Pharm

Liothyronine

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Liothyronine, Cytomel, Triiodothyronine Replacement, T3 Replacement

  • Indications
  1. Not generally recommended (no proven benefit and associated risk)
  2. Adjunct to Levothyroxine in Hypothyroidism
    1. Lethargy or memory deficits despite normal TSH
  • Adverse Effects
  1. Risk of Cardiovascular Risks when combined with Levothyroxine
  • Efficacy
  1. May improve neuropsychiatric symptoms
  2. Changes after replacing T3 and T4
    1. Improved mood and energy
    2. Decreased confusion, fear, and irritability
    3. No difference in TSH normalization
  3. Studies suggests no benefit
    1. Clyde (2003) JAMA 290:2952-8 [PubMed]
  • Dosing (with Thyroxine dosing)
  1. Start: 1:14 ratio of Liothyronine to Levothyroxine (e.g. 5 mcg Liothyronine to 75 mcg Levothyroxine)
  2. Typical: 12.5 to 25 mcg orally daily
  3. Maximum: 100 ug orally daily
  • References
  1. (2017) Presc Lett 25(1): 4
  2. Bunevicius (1999) N Engl J Med 340:424 [PubMed]