Thyroid Patients: Do You Need T3 To Feel Well?

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So many thyroid patients who contact us at Verywell or who post on the Facebook Thyroid Support page ask the same question: "I'm on Synthroid (or another levothyroxine drug like Levoxyl) and I don't feel well. What else can I do?"

For thyroid patients is this situation, the first thing to think about is whether or not you might benefit from the addition of supplemental T3.

(A brief recap: Synthroid, Levoxyl and other levothyroxine drugs—also called l-thyroxine, and L-T4—are synthetic forms of the T4 thyroid hormone.

T4 is the storage hormone, and it must be converted into T3, the active hormone, to be used by your cells. The drug Cytomel is a synthetic form of T3. There is a generic version of Cytomel, and some practitioners work with time-released/sustained-release T3 by prescription from compounding pharmacies. Natural desiccated thyroid drugs like Nature-throid, Armour Thyroid contain natural forms of T4, T3 and other thyroid hormones.)

Now, back to the issue of whether or not you might benefit from the addition of T3. The operative question is: will your doctor be willing to even discuss this with you, much less prescribe it? There's no definitive answer.

If you say to the doctor, "Could I benefit from some additional T3?" the response is likely to fit one of four possible scenarios...

  • A. The makes it clear that he/she has no interest in further discussion about T3.
  • B. The doctor respectfully says, "that's not something I'm comfortable with. Sorry."
  • C. The doctor thinks about it, and says, "well, let's take a look at your free T3 level to see what it looks like and then make a decision.
  • D. The doctor says, "that's certainly a possibility. Let's try a very low dose of T3 and see how you feel on it. But let's make sure there are no contraindications for you...

    Clearly, if you're a patient of Doctor A, a good option is to get a new thyroid doctor. Asking to discuss a possible treatment is a legitimate request, and it should never be met with disrespect or dismissal. Those sorts of responses are, in fact, clear evidence that it's time for a new doctor.

    If you're working with with Doctor B, well, you might want to ask what his/her rationale is for not being comfortable with adding T3 to a levothyroxine-only thyroid treatment. Here, you might want to mention, or even bring a recap or copy of, the Danish study that came out in late 2009 in the European Journal of EndocrinologyThat study looked at the controversial issue of treatment with synthetic T3 as a supplement to T4-only (levothyroxine) therapy for hypothyroidism.

    The research reported that 49 percent of the patients studied preferred the treatment that combined levothyroxine plus a T3 drug, and only 15% preferred levothyroxine-only treatment. (See below for more information on that study, and how you can get a copy to show your doctor.) If Doctor B still categorically refuses to discuss T3 with you and can't satisfy you with a rational explanation, it's time for a new thyroid doctor.

    If you are dealing with Doctor C, consider yourself lucky.

    Ask the doctor what his or her target is for Free T3. And go ahead and get that free T3 test, keeping in mind that many thyroid experts believe that patients feel best when free T3 levels are in the top half of the normal range, and even at the 75th percentile and above of the range.

    (How does that work? Let's do the math. If the lab's reference range for Free T3 is 2.0-4.4 pg/mL, then the midpoint is halfway between them, or 3.2, and the 75th percentile is 3.8.)

    And if you are Doctor D's patient, again, consider youself lucky to have an open-minded and knowledgeable physician. As for the contraindications, doctors tend to be cautious about using T3 in anyone who has a history of heart disease or heart problems, and in the elderly, so T3-savvy doctors will keep this in mind.

    A Note from Verywell

    If you need to share information with your doctor about th 2009 Danish study, here are some resources:

    • Article: Study Shows that the Addition of T3 is Superior to Levothyroxine/T4-Only Thyroid Treatment for Hypothyroidism 
    • Reference for the Danish Study: Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny, Anne Jarløv and Jens Faber. "Effect of combination therapy with thyroxine (T4) and 3,5,3'-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study," European Journal of Endocrinology, Vol 161, Issue 6, 895-902, December 2009
    • The Study: Read the Abstract / Get a Reprint (Don't forget that instead of paying online for a reprint, you may be able to get a free copy of a medical journal article if you have a medical school, hospital or science library nearby)

    Source:

    Nygaard, B et. al. "Effect of combination therapy with thyroxine (T4) and 3,5,3'-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study," European Journal of Endocrinology, Vol 161, Issue 6, 895-902, December 2009 

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