Liothyronine sodium: Has anyone heard of... - Thyroid UK

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Liothyronine sodium

ntrainer78 profile image

Has anyone heard of Liothyronine sodium 25mcg? Does taking it with levothyroxine help resolve symptoms of hypo?

57 Replies

Liothyronine is the thyroid hormone T3. The sodium molecule is added so that it can be made into a pill.

Levo is the thyroid hormone T4, and should convert to T3 in the body. But, not all hypos are very good at that.

So, if you are a poor converter, taking T3 will help with your symptoms, either taking it with levo or by itself. :)

ntrainer78 profile image
ntrainer78 in reply to greygoose

Thankyou,at this point im willing to give anything a try. They are 25mcg is that too much?

shaws profile image
shawsAdministrator in reply to ntrainer78

Many people respond very well to a T4/T3 combination and I wish you 'all the best' as the majority on this forum have been prescribed levothyroxine and 'the experts' have withdrawn options that have restored many people's health.

Did you buy your own 25mcg T3? If doctor prescribed he/she should have advised you.

25mcg of T3 has the 'equivalent' effect of 100mcg of levothyroxine so be very careful.

First of all, always take thyroid hormones on an empty stomach. I take mine when I awake with one glass of water and wait an hour before eating. Food can interfere with the uptake of thyroid hormones.

Usually, we can split the T3 into quarters (I have a pill-spliter and it works well as tablets are usually small). Add 1/4 initially to the levothyroxine. You can take both together with one full glass of water and wait an hour before eating.

Give your body time with the T3/T4 combination so it relieves all of your symptoms.

You can gradually increase dose of T3 to T4. If you get too high a pulse, drop to previous dose. Always take thyroid hormones with one full glass of water and wait an hour before eating.

When having a blood test, always get the very earliest blood draw (even if you have to make appointment weeks ahead). Don't take thyroid hormones before but afterwards.

ntrainer78 profile image
ntrainer78 in reply to shaws

Thankyou thats very helpful,i always take levo on empty stomach with water and wait 2 hrs b4 anything else. My husband bought t3 online from a source hes used for many years when he was doing Strongman competitions

Ntrainer78 Please pm me the online source for t3 thank you.

Will do as soon as hubby gets in as he orders it

greygoose profile image
greygoose in reply to ntrainer78

It's too high for a starter dose, yes. But, I think you should take note of what SeasideSusie says. It's too soon in your journey to be thinking about T3. You are still under-medicated on T4, so that's why you feel ill. Adding in T3 too soon is going to complicate things. :)

SlowDragon profile image
SlowDragonAdministrator in reply to ntrainer78

25mcg is far, far too much. It’s too soon to be considered

You would likely make yourself much worse

BrynGlas profile image
BrynGlas in reply to ntrainer78

I started taking T3 25mcg last year, I suggest that you get a pill splitter off Ebay and cut your 25mcg pill into 4, for a few weeks and go up from there. I found a full tablet gave me a headache at first.

SeasideSusie profile image


In your previous post today you said

My results from last wk were TSH 5.6 and normal T4,im now on 50mcg (since 2wks ago)

I see you've been asked to get a print out of your results so once you have that post your results, including their reference ranges (these are essential as ranges vary from lab to lab) so that we can comment further.

As far as T3 is concerned, it's far, far to early to know if you need that. First of all you need to be on Levo long enough for you to reach the dose which gives you a TSH of 1 or below which will give the highest possible FT4 level, then you look at the FT3 result tested at the same time as the TSH and FT4. If your FT4 is high and FT4 low you might benefit from adding T3, but that is a long way off yet. Also, before even considering T3 you need optimal nutrient levels.

Thankyou,ive been feeling so ill for 6 yrs now i just want some relief from this dibilating condition 😭

SeasideSusie profile image
SeasideSusieAdministrator in reply to ntrainer78

You really, really shouldn't use T3 at this stage. You have to know if you need it and it's far too early for that. You also need optimal nutrient levels as mentioned. People have tried it before when they don't know if they need it and regretted it. And you can't just popa 25mcg pill, even if you know you need it you start with 1/4 of a tablet and work up slowly. Please do not start taking T3.

Please be patient, you have been ill for a long time and it's going to take a good while to build up your dose of Levo to the point where your levels are optimal. Each increase takes 6-8 weeks for your levels to stabilise, you cannot rush this.

Yes i understand what your saying,thankyou,my husband is going to reg me online at docs as i cant concerntrate long enough to do it so i can see if they have tested my t3. I literally feel like im slowly dying and have done for yrs,im missing out on so much,esp having my little boy. Docs keep calling it "fatigue" i want to shout its not fatigie!!! Id be happy with fatigue over this,its like having a hangover from hell with flu on top on a daily basis

shaws profile image
shawsAdministrator in reply to ntrainer78

You need to ask GP to do a Free T3 and Free T4 test. He may not but you can get them through one of the recommended Labs who do a postal service.

Dottie44 profile image
Dottie44 in reply to ntrainer78

I'm sorry to ask, but have you been Covid tested? The symptoms you're stating, can be from the virus.

ntrainer78 profile image
ntrainer78 in reply to Dottie44

I doubt it ive been like this for 6yrs now,plus ive had both zenica jabs

Lalatoot profile image
Lalatoot in reply to ntrainer78

ntrainer for most of us adding t3 is not a quick fix and an instant feel better. Instead of have a dose of one thing you have doses of two hormones to manage. They interact and everybody has a different outcome with regards to doses and levels.It can take over 2 years of small changes with constant monitoring until you feel you have got there.

Addedto this you need to source a constant, reliable source of quality T3 unless you are lucky to get it prescribed on the NHS.

This is why I would agree with susie that you must get your TSH down to 1 on levo alone first and then seehow well you are doing.

shaws profile image
shawsAdministrator in reply to ntrainer78

When I was given levothyroxine, it was not easy at all as I had awful palpitations during the night and the cardiologist was having difficulty to find a reason. Eventually said he was 'puzzled' and was thinking of putting an implant in heart 'too see what was going on'.

Around that time T3 was added to T4 and my palpitations ceased and I didn't need an implant. I felt well again. Eventually I took T3 only.

Sometimes it is trial and error and few doctors seem to know how best to help patient resolve their clinical symptoms due to being hypothyroid.

Six years is a long time to feel unwell. Thankfully we have this forum and members are helpful.

ntrainer78 profile image
ntrainer78 in reply to shaws

Yes im so glad i found it,ive been fobbed off with"wide spread chronic pain syndrome" for 6yrs but the pain meds caused even more problems so been without for 2 yrs. I think its the hypo thats causing the pain but docs kept saying i was only boarderline hypo for yrs and wouldnt treat.

shaws profile image
shawsAdministrator in reply to ntrainer78

Unfortunately, doctors seem to have been told not to diagnose a patient with hypothyroidism until the TSH reached 10. They also don't seem to know any clinical symptoms so many patients do not get their thyroid hormones tested at all initially.

No doctor or specialist (in anything) could tell me what was wrong (even underwent an op which was completely unnecessary). I had to diagnose myself. Even when the surgery received my blood test of TSH 100, I was phoned to tell me I had no problems at all.

Thanks to 'Thyroiduk' as there was no Healthunlocked Thyroiduk at that time it helped me enormously..

I have recovered so being on this forum may also help you as there was no Healthunlocked when I first had symptoms. Many of our members are very skilled at advising how best to restore our health.

This is the method to use when having a blood test for thyroid hormones - I am assuming GP hasn't tested your thyroid hormones.

Blood draw should be the earliest possible - even if made weeks before. It is a fasting test (you can drink water) and don't take thyroid hormones before but after test.

You can also get a private blood test and if you decide to do so.

This is the method to get the best results:-

All blood draw should be at the earliest, fasting (you can drink water) and allow a gap of 24 hours between last dose of hormones and test and take it afterwards.

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

Always request a copy of your results with the ranges and post on a new question for responses if you wsih.

ntrainer78 profile image
ntrainer78 in reply to shaws

Yes he tested my tsh which was 6.7 ive had thyrotoxicosis in the past and also a multi nodular groiter and positive anti body. Was started on levothyroxine 4 mnths ago at 25mcg next blood test tsh was 5.6 put on 50mcg levo,not feeling even the slightest bit better,if anything i feel worse

My bloods were 9am and id fasted b4 hand

Redlester profile image
Redlester in reply to ntrainer78

have you had a salivary cortisol test done to test adrenal function?

if your cortisol is low it will cause similar symptoms to the hypothyroidism and there is a double whammy in so far as until you have enough cortisol then your body cannot use the thyroid hormone well enough and so you will remain hypo with miserable symptoms even though your GP has prescribed levo.

You need to do a 24 hr salivary cortisol test which tells you how much cortisol your body has at 4 times of the day. Regenerus Laboratories or Genova diagnostics sell testing kits.

ntrainer78 profile image
ntrainer78 in reply to Redlester

Hi he tested my adrenals via fasting 9am bloods and they 468 which he said was fine,hes diagnosed me with hashimottos

shaws profile image
shawsAdministrator in reply to ntrainer78

When we first get a diagnosis we feel relief to actually know why we feel so awful.

It is a disappointment when we're prescribed levothyroxine and find we feel worse than before being diagnosed. I am aware that thousands do fine on levothyroxine but some people cannot for some reason.

I never felt any improvement on levothyroxine.(everyone is different and I've met people who've taken well to it and seem to be neither up/down).

As your doctor increases levo, it might bring your TSH down to 1 or lower and you should then feel well as long as both Free T4 and Free T3 are in the upper ranges.

I will also state that I'm not medically qualified, and just have my own personal experience to go by.

shaws profile image
shawsAdministrator in reply to ntrainer78

I think many of us, initially, don't feel any improvement on levothyroxine - may even feel worse as you state (I did too).

As dose is increased (slowly) we should begin to improve.

Many doctors seem to think that if TSH is 'somewhere' within the range that we don't need thyroid hormone replacements.

Millions seem to do well on levo (T4) and they wont be searching internet for help/advice.

When first diagnosed and prescribed we assume the tablets will help but many find that they still are symptomatic and the reason may be that they're not on an optimum dose yet, as the increases have to gradual or they have deficiencies in vitamins i.e. B12, Vit D, iron, ferritin and folate. All should be tested.

Churchie profile image
Churchie in reply to shaws

shaws, can I ask how much t3 you take daily?

shaws profile image
shawsAdministrator in reply to Churchie

20mcg but I will give you a link and there are posts from Dr John Lowe who was a Doctor/researcher and scientist to Thyroiduk who died through an accident. He also took T3 himself - in the middle of the night so that nothing interfered with its uptake.

Churchie profile image
Churchie in reply to shaws

Thanks for your reply. I have been prescribed 40mg a day for the last six years and have felt very well until recently when I have discovered another lump in my neck I’m just wondering if 40mg seems very high comparatively.

Kandahar profile image
Kandahar in reply to Churchie

I take 70mcg of 3 and I’m fine.

Churchie profile image
Churchie in reply to Kandahar

That’s reassuring to know -thanks for letting me know

SlowDragon profile image

It’s far, far too early to consider taking any T3

You must get levothyroxine dose SLOWLY increased upwards in 25mcg steps

It can not be rushed

You must have optimal vitamin levels too for good conversion of levothyroxine into Ft3

Nether levothyroxine or T3 will work well if vitamins are low

Once on high enough dose levothyroxine, so that Ft4 (levothyroxine) is at top of range, ….all four vitamins at good levels and likely strictly gluten free diet too

If after all these steps Ft3 is still low …only then would you consider adding T3 and would need to do so EXTREMELY Slowly

Pain is often low vitamin D

T3 is not easy to manage, almost always suppresses TSH to extremely low level….this freaks out GP who then wants to stop prescribing levothyroxine or reduce it substantially

At moment

You need to push for next dose increase in levothyroxine and bloods retested 6-8 weeks after each increase

Get vitamins tested. Supplementing to improve if low

Get coeliac blood test done. Assuming negative going strictly gluten free diet. Gluten can be causing pain too

You need an increase in levothyroxine then retest in 6 weeks. Or if you wanted to hurry you could take 1.6mcg for each kilo of body weight and see how you feel as per NICE guidelines). Most people do fine on levothyroxine.

It had helped me a great deal. I finally feel human after 35years

Hi there, I take 100 mcg of levo and 20mcg of liothyronine in 3 separate doses as I have 5mcg tablets. They do help but I still have hypo symptoms and am trying to find out what is causing it. I would agree with everyone else’s comments that 25mcg of liothyronine is much too high for a single starting dose. Good idea to start very slowly. I hope it helps alleviate your symptoms😊

She should not start T3 at any dose. She's only been on Levo for a few months and is right at the start of treatment on 50mcg day. T3 now would be a disaster I fear.

Kandahar profile image
Kandahar in reply to CDN_Lady

50mcg of levo is low so you won’t necessarily feel much better yet. I was well on 150mcg for at least 12 years until it stopped working. Then I was back to how you feel now. Your description is spot on!I haven’t gone gluten free, even though I know I do better without bread. But it tastes nice!

Hi. from my own experience, after 20+ years on T4 mono therapy, it took me nearly 2 years working with a dr to find the right balance of T3 for me. Have you had your adrenals checked, I thought that drs were suppose to check adrenals before giving T4, but I’m not sure they do. I don’t recall ever being tested myself prior to the issue of T4, not until they involved an Endo 30 years later. And then the testing was debatable. Anyway my point is, I agree with others, getting your vitamins and minerals balanced is important and making sure your adrenals are functioning well, as this can all impact on how well you process any medication. When, and if, you do need to start on T3, start slow and low, and build up very gradually. If you have a half decent Dr it might be worth asking them to support you, by monitoring you, in trying it, if need be. Be prepared to have to stop and restart regimes until your body adjusts. But hopefully this wont be necessary and the T4, when you find your balance will be enough for you. Wishing you well and the best of luck.

Taking T3 as a hypo patient is very different to a healthy person taking it for body building (although why they do that I will never know as they risk harming their hormone feedback loops).

You are nowhere near the point to consider T3 as a medication yet. Nowhere near. I have recently started combination of Levo and T3 (December) after years of tweaking Levo and vitamins. But I just don't convert Levo to usable T3 very well at all. But it's a hard hormone to dose, you feel awful beyond imagining if you get it wrong and at this stage you have no idea if it would help you or make things worse.

Please be patient. I've been fighting this thing for 8-9 years, much of that time was used up whilst I learnt about the condition and how to treat it and test it etc. Then some trial and error etc. For most people they will feel worse before better on Levo as the intake of hormone in pill form will reach a point where the pituitary gland sees there is T4 in the blood and slows down the call for more, thus leaving a deficit. But as your dose builds up, 25mcg at a time, every 6-8 weeks following another blood test (argue your case to get your TSH below 1, don't let up) you will start to feel better. Don't let the doctor tell you that you must be fine because you are in range. Aim for 1 or below for TSH.

Thanks everyone,just spoke to an extremely patronosing gp. Ive asked him about my dose and being undermedicated,according to him the dose isnt dependent of your weight or height it goes off your readings? Anyway got to wait it out another 6wks then have bloods. I asked him if he could swap the brand and he said it wouldnt make any difference what so ever and would waste the nhs time and my time. Also the nhs doesnt test T3. Any way the results he did tell me were as follows:

T4 11.7

Tsh 5.6

B12 465

Vit d 52

Folate 24

Inflammation 1

Vit c 2.38

SSH 8.4

Adrenals and blood sugar were fine

Are all these levels optimol? He didnt seem to grasp how ill i feel and kept saying well its only your throid that needs treating. He confirmed it was Hashimotoes.

Redlester profile image
Redlester in reply to ntrainer78

if the adrenal test was done via a blood test it won't be very useful - it only gives a single measurement of what was in your blood stream at the time the test was done and it also doesn't tell you how much cortisol is reaching your cells - that is why you need to do salivary cortisol testing to find out how much cortisol you have at different times of the day

ntrainer78 profile image
ntrainer78 in reply to Redlester

When i was hypo 6yrs ago the endo did that and said i had mild adrenal insufficency,i was given a short cpurse of hydrocortisol. Ive not felt too bad today and yesterday touch wood,ive started on selenium as well as levothyroxine,hopefully i will continue to improve

SeasideSusie profile image


according to him the dose isnt dependent of your weight or height it goes off your readings?

I agree on this point. This dosing by weight business is a recent thing for a "starter dose" although always before Levo was started at 25 or 50mcg and gradually increased every 6 weeks or so by 25mcg until our levels are where we need them to be. I personally think this approach is better for most people although some can tolerate going onto a "full replacement dose" straight away.

So testing, looking at the levels, and taking into account how the patient feels are probably the best way.

I asked him if he could swap the brand and he said it wouldnt make any difference what so ever

No, he's totally wrong there. Every brand has the same active ingredient - levothyroxine sodim - but they have different excipients (fillers, etc), and it's these excipients that can cause problems in some people. For example, lactose is used in most brands but if someone is lactose intolerant they would have adverse reactions to taking a tablet containing lactose. There are a couple of lactose free Levo brands, but one of them contains mannitol instead of lactose and some people react badly to the mannitol. Some people react to acacia which is in some brands, or the maize starch. So your GP needs to brush up on what tablets contain besides the active ingredient.

Also the nhs doesnt test T3.

It does in some circumstances (usually when TSH is suppressed) but not as a routine test. This is why hundreds of us here do private tests.

Are all these levels optimol?

I'm afraid we can't interpret your results without their reference ranges as these vary from lab to lab so we must have your lab's raqnge that comes with your results. You need to ask the receptionist at the surgery for a print out of your results, the ranges will be at the side of the result.

What we can tell you is that your TSH is high, that's higher than the top end of any range for TSH that we see here. FT4 we have no idea because ranges seen here can be 7-17, 9-19, 11-23, 12-22, and we see others as well.

B12 465 - we need the unit of measurement, is it pmol/L or ng/L or pg/ml? It's not B12 deficiency but it may be below the recommended level.

Vit d 52 - this is probably nmol/L in which case it's low and just scraped into the "adequate category". The Vit D Society and Grassroots Health both recommend a level of 100-150nmol/L. Please confirm that nmol/L is the unit of measurement and I will work out how much D3 you need to improve your level and the important cofactors needed when supplementing with D3.

Folate 24 - need range.

Inflammation 1 - no idea what this is. CRP is a non-specific inflammation test, is this what the name of this test is? I've never seen one just called "Inflammation".

Vit c 2.38 - no idea, I've never had a Vit C test done and I don't think I've seen it on the forum before.

SSH 8.4 - no idea what this is.

Thankyou,t4 is pmol but hasnt given me any ranges same with b12 pmol,d is nmol,inflammation is CRP, SSH is my hormones to check for perimenopause which he said it would be over 60 if that were the case

Also my prev t4 from march was 9.7pmol

SeasideSusie profile image
SeasideSusieAdministrator in reply to ntrainer78

B12 465pmol/L = 630pg/ml

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

So your level is OK but you could, if you wish, improve it.

Vit d 52 nmol/L

To reach the recommended level (100-150nmolL) from your current level, you could supplement with 5,000iu D3 daily.

Retest after 3 months. Continue until recommended level is reached.

Once you've reached that level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

CRP: 1 - this is good, the range is usually either <5 or <10, the lower the better and yours is nice and low.

Hi thankyou,just spoken to them again,think im annoying them lol. These are the ranges:

Free T4 7- 17 pmol (11.7)

TSH 0.20- 4.50 (5.6)

B12 145- 910 (465)

Vit D 50- 250 n/mol/l(52)

Folate 3.0- 20 (24)

Crp 0-7 (1)

Cortisone 468 no range for this but its normal

HBO1C blood sugar 20-41 (29)

Hello I have in the last year been started on this drug and as a previous reply it is used to treat the T3 hormone, however my consultant only started it after he asked me to take a genetic saliva test (not available on the NHS (if you are in the UK) but worth every penny . Unfortunately for me mine was genetically compromised so even though it was at the bottom end of normal, it was never going to improve on its own. Since taking it (10mg twice a day) I have noticed a definite improvement in my energy levels. I hope this helps

Thankyou,how much is the test?

I was taking T3/T4 combo and at first I was ok. About a week in I started having nausea and things got worse as time went on. I ended up having nausea, dizziness, heart palpitations, sweating, headaches, back pain and jaw pain. I ended up in the ER as I thought I was gonna die. Ultimately the ER docs said it was my thyroid. (Which by then I knew it was from the T3 but I didn't know if the symptoms would kill me) My T4 and FreeT4 were both in the negative. I also discovered that it was messing with my blood sugar. It has been 5 weeks since being off T3 (Cytomel) and I am still dealing with the blood sugar stuff. I haven't had my thyroid labs done again yet. I am sorry for the long winded message. I hope none of this happens to you. But please pay close attention to any changes that happen as they started slowly for me and then I was in the ER.

Thats awful,ive decided to leave t3 for now incase docs with draw my levo thinking its treated because of tsh,ive started on Thorne selenium today and its like a light switch (unless its just a coincidence)

I am glad to hear that its so far so good. Maybe I need to ask my Dr about Thorne selenium

I ordered them of Amazon £10 its helps convert levo into t3 and also lower antibodies

Good to hear you got the vaccine. Just putting it out there. Sometimes it's something other than our thyroid, but since we're so focused on getting it healthy, it's the first thing we think of.

ntrainer78 profile image
ntrainer78 in reply to Dottie44

Yes these symptoms pre date covid,been told today by gp I have hashimottos and looking at my b12 vitd and folate i could do with them being much higher (even gp says they are"normal")

I have been taking Liothyronine and Synthroid (Levothyroxine) for years. Despite increasing and adjusting dosage many times, I still have hypo symptoms. I believe that I am a poor converter. I have appointment next week to make change possibly from Synthroid to Armour.

Hi I would also be interested in your T3 source if you could message me privately I would be very grateful. Thank you and I hope your T3 trial helps.

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