Liothyronine

you know, she's been on this relatively stable dose of levothyroxine for three years and with these great TSH levels, but with her T3 looking on the low side.

So actually we could simply keep her on her dose of levothyroxine and add in just an additional T3, which we refer to as Cytomel.

So that's one option we could choose.

Another option is to shift her off of levothyroxine, which is the synthetic form of thyroid medication that is T4 only, right? So we're relying on her to, we're making an assumption that she can appropriately convert all of her T4 to the active form of T3, but her numbers might be indicating she needs a little help with that.

All those things.

All the longevity bros are like the Joe Rogan stack, right? Which is PRT plus two IUs of GH plus a small dose of Cytomel daily.

And mushrooms.

Yeah.

So if you're hypothyroid on your labs and you have symptoms, that's an indication for levothyroxine.

Alternatively, we can also use levothyroxine plus Cytomel.

So levothyroxine is T4, Cytomel is T3.

We can also use NDT.

natural desiccated thyroid hormone, which a lot of people do really well with.

Obviously you want to talk to your doctor about that.

Cytomel, a synthetic T3.

Thyrolar, synthetic T3 and T4 combined in a fixed ratio.

On this side is Armour, West, Westroid, Naturethroid, and MP Thyroid.

And those are all Levothyroxine is what they are.

Then you have some that are T3 only formulations, which is Liothyronine.

And let's see, there's Triostat and Cytomel are the two name brands that I know of.

And then there are some, there's a T4, T3 combo, which is Liatrix Thyrolars, what it's called.

So you have a choice between the natural or the synthetic.

But then you have other options.

You could have a straight T3, like a synthetic, which is like what Cytomel brand is, or there's combinations, NP, Armor, these desiccated versions, which are combo T4, T3.

I see them both work fine.

But I'll be honest with you.

The goal is effective replacement while minimizing cardiac risk.

Liothyronine is not routinely required in every patient.

Its use remains controversial because severe illness can impair conversion of T4 to the active hormone T3, but T3 has a more rapid and potentially more pronounced cardiovascular effect.

The guidelines suggest that, when lyothyronine is selected, a low-dose regimen such as 2.5 to 10 micrograms IV every 8 hours may be considered.

Lower doses are particularly important in older patients and those with coronary disease or arrhythmias.

A practical approach is to begin with IV levothyroxine and reassess the clinical response.

Liothyronine may be considered with specialist input when the patient is failing to improve despite appropriate treatment.

Avoid high dose T3 because of the risk of fatal cardiac complications.

Nice sunglasses.

[laughs] "My doc added Cytomel to my Synthroid to help with my continuing symptoms.

Is this something you would recommend, Dr. Berry? I appreciate your advice."

Maybe, but what I would even recommend even more than that is to switch you to a natural, natural desiccated thyroid hormone replacement like Armour Thyroid, like Naturethroid, like WP, like NP, or Erfa in Canada, that is actually has real T4 and real T3 in it because Synthroid is fake.

It's synthetic T4.

It's not even real T4.

And then Cytomel's the T3.

But if you're taking Armour or Nature, you're getting T4 and T3.

They need some form of T3 gasoline medication added in to what they're already taking.

Okay? Those are meds like Cytomel, liothyronine.

Those pair very well with Synthroid.

May I ask, so i- is that helping convert the stored, uh, crude oil, or is that actually just straight up generating the gasoline? W- what is the mechanism there?

Right.

So I always advocate give them the fuel, and then they'll take that fuel and most of them will put, put that fuel, that energy back into their body to create more energy and better health outcomes.

One other class of medication I wanna touch on before I move more to the Hashimoto's piece is we talked about Cytomel, we talked about liothyronine.

Those are pure gasoline hormone medications.