Is anybody on 5mcg of T3 please

[hackman]

I have been prescribed the above privately but it seems it is not the standard dose of this medication. Is anybody on this dose and if so, are you purchasing from Europe or America and can share details with me of where to purchase? Please PM me if you can offer any advice. Thanking you all in advance x

[Rhsana]

Hi Hackman, to the best of my knowledge and experience, there is no "standard" dose with thyroid medication, it is all what the individual needs. Are you on combination T4 and T3 or just 5mcg of T3? Some people find they can't tolerate lower doses like 2.5 mcg where others find that they need 50, 70 100 mcg I have easily taken 50mcg in one dose and felt no side effects whatsoever. Like I said, it depends on the individual.

[hackman in reply to Rhsana]

Hi Rhsana - I am currently on 100mcg of T4. My Endo wants to put me on a trial of T3 but we are having to request funding on the NHS from CCG. I am assuming I won't get it so am doing the ground work now to see where best to get it from (abroad) if I have to pay for it myself. My Endo says the ratio of T4 to T3 should be between 1:12 and 1:16 but he is putting me on 1:10 as it's the closest we can get to the optimum ratio with dosages available, hence 100mcg of Levo and 2 x 5g of T3.

[MaisieGray]

They are readily available with a prescription, from Tollesbury Pharmacy - see here for more details of that, and other pharmacies that prescribe other than T4, against a prescription: thyroiduk.org.uk/tuk/treatm... but as is generally the case with such things, they are disproportionately costly. The 5mcg is £2.25 per tablet; the 20 mcg is £2.40 per tablet; and the 25 mcg is £1.67 (I think I've remembered the last one correctly). The pharmacist advises that the 20 mcg can be cut into 2/10mcg quite comfortably as they are scored, but advises against trying to quarter them. The pharmacy couriers your tablets to you free of charge. I use them and they've never been anything short of brilliant; but obviously if you were prescribed 20 mcg it would be cheaper sourcing them from Germany as suggested to you in a previous post (at least before the end of this month). But I think the first thing to decide is whether 5 mcg is the right dose for you - when I started taking T3 for instance, I started at 20 mcg in addition to my T4, and had no problem. Do you have blood test results to share for members to comment on, and are you already taking T4, I can't make out from your previous posts if you are already medicated. If not, what led to your private Dr starting you on T3 and why such a small dose?

[ Edited by admin to remove a close parenthesis at the end of the link - which was causing it not to work. ]

[Rhsana in reply to MaisieGray]

Hi MaisieGray,

That link seems to not be working,

"404 - File or directory not found.

The resource you are looking for might have been removed, had its name changed, or is temporarily unavailable."

[MaisieGray in reply to Rhsana]

That's odd, here it is again:

thyroiduk.org.uk/tuk/treatm...

But if it doesn't work, just go to the ThyroidUK web and you can find it from there. 🙂

[hackman in reply to MaisieGray]

Hi MaisieGray. I am currently on 100mcg of Levo and my Endo says the optimum ration of T4 to T3 is between 12:1 and 16:1. He is going to put me on 2 x 5mcg of T3 which is slightly outside the ideal ratio because of the doses available in the market place. My GP has applied for funding for a three month trial but on the assumption I won't get it, I am doing the research now on where to buy if I have to fund it myself. I have had a crazy mix of prices quoted from various pharmacies but all are more than you have to pay in Europe - hence my question to the forum re anybody already buying from Europe in doseage of 5mcg, I know I can buy 20mcg but haven't found anywhere selling 5mcg. I am hoping somebody is and can direct me to the same source. Thank you for your help x

[helvella Administrator Thyroid UK in reply to hackman]

So far as I know, there are only two countries from which you can get 5 microgram liothyronine tablets. USA and Netherlands.

The Netherlands has Ace who for some reason are able to sell their product as Cytomel (though it is not made by Pfizer/King).

ace-pharm.nl/en/cytomel-5-m...

Other than those, 5 microgram doses can only be obtained by having a specialist pharmaceutical company make them to order (what the USA call compounding pharmacies). That is strictly Prescription Only.

Another possibility is Liotir liquid liothyrnine available in Italy which you can dose by counting drops. Possibly very difficult to obtain anywhere else.

Many people find themselves having to split tablets to achieve their doses.

[SlowDragon Administrator]

Sigma Pharma 5mcg is available.

About £126 for 90 tablets on private prescription

sigmapharm.com/products/lio...

Thybon Henning 20mcg is 31 Euro for 100 tablets from Germany. Easy to cut into 1/4's

[hackman in reply to SlowDragon]

Thank you SlowDragon - do you know if I buy them directly from Sigma pharma or must I go to a pharmacy in the USA?

[SlowDragon Administrator in reply to hackman]

Plenty of people here in UK getting them on private prescription via local pharmacies at £126 for 90 tablets

NHS being charged between £384 (independent pharmacies) or £426 (Boots) for exactly same item and same number of tablets.....

Like other "special" request prescriptions for NHS, it would seem "specials loophole" is still being exploited

A "special" medication is one that is not listed on the standard NHS drug tariff. As outlined here, exploitation of the special market is common.

retailgazette.co.uk/blog/20...

express.co.uk/news/uk/91348...

[hackman in reply to SlowDragon]

Thank you SlowDragon. Interestingly, I asked my mother to check with her local independent pharmacies as she lives a long way from me. She has a price of £177.95 per 100 tablets of liothyronine 5mcg and her pharmacy is sourcing this with IPS Specials. I had a look at their website and am nervous that it says they source unlicensed and difficult to get hold of meds - do you think I should be worried or is it OK to get liothyronine from them in your opinion?

Thanks in advance x

[SlowDragon Administrator in reply to hackman]

That’s what a special prescription is ... all 5mcg T3 is Unlicensed

Only 20mcg is licensed

[Parbrook]

My 5mcg Liothyronine tablets are supplied in tubs of 90 tablets by Boots (on NHS prescription). Either Sigmapharm (USA) or Cytomel (Canada), depending on availability from Boots' UK distributor.

Cutting Liothyronine (and Levothyroxine) tablets is questionable, as the tablets are believed to degrade when exposed to humidity. It is why the most reliable tablets are those that are either in sealed blisters or tubs that contain humidity absorbers and, sometimes, cotton wool.

(I suspect that the lack of humidity protection the reason why Mercury Pharma Liothyronine 20mg tablets were short-dated and inconsistent.)

[hackman in reply to Parbrook]

Thank you Parbrook - that is really useful information. My Endo has recommended me to be trialled on these for three months. My GP has therefore requested funding from my CCG on the NHS which as we know, they try their best to avoid paying. On the assumption that they won't pay for it I am doing the research now whilst we are awaiting their decision in case I have to fund it myself. I know people are purchasing from Germany for 20mcg but this is too high a dose for me as the Endo has prescribed 2 x 5 mcg daily which is the correct ratio to the 100mcg of Levo I am currently taking. And I am not comfortable cutting pills into four!. You sharing the information that you have is really useful - I have had a price from Boots for an eye watering £855 for three months but I had no idea which brands they were using. I have also had varying other prices from chemists around me the cheapest of which is £420 for three months using LEXON which is a distributor but I don't know what the manufacturers name is. I have found Sigma Pharm on the internet but not sure how I can buy it yet as they are the manufacturer so presumably I need to find a pharmacy who can dispense it.

Thank you again for the information xxx

[SlowDragon Administrator in reply to Parbrook]

Sigma Pharma 5mcg usually comes in tubs of 90 tablets

Can you find out price of the Cytomel being charged on NHS? Compared to Sigma Pharma price (in reply above)

[Parbrook]

When I checked a while ago, it used to be possible to purchase 5mcg Liothyronine from on-line pharmacies in the USA for international shipment, although I don't know if they now require a prescription.

But, you will have to pay for shipping and UK import customs charges.

A reliance of the T4 to T3 equivalence ratio is open to misinterpretation, as I discovered when I started with 5mcg Liothyronine and reduced Levothyroxine under my GP (after 2-years of struggling to find the 'right' dose of Levothyroxine), I became severely hypothyroid and it took me another 2-years to find doses of both Liothyronine and Levothyroxine to find my 'sweet-spot' with gradual dose adjustments.

There are two ratios: around 10:1 relates to the output of the thyroid gland, plus around 3.5:1 relates to the serum levels of Free T4:Free T3, the latter being due to the additional T3 from conversion.

Using the thyroid output ratio for replacement hormone medication assumes that you will absorb 100% of the medication into the blood, so don't be surprised if you struggle with this.

For your information, I am currently taking 50mcg Levothyroxine and 25mcg (occasionally 30mcg) Liothyronine, which does not fit with any assumptions about the ratio. What works for me should not be expected to work for anyone else (I have both thyroid and conversion reasons for this).

I consider myself lucky that I have a cooperative GP and thyroid-specialising Endo. Plus, I am male which, regrettably, would seem to be a significant factor.

The medical profession loves to claim a lack of 'evidence' to support not prescribing Liothyronine. Their lack of evidence seems to be based-on serum TSH levels and not patients' symptoms or quality of life, so you can expect to be confronted by this during your Hypothyroid mission. When taking Liothyronine, serum TSH is as useful as a chocolate teapot!