1. #1

    T3 Only Dosing Advice

    I will be taking T3 only medication to clear my elevated RT3 and hopefully remedy my hypothyroid symptoms but I am looking for advice from those with experience. I cannot find much to reference but based on what I have found it seems like it will take 8-12 weeks to flush out the excess RT3 and I will need to dose 1-4 times a day and titrate up to somewhere in the 50-75mcgs...does this sound right? This is all pretty vague so what are some of the specifics of doing this the right and safe way? I really appreciate any help.


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  3. #2

  4. #3
    Thank you for the reply. I am pretty familiar with RT3, what it does and what caused (in my particular case) for my RT3 to be elevated and it has been remedied for about 6+ months but my RT3 has remained elevated. I am looking for specific info on dosing; how much, how often and for how long to get this cleared.

  5. #4
    Check out http://recoveringwitht3.com/blog/tra...s-signs-vitals

    or look up the work of Dr John C Lowe.

  6. #5
    Thank you too, HarryCat, for the reply. I did know about tracking temps and symptoms as well. So no one has any guidelines in terms of dosage to start off with, the frequency and the ultimate amount I need to titrate up to? I’m talking about amounts in “mcg”...like do I start off with 6.25 (1/4 of a 25mcg tab) once a day...4 times a day...100 times day? How much do I need to work up to...50mcg...75mcg...1000mcg? I know there will be variances based on tolerance and symptoms but there should be some sort of guideline.

  7. #6
    Read here and note the footnoted references also:
    http://www.tiredthyroid.com/rt3-9.html
    and
    http://www.tiredthyroid.com/rt3-1.html
    and
    http://www.tiredthyroid.com/rt3-3.html
    and
    http://www.tiredthyroid.com/rt3-4.html
    and
    http://www.tiredthyroid.com/rt3.html
    and
    She has book out that is so detailed and researched on the thyroid that it would easily account as a doctorial thesis on the thyroid and could also be used in MED school!
    Chapters are fully documented with references from NIH, major studies world wide, hospital research papers world wide.... NOT junk sources from people who wear tin foil hats...
    AND as noted above STTM also has great information also.

  8. #7
    Quote Originally Posted by shltn View Post
    Thank you too, HarryCat, for the reply. I did know about tracking temps and symptoms as well. So no one has any guidelines in terms of dosage to start off with, the frequency and the ultimate amount I need to titrate up to? I’m talking about amounts in “mcg”...like do I start off with 6.25 (1/4 of a 25mcg tab) once a day...4 times a day...100 times day? How much do I need to work up to...50mcg...75mcg...1000mcg? I know there will be variances based on tolerance and symptoms but there should be some sort of guideline.
    http://rt3-adrenals.org/t3_medication.html

    Usual starting dose
    • 5 mcg (5 mcg tabs) or 6.25 mcg (1/4 of 25 mcg tab)
    • Dosed waking and bedtime

  9. #8
    Thank you very much. I’m going to go read those now.

  10. #9
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    100mcg is a lot of t3. There's no way I would start with that.

  11. #10
    I wouldn’t either but I also wouldn’t dose it 100 x a day I was just throwing out random examples looking for advice.

  12. #11
    Quote Originally Posted by shltn View Post
    I wouldn’t either but I also wouldn’t dose it 100 x a day I was just throwing out random examples looking for advice.
    Agreed, 100mcg is not a starting dose, but it's not unheard of. Actually, it's my dose. And I'm gaining muscle so I'm certainly not hyper. I'm not catabolic either. So - lesson to learn: it's individual. 100mcg = full replacement dose. To combat rT3 issues you might have go get up to these dosages, just like me.

  13. #12
    Very interesting to know, Tiwas.

    I have read that 25mcg is a "full replacement dose" as well...so does then mean 4 does x 25mcg = 100mcg?

    Also, if you don't mind my asking, are you / have you been on thyroid medication previously? Or is your situation like mine? I have never been on any thyroid at any point in my 41 years but I had an infection from a root canal and was put on antibiotics for 6-8mos so my RT3 got stuck elevated; other than that my thyroid is functioning well in terms of FT3, FT4, TSH, etc. my RT3 is just over the range and giving my hypothyroid symptoms. So my objective is to clear my RT3 and then taper back off the T3...hopefully my RT3 stays low and that's that but we'll see.

    Thank you again for chiming in; it is always good to hear from those with firsthand experience. My T3 arrives tomorrow or the day after so I am a bit nervous about starting it but I plan on starting low and slow and building up to avoid sides and hopefully any cortisol issues.

  14. #13
    I too was dealing with high rT3. For me, what worked was changing from Synthroid to a NDT like Armour Thyroid and adding Milk Thistle to my supplement regimen. There are some evidence that Milk Thistle from the seed clears up a lot of rT3 from the liver. Mine results went from 22 to 11 in about 6 weeks. Armour Thyroid has a higher T3 amount than T4.

  15. #14
    That's great to hear, Kaliman911. I have added Milk Thistle to my vitamin / supplement routine already (about 2 weeks ago) so I'm glad to know I am on the right path there. Since I am not currently using or never have used any type of Thyroid medication I'm hoping this T3 only medication clears my RT3 and then I can taper back off of everything again.

  16. #15
    I have done the RT3 protocol three times. I have adrenal problems and SIBO so the improvement is temporary. I have used the compounded 15mcg extended release, the straight t3 and the NDT. The NDT is much gentler if slower in clearing out the RT3. I couldn't handle even the 5mcg t3 initially. Let "low and slow" be your guide. If you are just out of range, you may be able to handle more t3 faster than I can to start. I was way out of range.

  17. #16
    Thank you, Bombaac. I definitely plan on taking it slow; those side effects of too much T3 do NOT sound like anything I want to go through. I had to stop TRT because of anxiety / BP complications (probably due to my thyroid issue) so I do not want to start that all over again.

  18. #17
    Quote Originally Posted by shltn View Post
    Very interesting to know, Tiwas.

    I have read that 25mcg is a "full replacement dose" as well...so does then mean 4 does x 25mcg = 100mcg?

    Also, if you don't mind my asking, are you / have you been on thyroid medication previously? Or is your situation like mine? I have never been on any thyroid at any point in my 41 years but I had an infection from a root canal and was put on antibiotics for 6-8mos so my RT3 got stuck elevated; other than that my thyroid is functioning well in terms of FT3, FT4, TSH, etc. my RT3 is just over the range and giving my hypothyroid symptoms. So my objective is to clear my RT3 and then taper back off the T3...hopefully my RT3 stays low and that's that but we'll see.

    Thank you again for chiming in; it is always good to hear from those with firsthand experience. My T3 arrives tomorrow or the day after so I am a bit nervous about starting it but I plan on starting low and slow and building up to avoid sides and hopefully any cortisol issues.
    If you read experienced bodybuilders notes on T3 they recommend no more then 100mcg/day unless on gear, but some can handle 150mcg without going catabolic. For me, 100mcg assures I'm at 37,5C (normal body temperature) and I can still gain muscle just fine. I'm sure a lot of people can do just fine on smaller doses, but at 75mcg I will start producing T4, which means rT3 starts rising again.

    I'm not sure what you mean by asking if I've been on thyroid meds previously. I've been on them since '98. I've tried combination, T4 only and T3 only. T3 only is the only thing that works for me. Also, why are you hung up on TSH? If your TSH hasn't tanked you're per definition not on a replacement dose. fT3 and fT4 don't mean jack if rT3 is elevated above normal. fT3 is also just what's not in use. I go by feel and by temperature. And once in a while I have to fight my doctor who thinks it's better for me to feel like crap as long as I have "a healthy TSH".

    Bottom line is this - if you feel good and your rT3 is in check, that's the main objective. If that happens with armour, low dose T3, combination therapy - that's your dosage. If nothing else works, just ditch T4 altogether and go for T3 monotherapy by monitoring your body temperature and how you feel.

  19. #18
    So I started titrating T3 last Thursday and had a couple of questions...


    First, it may be a weird coincidence but I’ve put on like 3-5lbs since I started so I’m guessing it would have to be water weight. Is this common?


    Second, on a couple of days I have been extremely tired a couple hours after taking a dose. Almost like a crash. Is this normal as well?


  20. #19
    Quote Originally Posted by shltn View Post
    First, it may be a weird coincidence but I’ve put on like 3-5lbs since I started so I’m guessing it would have to be water weight. Is this common?


    Second, on a couple of days I have been extremely tired a couple hours after taking a dose. Almost like a crash. Is this normal as well?

    What's your dosage? My initial thought is overdosage and hypertyreosis. What's the reason for your medication? Thyroid shutdown? If so, I'd be pretty sure your thyroid's not shut down. What does your blood work tell you? If you have sides you should always try to look at the blood before asking random people in a forum. What's your rT3 like?

  21. #20
    Below are my most recent labs....


    TSH = 1.28 Range = 0.450 - 4.50
    FT3 = 3.7 Range = 2.0 - 4.4
    FT4 = 1.39 Range = 0.82 - 1.77
    RT3 = 26.2 Range = 9.2 - 24.1
    T4 = 7.8 Range = 4.5 - 12.0


    I started on T3 for 8-12wks just to clear my elevated RT3 then I will taper back off. I’ve never used any type of thyroid meds before so hopefully I won’t after bring down my RT3 - which was caused by an infected root canal and being on antibiotics for 6-8 months but all of that was fixed mid-2017 but my RT3 never went down and I’ve been presenting with hypothyroid symptoms since January 2017.

    Currently I am taking 6.25mcg 4x a day for a total of 25mcg per day.

  22. #21
    Quote Originally Posted by shltn View Post
    Below are my most recent labs....


    TSH = 1.28 Range = 0.450 - 4.50
    FT3 = 3.7 Range = 2.0 - 4.4
    FT4 = 1.39 Range = 0.82 - 1.77
    RT3 = 26.2 Range = 9.2 - 24.1
    T4 = 7.8 Range = 4.5 - 12.0


    I started on T3 for 8-12wks just to clear my elevated RT3 then I will taper back off. I’ve never used any type of thyroid meds before so hopefully I won’t after bring down my RT3 - which was caused by an infected root canal and being on antibiotics for 6-8 months but all of that was fixed mid-2017 but my RT3 never went down and I’ve been presenting with hypothyroid symptoms since January 2017.

    Currently I am taking 6.25mcg 4x a day for a total of 25mcg per day.
    FFS - look at your rT3. No wonder you're exhibiting symptoms. 25mcg T3 won't clear up your rT3. You need the big guns. Your TSH doesn't indicate hypothyroidism at all. Mine's 0.02. Your endogenous production is alive and kicking, and as long as you're producing T4 you'll convert to rT3. You need to suppress the T4 production in order to get rid of rT3.

    Think of it this way:
    x% of the T4 you produce end up as rT3
    Your body senses lT3 is ok, so it'll just produce *more* rT3 to not make you hyper
    What you're basically doing is keeping lT3 artificially high, forcing your body into making more rT3 from the T4.

  23. #22
    Well I wasn’t stopping at 25mcg (6.25mcg x 4) a day; just titrating up my dose to avoid any side effects like heart palpitations, etc. My goal was to get up to 50-75mcg and hold there for 6-8wks then taper off.

    Those were my plans but I just had those two questions (weight gain and tiredness) regarding T3 on my way up.

  24. #23
    Quote Originally Posted by shltn View Post
    Well I wasn’t stopping at 25mcg (6.25mcg x 4) a day; just titrating up my dose to avoid any side effects like heart palpitations, etc. My goal was to get up to 50-75mcg and hold there for 6-8wks then taper off.

    Those were my plans but I just had those two questions (weight gain and tiredness) regarding T3 on my way up.
    Weight gain should be oposite, unless you're eating like a horse while tanking your own production. If it's water, you can see if mild laxatives can get rid of it. Can you get hold of dandelion root extract? Noticed an elevation in blood pressure? Edema?

    I'm not giving you the short answer because your symptoms are potentially very dangerous.

    Check your blood pressure. Check for edema. Do you have a family history of cardiovascular disease?

  25. #24
    Well my diet has been horrible the past few months. My blood pressure has actually gotten a little better in the past week or so but that may be due to my starting Gene’s N.O. Stack (minus prescription products). I do have a family history of cardiovascular disease (one of the reasons I wanted to build up my T3 dose slowly as I am super paranoid about any heart side effects). I have not noticed any edema anywhere.

  26. #25
    Quote Originally Posted by shltn View Post
    Well my diet has been horrible the past few months. My blood pressure has actually gotten a little better in the past week or so but that may be due to my starting Gene’s N.O. Stack (minus prescription products). I do have a family history of cardiovascular disease (one of the reasons I wanted to build up my T3 dose slowly as I am super paranoid about any heart side effects). I have not noticed any edema anywhere.
    You should definitely go to a medical professional with experience with elevated rT3. Rapid weight gain, hyper symptoms, etc is not a good sign. I do have several potentially good ideas, but you need to get a professional opinion first. Someone who can assess your symptoms without bias.

  27. #26
    Put it like this. You've gained a quarter lbs every day since starting. If that was fat you'd have to eat 1000kcal in excess every single day - while having a higher than normal metabolism. If it's water, then it might be even worse for your health.

    EDIT: Sorry. Brain fart. You've gained almost a full lbs every day. Multiply my comment by four. Both calories and how bad it might be for you.

  28. #27
    I'm actually talking to another doctor tomorrow. I've been to about 5-6 so far and not a one of them believe RT3 is "thing" even though I have all the hypothyroid symptoms (lethargy, weight gain, cold body temps, cold hands and feet, anxiety, etc.) so that is why I had to order T3 (Cynomel) on my own but I am still looking for a doctor to help me get this cleared.

    Quote Originally Posted by tiwas View Post
    You should definitely go to a medical professional with experience with elevated rT3. Rapid weight gain, hyper symptoms, etc is not a good sign.
    I am not by any means arguing with you as I came here looking for some info BUT I am not sure I am experiencing "hyper symptoms"? I mean weight gain is hypothyroid - correct? And my body temps are still low and haven't increased since starting the T3.

  29. #28
    Quote Originally Posted by shltn View Post
    I am not by any means arguing with you as I came here looking for some info BUT I am not sure I am experiencing "hyper symptoms"? I mean weight gain is hypothyroid - correct? And my body temps are still low and haven't increased since starting the T3.
    Yeah, finding a doctor that believes in rT3 being "a thing" is hard. They claim it's inactive, and yeah - they're right. But it still binds to receptors making the active lT3 just floating around doing **** all.

    Lethargy is a hyper symptom. It can also be a hypo symptom. Weight gain should not be that rapid, which is a hyper symptom. All in all, hyper was the first impression I got. And it makes sense if it's your first days of T3 treatment. You'll get hyper, then TSH lowers and you'll get normal. Then you increase T3 again and go hyper for a period.

  30. #29
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    Quote Originally Posted by shltn View Post
    Below are my most recent labs....


    TSH = 1.28 Range = 0.450 - 4.50
    FT3 = 3.7 Range = 2.0 - 4.4
    FT4 = 1.39 Range = 0.82 - 1.77
    RT3 = 26.2 Range = 9.2 - 24.1
    T4 = 7.8 Range = 4.5 - 12.0


    I started on T3 for 8-12wks just to clear my elevated RT3 then I will taper back off. I’ve never used any type of thyroid meds before so hopefully I won’t after bring down my RT3 - which was caused by an infected root canal and being on antibiotics for 6-8 months but all of that was fixed mid-2017 but my RT3 never went down and I’ve been presenting with hypothyroid symptoms since January 2017.

    Currently I am taking 6.25mcg 4x a day for a total of 25mcg per day.
    Shitn your labs are identical to mine and I too was coming off a round of several antibiotics to clear up a severe sinus infection in January. I have no energy at all, trouble sleeping, feeling cold, etc. all the symptoms. Dr Calkins at Defy tested only the following:

    Thyroxine T-4 Serum 7.6 Range 4.2 - 13.0
    Free T 4 0.97 .8 - 1.7
    Reverse T3 Serum 28.1 9.2 - 24.1

    During consult yesterday he is prescribing the T3 only medication Liiothyronine 5mcg. He said to start out taking 1 in the morning 30 minutes before food and 1 at night for 2 weeks and, if symptoms do not improve, go to 2 in the morning and 2 at night. Give it 2 weeks and if no improvement go to 3 2xday and on until symptoms improve.

    He said if I take too much, I will have anxiety, feeling hot, excessive heart beat, etc. Then fall back to previous dose. We are going to test levels again in 3 months to see where they are and how I feel. I think from what I have read that I will know when I have the dosages correct by the way I feel.

    So his protocol is 5mcg 2 x day to begin with then go up from there if no improvements in 2 weeks. Your starting dose may be a bit too much for the slow reduction of RT3. Also, Liiothyronine is a very powerful drug and may not need as much as other RT3 lowering drugs.

    Good luck and let us know how you are feeling in a couple of weeks.

  31. #30
    A lot of the online “guides” are very aggressive with the T3 titration. There is no reason to be too aggressive or impatient, as the risks of T3-induced hyperthyroidism are real.

    The best and most general answer is that you gradually titrate up on the T3 and periodically CHECK THE RT3 to track its progress downward, while concurrently (and constantly) monitoring body temps, HR, and any signs or symptoms of hyperthyroidism.
    Lead Physician & Medical Director
    www.defymedical.com

    NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

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