients will need somewhere between 25-50mcg of T3 per day, potentially more but this is rare

▪ The combination of 2 grains of NDT + 25-50mcg of T3 is very powerful and most of my patients live around here

▪ Start with NDT dosing first, then switch to T3 dosing

Questions?8

Starting T3 therapy

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Lab Tests AdjustStart Dose

Your Thyroid Lab Tests

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TSH Free T3

Reverse T3 Free T4

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